The role of a mother should never be underestimated and when a mother’s mental health is strong, society benefits, says counselling psychologist Alison Rielly, a specialist in women’s mental health and member of the Post-Natal Depression Support Association.
Sadly, society does not look after the mental health of women too well, with tragic consequences. Mothers at both ends of the spectrum – from impoverished to affluent – have psychological and physical stresses and challenges, and there are often few resources to help them, says Rielly.
Particularly vulnerable are poor women. Studies show that up to 50 percent of women living in adversity experience depression during pregnancy. The Cape Town-based Perinatal Mental Health Project says high rates of gender-based violence and the burdens associated with gender inequality, mean women are particularly vulnerable to mental illness.
“The stress of living in poverty, increased obstetric risks, lack of social support, increased exposure to violence and poor physical health means poor women are more likely to experience psychological problems compared with other women,” says a report by the project. “Social and environmental adversity is strongly associated with maternal depression and impaired child development.”
Rielly says research shows one in three women in South Africa experiences a mental illness related to her pregnancy.
“During pregnancy, 23 percent experience anxiety, 67 percent have poor overall mental health and between 41 and 50 percent are depressed,” she says.
Rielly says poor mental health affects not only the woman’s sense of well-being, but also her relationship with her infant and her family. It impacts on her parenting, decreases her sense of competence as a mother, and exacerbates her depression.
“Lack of energy and low concentration impairs a mother’s ability to be involved with her child, increases her irritability and self-preoccupation and reduces her ability to meet her child’s need for attention. Mothers may experience a lack of affection towards their infants, which leads to feelings of guilt, worthlessness and anxiety. They may fear psychologically or physically harming their child, often they have an impaired ability to care for their child, and for themselves, and are frightened their child will be taken away, so they don’t seek help. It’s a vicious cycle.”
Among the most vulnerable are teenagers. According to the project – 39 percent of 15- to 19-year-olds have been pregnant at least once and 49 percent of adolescent mothers are pregnant again within the next 24 months.
The likelihood of another teenage pregnancy nearly doubles when adolescent mothers suffer from depression and one in five pregnant adolescents is HIV positive.
Maternal mental disorders are associated with poor obstetric outcomes, such as pre-term delivery and prolonged labour, and the debilitating effects of maternal mental illness compromise a mother’s care-giving capacity, for herself and her children
Her children are also more vulnerable. If a mother is poor, her child is more likely to lack medical care and to have poor nutrition.
It is not just women on the breadline who struggle with the demands of motherhood. Women in higher socio-economic groups have pressures too. They may worry about how they will provide for their child, find good childcare, deal with an unplanned pregnancy and many feel pressurised to be Supermoms.
“Becoming a mother is a process,” says Rielly.
“It is a time of change and a woman needs to be given the chance to adapt to those changes, while learning to respond to the demands of a baby.”
Post-natal depression affects up to 30 percent of mothers and it is often not recognised by the mother, the family and even professionals.
“I suffered with post-natal depression myself and I did not realise it at the time – and I am a psychologist,” says Rielly. “Help is available, and expectant or new moms should be encouraged to seek help, rather than to ‘grin and bear it’.”
In many hospitals and clinics, however, the focus is on the physical care of the mother, with insufficient attention paid to her mental well-being, says Rielly.
“In settings of poverty where women and children face enormous developmental challenges, it makes sense to also invest in maternal mental health. Even in resource limited settings, mental health interventions can alleviate the cycle of poverty and mental ill-health.”
Rielly says health professionals who treat mothers need to be trained in the identification and treatment of maternal mental health issues and there needs to be funding for this.
Many in the private health sector do take maternal mental health seriously.
Dr Augusta Dorning, general manager of Netcare St Augustine’s Hospital in Durban, says staff in ante and post-natal clinics were trained to identify and help with post-natal depression and other mental health issues.
“We take those issues very seriously and in the past year, we have started a number of initiatives in inpatient and outpatient services to make staff more aware of post-natal depression.
“It can be as simple as joining a support group or counselling for the mother to become fully functional and start enjoying her baby.”
Sister Barbara le Grange, who runs a daily baby clinic at Life Westville Hospital, says the mental health of mothers is a priority.
“Often, post-natal depression is not diagnosed early enough. Mothers think it is normal to feel tired and run down, but there are times when a mom is not coping and it is important to recognise the signs and get her the help she needs.”
How to recognise the signs in mothers
While up to 80 percent of new mothers in all circumstances have “the blues” soon after birth, post-natal depression is experienced by between 10 and 30 percent.
It is sometimes not easy to identify and may develop slowly any time during the first year of the baby’s life.
Untreated it may develop into chronic low-grade depression becoming more acute with subsequent births.
A mother may be more anxious or irritable than sad. Symptoms may be mild or severe and some feel they are “going mad”.
It is thought to be caused by several factors: being a perfectionist, lack of support, a traumatic birth, financial and other stress, loneliness, unsatisfactory relationship with the baby’s father and a previous history of depression.
Treatment includes medication, psychotherapy and individual or group support.
“Women hide their feelings because they feel ashamed and guilty,” says the Post-Natal Depression Support Association in South Africa. “They may receive help for tiredness or insomnia but the underlying causes are not examined.
“Health professionals may not recognise the depression or may not take it seriously. Partners and families may not understand how a mother is feeling and tell her: “Pull yourself together”.