Pregnancy is indeed a great experience. It’s 9-month long journey loaded with various ups and downs, enormous physical changes, loads of expectations and many more. Throughout the pregnancy, there are constant changes that happen in the body. The physical changes experienced are:
- Change in body shape
- Change in weight
- Morning Sickness
- Nausea and Vomiting
- Swelling in legs or overall body
- Increased cardiac and respiratory rate to cater to the growing needs of the fetus
- Increased reflux and heartburn
- Increased or decreased appetite
- Enlarged, sore and tender breasts
- Postural changes leading to lower back pain
- Increased hormones in the body
- Aches and pains in the abdomen
- Increased urination and incontinence
- Leg Cramps
- Increased body temperature
- Changes in Nail and Hair texture
- Stretch marks, hyperpigmentation or spider veins on the skin
These are the physical symptoms more or less experienced by all women but the intensity may vary.
Although, the physical changes are known and talked about almost everywhere at all times, the mental and emotional changes experienced by a woman during this period is hushed up. The emotional changes are often neglected that a woman goes through.
Apart from the physical changes, the emotional changes experienced are exactly similar to a roller coaster ride. Though the number of emotional changes is many, they often go un-diagnosed or overlooked. Research suggests that around 20% of pregnant women suffer from mental health concerns, particularly mood and anxiety disorders. Although the number is huge, the mothers-to-be often hide the feelings due to the fear of others having a negative view towards them. They often try to cope up all by themselves. Some get relief, some doesn’t. Let’s see how to identify the symptoms and causes and perform diagnosis and treatment of mental health concern for pregnant women.
Symptoms of Mental Health Concerns during Pregnancy
- Sadness that is constantly present
- Too little or too much sleep
- Difficulty in concentrating
- Reduced or lack of interest in pleasurable activities
- Feelings of worthlessness or hopelessness
- Feelings of guilt
- Altered eating habits
- Thoughts of death and/or suicide
If one notes the symptoms for a period of 2 weeks or more at a stretch or you note it in a dear one, seek help immediately.
Prevalence of Mental Health Concerns during Pregnancy in India
The prevalence rate of antenatal depression or depression during pregnancy is 17.4% as reported in a longitudinal study by Patel et. al. (2002). This is in line with the prevalence rate in all other countries which varies from 8-20%. However, it contradicts to all other reports from other countries on the fact of postnatal depression; it suggests that in Indian scenario postnatal depression are more prevalent due to factors like birth of a girl child, poor economy, lack of proper support where birth of a girl child is the most common factor contributing to depression. It is due to humiliation and non-acceptance of the mother and the newborn or even female feticide. Moreover, it must be noted that many of the cases goes undiagnosed due to lack of awareness, ignorance and initiative to diagnose.
Causes of Mental Health Concern during Pregnancy
The symptoms mentioned are experienced by 99.9% of women at some point of time during their pregnancy and it is absolutely normal to have experienced them. Most often the mood and emotional changes experienced by women during pregnancy can be attributed to the immense hormonal changes that occur in their body. The hormones, particularly estrogen and progesterone, flare up to maintain the pregnancy by keeping the uterine conditions at par. The estrogen is the hormone responsible for the heightened emotions in women in general and that is the reason women are more emotional than men. However, the extreme surge of these two hormones along with the bodily changes make women more vulnerable to mental health concerns during pregnancy.
Risk Factors for Mental Health Concerns during Pregnancy
Although the emotional changes and challenges experienced by women during pregnancy can be attributed to the hormonal changes and surge, a number of risk factors predispose a woman to have mental health concern. These are:
- Family or Personal History of Mental Health Concerns: As pregnancy brings in a lot of changes, even underlying problems at times comes to the surface during this time. Even though you might not have experienced a full blown episode of mental health concern earlier but had a tendency of having low mood and anxiousness when faced with a difficult time, you might have more chances of having mental health concern during pregnancy. A family history of mental health concern predisposes you to have a mental health concern during difficult times like for pregnancy.
- Marital Problems: Relationship issues where talking and sharing things with the partner is difficult can dispose you to have a mental health concern during pregnancy. Often it is heard that having a child when facing problems in relation will soothe and solve it; however, this isn’t at all true. The new responsibilities might be more of a burden and strain the relation even more when the other half is not supporting. The best thing to do is to seek marital counseling and try to repair the damage that is done. This should be done even more if you have had a relationship where you have been abused.
- Loss of Previous Pregnancy: Having a miscarriage is not just a physical problem; it brings along a lot of emotional concerns as well. The worries regarding the continuation of the present pregnancy and the health of the yet-to-born child are very normal. A recent miscarriage or a history of recurrent miscarriage increases the chances of depression and anxiety. It is even more if one has a health complication or restriction during the pregnancy.
- Fertility Treatments: The problem of infertility is itself loaded with lots of stress. People having fertility issues frequently report of having hopelessness, guilt, anxiousness to conceive and loneliness (women are often not allowed to participate in auspicious occasions or couples stop attending functions to avoid questions regarding their having a child). Although fertility treatments are on rise due to an increased number of couples having problems with natural conceptions; the treatment itself is quite demanding physically, emotionally as well as financially. Hence undergoing a treatment for conception can increase the chances of mental health concerns during pregnancy. Moreover, conception post fertility treatments can also increase the anxiousness due to the fear of losing the much awaited child.
- Problems in current Pregnancy: If the present pregnancy is difficult and has complications, you probably need to go through a number of tests. This adds on to the stress and can take a toll on your mental health status particularly when you are advised for bed rest or have to undergo genetic tests. These complications are likely to increase your worry about the child’s health as well. Even not being able to accomplish tasks that you usually did can increase emotional imbalance. This is truer if you are having a twin pregnancy.
