Health Nov / Dec 2020

New Mums: don’t suffer in silence

Better mental health care for new mothers

Pregnancy and the time just after birth can be exciting, but they also bring changes and stress. There are changes not only to the expecting mother’s body, but to the family, as well as to work and relationships. So it’s no wonder that, according to the World Health Organization (WHO), 10–20% of women worldwide suffer from some mental disorder during this time.

Left untreated, those mental health challenges can have long-ranging consequences. Mothers may experience depression and anxiety, and both parents could be affected by a higher incidence of obsessive compulsive disorder, according to one study by the New York Times. Some of these mental health disorders can even lead to suicide.

Children, in turn, may be affected if a parent is incapacitated, and may suffer anything from diarrhoea to developmental delays and low IQs.

That’s why this May, a cross-party group of MPs and peers in the UK lobbied Jeremy Hunt, the then minister for public health and primary care, asking for emotional and mental health assessments for new mothers. They are advocating that mental health checks be carried out six weeks postpartum, a benchmark backed up by a 2014 study conducted by Kettunen, et al, published in BMC Pregnancy & Childbirth.

The rationale is that many of these mental health disorders are going undetected while we focus on the child and mother’s physical health. There is a serious lack of access to mental health care in many places. Additionally, shame, stigma, fear of losing their children, and an unwillingness to consider medication may keep a suffering parent from reaching out.

Currently, it is estimated that only 3% of new mothers in the UK have good access to mental health care during the perinatal period, defined as the time from pregnancy until one year after birth. The NHS is starting a funding push to expand that access.

The numbers in Japan don’t seem to be any better. According to one 2015 study conducted in Japan, only 1.8% of more than 400,000 people surveyed had received mental health care while they were pregnant and during the immediate postnatal period. A literature review conducted in 2017 states that, in Japan, 5–20% of women in the perinatal period experienced depression.

“Many Japanese women get so much pressure from people around them when they become a mother. Not only relatives, but also neighbours and even strangers, tend to tell [them] what to do,” says Kyoko Sonoda, MA, LPCC, a psychotherapist at TELL who has extensive experience working with children and families. “Many new mothers are nervous about making mistakes. Any small mistakes tend to be criticised, the mothers being told, ‘Now, you are a mother! Shikkari shinakya! (Pull yourself together!)’”.

And when they come home after the birth, mothers often face isolation. Sonoda says: “Japanese men tend to work long hours and go on many business trips. Recent labour shortages in Japan result in excessive work, since filling empty positions becomes harder each year. New fathers are too tired to support new mothers during the week”.

Effective interventions
A national study conducted over 15 years in the UK, and published in 2016 in The Lancet, states: “Among women in contact with UK
psychiatric services, suicides in the perinatal period were more likely to occur in those with a depression diagnosis and no active treatment at the time of death. Assertive follow-up and treatment of perinatal women in contact with psychiatric services are needed to address suicide risk in this group”.

Despite the dismal rate of mental health care for new mothers and expecting women, WHO says:  “Maternal mental disorders are treatable. Effective interventions can be delivered even by well-trained non-specialist health providers”.

Sonoda outlines some points to remember.

There is no such thing as a perfect mother. It is okay to make mistakes. Many of your choices are not life threatening to your baby, and there are always other choices and opportunities to remedy unintended results.

It’s okay to take a break and have a rest. Asking others to take care of your baby does not mean you are a bad mother. Everyone needs time to be alone.

It is natural for you to become emotional and teary. There are a lot of hormonal changes occurring in your body.

Belonging to a parenting group will help to release a new parent’s stress and associated emotions.

If you can’t get out of bed or are crying frequently for more than a month, do not be afraid to seek professional help.

There is no need to suffer in silence. For the sake of our own health, and the health of our children, we need to address the gap in maternal mental health care.

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