As part of the Mamma Love Series, I approached Dr. Susan Pawlby, a Developmental Clinical Psychologist, and former Lecturer in the Section of Perinatal Psychiatry at the King’s College, London, UK.  She is also a member of the Multi-Disciplinary Team on the Channi Kumar Mother and Baby Unit at the Bethlem Royal Hospital, South London and Maudsley NHS Trust. Dr. Pawlby is now a visiting Senior Research Fellow at King’s College, London.

She shares below about depression in parents, mothers in particular, from her years of experience working in this field. She also shares what kind of support is offered clinically and how we can support the pregnant and postpartum mammas in our lives.

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How is antenatal depression different from postnatal depression and how do they affect the baby? 

A major depressive episode is an illness characterized by low mood and/or loss of interest or pleasure in usual activities, lasting at least 2 weeks, with secondary symptoms being appetite or weight changes, sleep difficulties, psychomotor agitation or retardation, fatigue or loss of energy, diminished ability to think or concentrate, feelings of worthlessness or excessive guilt, and suicidality. The difference between antenatal depression and postnatal depression is only in the timing of the depressive episode, one being during pregnancy and the other after the birth. The symptoms are the same. Antenatal depression may affect the foetus by increasing cortisol, norepinephrine and inflammation which affect the fetal environment and have implications for maternal and infant health. Maternal stress has been associated with poor birth outcomes including preterm birth, infant mortality and low birthweight. Postnatal depression may affect the baby if the mother’s symptoms mean that she finds it difficult to respond to her baby’s physical, emotional and social needs.

How does depression of mothers affect the emotional regulation of babies? 

One of our tasks as mothers is to help our babies regulate their own emotions. When a baby is born their brains are not well-developed. Infants have some limited self-directed regulatory behaviours such as thumb sucking, visual avoidance, and withdrawal but these behaviours have limited effectiveness. When babies have uncontrollable cries, it is up to us, the parents, to help them regulate their bodies and emotions, so that they learn to self-regulate. This is more easily accomplished during the sensitive period when the brain is still flexible. In order to do this a mother needs to notice, monitor and recognize her baby’s emotions and adapt her own emotions according to the situation. If the mother is depressed, her own emotional feelings may overwhelm her and she may not notice her baby’s distress or be able to offer appropriate support.

What kind of intervention is offered to mothers experiencing depression? 

In the UK, we have multidisciplinary teams of perinatal health professionals – psychiatrists, psychologists, nurses, nursery nurses, occupational therapists, social workers – who support women suffering from depression during pregnancy and following the birth, both in the community and in special Mother and Baby Units. They offer different interventions including medication, talking therapies, promoting well-being through support with sleep, nutrition, exercise, and specially tailored interventions promoting the relationship between mother and baby, keeping the whole family in mind.

How many women who experience postpartum depression actually seek treatment? Why do you think many do not come forward for help?

One UK study in 2011 showed that only 43% of people suffering from postpartum depression sought help. Among the reasons given for not seeking help were that

• it was not serious enough to warrant help from a professional
• they were too scared to tell someone for fear of the consequences, which included fear that their baby would be taken away by social workers
• they did not realise until later that they were suffering from postpartum depression
• they felt that the support they were receiving from family and friends was sufficient;
• they felt that their partner did not support their seeking treatment, they lacked sufficient information about what to do.

How can healthcare providers pay attention to the mental health of pregnant mammas during routine checkup?

In the UK midwives now routinely ask questions about a woman’s mental health at the first antenatal appointment, as recommended in the NICE guidelines (2014)

How common is PPD in fathers? Why might this happen? 

Research suggests that between 8% and 22% of new fathers suffer from postpartum depression. Men may be reluctant to talk about their symptoms and may self-medicate using alcohol. Men whose partners are suffering from postpartum depression may feel that they have to be strong, but once the partner has recovered, their symptoms may become visible. Look at Mark Williams website to learn more about how fathers experiencing postpartum depression can be supported. 

How can new parents be supported to avoid depression during pregnancy and after? 

More discussion in antenatal classes and in the media about the risk factors of becoming depressed and the importance of seeking help. Awareness of keeping stress levels down in pregnancy and encouraging women to take maternity leave from 36 weeks pregnant rather than from the birth. Reaching out to Governments to recognize the importance of supporting mothers-to-be and fathers-to-be in order to avoid mental health problems in this and the next generation. Seeing parenthood as one of the most important tasks that we do.

Are there any ways by which as a society, we can eradicate the stigma around mental health? 

Promote the slogan that mental health is as important as physical health and that Governments should invest as much in one as the other.