In my experience as a clinician, many times when caring for pregnant women and postpartum women (the time after giving birth when the body returns to a non-pregnant state, usually 6 weeks), we focus majorly on their physical well-being, we check if they’re taking their routine medications, we check on fetal well-being, we monitor the woman’s vital signs, post-delivery, we ensure the child takes all necessary vaccinations, and there are no “complications” post-delivery. However, one major complication that is typically overlooked is the mental health challenges that may accompany the postpartum period.
In my work, I ensure that I have conversations with my patients; I ask about their social circle and try to speak with people in their social circles, such as family and friends. This is especially important because, over time, I have seen the importance of strong social support in the postpartum period. Many women, especially first-time mothers, find it challenging to adjust to the new status of being a mother or caring for more newborns, as the case may be.
From the first time a woman becomes pregnant, her “normal” routine lifestyle changes immediately. She has to be careful what she eats, she has to take routine medications, there are hormonal changes, there are physical changes, and she has to go through this for approximately 9 months before going through labor and then caring for a newborn. Though joyful, the whole process can be overwhelming without proper support and care for the mother. The sad reality is that there’s a lot of stigma associated, and women who have postpartum depression are considered weak or not “motherly” enough.
According to the World Health Organization, globally, 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, usually depression. It is a global public health issue and is particularly enhanced in low-resource settings with limited access to healthcare. The condition affects a significant portion of new mothers and can have long-lasting impacts not only on the individual but also on their family, especially the newborn. In severe postpartum cases, the mothers can die by suicide.
Given the significance and magnitude of the impact of postpartum depression, it is essential to provide support and tackle issues that exacerbate these issues.
1) Screening and Diagnosis: Early detection is one of the most critical strategies that can be instituted. Healthcare providers must have a high index of suspicion, and mental health screening should be integrated into standard care to help identify women at risk and commence rapid intervention.
2) Medical Intervention and Psychotherapy (Talk Therapy): Access to mental health care at primary care centers is crucial in ensuring that all women have easy access to mental health resources. Integration of mental health care with obstetric care should be the standard. Women should also be encouraged to speak with their mental healthcare providers. Speaking with these professionals can help them effectively navigate their feelings and emotions. There are also medications available that can be prescribed by authorized healthcare professionals and are effective in managing and reducing symptoms.
3) Mental Healthcare Policies: Healthcare policy reforms that prioritize mental health training for healthcare workers at all levels, increased funding for mental health care interventions, and implementation of policies that protect women will be highly beneficial in combating mental health illnesses in pregnant and postpartum women.
4) Strengthening Support Networks: Social support is a critical protective factor against postpartum depression. Interventions that involve family members, friends, and community networks can provide emotional and practical assistance to new mothers.
5) Awareness and Reducing Stigma: Health awareness efforts should be strengthened to improve the knowledge of the general population about the realities of mental health challenges faced by pregnant and postpartum women. Societal pressure to conform to a particular picture of strength must be eradicated. It must be emphasized that every parous experience is different, even in the women who have previously given birth, and must be supported. It should also be noted that every woman should be supported through the journey.
6) Self-care: Pregnant and postpartum women should be encouraged to get adequate sleep and eat well. There is a strong tendency for women sometimes to focus on caring for the child and neglecting their own well-being. Knowing when to ask for help and allowing social support to care for the baby while getting some rest is essential. Also, speaking with trusted friends who have gone through similar experiences, joining peer support groups if necessary, and being kind to oneself can prove very effective. Women need to remember that they are still human and may not be able to meet their expectations for parenthood all the time.
With early and adequate intervention, support, and care, many women with mental health conditions during pregnancy and postpartum do excellently well and recover. It takes a concerted effort to tackle this issue., which has been highlighted. The World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) Intervention Guide is a valuable resource for healthcare providers in low-resource settings, offering evidence-based guidelines for diagnosing and managing common mental health disorders, including postpartum depression.
Postpartum depression is a significant global health concern, and only together can we change the narrative.
