Pregnancy and mental health

Pregnancy is a time of joy and eager anticipation. Throughout pregnancy, you may experience a roller coaster of emotions.

During the first trimester, the first three months of pregnancy, you may feel irritable, irrational and afraid, as well as joyful and elated. You may experience misgivings and bouts of weepiness or mood swings. Sometimes, these symptoms may cause relationship difficulties with your partner. Toward the end of the first trimester, a new sense of calmness often emerges.

During the second trimester, the fourth through sixth months of pregnancy, you may be apprehensive and anxious about the future. You may be frustrated in regard to the changes in your body as you outgrow your regular clothes but don't quite fit into maternity clothes. You may experience absent-mindedness and difficulty concentrating. You may also begin to accept the reality of pregnancy. Mood swings often decrease by the fifth or six month of pregnancy. Near the end of the second trimester, you may begin to feel bored with the pregnancy.

During the third trimester, the last three months of pregnancy, you may become increasingly apprehensive and anxious about motherhood, your baby's health, and the labor and delivery. You may have more frequent dreams and fantasies about the baby. Eagerness for the pregnancy to be over often leads to increased boredom and weariness during the third trimester. You may become increasingly irritable, sensitive, impatient and restless. Feelings of unattractiveness often prevail.


Depression during pregnancy
An estimated 10 to 16 percent of expectant mothers experience mild to moderate depression during pregnancy. Possible causes of depression during pregnancy include financial strain, lack of emotional support from your partner, bedrest or hospitalization due to pregnancy complications, and anxiety about your health or the baby's birth. A personal or family history of a mood disorder may increase the risk of developing depression during pregnancy.

Postpartum depression
Postpartum depression is a major depressive episode that typically develops within four weeks after a baby's birth. An estimated 12 to 16 percent of mothers develop postpartum depression. Risk factors for postpartum depression include a personal or family history of depression, a history of depression in prior pregnancies or postpartum periods, and being an adolescent mother. A variety of factors may contribute to postpartum depression, including:
quickly dropping levels of estrogen and progesterone after birth
a shift from being the center of attention during pregnancy to backstage attention once the baby arrives
returning to a regular routine after hospitalization or the emotional experiences of pregnancy, labor and delivery
exhaustion
a feeling of anticlimax or inadequacy
a sense of disappointment in the baby, the birth experience or yourself
a sense of mourning for your "old" self or an unhappiness with your postpartum weight or appearance
A baby's doctor is often the first health care professional to spot signs of postpartum depression.


Postpartum psychosis
Postpartum psychosis is a rare condition that may develop in one to two of 1,000 mothers. Postpartum psychosis typically develops rapidly, often within the first 48 to 72 hours after delivery. In some cases, however, it may develop up to a few weeks later. Postpartum psychosis is characterized by an elated yet unstable mood, disorganized behavior, hallucinations or delusions, and seemingly little need for sleep or an erratic sleep pattern. When a woman has postpartum psychosis, severe ruminations or delusional thoughts about the baby are associated with a significantly increased risk of harm to the baby. Extreme cases of postpartum psychosis often require hospitalization due to the high risks of infanticide or suicide.

Use of antidepressants
Antidepressant medication can be passed to a baby through the mother's placenta or breast milk. Some studies indicate the benefits of antidepressant therapy in women who are pregnant or nursing may outweigh the risks, however. The newer class of selective serotonin reuptake inhibitors (SSRIs, a class of antidepressant drugs used to increase levels of serotonin, a neurotransmitter that affects mood) appears to be reasonably safe during pregnancy.
Antidepressants may be appropriate during pregnancy or while you're breastfeeding if:

You would otherwise attempt to ease your symptoms with alcohol, tobacco or other drugs.
The depression interferes with your ability to provide adequate physical or emotional support to your baby.
You have a history of depression and a high probability of relapse without medication.
You're experiencing psychosis.
You have thoughts or impulses to harm yourself or the baby.

Anxiety and panic attacks
Some women experience anxiety or panic attacks during or after pregnancy. Typical symptoms include a disinterest in the baby, fear of being alone with the baby, or a level of attention that prevents the baby from getting adequate rest. During the postpartum period, women have an increased susceptibility to the development of a panic disorder or the exacerbation of an existing panic disorder.

Obsessive-compulsive disorder
Obsessive-compulsive disorder (OCD) is most likely to begin or worsen during the postpartum period than at any other time in your life. Risk factors related to OCD during pregnancy or the postpartum period have not yet been determined.

Eating disorders
Women who have eating disorders (particularly anorexia) rarely become pregnant due to disruption of menstrual cycles caused by the eating disorder. If you have an eating disorder, tell your doctor. Counseling is also strongly recommended. Remember, gaining a moderate amount of weight each week during the second and third trimesters is not only normal -- it's healthiest for you and your baby. During pregnancy, the use of laxatives, diuretics or other drugs can harm a developing baby by drawing nutrients and fluids from your body before they can nourish the baby.

Marital problems
Marital satisfaction tends to decrease significantly after the birth of a couple's first child. Many couples invest so much time and energy into caring for the new baby that precious few resources are invested back in the couple's relationship. Couples tend to have fewer shared activities, which may partially explain the statistical rise in extramarital affairs during this time. Violating expectations regarding the division of labor with child care or household responsibilities is a common sore spot among new parents, as well as the spousal relationship failing to meet expectations after the baby is born. Many spouses have difficulty coping with their partner's pregnancy-related mood changes, which often leads to frustration. Many new moms feel unattractive or even unloved by their partners.

Infertility
Approximately 20 percent of reproductive age couples have difficulty conceiving or maintaining an established pregnancy. Coping with infertility can cause a variety of emotional reactions, including:
frustration
sadness
loss of control
symptoms of depression
guilt or shame
an obsession or preoccupation with infertility and efforts to get pregnant
cycling of emotions between hope and despair

Miscarriage, stillbirth or infant death
When a pregnancy ends with the loss of the baby, typical emotional reactions can include:
sadness, hopelessness or helplessness
feeling isolated (Generally, the earlier the loss, the less it is acknowledged and endorsed by others.)
guilt and blame
anger
feeling the need to talk about the death and details of how it happened
symptoms of depression
irritability
conflict or intimacy problems with your partner
underestimating your partner's level of grief over the loss
feelings of apprehension about becoming pregnant or attempting to become pregnant again
If you've experienced a miscarriage, stillbirth or infant death, acknowledge the loss. You may want to name the child and have a funeral for the child. Pictures and other mementos often help in the grieving process. For example, it can be helpful to create a memory book or box of mementos containing items such as hospital records, certificates, sympathy cards, pictures and blankets. Give yourself and your loved ones permission to grieve. Acknowledge that your partner may grieve differently than you -- some people are more emotional and demonstrative with their grieving than others. A person may refrain from tearfulness, but still grieve intensely. Avoid blaming yourself or your partner, and refrain from using alcohol or other substances to self-medicate painful feelings. You might consider seeking support from clergy or a grief and loss support group.


Coping
If you or a loved one is experiencing emotional concerns related to pregnancy or postpartum recovery, it's important to seek support. Consult a doctor for a physical exam, and seek professional mental health assistance if needed. A trusting support system is vital for the safety and welfare of both mother and baby.