What to do about prenatal depression? How to recognize pregnancy depression and how to cope with it

Postpartum depression is a topic that is often discussed and causes anxiety and fear for many pregnant women. Less is said and written about prenatal depression, but, nevertheless, both expectant mothers themselves and specialists who are in one way or another associated with the period of bearing a child know about the emotional problems of this period. In this article I would like to answer several questions: “Is depression so terrible, and what does it actually express itself in?”, “Is it possible to avoid depression?”, “Are pre- and postpartum depression somehow related to each other? "

What is prenatal and postpartum depression

The simplest definition of depression is: “It is a depressed and depressed mental state.” A person who is in a depressed state has all his emotions and desires suppressed: he does not feel like eating, and he eats food mechanically, without pleasure; he doesn’t want to work, and he spends enormous efforts to drive himself out of the house in the morning; he doesn’t want to communicate with anyone, and he diligently avoids contact with people; and, finally, extreme manifestations of depression - reluctance to live and suicidal thoughts. I will take the liberty to say that all people, to one degree or another, encounter similar experiences in their lives. Moreover, modern psychology says that depression is normal for a mature person, for example, during a period of acute grief (death of a loved one, divorce, etc.). Another thing is that this depression does not last more than six months and is expressed in grief and regret about lost human relationships. Then how does all this relate to the period of pregnancy?

The birth of a child is more of an acquisition than a loss, but at the same time, you must agree, it is also a global change in our lives. Often, while expecting a baby, a woman realizes that her past life will never exist again. In essence, she needs to “bury” her old self and feel herself in a completely new capacity. In psychology, this is called a change in internal representation. As in the case of acute grief (when a person’s psyche is faced with the task of changing the internal representation, for example, from a married person to a divorced one), so in the case of bearing and giving birth to a child, a woman’s psyche is working to change her sense of self. The internal representation changes from a childless woman to a woman-mother, from a mother of one child to a mother of two children. It turns out that for the psyche, overcoming any global changes - both loss and gain - is an equally difficult task. That is why during pregnancy, especially in the third trimester, along with joy, a woman sometimes experiences complex feelings.

The following thoughts are not uncommon during this period: “Will I ever be able to return to my job?”, “If I can return, won’t I fall catastrophically behind my colleagues?”, “Will I be as interesting to my husband?”, “ A child is such a responsibility, and forever! Will I be able to stand this?”, “Will I make a good mother?” Such questions can be listed for a long time. They are known to everyone, it is in them that the very oppressed and depressed mental state is reflected, since it is the lack of self-confidence, in one’s own strengths and capabilities that leads to such depression. There are days when you don’t want to leave the house, see or communicate with anyone, when for some reason you feel incredibly sorry for yourself and want to cry. As you may have guessed, we are talking about prenatal depression, which, according to psychological science, is a normal phenomenon during the period of waiting for a baby.

There will be women who will say that they have never experienced anything like this. In my experience working with pregnant women, this really happens, and often. Most often, a woman experiences only positive, joyful emotions during pregnancy if the birth of a child is a super value in her life. For example, when pregnancy was preceded by long-term infertility and there was almost no hope left of becoming a mother, when the birth of a baby can cement a relationship with a beloved man, when a woman has lost a loved one in her life, when she has lost the meaning of life. In all these cases, as you understand, the child is not quite just a child. His appearance in a woman’s life plays an important role. How this situation affects the personality of the baby itself is a topic for another discussion, but the fact that such women experience prenatal depression to a lesser extent is for sure!

When a child is born, after 5-7 days postpartum depression begins, and most often it occurs in women who, during pregnancy, did not recognize the complexity of the impending changes. In the happiness of expecting a miracle, their psyche did not consider the fact that they would actually need to deny themselves everything, that there would be difficulties in relationships with their husband, mother and mother-in-law, that there would be jealousy of the older child, and so on. And so, suddenly faced with all these problems, the woman begins to experience despair, depression, self-pity - in general, everything that is called depression.

So, pre- and postpartum depression are not different mental phenomena, but one, caused by the need to “digest” complex changes in life. And it turns out that those women who began such “digestion” during pregnancy are less at risk of encountering severe, prolonged postpartum depression than those who lived all nine months in a state of complete happiness and were faced with the awareness of global changes only after the birth of the child.

Our whole life is saturated with the experience of death, if we consider death as a person’s complete renunciation of some of his qualities in order to meet a “new” self. Thus, in order for a child to become a boy or girl, he needs to bury something childish within himself, so as not to remain for a long time in an infantile state. And in adulthood, at the turn of maturity, a person has to abandon the features of youth, so that it is not said about him that “a small dog is a puppy until old age.” In turn, every woman who is pregnant and giving birth to a child is faced with the fact that her usual life is collapsing, and it is necessary to give up many things in this life forever.

