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July 26, 2016

Pregnancy is supposed to be a time of joy: your ever-expanding body is blossoming, your skin glowing. However it’s not that way for every woman Kate Monahan explains. 

For some mums-to-be, pregnancy can be a time of stress and anxiety. Hormones and fluctuating emotions can affect how you feel. Soon your whole world will be different, which can be both exciting and worrying. Some women are worried about losing their identity or career; others are terrified of the birth or something happening to their unborn baby. Most of the time these feelings are normal, but some women can develop antenatal anxiety or depression, and require extra help and support. Although antenatal mental health conditions are not as well known as postnatal depression, one in 10 women experiences depression during their pregnancy and 10-15 percent develop antenatal anxiety. Left untreated during pregnancy, these women are more likely to develop postnatal depression.

Clinical psychologist Laurette Longmann is part of the Perinatal Mental Health team at the Waikato District Health Board and spends much of her time meeting women with mental health issues during pregnancy. Women are usually referred from their GPs, midwives and Plunket nurses, but in some cases self-referrals are accepted. Some women benefit from therapy, while others also require medication to help them through.

“It can be the response to hormonal changes in your body, it can be a lack of support, or it can be an exacerbation of a pre-existing mental health condition such as depression,” she says. “Some women don’t know if they want to have a baby any more, and there is huge guilt for some of those clients. “There are a lot of expectations around motherhood, which can be overwhelming. I have career women who come to me struggling with a change in identity. She may not feel on top of things with work or feel like she is not coping. She may have fear and anxiety around her changing role or the stress of transitioning her workload as she goes on maternity leave.”

Women who have high expectations of being ‘the perfect mother’ may have an increased risk of antenatal anxiety and/or depression. Longmann works with women to identify where they can have control and to accept situations where they can’t be in control and develop strategies around that. “Just letting it all go can help,” she says. “Sometimes it’s about acknowledging that they were in a position of power and control (in their career) but now their body is controlling them.”

Women who have had a mental health condition in the past may need extra support during their pregnancy. Those who have battled eating disorders may find changes in their body shape can bring back old feelings. For others pregnancy can trigger post-traumatic stress disorder relating to a past incident, such as a difficult labour or delivery, or sexual abuse. “That previous trauma can cause anxiety around the birth, with flashbacks, and nightmares around giving birth,” says Longmann. Mothers who have lost a baby previously, or have struggled with fertility issues or recurrent miscarriages, may require extra support. “(They can) have a huge anxiety around the birth, and perhaps issues bonding with their baby,” says Longmann. “It might be that they need help grieving for the lost child.” They can sometimes worry excessively about physical changes or pregnancy pains and niggles.

“People can catastrophise if they have generalised anxiety tendencies or if they are feeling emotional.” Longmann helps women look at reasons behind their feelings, to put them into context. “We might look at things, pull them apart, look at thinking or changing ways of thinking,” says Longmann. “Sometimes it’s just saying to them they will be okay, or giving them hope and reassuring them.”

Antenatal depression and anxiety: Signs and symptoms to look out for

  • It’s normal to feel emotional and tired during pregnancy but if you are feeling excessive worry that is not responding to reassurance or are unable to relax, have difficulty sleeping or have obsessive compulsive thoughts, it may be a sign of an anxiety disorder.
  • Ongoing negative thoughts about yourself or the baby, feeling down and not getting enjoyment from things may be a sign of depression. If a woman is not coping with day-to-day tasks, and symptoms of depression don’t improve after a few weeks, it may be depression.
  • If you are feeling consistently down or anxious during pregnancy, or feeling extremes of emotion which won’t go away, please seek help. To find out what counselling services are available in your area talk to your GP, midwife, Plunket nurse or other health professional. Each regional perinatal mental health service has different assessment criteria, and can vary.

There are also support groups and resources online, such as

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