Pregnancy, which should naturally be a cause for joy, is a challenging period for most women. Sadly, chief amongst these challenges are issues related to mental health that are often overlooked in the Nigerian antenatal care system. It is not uncommon to find women change behaviourally during pregnancy or after childbirth and in some women, it is so bad that those around them may want to stay away from them during this period. Some of these changes may be due to the myriad of changes that occur within and without the body during pregnancy and after childbirth.
Very few people, if anyone at all, would want to admit to having mental health issues, but let us face it, at one point or the other in our lives, we have all had to deal with at least one mental health issue – depression, anxiety, mood swings or an eating disorder.
Within the past year, there has been a lot of conversation around mental health, based on the Sustainable Development Goals (SDGs) principle of “no one left behind”. Yet, as part of these discussions, we should also talk about mental health issues that are related to pregnancy.
Pregnancy-related mental health issues are specifically related to pregnancy and the period after birth. A lot of women suffer from mild to self-limiting, devastating, life-long mental health problems during this period and there is still a lot of misconception about this, as a result of too little or no information at all available. A lot of pregnant women and mothers, therefore, suffer in silence while the problem gets bigger.
According to the World Health Organisation (WHO), globally, about 10 per cent of pregnant women and 13 per cent of women who have just given birth experience, primarily, depression. In developing countries, this is even higher – 15.6 per cent during pregnancy and 19.8 per cent after childbirth. In severe cases, mothers’ suffering might be so severe that they may even commit suicide.
Some common mental health issues associated with pregnancy include:
Many pregnant women suffer from anxiety during pregnancy, especially if it is their first. They may become anxious about how the pregnancy will affect their bodies (every woman is bound to gain some weight during pregnancy and only very few regain their former weight and body shape after childbirth), their capability to carry the pregnancy to term and the baby’s health or, generally, about things that could go wrong during the pregnancy. For those who have had past experiences of a difficult pregnancy or childbirth, they may become anxious that the experience may be repeated.
Depression, like anxiety, is very common amongst pregnant women. In developed countries where women are screened for depression during pregnancy, about 15-20 per cent of them turn out to be depressed.
In developing countries such as Nigeria, there is no data to this effect. Pregnant women may become depressed for any of a number of reasons, some of which may include an unplanned pregnancy, stress during pregnancy, relationship or marital stress, having unrealistic expectations concerning the baby, lack of social or familial support, previous traumatic experiences during pregnancy, having a sick or unsettled baby and a family history of pregnancy-related or genetic illnesses.
Generally, women tend to have larger and exotic appetites during pregnancy. In some women who already have eating disorders, this may become exacerbated during pregnancy and can have serious health effects on both mother and child.
This is when a woman develops depression some time during the first few weeks after childbirth. If left untreated, it can go on for about a year and may affect the level of care a mother gives to her baby.
This is a very serious mental health problem that poses a serious risk for both mother and child. Some sufferers may go on to commit suicide or murder their babies. It does not usually resolve itself fully without treatment.
Other mental health issues that may be associated with pregnancy and childbirth include bipolar or multiple personality disorders, schizophrenia, substance use and addiction.
Now that we have talked about the problems, what are the solutions or treatment options?
First off, having a mental health problem is nothing to be ashamed of, because a whole lot of other people also have the same problem and there is always help for those who seek it. Keeping quiet about your mental health status only makes you sink deeper into it.
Here are a few tips for dealing with and overcoming mental health problems in pregnancy:
Be open about your problems; know that you are not alone.
Have a solid support base during this period – spouses, family, close friends that you can always talk to about how you feel and who will always be ready to help you.
Talk to your doctor during your antenatal visits about any emotional changes you may be experiencing. Your doctor may refer you to a specialist who deals with such cases.
Know your history: many mental problems are genetic and so may not be resolved so easily. Knowing if you or any member of your family has a history of mental health issues will help you prepare and thus reduce the risk of further complications. If you are also on any drugs that treat mental illness, such as anti-depressants, you should talk to your doctor. You may need to be taken off the drugs before you get pregnant, because some of these drugs may have a negative effect on the baby. Ensure, though, that you talk to your doctor before you stop medication.
Eat healthy, balanced meals
Find time to engage in something you enjoy. This helps you relax and lifts your mood.
Get regular sleep.
COO of Silver Lining for the Needy Initiative (SLNI), a stakeholder NGO in the delivery of Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) services in Northern Nigeria, Hauwa Abbas Hadejia says, “It is vital to continue stressing the importance antenatal and postnatal care play in preventing harm to mother and child. For this reason, we must increase efforts in training and ensure that healthcare providers incorporate basic mental health topics into physical care education.”