As a result of the processes occurring in the psyche of the expectant mother, over the course of nine months the ground is prepared for a change in internal representation. If the processes proceeded normally, and the birth was natural, with a minimum number of interventions, then at the moment when a woman first sees, holds and inhales the smell of her child, a metamorphosis occurs in her, as if by magic - she feels like the mother of a newborn, and this feeling is accompanied by a huge surge of strength and joy. You ask: “What's special here? Everyone who gave birth feels the same!” Unfortunately, many women then face several months of anxiety, loss, despondency, and maybe even despair. Suddenly questions appear: “Is this really my baby, and am I his mother?” All these points indicate the incompleteness of the process of a woman’s growth into her new quality.

In order to understand how to help yourself cope with depression, let's first understand how pregnancy should be experienced normally (at the psychological level). Psychologists and doctors distinguish three periods of pregnancy that are equal in duration.

Causes and risk factors for postpartum depression

Describing the conditions for the occurrence of the disorder, psychiatrists point to a number of reasons, which include the personality characteristics and heredity of the mother, the condition of the baby, living conditions, and the presence of support from loved ones.

Who are they - women at risk

Psychologists who are approached by mothers with symptoms of postpartum (or postnatal) depression list certain age and personality characteristics of women who are most vulnerable to developing the disorder. The risk group includes:

women who became mothers before 18 or after 35 years of age;
suspicious patients with a high level of anxiety, sensitive to external influences;
emotionally labile, excitable women with a tendency to impulsive actions;
inflexible, straightforward women with a heightened sense of responsibility and a desire for perfectionism (everything must be perfect);
immature women who are not yet ready to take on the responsibility of parenthood.

The presence of certain personality traits does not always “lead” a woman to depression. But lack of support, a difficult life situation, illness of the mother or child can decompensate with the development of a depressive reaction.

Causes of PRD

The exact causes of the disorder have not been fully established. There is a likely connection with episodes of postpartum depression in the past, hormonal changes in a woman’s body, inability to get enough sleep, and a certain hereditary predisposition to disorders of the biochemical functioning of the brain. Obstetric history and the condition of the child make a certain contribution to the development of depression.

Complicated obstetric and gynecological history includes:

long-term infertility;
circumstances of pregnancy (unplanned, after IVF);
difficult pregnancy;
the need for an emergency caesarean section;
maternal injuries during childbirth.

The serious condition of the baby can also provoke the development of a disorder in a situation where a woman, for objective reasons, is not able to take him out of the hospital, touch him, or breastfeed him. PPD in such mothers develops 70% more often than in those who have not faced such trials. Worrying about your child’s health can cause depression and guilt in the future. It is impossible to say for sure in which case the likelihood of depression is higher: if a woman already knew that she was carrying a baby with a developmental pathology, or she became aware of the child’s illness after birth.

Negative factors that provoke the development of PDD include:

maternal depressive episodes in the past, including those associated with childbirth (for example, transient episodes that occur during the first month after completion of pregnancy);
PDD in the woman's sisters, cases of depression in the family environment;
serious stress during the last year (death of a spouse or close relatives, divorce, separation or serious illness of a partner);
unsuccessful pregnancy outcomes in the past, long-term infertility with a persistent intention to conceive a baby;
lack of help from those close to you - refusal to help with the child or support financially;
complex, ambiguous attitude towards the completed pregnancy. For example, a woman was going to have an abortion, but for some reason decided to keep and give birth to the baby;
unforeseen circumstances during childbirth or after it, one way or another beyond the scope of the woman’s scenario: a painful process, injuries. Caesarean section and difficulties with lactation can also trigger the development of PPD.

Psychological factors and environmental features in the situation of the development of the disorder have a common property: The woman in labor understands that what is happening does not meet her expectations: it turns out that parenthood is a responsibility, the opportunity to devote enough time to oneself is lost, the child requires too much effort, and family members ignore her tired and refuse to help. The situation can be aggravated by a lack of skills in caring for a baby and thoughts of one’s inadequacy as a mother.

Depression in early pregnancy

The initial period, corresponding to the first trimester of pregnancy, is called by psychologists the period of denial. During these three months, a woman’s thoughts and actions that deny the existence of a new life are completely normal. Well, in simple terms, a whole day can pass, and only in the evening does a woman suddenly remember that she is pregnant. Or in his long-term work plan he will put a business trip somewhere around the 38th week. Or he will seriously discuss with friends a hiking trip, or even skiing. In these first three months of pregnancy, when there is no belly and the baby’s movements are not yet felt, it is considered normal if the woman at times does not take her new condition into account.

