Conversations about mental well-being have shifted over the years, with people more open to discussing it, but perinatal mental health is still often overlooked.

Perinatal mental health problems occur during pregnancy or in the first year following the birth of a child. It affects up to 20% of new or expectant mothers and covers various conditions like depression and anxiety.

The Perinatal Mental Health Project (PMHP) is a Cape town-based organisation that addresses the problem of widespread common mental health conditions among pregnant and postnatal women in low-resource settings.

According to PMHP, studies have found that more than 30% of women living in adversity will experience a mental illness during or after pregnancy in South Africa. The prevalence of depression and anxiety during the perinatal period ranges from 16 % to 47% of women. About 10% of women are at high risk of suicide during this period.

Most of these women do not receive the healthcare or support they need. 

Mothers making a difference

Mums Lauren Shapiro and Danielle Reynolds are two people who are passionate about making sure that conversations around perinatal mental health continue to expand and mothers get the help that they need.

Shapiro (40) is a journalist and author of Through the Window: How I Beat PND. The mom-of-three from Durban said her mental health was excellent with her first two children.

“I was delighted to be pregnant the first two times. I had no complications, physically or mentally. When I fell pregnant with my third child, we were so excited,” Shapiro said. “The morning sickness and fatigue hit, but we weren’t very worried as those are common in the first trimester.”

But, instead of improving, it worsened, and Shapiro sunk to new lows. “That’s when we decided to see a doctor and get help for perinatal distress (PND),” she explained.

“It’s imperative to be aware of your mental health and if you feel like you’re taking any strain, reach out for help,” said Shapiro.

Dealing with stigma

Shapiro believes considerable stigma is still associated with mental health, especially perinatal mental health. 

“I think because it’s supposed to be such a blessed, happy time of your life, people expect you to be happy all the time, and that’s not always the case. I think the stigma is worse with perinatal depression”, she said.

Shapiro says that perinatal depression or distress is 100% treatable and, if treated, has a 100% recovery. “It’s not a terminal illness, but if left untreated, it can be fatal.”

She added, “Terminal means it kills you, fatal means you might end up killing yourself, which almost happened to me. I am very pro-talking about it now because there’s a stigma, and we need to reach out to people and explain that these feelings can be treated. “

“The more we talk about it, the less stigmatised it will become. The more normalised treatment becomes, the more we can help so many women and their families”, she said.

Looking back

Shapiro was very reluctant to seek help because she didn’t want anyone to think something was wrong with her. She was also very reluctant to take medication because she was scared of it and didn’t know what it would do to her or her personality.

“I had written an article on postnatal depression a couple of years before. So, when this happened to me, I waited too long to get treated because of the stigma and fear. I, however, got to a point where I couldn’t handle it anymore and remembered having written that article,” she noted.  

Shapiro continued: “I remember walking down the passage, clinging to the wall because I was crying so hard I couldn’t see where I was going. And remember going to my office, ripping through files, looking for that story because there was a hotline I could call. 

“I found it. I phoned, and they put me through to somebody who could help me,” said Shapiro.

Shapiro said that South Africa doesn’t talk about perinatal mental illnesses enough because we don’t know enough.

“I’m committed to raising awareness. I’m a member of the Mum’s Support Network, an NPO dedicated to raising awareness and helping mothers struggling emotionally and mentally.

Not enough knowledge, talking about it

“We don’t know about it, so we don’t talk about it enough. I believe that in certain cultures, it is even harder to speak about these things because people are entrenched in their ways of thinking and are not always open to understanding things,” said Shapiro. She believes that the more we speak about it, the more normalised it will become.

“PND can affect anyone. When you speak about something, it takes away its power. When you talk about something fearful, it takes away the fear. A problem shared is a problem halved.”

A topic ‘very close to my heart’

Reynolds (34) resigned from her job to start a mental health app which connects people with therapists, support groups, or counsellors. Reynolds also runs two support groups. ‘This is a topic that is very close to my heart,” she said.

Reynolds had her first child when she was 30 years old.

“I only have one child because perinatal distress or postpartum depression is so severe that I don’t think I’ll be able to have another child. As much as I would’ve wanted to, the idea of working through that again is still upsetting,” said Reynolds.

Unlike Shapiro, Reynolds realised what she was going through very quickly. She was diagnosed with major depressive disorder a year before getting pregnant.

