A heavily pregnant Muslim woman wearing a salmon pink top and turquoise hijab is sitting in a black bucket chair. She has her eyes closed and one palm on her forehead in a state of stress or worry. Her other hand rests on her large bump.
Maternal Mental Health,  Mental Health

Why Does Maternal Mental Health Matter?

May 24, 2019 / 6 Comments

Pregnancy and matrescence (the transition to motherhood) are vulnerable times for women who are subjected to surging hormones, changes in their bodies and roles, and poor sleep.  In many ways, it is the perfect melting pot for mental health problems; whether the recurrence of an existing condition or a first episode.  

Motherhood is demanding, and for a depressed, anxious, psychotic, or traumatised mother, the moment-to-moment care of their infant may feel overwhelming.  This can have consequences for the child’s development and the mother’s physical and emotional well-being.

Let’s imagine a mother and baby.

This is Aisha.

Aisha would describe herself as generally being “a bit of a worrier”, and is having a stressful time at the moment.  As a result, she is feeling quite anxious and depressed. She is not alone.  The World Health Organisation (WHO) estimates that up to 10% of pregnant women and 13% who have recently given birth experience a mental health problem, some of which are serious enough to result in suicide attempts, and occasionally, risk to the baby.

A heavily pregnant Muslim woman wearing a salmon pink top and turquoise hijab is sitting in a black bucket chair. She has her eyes closed and one palm on her forehead in a state of stress or worry. Her other hand rests on her large bump.

At this time, Aisha is feeling sick with anxiety and is eating and sleeping less than usual.  Her thoughts are racing and she has an unshakeable sense that something terrible is going to happen, maybe to her baby, or maybe to her husband, Hassan.  All this worry is getting her down and she finds it difficult to feel hopeful about the future.

An illustration of a foetus sleeping inside a womb.

The behaviour of Aisha’s unborn son, Bilal, starts to become dysregulated.  His levels of activity and patterns of sleep and movement are not typical of a foetus at this stage of development.  His heart rate is different and he is less responsive to vibratory stimuli (Gold & Marcus, 2008).  As the baby of a depressed mother, Bilal is at risk of being born prematurely, with a low birth weight, which has consequences for his later development (Ibanez et al., 2015).

At birth, Bilal’s sleep pattern is still not predictable or settled.  He seems not to eat much, and often gets diarrhoea. 

Aisha is still feeling depressed, and varies between being both physically and emotionally withdrawn and being overly intrusive and fussing with Bilal in a way which makes him irritable.  Bilal is not sleeping well and Aisha is frustrated and exhausted.  Whenever she looks at Bilal she thinks he looks miserable, and nothing she does seems to make him any happier.

Aisha feels like a failure as a mother and starts to struggle to get out of bed.  She doesn’t wash her hair and forgets to eat.  She does everything she can think of to make Bilal happy and meet his needs, but she’s starting to think she just wasn’t made to be a mother, even though she has wanted this for so long.

 

An illustration of a crying baby with a light brown skin tone. The baby is swaddled in a green and blue blanket and is wearing a hungry caterpillar hat which appears to be knitted. It is red with yellow and green eyes,, and brown antennae. The image is signed "Bear in Mind Psychology".

This situation is not good for either Aisha or Bilal.  Aisha is experiencing immense suffering and is becoming increasingly hopeless, whilst Bilal, a tiny baby who is acutely sensitive to his environment (WHO) is not getting his emotional needs met.  Research suggests babies whose mothers experience persistent depression during pregnancy and in their early life are 50% more likely to experience developmental delay, whilst those whose mothers remained anxious throughout pregnancy are more likely to have emotional or behavioural problems at age 4 (Deave, Heron, Evans, & Emond, 2008).

They need some help.

The good news for Aisha and Bilal is that maternal mental health problems are treatable (NHS), and some can even be resolved with the support of well-trained non-specialists (World Health Organisation, 2015).  Whilst more severe difficulties (including psychosis) can require inpatient care and medications, many women can be supported at home to adjust to motherhood, bond with their baby, and attend to their own mental and physical wellbeing.

 

Getting Help

A Muslim woman wearing a royal blue hijab and a sky blue top is sitting on a brown sofa, talking to a counsellor. The woman faces us in a three-quarter pose. She has one hand on her chest and one in her lap. The counsellor has her back to us and is facing the Muslim woman. She has brown curly hair and is wearing a pink top and light jeans.