Clinical manifestations of PDD

The symptoms of PDD are not fundamentally different from the classic depressive syndrome. The severity of symptoms can vary from mild to moderate to severe. Pathological mood swings (or affective disorders) often begin soon after childbirth:

at 1 week - in 70% of women;
at 2 weeks - in 23% of women;
at 3 weeks - in 3.5% of women.

For the remaining 3.5% of women - at a later date. Psychiatrists studying this condition point out that it is “linked” to the season - more than 60% of cases are registered in the autumn and spring months.

"Baby Blues"

It is postnatal depression that should be separated from the deterioration of the emotional state immediately after childbirth. The so-called baby blues develops in 80% of women due to changes in hormonal levels. The pregnancy state is maintained by high concentrations of the hormone progesterone. From an emotional point of view, this can manifest itself in the form of high spirits, euphoria, and complacency. Before childbirth, progesterone production decreases. On days 3-4 after giving birth, women may feel depressed, confused, and want to cry. The state of sadness, insecurity, and lack of self-confidence can last up to 2 weeks. The characteristic differences of such a depressive reaction are its short duration, reversibility, and low severity.

A young mother in such a state also needs support and the opportunity to rest and come to her senses; a favorable course often allows her to get by with the help of her family and friends. However, any alarming changes in condition are grounds for immediate contact with a specialist.

Symptoms of postpartum depression

Clinical manifestations are represented by the classic depressive triad:

low mood;
slow thinking;
motor retardation.

It often turns out that during pregnancy a woman’s physical and mental well-being is of keen interest to those around her. With the birth of a baby, everything changes, attention goes to the newborn, and the young mother’s complaints about fatigue and depression may be ignored. It is important to know how not to miss the deterioration and avoid the development of symptoms of the disease. Close women should monitor not only the dryness of the baby’s diapers, but also the well-being of the mother. You should be wary if a woman:

complains of low mood, loss of strength;
often cries, behaves as if something terrible is about to happen;
worries excessively about the child’s condition and does not allow loved ones near him;
indifferent to the child, says that he has no feelings for him;
expresses fears that he cannot care for the baby properly;
looks closed, fenced off from family members, reluctant to talk about her condition;
has difficulty doing ordinary things, can stay in bed for a long time;
drowsy or cannot fall asleep for a long time, interrupted sleep;
talks about his guilt in front of the child and others;
complains that he cannot cope with the baby;
refuses food, loses weight;
expresses thoughts about not wanting to live.

The development of PDD is said to occur when signs of the disorder persist for at least 2 weeks. Close people do not always imagine how long it lasts. If a woman has not previously suffered from episodes of depression or bipolar disorder, symptoms will persist for about 2 months. In the case of a complicated medical history, the duration of the attack will be longer, and the likelihood that the woman will cope with it on her own is low. Worried about her condition and the well-being of the child, a mother may hide alarming symptoms.

Late antenatal depression

The next three months are the time when a pregnant woman normally no longer denies her condition. In other words, her psyche has accepted the fact that there will be a child, but what she still cannot fully agree with is that with the birth of the baby, the usual way of life will come to an end. In psychology, the name of this period is quite complex. I'll voice it and then decipher it. So, this stage is called the period of “searching for a replacement for the lost object.” The lost object in this case is a familiar life, a life with a certain rhythm of work, leisure, with established relationships in the family and with friends. Gradually realizing that with the birth of a child she will have to give up a lot, the woman begins to look for a replacement for what she has lost. The classic reasoning of a pregnant woman at this stage is as follows: “Yes, I will have to leave my job, which means my career growth will stop. What a horror! But my colleagues will remain where they are, and I will be hopelessly behind them! No problem, now is the time to take a Chinese course! Relations with China are very promising, the baby will grow up, I will go to work in a new direction with a good knowledge of the language!” Thus, the second trimester becomes the most active. And indeed, the woman usually feels well, the nausea has already passed, and the stomach is not yet bothering her. And wherever expectant mothers go during this period! As they explain: “So as not to waste time.” It happens, and not rarely, that it even comes to driving courses. "Why not? The baby will be born, I will need mobility, but I still don’t have a license!”