- Major Life Changes and Stressful life events: A major change in life like separation with partner, loss of a loved one or a friend, loss of job or stressful events like relocation, change of job, financial crunch can all increase the chances of having a mental health concern during pregnancy.
- Other Factors: The other factors that could contribute to mental health concerns during pregnancy are being young, being a single parent, being pregnant due to rape or an unplanned pregnancy when the resources aren’t available.
Diagnosis of Mental Health Concern during Pregnancy
Mental health concerns during pregnancy can be easily diagnosed if paid a little attention to it and people and aware of the occurrence and open to accept it. If the symptoms mentioned above are present for 2 weeks or more, a diagnosis of the mental health concern is made. The initial diagnosis can easily be done by a physician or a gynecologist and then the person can be referred to a mental health professional.
Treatment for Mental Health Concern during Pregnancy
The treatments for mental Health concern during pregnancy include:
- Counseling: Counseling incorporates discussion with a counselor or psychologist about the concerns a woman is having, identifying the problem and discussing the different ways available to deal with the concerns and challenges that a woman is facing.
- Psychotherapies: Psychotherapies are therapies that help in identifying the negative thoughts and feelings that a woman is experiencing and provides a solution by altering these into more positive and productive ones. The common psychotherapies used in this regard are Cognitive Behavioral therapy, Rational Emotive Behavioral Therapy, Acceptance and Commitment Therapy, Emotional Freedom Techniques etc.
- Dance Movement Therapy: Dance therapy or Dance Movement Therapy is also a form of psychotherapy which provides healing both to the emotional and mental health concerns and the physical discomforts. On the physical side, it provides the benefits of exercising during pregnancy and helps in reducing back pain, increases flexibility and prepares the body for childbirth; while on the emotional side, it helps in expression and releasing of emotions, relaxation, and promotes communication which leads to overall being.
- Medication: Depending on the severity of symptoms, the counselor can refer to a psychiatrist for assessing the requirement of medication. The medicines are prescribed taking a number of factors into consideration like severity of symptoms, thoughts of self-harm, previous history of mental health problems, etc. The medicines are carefully evaluated as not much data are available on the harmful effects of these medications on the mother and the fetus and also the factors like whether it would have any detrimental effect on the child, or the child could have withdrawal symptoms post birth, etc. However, the advantages and disadvantages of prescribing a medicine during pregnancy must be evaluated based on the immediacy of the situation. It must also be noted that untreated depression poses higher risk for pre-term birth, low birth weight, postpartum depression and also poor growth in the child.
- Alternative Therapies: A number of alternative therapies like acupressure and acupuncture, Tai Chi, Ai Chi, have proven benefits to treat mental health concerns during pregnancy. These promote the healing in a holistic way.
Coping with Mental Health Concern during Pregnancy
Apart from seeking help from a mental health professional, one can also practice the following things which will provide them some relief. The coping strategies for dealing with these emotional and mental health concerns are:
- Sharing the Concerns: It is normal to have emotional changes during pregnancy due to the hormones and also since it is a huge transition. However, if the concerns are bothering too much then share it with husband, family and close friends. Remember sharing provides more relief.
- Adequate Rest: During pregnancy, the body undergoes tremendous changes, and hence it is very vital to get adequate amount of rest. Learn to prioritize your work and do not try to overdo things. It is absolutely okay if you are unable to accomplish everything you planned. Take help from others in doing things that others can do.
- Take a Good Care of Yourself: Pregnancy is a crucial phase of life and demands a lot from your body. Thus it is very important that you take a good care of your own self. Take healthy and wholesome diet, make sure you take lots of fluid in any form (water, juice, and soups), avoid aerated and caffeinated drinks, do not exert too much or overdo things. It is also important that you incorporate some regular exercise, prenatal yoga and meditation in your daily schedule as these helps in keeping both the body and the mind in a good state. Exercise initiates the release of Endorphins (Neurotransmitters) which helps in reducing depression while meditation helps in calming the mind and body.
- Ask for Detailed Information: Another important factor which increases worry in women during pregnancy is the birthing process. If this is the major concern that you have, discuss with your physician what probable birthing options you have and which one would be best for you. Learn the signs of labor, the pros and cons of each process and discuss which method you would prefer.
- Manage your Lifestyle: As pregnancy advances, a woman needs to manage and alter her lifestyle. Reconsider hectic work schedules, hectic travel, busy social life and continuing of stressful job as per your body’s need. It is important to let go of things that are taxing you too much in this phase.
- Settling of Finances: This indeed is a factor to worry about. Discuss with your partner and your gynecologist which option would cost how much and plan ahead. Check whether you can take help from someone if you need and also what insurance covers pregnancy expenses and to what extent. It is important to pre-plan and be ready with this to reduce a major part of your worry and also to be prepared in case of an emergency.
In most cases, the coping strategies can be practiced even before one seeks help from an expert and in many cases it gives relief. However, if the worries are still present and don’t fade away in 2 weeks, then seek help immediately. A mental health professional will evaluate the symptoms and its severity and provide help for reducing your concerns. Above all, it needs to be mentioned that much of the normal emotional changes during pregnancy are due to hormonal changes and fade away post-delivery. However, if it is bothering you to the extent of hampering your daily activities consider taking help. Remember mental health concerns during pregnancy are completely curable; however, untreated stress and depression can lead to complications in the child and also in the mother. So take care of your mind just as you are taking care of your body and baby.
Note: This information is only for reference and is not a substitute of a medical care in any form. Kindly consult with a Healthcare Professional for detailed diagnosis, treatment and follow up.