This week (2-8th May) is Maternal Mental Health Awareness Week – a week-long campaign dedicated to talking about mental illness while pregnant or after having a baby, as well as raising awareness of how people can seek support.
To get the conversation started, we caught up with Dr Andy Mayers. principal academic at Bournemouth University, to explore why maternal mental health matters, why we need to be looking at the whole family unit and why early intervention is so important.
Dr Andy Mayers is an academic psychologist, specialising in mental health and particularly perinatal mental health. He has been working with mothers’ mental health for the best part of 20 years, largely campaigning, educating, trying to get better services, informing local and national charities and other groups about the kind of services they can provide, and generally promoting the need for better awareness and services for perinatal mental health.
We hope you find this post a helpful and informative read. Please share to help raise the awareness and keep the conversation going, so that more mothers and their families reach out for the support they need.
Why does maternal mental health matter?
I think there is no other more important mental health issue than maternal mental health, because it is not just affecting the person, it's affecting the family and it's affecting the babies. We need to understand that this isn't just a mental illness that we can sort with standard solutions. It's not something we ‘might’ need to do. It is absolutely essential, for this generation and every generation to come, to get this right.
Why do we need to look at maternal mental health differently to other mental health issues?
There are many different reasons why we need to look at maternal mental health differently to typical adult mental health. Let’s look at why postnatal depression for a mother is different to any other major depression for a woman of similar age or background that doesn't have a new baby.
Mum guilt and feelings of failure
Firstly, one of the things we notice with any form of depression is one of the symptoms is guilt. For a mum with postnatal depression, that guilt goes through the roof. This is largely because of the societal perception that becoming a mum is wonderful, the most incredible thing, a time of pure happiness. But what if that’s not mum’s experience? What if mum starts feeling like she can't cope? Maybe her mood is being compromised or perhaps she hasn't got the motivation or she’s feeling unsupported and exhausted. Various things could be impacting her mental state, and because of the societal pressures, she's going to feel intensely guilty. The guilt that we'd normally see in adult depression is escalated because suddenly she'll feel like she's failed to be the ‘simple’ thing of being a mother.
Another factor, which is similar, is that if we were treating any other adult for depression, one of our options is medication, such as antidepressants. But it’s not so simple when treating a new mother. Obviously, we’d always need to check with a medical professional and be under their guidance. But many medications are safe, depending on dose. However, that doesn't stop mum worrying about taking the medication. She could be told, by a medical professional, that she and her baby will be absolutely fine taking the medication. However, she might feel intensely guilty about doing so, because she might have been told by friends, family, Facebook, or something else, that you really shouldn't take medication. Mum therefore can’t be sure whether it is going to harm the baby and is heavily conflicted.
Breastfeeding is supposed to be ‘the most wonderful experience’. However, many mums struggle in the initial stages of breast feeding. For mums with postnatal depression, those struggles can become even more intense. This is either because of the side effects of the medication, or because of the illness itself, which can complicate breastfeeding. This might mean mum has to stop breastfeeding, and of course, this can make her feel even more guilty. She feels like it is yet another thing that she has ‘failed’ at.
Baby bonding & connection
When a mum has postnatal depression, this can also create complications for how she interacts with her infant, and this can ultimately impact the child’s emotional development. We know that the bonding and the interaction with the baby at this time is crucial. When mum has postnatal depression, her cognitive and emotional resources are compromised to the extent that she is often not able to interact with baby as well as she might be able to.
It's important that mums understand this is not their fault. They are not well. But again, this often causes feelings of guilt and failure to arise. We therefore need to be able to give mum the resources to be able to interact and strength those connections with her baby. One of the things we can do is to work with the breastfeeding. But if this doesn’t work, this can make mum feel even worse.
As you can see, mental health challenges in new mothers and how we need to support them, is very different to treating and supporting mental health issues in an adult without a new baby. Importantly, we need to work to try and remove, or at least reduce, those feelings of guilt and failure. We need to give mothers the resources to not only get better in herself, but also help her engage better with her baby.
Is it only mums’ mental health that we should be talking about?
No. Although this is Maternal Mental Health Awareness Week, it’s not just mums’ mental health we need to be concerned about. We also need to consider the fathers and any other partners’ mental health. That includes same sex partners. Because they are all part of the pregnancy, the birth, the postnatal care.
If one parent’s mental health is compromised, it is going to have an impact on their partner. It is also going to have an impact on the child. Dads or same sex partners can also develop postnatal mental health problems, either because of what the birth mother has been going through or indeed, through something independently. We need to look at all partners. The whole family unit is important.
