Maternal mental health

If you've experienced severe postpartum depression, you do have a higher risk of it recurring after a second child. The most important thing is that, because you already have a history of depression, preventative treatment, such as psychotherapy or medication, can be used to reduce the risk of relapse. Early symptoms can also be detected and treated effectively and quickly, preventing the depression from progressing. The most important thing is to maintain close follow-up with your psychiatrist so that, this time, you can have a symptom-free postpartum experience.

Being immersed in fertility treatment will inevitably be an extra source of worry that can trigger anxiety. Managing uncertainty, frustration, and a lack of control is no easy task, but we can try to keep anxiety at bay with a few ideas:

• Physical exercise is a great way to manage anxiety. Playing sports helps regulate cortisol levels (the stress hormone) and also promotes the release of endorphins and many other hormones, which help us feel better. Adapt your exercise to the intensity level that is appropriate for your current situation. Walking is recommended in most cases.
• Share how you feel with your partner, don't keep it inside.
• Take care of your inner dialogue as well . Try to speak to yourself with kindness and love, and avoid self-criticism. Our minds react to what we tell ourselves is happening or will happen, not so much to what is actually happening. Therefore, avoid anticipating everything bad and look for more realistic alternative thoughts.
• Make time for the rest of your life. Don't let everything revolve around treatment; enjoy each day, socialize with worthwhile people, stay active, and do activities you enjoy and that fulfill you.

Several antidepressants can be taken during pregnancy and have been shown to be safe for both mother and baby. Many women take antidepressants during pregnancy and while breastfeeding, achieving good control of their emotional symptoms and supporting healthy development for their baby. For the physical and mental well-being of both mother and baby, it is important that anxiety and depression symptoms are well managed. In some cases, this stability can be achieved through psychological therapy, while in others, medication with antidepressants will be necessary.

The most important thing is to develop a treatment plan with your psychiatrist as soon as you start trying to conceive. This will allow you to determine if the antidepressant you're taking is safe during pregnancy, if it needs to be discontinued, changed to another medication, or if psychological treatment should be added for better symptom management. If your antidepressant is prescribed by a primary care physician or general practitioner, you should request a referral to a psychiatrist for specialized follow-up during the perinatal period.

Most women experience some kind of fear during pregnancy, and therefore, worrying during pregnancy is very common . We can be afraid of many things: that something bad will happen to the baby, fear of the changes our lives and bodies will undergo, fear of how it will affect our partner, our work… In addition, women with highly perfectionistic, self-demanding personalities and a great need for control may find it very difficult to navigate pregnancy by accepting that they are probably facing the most important life event of their lives and that they cannot control it.

If you're already pregnant and everything is going well, besides taking care of yourself and keeping up with your checkups, there's not much more you can do because the pregnancy will progress on its own. Try to loosen up a bit and trust your body.

Also, on many occasions, all the fear is compounded by guilt and social pressure for not enjoying this moment as we are "supposed" to.

It's important to learn to tolerate suffering and accept that we won't always feel good, and not add more pressure with thoughts that tell us we shouldn't feel what we're feeling. We don't choose how we feel, and blaming ourselves for it is never a good idea; it will only increase the discomfort.

We tend to believe that worrying and dwelling on things can help us find solutions, but the reality is that constantly and almost obsessively going over things is of little use and, in fact, makes us more vulnerable to anxiety and depression. Try to avoid spending too much time thinking about everything that could go wrong, and when you catch yourself doing so, try to generate a more realistic alternative thought, based on facts and not so much on fears, focusing on what is happening now and not on all the bad things that could happen. There are surely many good things happening too. Remember to remind yourself of them.

If you find yourself stuck in a loop, get out, go for a walk, a hike, or do some physical exercise.

Share your feelings with someone you trust. Putting your thoughts into words helps structure and organize them.

If you don't know who to share it with, writing can also help.

That's not true. There is no mental disorder that prevents women from being mothers . Schizophrenia, like all physical and mental illnesses, can have varying degrees of severity, and the symptoms can manifest in a wide range of ways. Many women with schizophrenia can lead fulfilling and satisfying lives in many respects, including starting a family and becoming mothers. An important aspect for women with this disorder is maintaining stable symptoms during the perinatal period and adhering closely to their treatment plan and therapeutic guidelines.

