Antenatal Lead
“I’d only been married to my husband for a few months when we started trying for a baby and I didn’t expect we would fall pregnant so quickly, on the second try,” says Bree, now six months pregnant. “I felt anxious that we hadn’t saved up as much as I would have liked and that we were still renting instead of being in our own home. I was the first of my close friends to fall pregnant and I started thinking of all the things I hadn’t done yet that I’d wanted to do before I became a mother. I felt I’d overlooked all of the practical things just because I was clucky. And then when my morning sickness started and I was nauseous for the next three months I started feeling like I’d made a horrible mistake. Only the fact that we had told some family members I was pregnant stopped me from going through with an abortion and my husband couldn’t understand why I was so unhappy.”
Sound familiar? To a degree, it is typical for couples to feel overwhelmed by the idea of having a baby and the enormous responsibility that accompanies it. But for certain women the excitement, elation and anticipation that are supposed to be felt after seeing two blue lines on a pregnancy test are outweighed by other emotions like doubt, regret and fear, and are indicative of antenatal depression.
“Studies show 10% of women will be diagnosed with depression during their pregnancies. Anecdotally it is possible that the actual rates are much higher as many women are not diagnosed or do not identify their depression until they are diagnosed at a later date such as after the birth of their baby,” says Belinda Horton, CEO of PANDA, the Postnatal and Antenatal Depression Association of Australia. “Women often reflect that that the depression started during pregnancy but was not picked up. There is definitely more awareness about postnatal depression than antenatal depression.”
One of the reasons why postnatal depression is more easily understood than antenatal depression is because many of the symptoms of depression such as fatigue, mood swings, irritability, anxiety, insomnia, loss of appetite, lack of libido and low self-esteem are associated with hormonal changes that occur throughout pregnancy, and a well-meaning partner or doctor can assume as much when a pregnant woman is suffering from depression. “It can be hard for women and their health care providers to identify antenatal depression. This may be because it has been thought that antenatal depression is self-limiting – that it will improve once the baby is born,” says Belinda.
There are a number of reasons why a woman may develop depression during her pregnancy. Some women are slightly more susceptible to it, due to a history of depression or if the pregnancy is unplanned or if she has a complete lack of support. Stressful situations such as relationship, financial or career problems can trigger depression, while issues related to the pregnancy itself such as previous infertility issues, pregnancy complications or concerns about giving birth further compound any initial stress.
In most cases, it is a combination of circumstances that are unique to the individual, which Belinda says makes diagnosis even more difficult. “Younger women may struggle to manage the immense changes in all aspects of their lives, combined with fear about the future and the loss of any unplanned pathways for their lives. Older women can battle with the upheaval of their usually settled lives,” she says. “Either way many of the changes are the same and having a baby is so life changing that some women may struggle no matter how stable their circumstances are.”
Julia, a mum to three children, believes her depression began by not having a support system and intensified as a result of pregnancy complications and the premature birth of her first baby. “I moved from Melbourne to Sydney shortly before falling pregnant so I was still adjusting to my new life and my first son was born at 27 weeks due to placental abruption. He has Sensory Processing Disorder due to his prematurity so for my subsequent two pregnancies the lack of relief support from my family and being monitored through Monash Medical’s high risk clinic caused me to become depressed again. I was lucky that I never had postnatal depression after any of my pregnancies – I guess there is just a chemical imbalance between my body and the hormones produced in pregnancy that doesn’t agree with me.”
Another mother, Nicky, found that although her depression was diagnosed until after the birth of her first child, she had been suffering from depression from about five months into her pregnancy, with fertility problems leading into a phobia of childbirth. “I tried so hard to get pregnant after being told I would have problems because of endometriosis, and severe anxiety set in, all related to what the future would hold for me as my partner and I ventured into starting a much longed for family. I was terrified I was going to die during the birth and for my baby’s health and I pleaded for a caesarean just to be in control. It got worse as the pregnancy went on and after a horrific natural birth I was traumatised and diagnosed very quickly with postnatal depression.”
The trouble with leaving antenatal depression undiagnosed is not only that it matures into postnatal depression, but that it can lead some women to endanger their health and the health of their unborn baby by not caring for themselves properly, or to terminate the pregnancy altogether. Belinda says this is unusual but it does happen.
For Megan, her depression in her second pregnancy made her lose interest in her unborn baby. “I had private thoughts that it would be nice if I miscarried as then I wouldn’t have to make any hard decisions,” she says.
Kylie also had negative ideas, when she started feeling depressed from the very first day of her second pregnancy after developing postnatal depression with her first baby. “I recognised the symptoms instantly as I had waves of dark thoughts and high anxiety. The pregnancy and delivery were quite a dark time for me, with panic attacks, not wanting to get out of bed and an inability to cope, and it didn’t help that I broke my pelvis delivering my second baby. I had suicidal thoughts but fortunately never attempted anything as I knew it would pass eventually.”
In addition to these risks, is the impact antenatal depression can have on a growing foetus. Research has linked the prolonged production of the stress hormone cortisol in a pregnant woman to a number of problems in infants including high blood pressure, nervous system damage and low birth weight. Antenatal depression that develops into postnatal depression may also prevent a mother and baby from bonding which makes a baby vulnerable to a range of emotional and behavioural problems as well as depression later in life. “I feel guilty that my postnatal depression may have something to do with my oldest son’s anxiety disorder,” says Nicky. “I try to do all I can to help him so as an adult he can be better at managing it than me.”
“Guilt attached to depression and anxiety is very high during both antenatal and postnatal periods,” says Belinda. “With increased understanding of the link between antenatal and postnatal depression, greater attention is being focused antenatally.”
The best way to know when depression is not just a by-product of pregnancy is when it persists for long periods. It is not uncommon to go through denial as well as extreme highs and lows. “Often it is family and friends that notice the warning signs and push the new mother to get help,” says Belinda. Sometimes simply being aware of the onset of depression can prevent it from escalating.
Bree took action about her depression in the very early stages of her pregnancy by getting counselling and started to feel positive by her second trimester. For several of the other mothers with antenatal depression who went on to experience postnatal depression, medication helped them to overcome their feelings, on top of making life changes that were related to their depression.
“I was too nervous to take medication during the pregnancy because I was worried about harming the baby but started taking antidepressants straight after the birth of my daughter,” says Kylie. “I didn’t breastfeed as I was worried she’d get the medication through the milk but with counselling I was able to come off the medication six months later and I was fine. I’ve since changed my career now as well from a demanding corporate role to running my own business, which may be why I haven’t experienced any antenatal depression with my third pregnancy and can hopefully avoid postnatal depression as well.”
The use of antidepressants during pregnancy is a delicate issue because most medications will cross the placenta to the baby. It should always be discussed with a doctor who will determine which kind, if any, are suitable. “For some women it may be important that they take medication because of the severity of their symptoms and for the wellbeing of both mother and baby,” says Belinda. “But seeing a counsellor can also be a very important part of recovery.”
Women seeking support for antenatal and postnatal depression can call the PANDA phone support line 9am-7pm Monday to Friday on 1300 726 306 or visit www.panda.org.au for more information.