How are the challenges similar or different between mums vs. dads or other caregivers?
People often think that dads can’t get postnatal depression because they think postnatal depression is all hormonal. But that is not true, even for women. Yes, hormones are a factor at play for mums, but environmental and social issues play a huge fundamental part. This is true for all partners.
Becoming a new parent is a hugely transitional time for both parents and both are required to make many adjustments in their lives. The partner, for instance, will need to negotiate the change in relationship with the mother. They may have financial implications because their partner's given up work. They may be finding it very difficult to engage with the whole rush of emotions of a baby arriving and the whole adjustment.
But there are obviously differences too. The complications that I mentioned earlier related to guilt regrading breastfeeding and medication, obviously don’t apply to fathers or partners.
Is it only severe / complex, perinatal mental health issues that we should be worrying about?
Not at all. I'm privileged to be linked with Maternal Mental Health Alliance, and we’ve been campaigning governments and the NHS for better NHS mother and baby units and community perinatal mental health teams. And largely across England, we've been very successful in doing that. However, only the most severely unwell mums will qualify for being attended in a mother and baby or similar.
Unfortunately, there are a large number of additional mums who do not meet the threshold for support, and yet they're still struggling. We need to give these mums the resources and toolkits, to be able to navigate what they're going through, and above all else, to reassure them that this isn't something that is to be ashamed of. We need to give them the confidence to be able to ask for help and then give them the support they need, either through charities or third sector or community groups.
Maternal Mental Health Week Awareness Week was started by the Perinatal Mental Health Partnership in 2017 to support those mums in the community. Those sub-threshold mums, who need that support are every bit as important as those who are intensely unwell.
What is the benefit of supporting those mild/moderate or ‘sub-threshold’ mothers?
Early intervention is always key. If we can support these mild/moderate mums, we can reduce the likelihood of those problems escalating to the point where she will need the more intense help.
Firstly, it's about encouraging mums to actually seek to help in the first place. Because many mums, in fact half of mums, will not tell their partner, their family, the health professionals, that they are feeling this way, for fear of judgement and for fear that their baby will be taken away from them.
The other thing we need to focus on here is if we get an early intervention, if we give her the toolkits, either to work through some of the feelings that she's having, or work on the interaction with the infant to try and improve, the sooner we do that, the sooner she's going to get better, the sooner she'll be able to interact with the child. It is essential to get those resources in place, and we need to do that across the board.
As a society, what more should we be doing to address the issues of perinatal mental health?
I think we need to educate people fundamentally on why this is so important, because at the end of the day, there's no other more important mental health issues than this. It is not just affecting the person, it's affecting the family and it's affecting the babies.
We need to remove the stigma about having a perinatal mental health problem. It's not a choice, it's not a weakness, it's something that needs to be addressed. We need to increase the dialogue around it. We also need to ensure that all mothers through from mild/moderate to the most severely ill are properly supported. And we need to be able to provide those resources from governments and local authorities and the NHS.
I think we also need to start thinking about this in the workplace. When mums return to work, or indeed, when dads return to work, often much earlier, we need to be able to recognise within our parental employees, that they might be struggling. We then need to work with them to say, okay, I think you're struggling, here are some resources and other support that can help you. There may be resources within the organisation, but if not, organisations need to be able to reach out to other organisations that can help them. At the end of the day, that's better for the parents and it's better for the productivity of the organisation. It’s win win really.
What is your number one piece of advice to all expectant or new parents?
Always ask for further help if you've got any doubt that you're struggling, if you've got any doubt about your mood, about your anxiety, about your sense of reality, about feelings of intrusive thoughts, all of these are important. You will not be judged. And the sooner you seek that help, the sooner we can get that help that you need and deserve.
Everybody has mental health, just like we have physical health, and we all have the capacity to suffer from mental health disorders. If you are at all concerned about your mental health, it is very important you seek professional health. Your doctor or other health professional will want to hear from you. For further information on maternal mental health issues and support on getting help, check out these resources:
About Dr Andy Mayers
Dr Andy Mayers is Principal Academic, based at Bournemouth University, specialising in mental health, particularly in the perinatal period (for mothers, fathers and their families). He has published several papers on perinatal mental health. Dr Mayers helps design and improve mental health support services and serves on several local and national advisory groups for maternal mental illness, including groups that influence NHS policy changes. He also represents mental health charities nationally and across Dorset.