It's normal to have doubts. Motherhood raises questions for all mothers . The most important thing is to talk to your psychiatrist so they can guide you in your specific case, on how to approach pregnancy, childbirth, and postpartum. In general, you should keep in mind that pregnancy and postpartum are periods of heightened psychological and physiological stress, making them especially risky for relapses. An important point to remember is that with good adherence to your medication regimen, you shouldn't experience any relapses, and many medications for bipolar disorder are safe during pregnancy and postpartum. An important symptom to monitor during pregnancy in mothers with bipolar disorder is insomnia . Therefore, it's important to maintain a stable sleep schedule, using medication to treat insomnia if necessary.

Unfortunately, traumatic childbirth is more common than we might think. Some practices performed during labor can have a high potential for trauma. Furthermore, what happens during childbirth leaves a lasting impression and affects the physical and emotional well-being of both the mother and her baby.

In some cases, women will experience significant obstetric complications that can lead to highly instrumental deliveries, the need for emergency cesarean sections, or other highly complex situations. Clearly, these circumstances will negatively influence the subjective experience of childbirth. However, it's important to remember that a situation of great clinical severity doesn't have to occur for a mother to feel she has had a difficult birth. What defines, for a woman, whether her birth was traumatic or not is her own subjective experience. If, during labor, the mother feels that things happened that she didn't think she was capable of handling, if there were any complications, if she felt judged or disrespected, if decisions were made without her consent… all these situations can lead to a traumatic birth experience.

In these cases, it is common for feelings of anger, irritability, low mood, anxiety, nightmares, or recurring thoughts about what happened to appear; difficulty bonding with the baby may also occur.

Some recommendations are:

• It's important to give yourself permission to talk about your birth . All women need to share their birth stories. In the case of a traumatic birth, we often avoid talking about it because remembering it causes pain or because we feel misunderstood. But if we don't talk about what we've experienced, if we don't name what we feel, we can't organize and process it emotionally. We need to talk about it to integrate the experience.
• Look for someone sensitive and trustworthy, someone you know will listen to you without judging you .
• Write about your birth experience.
• There are also online support forums for mothers; sharing your experience can be a first step towards healing from your birth.
• It is also important to remember that, even if your baby's arrival into the world was not as you expected or wished, you have plenty of time ahead to "mother" your baby as you wish.

However, if the symptoms do not improve, it could be post-traumatic stress disorder, and it would be advisable to consult with a professional sensitive to perinatal issues.

Depression is an illness characterized by intense and persistent feelings of sadness. It's important not to confuse sadness with depression; sadness is a normal emotion and falls within the usual range of mood fluctuations. Depression is not simply having a bad day, but rather a state in which a person is affected holistically.

The signs that could indicate we are suffering from postpartum depression are:

• Intense and persistent feelings of sadness (more than two weeks).
• Uncontrollable crying.
• Loss of interest and difficulty in enjoying activities that we used to enjoy.
• Sleep and appetite disturbances.
• Difficulties in carrying out daily activities.
• Difficulty concentrating, slowed thinking.
• Feelings of guilt for not being the mother we hoped to be.
• Doubts about our ability to care for the child, feelings of inadequacy
• Difficulties bonding with the baby.
• Thinking that we made a mistake in having a son or daughter.
• Thoughts of death or suicide.

If you identify with this, it's important to consult a healthcare professional.

To all the changes that come with motherhood, we must also add exhaustion and lack of sleep. In this scenario, it's no wonder that ambivalent feelings can arise. The idyllic image of motherhood, where only positive emotions exist, is far from reality, where all the wonderful aspects of postpartum must be integrated with all its more challenging ones.

Occasional bursting into tears, by itself, is not a sign of depression. We shouldn't confuse a moment of sadness, tears, or even hopelessness with depression.

In fact, up to 50% of mothers experience a phenomenon known as the " maternity blues" in the postpartum period. This reaction, considered normal, appears between the third and fifth day postpartum and is closely linked to hormonal changes. It consists of increased sensitivity, crying spells, mild sadness, irritability, and worries about the baby. It usually resolves itself. spontaneous and does not exceed the first two weeks after delivery.

However, if these symptoms worsen, become chronic, or if more symptoms appear, we should consider the possibility of postpartum depression and seek professional help.

We've already discussed the warning signs of possible postpartum depression. If you think your partner is feeling this way, it's important to seek help. Postpartum depression is treatable.

