Rosey Adams was at the start of her third trimester when her midwife encouraged her to go and see her GP. That same day, she was put on medication for depression.
“For a while, I was just in denial about it. I was scared to speak to my GP or my midwife, because I wasn’t sure of what would happen if I wasn't very well,” says the 29-year-old mother of three from Scotland, talking about her last pregnancy, eight years ago.
Despite having suffered from depression since her teenage years, Adams didn’t really worry about it when she found out she was expecting her first baby, at 18. “The thought of being a young mum and having a pregnancy was more of a worry than my mental health. It just didn’t really occur to me, I didn’t realise that pregnancy could have such a big effect on my mental health, and a lot of women go through the same, there’s just not enough awareness out there,” she says.
She now thinks depression affected all three of her pregnancies, although her last experience was the worst: “My third pregnancy was the one where it was most severe and the symptoms were far more obvious, with things like intrusive thoughts about not wanting to continue with the pregnancy and not wanting to be here,” she remembers.
Depression, anxiety and other mental health issues don’t only come up after giving birth, as a quarter of pregnant women actually experience these problems while expecting, according to a new study from King’s College London – more than previously thought, researchers say.
“There has been a lot of focus on the after-birth period, on postnatal depression particularly, it is almost as if people have assumed that pregnancy is a protective time. What the study illustrates is that it is not because, actually, mental health problems are really common,” says Louise Howard, professor of women’s mental health at King’s College London and author of the study.
While it is likely that some of the conditions detected in the research were longstanding, there are also many reasons why somebody would develop a new mental illness during a pregnancy. Especially if that pregnancy is unplanned, unwanted or the result of rape or partner violence, Howard points out.
A lot of focus is usually put on depression – which still affects an estimated 11% of pregnant women – but the study found anxiety to be the most common problem (15%), with women also experiencing eating disorders (2%), obsessive-compulsive disorder (2%), PTSD or bipolar disorder, as well as a combination of different issues.
“There isn't as much knowledge – research knowledge or general knowledge – about these problems in pregnancy, particularly the problems that aren’t depression,” Howard explains. All these illnesses are problematic, all of them are going to have an impact on the woman and her pregnancy, and there need to be tailored treatments in place, she argues.
Since 2015, the UK has been developing new services for maternal mental health care, but availability is still patchy and interventions tend to focus on treating cases at the more severe end, instead of working to prevent them.
Women usually seek help and advice from their GP, their midwife or health visitors, and Howard says these are the people who need to be trained to identify mental health problems and give the most appropriate information and advice – about possible risks, best psychological interventions or medication issues, for instance. “Certainly we have quite a way to go in terms of these professionals being trained up enough to feel confident that they know how to ask and know how to respond. And, of course, there is no point in asking if the services are not yet available.”
Christina Taylor was 26 when she got pregnant with her first child about six years ago, probably after a bulimic episode affected her birth control. Having struggled with eating disorders since the age of 13, she felt absolutely terrified and excited, at the same time.
“I told my midwife [about my eating disorder] immediately, but at 16 weeks I was struggling so much with keeping any food in me at all or knowing how to feed myself that I saw my GP and asked to be referred to eating disorders services and a dietician,” she explains. She didn’t receive any help, and it was only after a fall at 28 weeks pregnant that a midwife picked up on her distress and referred her to mental health services.
“I remember walking into my first appointment and the therapist asking why it had taken me 34 weeks to get any help, and I just burst into tears,” she recalls.
Three years later, when she became pregnant again, she was much further along her recovery process and more assertive about getting help. At that point though, she wasn’t considered unwell enough to receive support from mental health services: “It got to a point where the consultant I was under just brought me in every two weeks to talk to me and reassure me about the pregnancy, simply because no one else was interested in helping me,” she says. Her midwife also granted her extra appointments, but it is crucial that everyone is able to access the resources they need before symptoms get worse and recovery more difficult.
Some women may not even realise they have a mental health problem – despite having symptoms like extreme fatigue or not being able to sleep or to eat, for instance. They may not have been asked about their emotional wellbeing in a sensitive way, causing doctors to miss an official diagnosis.
Even for those who do realise, they may not want to get help, for fear of being judged. “A lot of women worry that social services might be involved, so they don’t want to access services for that reason,” Professor Howard says. “It isn’t the case that just because you have a mental illness there is going to be an impact on the child,” she clarifies. And no, you will not automatically get postnatal depression, if you had depression during pregnancy. “The simplistic messages that are sometimes out there are unhelpful and actually blame women, who end up feeling very guilty, thinking that somehow they’re causing damage to the next generation and that maybe they’re not good mothers,” she warns.
Having dealt with depression during and after pregnancy, Adams says women need more honesty from healthcare professionals, as well as other women and the media, to overcome the misconception that pregnancy is an ecstatic experience for everyone. “There’s a lot of taboo of not wanting to say you’re actually struggling and not enjoying your pregnancy,” she says.
Taylor’s eating disorder made her feel especially guilty: “So many women would kill to have a healthy pregnancy and baby – how can you talk about the fact that the idea of putting on weight paralyses you with fear or that you feel so miserable you can barely get up in the morning?” She feared talking about it, and even experienced a backlash on a website for mothers where women told her she was lucky to be pregnant at all, when she asked for advice.
Even though access to specialist resources is still limited, if a woman is struggling through her pregnancy the advice is to talk to a trusted professional – maybe a GP or a midwife – to work out the best intervention available locally. “Some GP practices actually do have a psychologist there, or they might be referring to a perinatal psychiatrist if it’s a different kind of problem, it really depends,” explains Professor Howard. “The important thing is to share how you are feeling with a health professional, ideally as early as possible, so you can receive treatment and hopefully enjoy the rest of your pregnancy.”