When Alex Laver’s son was born in 2009, she threw herself wholeheartedly into motherhood, establishing a feeding routine, joining baby groups and revelling in overwhelming love for her new baby. “I was tired. I worried a little, but no more than any other new mother,” she says, “I was feeling well.” However, as the weeks passed, things began to change. By the time her son was 10 weeks old Alex had developed vomiting and diarrhoea, her appetite had disappeared and she was unable to sleep. The baby’s feeding became erratic and she became very anxious.
Soon afterwards – with physical problems ruled out – she was diagnosed with postnatal depression and anxiety. It was both a relief and a surprise. “I wasn’t down or sad. I was hyperactive, constantly buzzing, on edge and anxious,” she says.
Figures released last week by the Royal College of Midwives suggest up to 20% of women experience perinatal mental illness during pregnancy and the first year of their babies’ lives. For many of these women, such as Alex, the main problem is anxiety. The National Institute for Health and Care Excellence (Nice) has said that 13% of women experience anxiety during pregnancy, with around 12% experiencing depression – and many affected by both. Yet perinatal anxiety – in conjunction with depression, or as a separate clinical condition – is little discussed and too rarely recognised. The RCM estimates only around half of cases are identified.
“I was in a vicious cycle,” recalls Alex, whose story is included in a new book about postnatal depression, Fine (Not Fine) by Bridget Hargreave. “I was vomiting, so I was worried I was ill. Then I would worry what that would mean for the baby and become even more anxious and sick.” After discussing options with her GP, Alex chose to take Sertraline – used for depression and anxiety disorders – as well as joining a support group at her health centre. “The doctor said I might manage without the drugs but I desperately wanted to get better.” Her anxiety quickly began to lift. “I remember walking through the park with my mum one day and saying it was going to be OK. It was the first sense I had that it would get better.”
While Alex had access to specialist care, many women do not. The Maternal Mental Health Alliance, made up of more than 60 professional bodies and charities, states that almost half of the UK has no specific perinatal mental health services. At Bluebell, a Bristol-based charity supporting families affected by perinatal mental illness, anxiety is the most commonly presenting condition.
“We have designed our programmes to tackle anxiety early on because it is such a big issue,” says Rachel Jenkins, occupational therapist and leader of the charity’s therapeutic group courses.
“Perinatal depression is misleading as a term. Far and away the most prevalent condition I see is anxiety,” she says. “It is common to catastrophise. Often women worry something is wrong with the baby.”
Women referred to Bluebell (usually by a GP or health visitor) frequently report “tumble-dryer mind”, insomnia, feeling tense and irritable, social paranoia, sickness, shakiness, blurred sight, racing heart and breathlessness.
Discussing this physical experience of anxiety is, Jenkins says, a useful starting point. “Women often find this initially easier to tackle than the emotional side. We look at the fight or flight reaction and explain why they feel this way.” Jenkins teaches simple controlled breathing and progressive muscle relaxation exercises that can quickly help to reduce tension. “They don’t have to think about what is going on in their head and they start to be more aware of the warning signs and act on them.”
Other “tools” include noting thoughts in a journal and taking exercise. Women are also encouraged to create therapeutic playlists as a distraction technique, while craft and baking sessions – occupying hands – are also often helpful. These activities are based on flow theory: “Flow is very good for distraction, motivation and self esteem, giving the brain a rest from anxious thoughts,” says Jenkins
Dr Christine Langhoff, a clinical psychologist running a private perinatal service in London, uses cognitive behavioural therapy, mindfulness and other therapies. “Figures suggest around a third of women will suffer an anxiety disorder in their lifetime and the perinatal period is often a trigger,” she says. Clinically significant anxiety is, Langhoff points out, very different to normal worry. “Everyone has some anxiety, particularly at this time, but we are talking about a stifling level that gets in the way of life. Relationships, work, ability to enjoy the baby can all be affected.”
Pre-disposing factors can include previous anxiety disorders (often undiagnosed), previous birth trauma, miscarriage, high-risk pregnancy, and perfectionist tendencies. Langhoff works with women on “normalising” some productive worries, while recognising unproductive worries and the negative cycles they create. “We challenge thoughts and behaviours that might feel helpful in the short term – for instance, constantly waking a baby to check breathing or Googling health worries – but which maintain anxiety in the long run.”
Trying to address the problem early is, she says, important. “Anxiety in pregnancy increases the risk of depression or continued anxiety postnatally. It can start small and get bigger, generalising into all areas and causing panic attacks.” In addition, she says, parents may unwittingly transfer anxieties to their children.
Langhoff would like to see a greater focus on mental wellbeing for all pregnant women and new mothers as well as a significant increase in care provision, and Nice’s new guidelines do suggest professionals “consider” asking screening questions. “We are starting to see awareness rising, midwives asking questions, preventative support, albeit slowly,” says Jenkins. “Women need to know in advance how to get help.”
Fine (Not Fine) by Bridget Hargreave (Free Association Books) is published on 30 November. For more information about Bluebell see bluebellcare.org