Some recommendations for caring for the mother and baby:

• Free the mother from all the household logistics: shopping, cooking, cleaning. Ideally, she should only have to take care of the baby and herself.
• Taking care of the other children, if any, taking them to and from school, taking them to the park, keeping an eye on them.
• Ensuring the mother gets enough rest and sleep is essential. Encourage her to sleep when the baby sleeps, and prevent her from taking advantage of the baby's nap time to do housework.
• Sharing the baby's care.
• Encourage him to leave the house, encourage physical exercise, we can go for a walk.
• Promote a healthy diet; now is not the time for restrictive diets.
• Promoting breastfeeding. We know that breastfeeding is not only beneficial for the baby but also for the mother. Oxytocin and prolactin (hormones involved in breastfeeding) have an impact on the mother's emotional state, helping to reduce anxiety and stress levels. However, we must always respect the mother's decision, and if she does not want to or cannot breastfeed for whatever reason, we must respect her and support her in that decision.
• Offer her active listening without playing games, avoid comments like "but how can you not be happy if you have a beautiful child, if everything has gone well..." and that could make her feel more guilty than she already should.
• Value and reinforce everything she does well, help her feel capable as a mother.
• Ask her directly what she needs help with.
• Do not leave the mother alone, especially if she doesn't seem well.

You don't have to stop breastfeeding, even if you're taking medication. Many medications don't pass into breast milk and therefore don't reach your baby, making them completely safe (for example, escitalopram or lorazepam). When the mother is breastfeeding, it's important that she remains calm so the baby can also relax and feel comfortable with her. Therefore, if the mother needs it, it's preferable for her to take medication to manage anxiety or depression, as this doesn't affect the baby and allows them to interact more relaxed during breastfeeding. If you're taking any medication and want to breastfeed, discuss it with your doctor, who will advise you on whether you can continue taking it or if you need to switch to another medication that doesn't pass into breast milk.

Not all mothers bond with their babies immediately, nor do they all experience that supposed infatuation the moment they see them for the first time. Many mothers take longer to bond with their babies; some feel a kind of protective instinct toward such a vulnerable being, others have serious difficulties bonding with their babies, and some even experience rejection. Experiencing mental health problems during pregnancy or postpartum, or having a difficult delivery, can interfere with the formation of this bond.

Many mothers experience mixed feelings. On the one hand, they feel happy, and on the other, they feel overwhelmed and distressed. Feelings about motherhood don't have to be singular and can be a mixture of many different emotions.

Once the bond has been properly established, raising children becomes much easier.

Skin-to-skin contact with your baby, breastfeeding, or in its absence giving a bottle as if we were breastfeeding, massages, all the behaviors typical of motherhood and close contact with your baby help to promote bonding.

Pregnant women go through a life stage that we know is especially sensitive and makes them more vulnerable to mental health issues. It's a myth that pregnancy protects mental health. Having experienced anxiety previously increases the likelihood of experiencing it during pregnancy as well.

There are different things we can do to control anxiety.

• Breathe. When we're anxious, we tend to take short, shallow, and very rapid breaths. Practicing slow, cyclical, and deep breathing can help reduce anxiety because it activates the parasympathetic nervous system, which is responsible for initiating relaxation once the perceived danger has passed, and helps us return to a state of calm.
  How to do conscious breathing?
  • Take a 3-second breath.
  • Hold your breath for 1 second.
  • Exhale for 3 seconds and hold your breath for another second before inhaling again. Make sure the air reaches the bottom of your lungs, filling them completely.

While breathing this way, try to focus your mind on the present moment. You can concentrate on your breath, on how the air enters and leaves your body, on the pressure of the air inside you… When you find your mind has wandered, without judgment, gently bring your focus back to your breath. Practice this a couple of times a day for 10 minutes.

• Take care of yourself physically, make sure you are sleeping all the hours you need.
• Physical exercise is the best way to reduce stress levels in our body.
• Identify your thoughts . If they cause you anxiety, analyze them. Ask yourself if they are real or a product of your fears. Look for evidence for and against them, and try to generate more realistic alternative thoughts.
• Be kind to yourself. It may not be how you'd like to feel right now, but punishing yourself for it will only create more guilt and anxiety.

If anxiety intensifies and significantly interferes with your daily life, seek help from your GP, gynecologist, or midwife.

Becoming a mother for the first time is a transformative and life-changing experience that has a profound impact on the lives of both a woman and her partner. This new stage of life will be accompanied by hormonal changes, shifts in routines, changes in family dynamics, and changes in priorities. Our lives will be completely different, and it will transform the entire family system.

