The World Health Organization defines maternal mental health as “a state of well-being in which a mother realizes her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to her community” (Herman, et al., 2006).
Perinatal mental health issues are common
10 percent of women experience depression from the preconception stage. This continues into their pregnancy and postpartum periods. The prevalence rates of perinatal maternal anxiety is higher than that of depression (Kee, et al., 2021).
Pearson, et al. (2018) did a multi-generational cohort study in the United Kingdom on pregnant women and found that young pregnant women today are more likely to have depression than in the 1990s. Reasons include a faster pace of life, increased use of social media, increased feelings of isolation and insecure employment (Pearson, et al., 2018).
Preconception and postpartum periods are important
The Singapore healthcare system traditionally emphasizes disease treatment rather than preventive healthcare. Hence, we do well with routine checks and managing of medical disorders during pregnancy, but neglect optimizing women’s health at the preconception and postpartum periods (Yap, et al., 2022).
Unfortunately, these gaps extend to maternal mental health and wellbeing.
Maternal wellbeing benefits the mother, the child and the family
Maternal mental wellbeing not only contributes to better self-esteem and adaptation into motherhood (Meaney, 2018), it also supports the child’s brain development.
This starts prenatally. Early brain development has been found to be influenced by the prenatal environment (Dean, et al., 2018). Dean, et al. (2018) found changes to the white matter microstructure of infants born of mothers with depressive symptoms. Qiu, et al. (2015) found altered neural pathways to the amygdala and increased risks of depression in infants born of mothers with depressive symptoms.
Furthermore, research has shown that maternal mental health is correlated to children’s health and developmental outcomes postnatally. Lovejoy, et al. (2000) found that maternal depression changes mother’s behavior and attunement to the child, with the former having a stronger impact on child’s outcomes. These outcomes include academic performance, emotional regulation and social skills.
The London School of Economics estimated the annual costs of maternal mental health problems in the United Kingdom to be at 8.1 billion pounds (13.6 billion Singapore dollars). 72% of this cost is associated with services for the child (Meaney, 2018).
Further challenges in the postpartum period
After the baby is born, attention is swiftly and largely shifted onto the newborn. The unexpected physical and emotional challenges can increase risks of perinatal mental disorders. A difficult or traumatic birth, and ongoing breastfeeding challenges negatively impact adjustment to motherhood (Mitchell, et al., 2018).
The lack of informational and emotional preparedness during the preconception stage extends into the pregnancy and postpartum stages. Information such as good eating and exercising habits. Emotional preparedness includes a therapeutic lifestyle change for improved mental wellbeing.
What can be done about it
I believe in taking action and being practical. So here are two fundamental strategies for mothers – new and experienced.
Cultivating mindfulness
Mindfulness is a practice from Buddhist psychology. There are two components. One, it’s being attentive to the present moment experience as it is happening. Two, it is related to this experience in a posture of openness and curiosity.
Mindfulness is the foundation to practicing compassion and for compassion-based strategies to work. Neff and Germer (2012) agrees that being mindfully aware of one’s suffering is essential to extending compassion towards self. I elaborate on self-compassion in the next section.
How do you cultivate mindfulness? If you find yourself time-starved or unable to sit still for five minutes, i feel you. Jon Unal introduces the idea of micro-practices. Essentially, take just one or two minutes to become mindfully aware of what you are doing, what’s happening around you and what’s happening within you.
I’m going to stack this up with what BJ Fogg teaches in his book titled “Tiny Habits.” Combine this micro-practice with one activity that you do repeatedly throughout the day.
- Think of one simple activity that you would definitely do at least once in a typical day. This could be waiting for the bus, getting up from your seat or drinking a glass of water.
- Every time you do this activity that you’ve thought of, start a short practice of becoming mindfully aware.
- Take notice of what you are doing, what’s happening around you and what’s happening within you.
If you’ve read my blog post about mindfulness, I share three additional tips to introduce mindfulness into your daily life. No App. No need to get into a particular posture. No need to ensure your kids give you five-minutes. Read the blog post here.
Compassion-based strategies
In this article, we adopt the definition of self-compassion by Kristen Neff, which involves being touched by one’s own suffering, having the desire to alleviate suffering and to treat oneself with understanding and concern.
Practicing self-compassion is a learned skill. It involves responding to oneself with kindness, recognizing that you’re part of a shared humanity and being mindful. We have covered mindfulness in the previous section. In this one, we’d be looking at responding to oneself with kindness.
