Few life experiences introduce feelings of euphoria and despair more quickly, consecutively and frequently than becoming a first-time parent. The elation of holding your first child can be as acute as the melancholy of postpartum depression.
But what if the latter were not only more manageable, but also foreseeable?
Dawn Kingston, a registered nurse, and PhD is Canada’s only endowed research chair in perinatal mental health. Before specializing in the causes and prevention of postpartum depression, she was a neonatal nurse focused on preventing preterm birth. Her research led her to examine the effects of stress on premature births, and low birth weights. The data began to lead her to the cause-and-effect relationship between a mother’s perinatal anxiety and depression, and the development of more acute conditions post-delivery. In other words, as with maternal instinct after birth, women often feel something is wrong before they even become pregnant. This can then manifest itself into postpartum depression.
“One of the biggest predictors of whether women get postpartum depression and anxiety is if they had something not only during pregnancy, but before pregnancy as well. For women who struggle with prenatal depression and anxiety, as many as fifty to eighty percent continue to have symptoms postpartum. So we’re used to thinking of postpartum depression as this globular thing that happens after women have a baby, but (if you have) those symptoms prenatally, those symptoms very often continue, which is another reason to make sure you get help in pregnancy.” Dr. Kingston said, when we spoke recently.
As is so often the case when attempting to overcome mental health issues, stigma is the tallest hurdle. Women who are, or who are attempting to become pregnant, will pay closer attention to their work schedules, their diet, and their exercise routine - generally with the blessing of their partner, family and friends. But expressing concern about stress or worry is still discouraged or dismissed. I asked Dr. Kingston why women were reluctant to broach the subject.
“I think part of it is the media propelling the myth that the only mental health issue in the perinatal period is postpartum depression - I think that’s a big part of it. I think that the other part of this is that women who are pregnant are stigmatized and silent. Without even understanding there is even such a thing as prenatal anxiety and depression, women are afraid to ask their physicians about it. It’s interesting, when we’ve interviewed women, and asked what are their barriers to raising a conversation about mental health and pregnancy, some of them have given answers like, 'We want to be a good patient. We don’t want to talk about things that might not be an issue during our seven-minute prenatal visit.'”
Like many of us, they don’t want to seem a bother to their physician.
Upon hearing that a mother is anxious or worried about her pregnancy, it is natural for a friend’s or partner’s calming instinct to take over. After all, parenting is a tremendous responsibility that a mother and father are committed to for a lifetime. “Don’t worry, it’ll be fine,” seems a responsible form of encouragement. Unfortunately, this sort of support can be one of the biggest barriers to a mother-to-be who is considering mental health treatment, or who feels despair.
“Three-quarters of women told us, ‘If my partner, or my mother, or my sister normalized or told me I was okay, I would likely not have raised it with my doctor.’ So it becomes a barrier. I tell women, trust your gut. At this stage in our healthcare system you must raise it with your doctor. They are not going to ask, so you’ve got to trust your gut that something is wrong. What is wrong with asking? There is no cost to asking the question whether this is normal or not.”
A woman’s personal support system may not even be the biggest obstacle. Dr. Kingston explained that, shockingly, the Canadian Medical Association guidelines don’t support depression screening in primary care. Why? There is a fear that the screening itself will make the condition worse. There is a sense that talking about depression will be a catalyst to triggering the condition. However, Dr. Kingston says, the exact opposite is true,
“There’s no evidence. And we found in our work that women actually feel validated. You want women to be able to say, ‘That’s me; that’s exactly me.’ Then the next step is, where so we go from here?”
This triggers mental illnesses most nebulous questions, “What is normal?” and, “When is it time to ask for help?”
“A normal life anxiety or a bit of worry over the baby, or the baby’s health, or (the baby) not eating the right thing...are not going to be long-lasting in general. You won’t have those for weeks on end; maybe minutes, maybe hours, but certainly not much beyond that. The diagnostic marker is always two weeks or more; for anxiety it’s more. I think, in general, it’s the longer you have something the more you should be concerned that it’s something above normal.”
Dr. Kingston goes on to describes acute situations,
“You’re worrying about things you might not have worried about before, and your worry is relentless; you wake up with it in the morning and you go to bed with it. There is this uncontrollable, agitating, restless worry where you just can’t stop it. Your mind is spinning. All the things that you do to control your normal anxiety and worry don’t work anymore. So it becomes this relentless kind of gut-wrenching tension, irritability, (a) sense of not having control.”
Trust in your instincts is invaluable. Raise your hand, step forward, ask questions. There is never shame in self-care. Approximately 9 months after conception, a parent becomes a psychologist, a relationship and grief counselor, a teacher and a doctor to their child for the rest of their lives. Time put aside for yourself becomes inversely proportional with your dedication to your child. Talking about your anxious feelings, and your worry about becoming a mother, is more easily said than done. But going into pregnancy with joy and confidence can lead to two lifetimes of benefit. It will allow you better manage the occasional despair of parenting, also to revel in its frequent euphoria.