When a baby is born, not only is a mother and father born, but a family is born as well, including grandparents and even aunts and uncles. If there are more children, a brother or sister will also be born.

Sometimes integrating all these changes isn't easy. It's very important that each family member understands their primary role . In the case of the mother, her priority is, or should be, caring for the baby and herself, and for that, the mother's partner plays a fundamental role. His main role is to care for the mother and baby and be their support.

The families of origin of each parent will also have a significant influence on the new family that has been created. Their logistical and emotional support is fundamental, but it is very important that they understand that their role is to provide the support that the parents have indicated they need and to respect the pace and decisions that the new parents make regarding raising the children.

It's natural to expect that family members will want to visit the newborn and be part of their life, but if visits from family and friends are causing stress, it's important to communicate this and, if necessary, agree on a realistic visiting schedule for the mother. The immediate postpartum period is a time when women generally need little social interaction and prefer the calm of their immediate family. At the same time, sleep is a vital need, and visits can sometimes interfere with it. My recommendation is that if the mother is asleep, she shouldn't be woken up to attend to visitors.

It's also important to consider that, in the current pandemic situation, many women feel particularly uncomfortable with visits. They have sometimes also received instructions from their pediatricians to restrict them.

Respecting the mother's needs and the decisions the couple has made regarding parenting is very important and will prevent an escalation of family tensions.

Parenting is a stage that very often involves exhaustion and stressful moments, and this can be even more intense when babies have special needs. Stress levels for mothers and fathers of children with difficulties are often particularly high. Thus, burnout and exhaustion can become significant, sometimes difficult to bear.

Therefore, it is often helpful to connect with other parents of babies with similar needs, to share perspectives and strategies, and to feel understood and supported. It can also be helpful to try sharing some of the baby's care with family members or other caregivers, allowing for personal respite, which helps parents recharge and continue caring for their children with greater peace of mind. In cases where stress manifests as anxiety or low mood, parents should consult their doctor to assess the need for medication or psychotherapy.  

If you're feeling unwell and the discomfort has lasted for more than two weeks, it's important to be evaluated by a healthcare professional. You can see your midwife, your primary care physician, or a perinatal mental health specialist. Look for resources in your community.

The first thing is to share how you feel with those around you, especially your partner, and ask for help with anything you honestly feel you need. Let yourself be helped and allow yourself to rest. A good mother isn't one who can do everything alone. Taking care of yourself is taking care of your baby.

Look for peer support groups, mothers' groups and parenting groups; there may be one near where you live.

What you're feeling isn't your fault. Raising children isn't easy.

Motherhood is the most selfless and generous act you will ever perform. Don't dwell on how you think you should feel; instead, appreciate and remember all the good things you do. Don't just focus on how anxious or sad you are; also consider all the effort you are making for your baby. Remember, you don't have to be a perfect mother. We all feel overwhelmed or overloaded sometimes; it's not pleasant, but it doesn't mean you aren't a good mother.

Breastfeeding is an important aspect of the mother-baby relationship, as it is a moment of intimacy, affection, and synchronicity shared exclusively by mother and baby in the early stages of parenting. Once breastfeeding is established, and if there are no symptoms of anxiety related to it, breastfeeding can be a pleasant and satisfying experience for both mother and baby, strengthening the bond between them and providing security in the relationship. Furthermore, some studies suggest that the hormones responsible for lactation, oxytocin and prolactin, can have a positive effect on mood and also on regulating maternal stress.

We also know that breastfeeding difficulties exist and are often a source of concern for mothers, especially those with postpartum depression. We could say that there is a bidirectional relationship between breastfeeding difficulties and postpartum depression, and it's not always clear whether breastfeeding difficulties are a symptom of depression or whether depression is negatively affecting breastfeeding.

In general, mothers who successfully breastfeed tend to report more energy, better sleep quality, and an improved overall well-being. It's important to remember that there isn't a single cause for postpartum depression, nor is there a single protective factor. The general recommendation would be to attempt breastfeeding, since successful and enjoyable breastfeeding can, in principle, act as a protective factor against postpartum depression. However, the reality is that many other factors influence our mood postpartum; breastfeeding isn't the only one, and it's important that other aspects are also functioning well to navigate the postpartum period as smoothly as possible.