Need to raise awareness on pregnancy depression

The prevalence of depression among pregnant women at 36 weeks gestation stood at 11 per cent, according to research carried out by a consultant psychiatrist.

The study by Ethel Felice among single and married women in 1999 stressed the importance of raising awareness on depression during the pregnancy, a condition that often went undiagnosed.

"Pregnancy and childbirth involve a rapid social and emotional transition and the mother has to adapt to a new figure, among many other changes, and undergo inter-personal reorganisation," Dr Felice said.

Antenatal depression frequently precedes postnatal depression but while abroad the prevalence of the latter is about 10 per cent, in Malta it stood at about 8.9 per cent at eight weeks after birth.

"The hypotheses behind a slightly lower rate of postnatal depression in Malta could be attributed to a family network, which still remains strong here," she said.

Dr Felice was one of the speakers addressing the half-day seminar on The Other Side of Motherhood: Your Emotional Well-Being, held on Tuesday at St James Cavalier, Valletta, to coincide with the activities marking International Women's Day.

Organised by the Richmond Foundation and ParentCraft Services at Karin Grech Hospital, the seminar was supported by Svea Distributors of Multi-Gyn and Multi-Mam, women's products for treatment and relief.

The seminar was opened by Parliamentary Secretary Helen D'Amato who gave a heartfelt talk on childbirth and the conflict of emotions the mother had when suffering from postnatal depression.

Dr Felice said postnatal depression affected not only the quality of a woman's life and her expectations of mothering but also her infant, her other children, her partner and everyone around her.

Dr Felice has been involved in setting up the Perinatal Mental Health Service clinic of the Department of Obstetrics and Gynaecology, with the support of the Department of Psychiatry at St Luke's Hospital to tackle depression both before and after birth.

This year alone the clinic has had 18 referrals for assessment and Dr Felice is hoping that eventually the clinic will be in a position to screen all mothers during their pregnancy to pick up any problems that may exist and avoid the possibility of depression after birth.

Feeling low, miserable, tearful and irritable for no apparent reason are among the symptoms of postnatal depression as well as decreased sexual desire, appetite and no desire to go out.

Another speaker was ParentCraft coordinator Louise Bugeja who pointed out that once a baby was born all the attention shifted on the child and it was important to support the mother.

Postnatal depression often occurred in high-achieving and perfectionist women who suddenly felt out of control of their lives.

"A strong family network should focus on helping the mother feel safe and not inadequate. Depression is nobody's fault and a mother cannot just snap out of it. Avoid telling her to count her blessings because at times it can only make matters worse. What's important is to provide unconditional acceptance without offering solutions," Ms Bugeja advised.

Occupational therapist Vince Cassar raised the subject of how a woman's life turned upside down when she became pregnant and the hardest step was adapting to all the changes that were happening simultaneously.

"You spend nine months preparing and then when the baby arrives you feel like a ribbon that has come loose. The hardest part a woman faces is speaking about her emotions," he said.

Mr Cassar stressed that time management was crucial for the mother to pamper herself and address her needs; care for the home and the family and, most importantly, to rest.

"Use all the help at your disposal. And work to strengthen your relationship with your partner during the pregnancy, instead of focusing on refurbishment projects, otherwise you risk waking up one day after giving birth and realising your love has fizzled out," he advised.

Psychotherapist Patricia Bonello pointed out that one emotion a mother faced at childbirth was the state of shock. "A mother does not instinctively know how to care for her baby, nor do the women around her have some inherent wisdom. Easing into motherhood depends on support and how well a woman can access her internal images of motherhood," she said. All the speakers had one common message: there is help out there so it was important for the mother to tap the resources available.

Whoever needs help or advice may call ParentCraft Services on 2123 4637 or 2595 1375.

A mother's experience of postnatal depression

"As a mother you always want the best for the baby and you want everything to be just right and I happen to be a perfectionist. I became depressed when I had my unplanned second child at a time when I was moving house.

"While I had had everything prepared for my first child, I felt I had nothing ready for my second one and the feeling of inadequacy started settling in. I was getting dizzy spells so one day, thinking I lacked energy, I set out to buy six bottles of Gatorade to help me get through the day - the shopkeeper just stared at me incredulously. I had no idea I was suffering from postnatal depression.

"I lost quite a lot of weight but I refused to stay in and spoke about my condition. Those around you tend to unknowingly feed you negative thoughts at times. What you must not do is feed the monsters in your mind to avoid falling into a vicious cycle - I called my condition the devil sickness.

"To get out of the dark hole you have to struggle to change your perspective as hard as it may be at the time. When I used to be really down I would put on some mellow music, hold my baby tight and chill out, forgetting all those around me. Many said I was passing on my negative emotions onto the child but this was also my way of bonding.

"There are times when you are wracked with guilt and insecurity but what's important is to talk about your emotions."

Steps a mother should consider to be more in control

¤ Inform yourself on baby blues and postnatal depression and involve your partner and family so that they can monitor your moods and emotions.

¤ It is vital to find time to rest.

¤ Eat a diet rich in protein, calcium, iron and pile up on fresh fruit and vegetables. Also make sure to drink water.

¤ Spend time outdoors with your baby - the fresh air will alleviate your mood.

¤ When you feel alone and frustrated, leave your child with a person you trust and dedicate some time to your hobbies.

¤ Talk about your feelings.

¤ Be realistic and only do what's a priority. Don't try to be a "supermum".

¤ Be patient with yourself.

¤ Seek advice from professionals. There are numerous self-help groups out there that can provide help and a sense of belonging. Such groups can alleviate the sense of belonging and balance out your negative thoughts.

These points were taken from the speech by Richmond Foundation CEO Doris Gauci during Tuesday's seminar.