Pregnancy and mental health

Magda, a 29-year-old software developer, regularly fends off questions about when she will have her first child. Coming from a close-knit family and having been with her boyfriend for a decade, the topic is brought up regularly. But Magda grimaces in response, only to be told: “Don’t leave it too late.”

For Magda, the question of when she wants to have a child is complex. There is a serious history of depression and psychosis in her family on both sides. In fact, her mother was sectioned for a long time after giving birth to her.

“I’m not just concerned about passing on mental health problems to any child I might have, I also have serious concerns about the risk to my own wellbeing from having a baby,” she says.

She also worries about the kind of treatment she might receive if she were to have problems. “I’m acutely aware of how awful the mental health support can be in the NHS. I have witnessed failing after failing in the care of my mother. If I speak to a GP about my concerns, will they care and offer advice? If I did decide to have a baby, would they make sure I’m looked after through pregnancy and beyond?”

This is just one of the individual stories sent to the Guardian as part of a project inviting people to discuss the often taboo topic of mental health and pregnancy. Between 10 and 20% of women develop a mental illness during pregnancy or within the first year after having a baby. Conditions range from postnatal depression to obsessive compulsive disorder and psychosis.

It’s not just women either: one in eight first-time fathers suffer from depression while their partner is pregnant, according to a survey by scientists at McGill University in Canada.

So, why is help desperately needed and what sort of experiences do people have?

The decision to have a child
For some, like Magda, the challenge begins before pregnancy – many women and men experiencing mental health problems worry about their children developing similar conditions. They also worry about how their condition could affect their ability to be a parent.

The medication question
A lot of women also have to weigh up whether or not they are prepared to come off their medication to have a child. While some drugs are considered relatively safe the evidence is not conclusive, and some have been linked to health problems in babies.
But those who come off any medication are at risk of getting ill again: for example, seven out of every 10 women who stop antidepressants in early pregnancy become unwell again.

Antenatal
Postnatal depression is often reported on, but less attention is given to mental health issues during pregnancy. While it’s normal for women to experience “baby blues” as a result of hormonal changes, for a large number this is much more extreme. In fact, it is estimated that 7% to 20% percent of pregnant women are affected by what is known as antenatal depression, which if untreated can lead to postnatal depression after the birth.
Women and men can also experience a great deal of anxiety during pregnancy – it is thought that more than one in 10 women struggle with symptoms of anxiety while carrying a child.

Miscarriages
There are no official government statistics held on women who miscarry (they are only collated for women admitted to hospital), but the pregnancy charity Tommy’s says around one in every four women with a BMI of over 30 will miscarry a child.
The effects of this last longer than you might imagine: a study in 2011 found that the depression and anxiety experienced by many women after a miscarriage can continue for years, even after the birth of a healthy child. Men are also affected, although perhaps differently. One British study of 323 men found that although they displayed less “active grief” than their female partners, they were more vulnerable to feelings of despair and difficulty in coping eight weeks following the loss.

Postnatal
Postnatal depression is an illness that affects between 10 to 15 in every 100 women having a baby. It can start within one or two months of giving birth. It’s also something that hits men too: studies predict about one dad in 10 has postnatal depression. Traditionally, the mother’s mental health gets more attention, but recognition of the dad’s mental health is increasing.

Psychosis
One of the most severe forms of illness seen in psychiatry are postpartum psychoses. In rare but tragic cases it can lead to women taking their own lives.It’s thought that postpartum psychosis affects women in every 1-2 of 1,000 births. It’s more likely to affect women who have had it before (or have a relative who has) or have a serious mental health condition, such as bipolar disorder or schizophrenia.

Post-traumatic stress disorder
Research is limited but estimates of post-traumatic stress disorder (PTSD) after delivery tend to be around 1-2% in high-income countries. One study in Sweden . While some women experience it after a particularly traumatic birth (with medical difficulties), others have PTSD from the birth process itself.
A spokesperson for the Birth Trauma Association said: “The help on offer for women is very patchy and generally poor. Individual health visitors and midwives may help but waiting lists are long – up to a year – and almost no one gets on a list for cognitive behaviour therapy or other treatment unless they have been symptomatic for at least 12 weeks.”

Obsessive compulsive disorder
It’s thought to affect 2-4% of all new mothers, but – until recently – has received relatively little research attention. Some women develop obsessive compulsive disorder (OCD) for the first time either during pregnancy or shortly afterwards, while others find it makes a pre-exisitng condition worse. This is partly down to the fact that pregnancy is a time of increased stress, with most women becoming concerned about protecting their baby. It is a time of major physical change, which can cause difficulties.
It’s not just down to hormones, however, and some fathers also experience postnatal OCD because of their feeling of responsibility to protect their new baby.

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