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WayAhead

New parents

Most new parents experience some type of worry and/or fluctuation in mood during pregnancy and/or early parenthood. Maintaining positive mental health is important for the health of new parents and for the health of the baby.

If you suspect that you, or your partner or someone else you know may have a mental health condition which would benefit from further support then it is recommended to ask for help.

What are the risk factors which increase stress during pregnancy and in early parenthood?

  • difficult and unhappy childhood
  • unplanned pregnancy
  • being a young/single parent
  • relationship problems
  • obstetric complications in the past, including fertility problems
  • long labour and/or difficult birth
  • premature, postmature or multiple births
  • baby health problems
  • baby feeding/sleeping problems
  • unexpected and/or unwanted feelings about the baby
  • not the expected baby (appearance, gender)
  • lack of sleep for parents
  • low self esteem
  • self-critical, anxious or perfectionist personality
  • socioeconomic disadvantage
  • separation of baby and mother

Stress during pregnancy and/or early parenthood may also trigger mental health problems in partners[1. Beyondblue. (2015a). Life factors that increase risk: Factors which increase stress. Retrieved from https://www.beyondblue.org.au/resources/for-me/pregnancy-and-early-parenthood/mental-health-conditions/life-factors-that-increase-risk].

What are normal reactions during pregnancy and early parenthood?

The physical effects of pregnancy can have a significant impact upon mental wellbeing. It is also common for new parents to experience a range of emotions following the birth of their baby.

The baby blues

Women may experience irritability, over-sensitivity, extreme emotion and substantial mood changes in the days following the birth. Up to 80% of new mothers experience the ‘baby blues’[2. The women’s. (n.d.). Mental health & Pregnancy. Retrieved from https://www.thewomens.org.au/health-information/pregnancy-and-birth/mental-health-pregnancy/]. Symptoms tend to resolve within a few days with support and understanding from loved ones[3. PANDA. (2015). Anxiety & depression in pregnancy & early parenthood. Retrieved from https://www.panda.org.au/images/resources/Resources-Factsheets/Anxiety-And-Depression-In-Early-Parenthood-And-Pregnancy.pdf], however, if symptoms persist beyond two weeks and are coupled with thoughts of self-harm, professional advice should be sought[4. Lusskin, S. I., Pundiak, T. M., & Habib, S. M. (2007). Perinatal depression: Hiding in plain sight. Canadian Journal of Psychiatry, 52(8), 479– 488.].

Women with a history of mental illness should be closely monitored to determine whether symptoms indicate relapse.

What are the causes or triggers of mental health problems during pregnancy and in early parenthood?

  • previous or current mental illness (including depression, anxiety, eating disorders, post-traumatic stress disorder)
  • family history of mental illness
  • physical/hormonal changes during pregnancy and early parenthood
  • history of interpersonal violence or abuse
  • lack of support from partner or relationship problems
  • lack of practical, financial, social and/or emotional support
  • major life stressors (death of a loved one, serious illness, relationship breakdown, loss of employment etc.)[5. PIRI. (2013). Understanding your emotional health – What are postnatal depression & anxiety? Retrieved from http://www.piri.org.au/parents-corner/understanding-emotional-health-postnatal-depression/#about_fathers]

Mood disorders

Depression

During the perinatal period, 10-15% of women are diagnosed with depression. However, as symptoms of pregnancy/early motherhood often imitate symptoms of depression, mood disorders often go undiagnosed.

Common symptoms of depression include:

  • low mood
  • feelings of low self-worth
  • irritability, anger or anxiety
  • increased crying, often for no reason
  • loss of interest in activities which were previously considered enjoyable
  • changes to eating and sleeping patterns
  • loss of motivation and excessive fatigue
  • difficulty concentrating/confusion
  • social isolation
  • thoughts of self-harm

Bipolar disorder

Bipolar is characterised by extreme highs (mania) and extreme lows (depression), which are the same depressive symptoms as for unipolar depression1. Symptoms of mania include:

  • excessively happy mood, or excessively irritable mood, or both
  • speaking very quickly, to keep up with racing thoughts
  • having lots of energy, with no need to sleep
  • feeling overconfident/invincible
  • increased libido/spending/drug and alcohol consumption
  • making lots of plans and behaving rashly and out of character
  • in some cases, psychosis and disassociation

Post-partum psychosis (PPP)

PPP is a rare, acute mental illness which affects 1 or 2 women in every 1000 and most commonly occurs in the first 1-4 weeks after birth. Post-partum psychosis poses a significant risk to mother and baby, requiring hospitalisation. Symptoms include: hallucinations, agitation, delusions and dramatic mood swings.