Aisha decides she can’t manage this alone anymore and tells her partner Hassan.  Hassan is very supportive and encourages her to speak to the Health Visitor and her GP.  

The Health Visitor recognises that Aisha is struggling with postnatal depression and anxiety, and reassures Aisha this is not her fault and things can and will improve.

She reminds Aisha that she doesn’t have to do everything herself, and helps her identify people who can help, including Hassan, Aisha’s mother, and Hassan’s brother and sister who live locally.  The Health Visitor tells Aisha to take time for herself and do things she enjoys.  She observes Aisha attending to Bilal and gives her positive feedback on how she is interacting with him. Hassan listens to what is needed and agrees to do the cooking each evening and to do some of the night feeds to let Aisha sleep.

Because Aisha has always been a worrier, her GP thinks she might benefit from CBT (Cognitive Behavioural Therapy) for anxiety, and makes a referral to her local IAPT service.  

Hassan and Aisha ask their family members to try to help Aisha out while Hassan is at work.  When he is home, he spends time cuddling and playing with Bilal alongside Aisha.  Bilal benefits from the attention, and as Aisha’s mood improves, she feels more confident in understanding what he wants and needs, and providing this.  This sensitive, attuned care is excellent for Bilal’s development and will be helpful in teaching him to understand his own feelings, as well as feeling confident he will be cared for.  

A Muslim couple coo over their baby who is lying on his back in his father's arms with his head nearer to his mother, who kisses his left hand. He is wearing an aquamarine top with blue dungarees. His mother is wearing a yellow hijab and orange kameez. His father is wearing a grey tshirt and jogging bottoms and has black hair and a beard. Both parents are focused on the baby who is smiling.

As both Bilal and Aisha start to feel better, they gain confidence in and comfort with each other.  They are able to bond more, and both sleep and eat better.  Bilal stops getting diarrhoea (WHO, 2015), and Aisha stops feeling hopeless.  

A Muslim mother wearing a purple hijab and a black kameez looks lovingly at her small baby who is swaddled in an aquamarine blanket and has a full head of black hair.

With the support of those around her and time to attend to her own needs, Aisha recovers from her episode of depression, and continues to work on her anxiety.  She feels less pressure to be a “super-mum” and settles for being “good enough” which is all Bilal needs to flourish.  The two of them grow closer and enjoy their unique bond as mother and son.

So why does maternal mental health matter?

Maternal mental health matters for a number of reasons:

  1. Mental health matters, maternal or not.  We all have physical health and we all have mental health and the two are inextricably intertwined so that if one suffers, the other often does too.  This is painful and unpleasant, and yet we can feel reluctant to seek help for our mental health in the way we would for our physical health.
  2.  Mental health problems are incredibly common during pregnancy and early motherhood as a result of a perfect storm of hormones, changes in role, sleep deprivation, and the responsibility of caring for a tiny, precious, and very dependent little being.
  3. Women who experience depression or anxiety during pregnancy are more likely to have premature babies or babies with low birth weights, both of which can have implications for their development.
  4. A mother whose mental health is suffering may be less attuned to the needs of her child, with consequences for their development.
  5. Infants are acutely sensitive to their environment, and may therefore pick up on the mother’s distress and reflect this themselves.  This might make them more difficult to settle and more prone to difficulties like diarrhoea, which in turn may cause the mother more stress or distress.

Although some women may require medication and inpatient treatment, many do well with a little bit of extra support, some well deserved rest, and the understanding that mothers don’t need to be perfect, just “good enough”.


Bear in Mind xXx 

REFERENCES

Deave, T., Heron, J., Evans, J., & Emond, A. (2008).  The impact of maternal depression in pregnancy on early child development. General Obstetrics, DOI: 10.1111/J.1471-0528.2006.01752.x

Gold, K.J., & Marcus, S.M. (2008). Effect of maternal mental illness on pregnancy outcomes. Expert review of obstetrics and gynecology. 3, 391-401.

Ibanez, G., Bernard, J.Y., Rondet, C., Peyre, H., Forhan, A., Kaminksi, & Suarez-Cubizolles (2015). Effects of antenatal maternal depression and anxiety on children’s early cognitive development: A prospective cohort study. PLOS ONE, 10(8): E0135849.

World Health Organisation. Maternal Mental Health.  
www.who.int/mental_health/maternal-child/maternal_mental_health/en/

World Health Organisation (2015). Thinking Healthy: A manual for psychosocial management of perinatal depression. (WHO generic field-trial version 1.0). Geneva, WHO, 2015.

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