The journey from pregnancy to birth is one of the most stressful and overwhelming experiences one will ever encounter, both mentally and physically. The saga of creating and raising my now-four month old was riddled with instability and hardship, and in this I am not alone. Psychiatric disorders, including those induced or worsened by the stress of pregnancy and birth, affect many women both during and after pregnancy. The most important step is treating these issues with healthy, compassionate care in order to insure the physical and mental well-being of both mother and child.
What if I Have a Mental Health Disorder and Become Pregnant?
First of all, you are not alone. Research shows that “nearly half of Americans will have a mental illness in their lifetime, and one out of four experiences a psychiatric disorder in any given year” (Gold, 2008). However, research also shows that there is a correlation between mental health disorders, such as anxiety disorders, eating disorders, and psychotic illnesses and instances of low birth weight, premature delivery, or other adverse circumstances.
If you currently have or have previously been diagnosed as having a mental illness, you should consult a mental health professional during your pregnancy. Pregnancy can change, enhance, or create symptoms you may not always experience. Keep track of your thoughts, feelings and actions as they relate to your mental health, and note any changes. Accurately tracking your symptoms and experiences can aid professionals in making your pregnancy as safe and healthy as possible while simultaneously managing the symptoms of your disorder.
Because these issues can affect the health of the pregnancy, treatment is of the utmost importance.
What if I Develop a Disorder After Pregnancy?
The fourth trimester, after you have given birth, is often equally or more stressful than pregnancy itself. Being responsible for the daily care of a newborn is a harrowing task. With a constant lack of sleep, the stresses of breastfeeding, and the hormonal changes your body experiences, it is important to be aware of your self-care and mental health during this time.
Recent studies demonstrate that Post-Partum Depression often begins during pregnancy. Signs of depression include lethargy, listlessness, and lack of appetite, which can be easily confused with the general stress of pregnancy and birth. These symptoms can be accompanied by high anxiety, suicidal thoughts, or other serious symptoms. These depressive symptoms can have adverse effects on both mother and child.
Due to the stress of pregnancy, along with the mental and physical changes that occur, many mental illnesses and disordered behaviors can be triggered or worsened during pregnancy. If you notice any change in your thoughts or behaviors that seems alarming or strange, the first step is to contact a mental health professional and determine a course of care.
A significant issue in obtaining treatment for mental health disorders, especially during pregnancy, is the effect of mental health disorders on one’s health and ability to seek treatment. The lethargy and listlessness of maternal depression, and the negative symptoms of psychotic illnesses, can often prevent a patient from seeking or receiving adequate care.
Combined with the stress and hardship of being pregnant, mental health issues can make it difficult to seek care. Anxiety may prevent phone calls to the doctor. Depression may make it difficult to leave the house and seek treatment. Psychotic illnesses can have significant symptoms that cause bodily harm to a person, or create an unstable environment. Many women who experience mental health disorders and pregnancy simultaneously have been shown to seek less medical and prenatal care, engage in more unhealthy habits such as smoking, substance abuse, unhealthy eating, and a general lack of self-care. It is imperative for pregnant women and mental health professionals to work together in combatting these issues in a healthy way.
It may be helpful to contact a partner, family member, or trusted friend to help you seek treatment. Finding resources in your area, such as someone to help connect you with new physicians or assist you with insurance claims, can help take the stress off seeking treatment and care.
What Treatments are Safe During Pregnancy?
It is important to remember during pregnancy that what affects your body also has a chance of affecting your child. The absolute safest treatment for mental health disorders during pregnancy is therapy. Seeing an experienced therapist can help ease anxiety and develop healthy techniques to manage your mental health and avoid adverse effects to your pregnancy.
If you are already taking medication before you become pregnant, it is important to consult with your doctor regarding the best choices for your medication. Many women cease the ingestion of their prescribed medications during pregnancy. However, in many cases this may be unnecessary and pose a risk to the mother in terms of relapse or negative reactions to a sudden lack of medication. An experienced doctor will be able to guide your decisions on whether to cease or change your medication.
If you are not utilizing pharmacotherapy for your disorders, or develop mental health issues during your pregnancy, it may be safe to take SSRIs and serotonin norepinephrine reuptake inhibitors (SNRIs). These types of medications have been shown to be effective in the treatment of maternal depression. The American College of Obstetricians and Gynecologists (ACOG) suggests using a “single medication at higher dose over multiple medications if possible, in order to limit the number of drug exposures to the fetus.” (Gold et al, 2008)
More serious illnesses are more difficult to treat during pregnancy. For example, Bipolar Disorder requires anti-psychotic medications that have a more significant chance of passing adverse effects on to the fetus. In cases like this, it is necessary to consult a professional in order to determine the pros and cons of different treatment options, taking into consideration the long-term health of the mother and child.
You may be guided to change, cease, or lessen the dose of your medications during your pregnancy. Once you have given birth, your medication or dosage may need to change. Consult a mental health professional for individual advice on which course of treatment and medication is best-suited for your individual needs.
Pregnancy and mental illness are incredibly difficult and draining experiences on their own, but there are even more considerations when they occur simultaneously. Research is constantly being conducted to determine links between mental illness and complications in pregnancy, and effective, safe treatments to ensure the health of both mother and child.
If you are experiencing signs of mental illness or depression during pregnancy, or have a mental health disorder and become pregnant, the first step is to consult with a mental health professional. Determining the most effective and safe course of treatment, from therapy to medication, is imperative in fostering a healthy pregnancy and maintaining mental health post-partum.
Gold, K. J., & Marcus, S. M. (2008). Effect of maternal mental illness on pregnancy outcomes. Expert Review of Obstetrics & Gynecology, 3(3), 391-401. doi:10.1586/17474220.127.116.111
Antenatal and postnatal mental health: Clinical management and service guidance. (2014, December). Retrieved March 17, 2017, from https://www.nice.org.uk/Guidance/CG45