Anxiety disorders

Approximately 13% of women experience anxiety during pregnancy or in early parenthood. Symptoms common to all anxiety disorders include:

  • feeling stressed, or constantly being on edge
  • muscle tension
  • difficulty staying calm
  • sleep disturbances
  • constant, recurrent worry

Generalised anxiety disorder (GAD)

GAD is characterised by persistent and unrealistic worry occurring most days per week for a period of at least 6 months[7. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.]. Often diagnosis of GAD is overlooked in pregnancy and early parenthood as symptoms resemble common pregnancy-related anxiety[8. Misri, S. & Joe, K. (2008). Perinatal mood disorders: An introduction. In S. Dowd Stone & A.E. Menken (Eds.), Perinatal and postpartum mood disorders: Perspectives and treatment guide for the health care practitioner (pp.65-84). New York: Springer Publishing Company.].

Obsessive compulsive disorder (OCD)

OCD during pregnancy and early parenthood is characterised by intrusive thoughts and compulsive rituals involving the baby; constant worry about suffocation and accidents, uncontrollable checking and re-checking of the baby, or repeated hand washing[9.Abramowitz, J. S., Schwartz, S. A., Moore, K. M., & Luenzmann, K. R. (2003). Obsessive compulsive symptoms in pregnancy and the puerperium: A review of the literature. Journal of Anxiety Disorders, 17(4), 461–478.].

Post-traumatic stress disorder (PTSD)

PTSD sometimes develops after exposure to a traumatic life event. PTSD involves re-experiencing the traumatic event, avoidance of situations associated with the trauma, and a heightened emotional state7. Women who have experience sexual abuse or traumatic birth, for example, may avoid medical appointments as this may trigger distressing memories or feelings[10. Ross, L.E. McLean, L.M. (2006). Anxiety disorders during pregnancy and the postpartum period: A systematic review. Journal of Clinical Psychiatry, 67(8), 1285-1298.].

Maintaining mental health during pregnancy and early parenthood

  • taking care of yourself is taking care of your baby
  • a healthy diet and exercise are good for parents and baby
  • avoid alcohol and drugs
  • rest whenever possible (e.g. when baby sleeps)
  • remember that there is no one right way of parenting
  • ask for help and accept it when it is offered
  • socialise and take time for yourself when possible
  • avoid major life changes in late pregnancy and early parenthood
  • if you are susceptible to mental health problems seek help and support prior to symptoms presenting
  • if symptoms do present seek professional advice early.

The importance of support

Social support can function as a buffer against the onset or reoccurrence of mental health problems[11. World Health Organisation. (2014). Mental disorders. Retrieved from http://www.who.int/mediacentre/factsheets/fs396/en/]. Social connections have a favourable impact upon mental wellbeing and act as a defence against negative effects of stress[12. Kawachi, I. & Berkman, L.F. (2001). Social ties and mental health. Journal of Urban Health, 78(3), 458-467.]. Social networks can also promote the building of self-esteem and coping ability[Berkman, L.F. & Glass, T. (2000). Social integration, social networks, social support & health. In L.F. Berkman & I. Kawachi (Eds.), Social epidemiology (pp. 137-173 ). New York; Oxford University Press.].

Indigenous Australians

Aboriginal people may experience unique mental health needs due to cultural beliefs and traditions. Some aboriginal parents may feel isolated when exposed to the health system outside their traditional community which may add to the stress associated with having a child.