Two simple, actionable strategies to enhance self-compassion would be:
Say aloud “It sounds really difficult for you.”
Imagine you tell a compassionate friend about all you’re going through postpartum. How realistic would it be that your friend would respond with “it sounds really difficult?” Hopefully, your answer is VERY REALISTIC, I TOTALLY HAVE SUCH A FRIEND.
We can be our harshest critic. I find this statement easy enough to say to myself because when I tell a friend or when I cry buckets, I am essentially screaming IT’S SO DIFFICULT. Saying it aloud helps you to slow down and take in the weight of how difficult it is.
You can also give yourself a big, warm hug by wrapping your arms around yourself, or place your hand on your chest. Feel the warmth of this touch. It can be very grounding.
Change “I am” to “I feel”
For example, I am a terrible mother because I’m unable to breastfeed my child. That’s a statement of identity. Instead, change “I am” to “I feel,” such as “I feel terrible because I’m unable to breastfeed my child.”
You immediately are doing two things: (1) Acknowledging your own emotions and (2) Realizing that there is a trigger for that emotion. It allows you to communicate your need.
Let’s talk about that
Beneath the feelings of guilt, shame, inadequacy, anxiety, it’s the underlying desire to nourish your child. Breastfeeding can be tricky. After you get the first latch and manage to successfully practice with your child for a couple of weeks, he might go through a growth spurt or nursing strike. Or you might go back to work and the groove you’ve got is being thrown off.
Try identifying and communicating a need. For example, “I FEEL terrible WHEN I see my child rejecting the breast or hear the pediatrician talk about weight loss. I NEED to get professional help from a lactation consultant.” It builds on the previous strategy, where you:
- Acknowledge your feelings by saying “I FEEL”
- Identify the trigger with “WHEN” and
- Communicate your need with “I NEED”
There is emerging research on the power of mindfulness + self-compassion in parenting. In fact, Duncan, et al. (2009) looked at the impacts of having mindfulness and self-compassion skills training and exercises in existing research-backed parenting programs.
There is improved non-judgmental acceptance, listening and emotion regulation among parents (Duncan, et al., 2009). For pregnant and postpartum mothers, it serves as an EFFECTIVE COMPLEMENTARY AND PREVENTIVE healthcare service that REDUCES ANXIETY AND DEPRESSION RISKS (Sacristan-Martin, et al., 2019).
If you’d like to join the monthly growth circles where you get to connect with fellow mamas, and learn practical strategies for personal growth and transition, DM me at @mumswithlittles on Instagram.
References
Dean DC, Planalp EM, Wooten W, et al. Association of Prenatal Maternal Depression and Anxiety Symptoms With Infant White Matter Microstructure. JAMA Pediatr. 2018;172(10):973–981. doi:10.1001/jamapediatrics.2018.2132
Duncan, L. G., Coatsworth, J. D., & Greenberg, M. T. (2009). A model of mindful parenting: implications for parent-child relationships and prevention research. Clinical child and family psychology review, 12(3), 255–270. https://doi.org/10.1007/s10567-009-0046-3
Lovejoy, M. C., Graczyk, P. A., O’Hare, E., & Neuman, G. (2000). Maternal depression and parenting behavior. Clinical Psychology Review, 20(5), 561–592. doi:10.1016/s0272-7358(98)00100-7
Neff, K. D., & Germer, C. K. (2012). A Pilot Study and Randomized Controlled Trial of the Mindful Self-Compassion Program. Journal of Clinical Psychology, 69(1), 28–44. doi:10.1002/jclp.21923
Neff K (2003) The development and validation of a scale to measure selfcompassion. Self Identity 2:223–250
Pearson RM, Carnegie RE, Cree C, et al. Prevalence of Prenatal Depression Symptoms Among 2 Generations of Pregnant Mothers: The Avon Longitudinal Study of Parents and Children. JAMA Netw Open. 2018;1(3):e180725. doi:10.1001/jamanetworkopen.2018.0725
Qiu, A., Anh, T., Li, Y. et al. Prenatal maternal depression alters amygdala functional connectivity in 6-month-old infants. Transl Psychiatry 5, e508 (2015). https://doi.org/10.1038/tp.2015.3
Yap, F., Loy, S.L., Ku, C.W. et al. A Golden Thread approach to transforming Maternal and Child Health in Singapore. BMC Pregnancy Childbirth 22, 561 (2022). https://doi.org/10.1186/s12884-022-04893-8
Thriving New Mama 
Leave a comment