However, this period is also ending. It is followed by the last, coinciding with the third trimester of pregnancy, which, unlike the previous one, in psychology is simply called the period of depression. That is, that same prenatal depression sets in. In the psyche there is a full awareness of what happened, and the process of saying goodbye to the past begins: “What Chinese?!” What career?! Perhaps I will never be able to work as before, but will forever be tied to pots and pans!” In the three months remaining before giving birth, at times (of course, not 24 hours a day), a woman is faced with feelings of loneliness, hopelessness and despondency. Sometimes this results in streams of tears, sometimes in irritation, resentment and anger. You can be offended and angry with your husband, whose life does not change so dramatically, and he, of course, “doesn’t understand anything and doesn’t support much.” On the mother-in-law, who always interferes with her advice and stupid purchases for the baby. For friends who are not at all interested in your belly or your child, they only care about rags, men and work. You never know what can upset a pregnant woman. All this is normal, there is no need to be afraid of your own experiences. Respect your condition and, most importantly, do not try to avoid it.

This is where we, in fact, come to the main practical conclusion. Pregnancy is not all about the joy of waiting nine months. This is the time when not very pleasant feelings and emotions are appropriate, especially in the last three months. There is no need to feel guilty, let alone shame, if in the first trimester you sometimes forgot about the baby, and sometimes even thought that it would be good if pregnancy occurred not now, but at another time.

And one more very important point. Take maternity leave on time. The fact is that the working rhythm helps a woman’s psyche stay in the first or second stage and thus not experience depression. By remaining in a familiar work environment, a woman protects herself from an acute confrontation with the awareness of drastic changes. But you can’t run away from the truth, the time will come, the baby will be born, and she will still have to understand that her old life is over forever, only this process will no longer be called pre-, but postpartum depression, and it will be harder and longer.

Although giving advice is often useless, and from the point of view of the science of psychology, it is simply unacceptable (a psychologist should help each person find their own path, draw their own individual conclusions from the current situation), I will still take the liberty of giving a few recommendations to pregnant women or already pregnant women. women who have given birth and are experiencing depression.

Causes of Prenatal Depression

Some of the main traumatic factors in the development of prenatal depression remain social:

Ÿ no support,
Ÿ there is not enough money,
Ÿ no housing or housing is not spacious enough,
Ÿ bad relationships with spouse and relatives, etc.

The presence of gestosis (late toxicosis of pregnancy) plays a major role - swelling, increased blood pressure, serious deterioration in well-being and an objective increase in risks for the mother and child.

Another serious reason for the development of depression before childbirth is fear:

Ÿ for a child,
Ÿ for yourself,
Ÿ before the pain,
Ÿ before anesthesia (in case of expected surgical delivery).

Sometimes a woman fears that she will not be able to cope with her maternal responsibilities. That there won't be enough milk, that...

In general, pregnant women find hundreds of reasons for concern. And if some of them are objective, then some are clearly far-fetched, taking into account the modern capabilities of medicine, pharmacology and the food industry. Expectant mothers themselves joke about this: “It’s scary to give birth, and the pregnant woman is tired of walking.”

Untreated depression - impact on the child

According to some reports, treatment for depression during pregnancy is not always necessary, since in many cases it goes away on its own. However, this position should be approached with great caution. According to many studies, untreated depression during pregnancy can have a serious impact on the baby.

To be precise, it is now known that:

Depression during pregnancy significantly increases the risk of preterm birth (untreated women are 1.5 times more likely to develop premature labor than those who do not suffer from depression);
Severe symptoms of depression during pregnancy significantly increase the risk of low birth weight in the baby (the risk is 1.4 to 2.9 times higher in undeveloped countries and 1.2 times higher in the United States);
Depression during pregnancy increases the risk of developing neurological disorders in the child, which result in deterioration in cognitive and motor development, a fearful temperament and a negative approach to novelties in the first year of life, behavioral and emotional problems, and even the speed of processing stimuli in adolescence;
Depression during pregnancy negatively affects the mental health of the baby;
Depression during pregnancy may increase the baby's risk of developing ADHD.

In addition, studies have shown that symptoms of depression - anxiety and depressed mood - affect fetal activity, sleep patterns and motor skills (which means a pregnant woman's mood affects the development of the fetus's central nervous system).

Other Treatments for Depression During Pregnancy

Depression during pregnancy can also be treated with electroconvulsive therapy. This therapy completely wrongly causes social anxiety—it is currently one of the safest and most effective treatments for mood disorders. According to many experts, electroconvulsive therapy has an advantage over pharmacotherapy in that it has a negligible effect on the child.

Treatment of depression during pregnancy with electroconvulsive therapy is performed under general anesthesia. The procedure lasts only a few tens of seconds and – something worth mentioning – it is not like the dramatic scenes from the movie “One Flew Over the Cuckoo’s Nest.”