Immigrants & refugees

Individuals from culturally diverse backgrounds may be at higher risk of mental health problems due to lack of social support and experience of trauma. Cultural background has a significant impact upon help-seeking behaviour; in some cultures stigma is attached to seeking professional help for mental illness[14. Small, R., Lumley, J., & Yelland, J. (2003). Cross-cultural experiences of maternal depression: Associations and contributing factors for Vietnamese, Turkish and Filipino immigrant women in Victoria, Australia. Ethnic Health, 8(3), 189– 206.].

Partners

Studies indicate that in the perinatal period approximately 5% of expectant and new fathers will develop depression, anxiety or other forms of emotional distress[15. Condon, J.T., Boyce, P., & Corkingdale, C.J. (2004). The First Time Fathers Study: A prospective study of the mental health and wellbeing of men during the transition to parenthood. Australian and New Zealand Journal of Psychiatry, 38(1-2), 56-64.], and

3.6 % of fathers will experience postnatal depression[16. PricewaterhouseCoopers for beyondblue. (2013). Valuing perinatal health: The consequences of not treating perinatal depression and anxiety. Retrieved from https://www.beyondblue.org.au/docs/default-source/8.-perinatal-documents/bw0079-report-valuing-perintal-health.pdf?s fvrsn2]. Mental distress in partners can impact significantly upon maternal mental health; therefore, it is important that partners also seek help.

Treatment options

Psychotherapy

Therapeutic sessions with a mental health professional can be beneficial for perinatal mental health.

  • Cognitive behavioural therapy (CBT) addresses the relationship between thoughts, feelings and behaviours, and is often used to treat depression and anxiety.
  • Interpersonal therapy (IT) examines relationship issues and roles within relationships, such as partner/mother, while mother-infant therapy aims to enrich the relationship between mother and baby.
  • Relaxation and mindfulness therapies are also used to treat the symptoms of anxiety and depression.

Medications

Sometimes medication is required to treat the symptoms of depression, anxiety or psychosis. Medication is usually prescribed in conjunction with psychotherapy. Your doctor will be able to determine what medication is most suitable for you.

Discontinuing medication prior to, or during, pregnancy can result in relapse[17. Cohen, L. S., Altshuler, L. L., Harlow, B. L., Nonacs, R., Newport, D. J., Viguera, A. C. (2006). Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. The Journal of the American Medical Association, 295(5), 499–507.]. Speak to your GP about what your options are in regards to current and potential medications. It is important to not stop taking psychiatric medication abruptly.

Residential units

If symptoms are severe, and mother and baby are significantly affected, health professionals may recommend a stay in a residential unit. This can be respite for the mother, where she is admitted alone, or a mother-baby unit where the baby is admitted with the mother while she receives necessary treatment.

Self-help/Support groups

Self-help groups are structured programs where groups of individuals learn various strategies and coping mechanisms for the day-to-day management of mental health issues.

Support groups allow individuals to receive emotional and practical support in a group environment, with co-members who are all dealing with similar conditions

Support groups also exist which assist men in adjusting to fatherhood.

Some self-help and support groups can even be accessed online.

Who can help?

Has this fact sheet raised questions or concerns for you? Seeking help doesn’t have to be daunting!

Your GP is an excellent starting point! They can then refer you on to appropriate services if required.

What can I do to help myself?

Ten Tips to Stress Less for Mums

  • Have the courage to be imperfect
  • Take time for yourself
  • Sign up for that course/join that club
  • Be active every day in as many ways as you can
  • Spend time with people who make you feel good
  • Laugh out loud each day
  • Invite your neighbor over for a cup of tea
  • Do one thing now you’ve been putting off
  • Remember, this too shall pass
  • Focus more on things you can control

Where do I go for help?

The WayAhead Directory is an online resource providing a comprehensive list of mental health related services in NSW.

Mental Health Information Line

1300 794 991

Anxiety Disorders Information Line

1300 794 992

Your local doctor (GP)

Translating & Interpreting Service

(TIS) 131 450

Please call the Mental Health Information Line through the Telephone Interpreter Service (TIS). Free to Australian citizens or permanent residents.

Disclaimer

This information is for educational purposes. As neither brochures nor websites can diagnose people it is always important to obtain professional advice and/or help when needed.

This information may be reproduced with an acknowledgement to WayAhead – Mental Health Association.

The Association encourages feedback and welcomes comments about the information provided.