When depression hits before you have the baby

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 Photo: Getty Images

Kate Moser waited until the night before her due date to set up the nursery.

Dark emotions had persisted throughout her pregnancy, despite the 32-year-old's efforts to be positive. So the eve of her 2014 due date found Moser and her husband piecing together the crib.

Moser hadn't had a glowing pregnancy. After two wrenching miscarriages, the teacher felt fraught with anxiety and fear that she tried to suppress. Strangers commenting on her growing belly left her feeling wilted or incensed. Driving to a doctor's appointment seemed impossible.

"I felt like I was walking a plank every time," she said.

Moser is one of many women who suffer depression and anxiety while pregnant. The American College of Obstetricians and Gynecologists estimates one in seven women experience depression during pregnancy or within 12 months of delivery.

"It's very, very common," said Dr Marcela Almeida, director of the Women's Mental Health service at the University of Illinois at Chicago, which treats hundreds of women from multiple states.

But despite growing awareness of postnatal depression or "the baby blues", anxiety and depression during pregnancy remain under-reported, with no standard screening procedures in place, experts say.

And yet, "it's the most psychologically vulnerable time in a woman's whole life," said Kellie Wicklund, a psychotherapist.

Hormones, stress, infertility, previous experiences with depression or anxiety all act as triggers, experts said, with isolation often exacerbating them. 

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Behind smiling belly shots floating across social media, many say they feel pressure not to be negative about their pregnancy.

Although many women report a range of mental health issues while pregnant - from suicidal thoughts to poisonous, persistent unhappiness - fewer than 20 per cent of women diagnosed during the postpartum period had self-reported symptoms, according to the American College of Obstetricians and Gynecologists.

"You're supposed to be enthralled with being pregnant and excited and have all positive feelings about it, and a lot of women are just riddled with anxiety," said clinical psychologist Dr Gina Hassan. "It's very hard to speak openly about that with others."

In interviews, women recounted a range of struggles.

One 29-year-old woman battled toxic thoughts and depression as strangers constantly asked her about her post-pregnancy plans. "Each comment would make me spiral further," she said.

A 29-year-old mom of a toddler son is delaying having a second child after her first pregnancy emotionally shattered her and her husband. Ravaged with twice-daily sickness and what she now realises was depression, neither of them was sure how to find help.

Another woman, 31, said that, during her last pregnancy, she researched how long it would take to bleed to death without hurting the baby. For months, scared her older two children would be taken away, she told no one - not even her husband, who is a nurse.

For Moser, it was hard to articulate her loss of happiness.

"You lose that joy that a lot of women and families experience during a first pregnancy, and strangers don't realise that," she said. "They just see you being pregnant and feel like it's acceptable to rub your belly and talk to you about the baby."

Many see awaiting a child as magical and merry, Hassan said, and that cultural expectation contributes to feelings of guilt and shame when hopelessness creeps in instead.

An unexpected positive pregnancy test can spur stressors, like planning for a new phase of life, perhaps marriage or moving - those alone being enormous life changes. And even a pregnancy both orchestrated and welcomed can deal a blow.

"Women are caught off guard," Hassan said. "They planned the pregnancy and anticipated it, and it's not what they expected."

Moser, who now has a bubbly 9-month-old daughter, said that slowing down, allowing space for emotions and joining a support group helped.

"A lot of people feel guilty for having those feelings, which of course compounds the feeling, because they feel like they should just be just overjoyed," she said. "Having people who really understood and were not at all judgmental of what I was going through, internally, it helped tremendously."

Partners, friends and family can play a huge supportive role, doctors and therapists said. One thing to avoid? Focusing only on the baby, or saying things like, "Once the baby's here, you'll feel differently."

"Because for some women, that doesn't happen," Turner said.

Partners, who experts say often are first to spot symptoms, should proactively ask women how they're feeling and provide patience and a team-oriented philosophy.

"That can really help the mother feel like she's not alone," Turner said.

Indeed, women are not alone. Talking to someone, whether a partner or medical care provider, is an important first step, experts said.

"The more it's kept inside, the darker it becomes," Hassan said.

SIGNS: As a birth doula, Eleanor Turner looks out for small signals: disinterest in a baby shower, perhaps, or a dismissive attitude about the baby's progress.

Maybe a client casually says, "I don't really know that I'm bonding", as an example, said Turner. Or, "I haven't really felt the baby move, so I don't really even know there's anything in there."

Signs of depression, which experts caution can be mistaken for typical pregnancy changes, include less energy, changes in sleep or appetite, and feelings of guilt, helplessness and hopelessness.

Strong negative emotions during pregnancy can domino, spiralling into fears of motherhood.

"It does bring up sort of self-doubt: 'Maybe I wasn't meant to be a mother, maybe I shouldn't be a mother, maybe this is a sign,'" Hassan said. "As opposed to, 'This is how my body is responding and something I'm going through, and it's not necessarily permanent.'"

FINDING HELP: The first step toward help is openness about feeling down, and regular screening is needed.

After birth, doctors typically use the Edinburgh Postnatal Depression Scale to gauge mothers' mental health. About a five-minute questionnaire, it asks about the past week with statements like "I have felt scared or panicky" or "I have been so unhappy that I have been crying."

Almeida urged women to feel comfortable confiding in their physician at every stage of pregnancy. Be honest, she said: "That way we would be able to help them."

Treatment is very personalized, Almeida added. Therapy and medication both come up in conversations with patients.

Whether women should take medication during pregnancy is a controversial conversation. Almeida said every person is unique - medication might be considered useful for some; others might benefit from seeing a counsellor. Some doctors might be comfortable treating them through regular check-ins, Almeida said.​

Chicago Tribune

If you are having thoughts of suicide or harming yourself or your baby, seek professional help immediately. Contact BeyondBlue on 1300 224 636 or PANDA on 1300 726 306.