“I started feeling depression and anxiety come back about halfway through the pregnancy but with medication and being pregnant, we wanted to be very careful”, said Reynolds. She did not take medication for a long time. However, when the baby was about three weeks old, Reynolds resumed.

“We said even if I’m breastfeeding, I have to take some form of medication because it was just getting worse and worse”, she said.

According to Liesl Hermanus, clinical services coordinator at PMHP, most antidepressants, particularly SSRIs, are safe to use during pregnancy and breastfeeding. 

“Many pregnant women stop using their meds out of fear or concern that it might harm the developing fetus. They often do this without consulting a professional,” said Hermanus.

Bottled emotions

Reynolds agrees that a stigma is attached to mothers seeking help for their mental health. “For the longest time, I struggled to tell people I needed help. I went to see my psychiatrist and didn’t tell anybody about it because they’d think I was incompetent.”

“I struggled to connect with my baby in the beginning, and I didn’t want people to think that I don’t love her or that I’m going to be a bad mum,” said Reynolds.

Reynolds said it was difficult, especially because other people saw her as strong and independent. She felt she could not admit she was afraid to leave the house because people would judge her. “I was very worried about what people would think.”

Reynolds said there is currently a lot of movement around depression and anxiety, especially in the workplace, because of COVID-19. “There is not enough awareness for mums struggling with postpartum depression and perinatal distress. 

Find support as soon as possible

Reynolds also said teenage mothers do not get enough support.

“Mums and family members should look to see if there is a support group in the area. Depression lies to you. Depression and anxiety tell you you’re alone, isolating you from other people,” she added.

If you can get support from your family, then do that. If your family needs help, then they should get it too. Even for my husband, it was very difficult for a long time because he didn’t understand what I was going through or how to help me.

If you don’t have a supportive family, then your friends or a support group are worth even more because you have people who understand what you are saying and will encourage you and be there when you need them.

“I’ve made some of my best friends, from attending a support group meeting. People don’t judge you, you can rock up in your PJs, looking a mess and they’ll just be there to support you.”

"1 in 3 women in South Africa suffers from common mental disorders during and after pregnancy." – Perinatal Mental Health Project

It's #FanFriday & we're thanking @PMHPatUCT for working to get quality mental health care into maternal & child initiatives in low-resource settings. pic.twitter.com/25LWs5Tqd7

— Digital Medic at Stanford (@DM_Stanford) January 8, 2021

Perinatal mental health explained

According to Hermanus, the perinatal period is the time from conception to a year postnatally. 

Perinatal mental disorder or illness refers to the development and onset of depression and anxiety during the perinatal period.

“When we discuss anxiety and depression, people often think we are referring specifically to mood. However, depression and anxiety also affect one’s thoughts, behaviour, and functioning,” said Hermanus.

Hermanus said that women from marginalised groups are at greater risk of experiencing high levels of depression and anxiety, with adolescents being the most vulnerable. 

Risk factors for perinatal mental health disorders include poverty, gender-based violence, and HIV infection, to mention a few.

“Mothers, specifically young mothers, need all the emotional and practical support they can get. Caring for a newborn baby can be very overwhelming and demanding. A well cared for and nurtured mother can then care for and nurture her baby.”

Loved ones also need to let the new mom know perinatal mental health disorders are common and that many new mothers struggle with this for many reasons. 

And with help – counselling and medication- there is a greater chance of resilience within the mother”, she said. 

Not always sunshine and roses

Hermanus said for some women, pregnancy and motherhood are not a happy period. For these new mothers, it is a time of great distress, shame, and guilt.

“Those experiencing mental health disorders are often afraid to seek help because of the stigma associated with it. There are many misconceptions out there preventing women from asking for help. How often have you heard ‘people with depression are mad or lazy?’. Or that they are just looking for attention. Family or friends tell them to pull themselves together,” she asked.

This thinking is not helpful to people experiencing mental health problems,” said Hermanus.

Hermanus believes that we must advocate for the mental health of all mothers to ensure that those most vulnerable receive the care they need. 

She concluded: “We can start by having conversations about mental health and, hopefully, change the narrative around maternal mental health. This will allow for a meaningful shift in our relationship with mental health so that generational wellness can be established. – Health-e News