How to help a woman with symptoms of postpartum depression

Suspicion of a change in state is the basis for telling yourself: “Stop!” and ask for help. Often a woman can be stopped by a false fear that others will consider her abnormal or devalue her experiences.

Help at home

First, you need to believe in the possibility of recovery and contact your loved ones, a visiting nurse, a pediatrician, call the emergency psychological helpline, and make an appointment with a psychologist. A specialist will evaluate your complaints and tell you how to avoid falling into a more serious condition.

A woman should not try to endure all the hardships on her own, especially if she understands that her strength is already running out. Non-drug help for PPD is as follows:

don’t try to be a “super-woman”;
choose every opportunity to relax;
delegate night feedings (expressed milk) to your partner;
eat enough, choosing tasty and healthy foods;
ask loved ones to help around the house;
allocate time for activities that fill you with strength;
find a support group for young mothers;
go for a walk or a run more often;
change your place of residence.

These actions can also be used “proactively” - to prevent PPD.

Psychotherapy and drug treatment

Seeing a doctor for PPD does not mean that there is something wrong with a woman. This fact speaks of her courage and desire to feel healthy again. According to statistics, about 25% of women seek specialized help in the postpartum period. As a rule, treatment takes place on an outpatient basis. To correct symptoms, the doctor prescribes antidepressants that are compatible with breastfeeding. This issue should be discussed before a prescription is written. A psychiatrist may also recommend individual or group psychotherapy.

In case of severe PDD and threatening behavior of a young mother, hospitalization in a hospital may be required for more intensive treatment and prevention of a suicide attempt.

What to do if a woman’s condition remains unstable for a long time? And complaints about low mood and apathy persist not only for the first few weeks from the moment of discharge, but also remind themselves 3-5 months later, after the first year of the baby’s life? Prolonged depression indicates the need for repeated examination to exclude other somatic or mental disorders.

Postpartum depression is a specific condition that lasts from 2 weeks to 2 months. Clinical symptoms are indistinguishable from a typical depressive episode. If you suspect a deterioration, you should immediately contact a psychologist or psychotherapist.

Self-care

How can you help yourself cope with depression? Rest, rest and rest again as much as possible. Nature itself took care of this, because for the first few months the child sleeps a lot, and the mother can relax with him. Give yourself time to establish contact with your baby: carry him in your arms more often, kiss him, hug him, and breastfeed him. This helps to overcome the feeling of alienation if it appears. In the first weeks after birth, minimize visits from friends and family and focus on yourself and your newborn.

Get enough sleep and eat well, especially if you are breastfeeding: you need all the microelements and vitamins. Treat yourself to tasty and healthy food, because buckwheat and crackers do not contribute to a good mood. It is ideal if someone can help you with everyday life: go grocery shopping, cook food, clean the house.

6 tips to prevent postpartum depression:

Surround yourself only with beautiful things, choose those news sources and information channels that do not carry negativity, listen to good music. Try not to read bad books, watch horror films, or go to online forums where children’s problems and illnesses are discussed;
Don't burden yourself with all sorts of things. At the moment, the main thing is the child, and for him there is nothing more important than a happy and satisfied mother. Cleaning and work can easily wait;
Don't believe everything "good mothers" say on social media. In fact, there is no ideal, and photographs on the Internet do not convey the true state of affairs. You don’t have to look up to them, because you don’t know how they really live;
Add light and air! Walk more often in the morning and during the day, ventilate the apartment, do not sit in the dark. You can buy a beautiful new lamp or set of candles for your home;
Avoid communicating with those who do not support you, accuse you, or are generally unpleasant to you. You can choose your social circle yourself: leave only good people in it;
Find an ally - someone you can talk to about your condition and who will definitely support you. For example, this could be a friend who also went through postpartum depression and understands exactly how you feel.

Remember that you and your baby come first now. By any means you need to achieve harmony with yourself and start enjoying motherhood. The postpartum period is the best time to learn to love yourself. Believe me, this will benefit not only the newborn, but the whole family.

Symptoms of depression

If you notice a couple of symptoms, you shouldn’t panic right away. You can assume the presence of a depressive disorder if five or more symptoms persist in you or your loved one for quite a long time, from two weeks or more. Signs of depression in pregnant women can be observed as follows:

the woman feels depressed, her sadness is unfounded, she is apathetic
you notice a person’s weakness, lethargy
irritation
negative vision of the future, feelings of hopelessness, tearfulness
feeling of guilt, constant lack of self-confidence and the correctness of one’s choice
feeling of helplessness and worthlessness
Digestive problems: loss or increase in appetite
insomnia, drowsiness, nightmares, sleep inversion
various fears
indifference to one's health
reluctance to communicate with relatives and friends, with her husband.