Pregnant women who experience stress and related negative emotions develop certain adaptive mechanisms to protect the health of the mother and the developing child. Nevertheless, due to the high dynamics of change, the perinatal period favors the occurrence of emotional disorders. Stress felt by a woman in the perinatal period can take various forms—acute (triggered by a sudden major life change: the birth of a child, a child’s illness, a PANDEMIC) or chronic, caused by the tiring routine of everyday life, isolation when a woman cares for a child feeling lonely, or struggles with daily problems. A pregnant or new mother, under the influence of stressors, assesses her reserves for coping with difficult situations. These reserves include all psychological, physical, material, and social resources available to face forthcoming events. Every woman knows how she usually reacts to change and stress. If during pregnancy or after childbirth her “inability to cope” exceeds what she knows from experience, she should seek help. It is known that women with neurotic personality traits—hypersensitive, with a pessimistic view of the world and themselves, anxious, or perfectionistic—are at higher risk of postpartum mood disorders. It also happens that a confused and fearful woman, if she has poor contact with her emotions, may not notice or may deny that she is experiencing something difficult. It should be borne in mind that traumatic experiences during pregnancy affect fetal brain development, causing inhibited neurogenesis, atrophy of hippocampal and prefrontal cortex neurons, amygdala hypertrophy, synaptic disturbances, impaired brain plasticity, and many other changes. Severe chronic stress during pregnancy may cause miscarriage, preterm delivery, or low birth weight. Changes in the central nervous system may also lead to depression, mental illness, various somatic diseases, and personality disorders. Once again, it is worth emphasizing that the perinatal period is a stage in a woman’s life during which the risk of mental disorders increases several times. For the physician and midwife caring for a pregnant woman, it can be difficult to identify when mood swings, irritability, or sleep disturbances cross the line of what is typical for this period and when closer observation or referral to a psychologist is warranted. Expectant mothers often experience anxiety or tension and periodically have a lowered mood; this is usually transient, but sometimes the intensity and frequency suggest a mental disorder. In patients with many risk factors requiring special care, multidisciplinary collaboration should be standard.
Depressive mood disorders related to the postpartum period have serious consequences not only for the woman herself. Often, due to disease symptoms, a woman is unable to fulfill the duties of her new role and fully realize herself in motherhood, or function adequately in existing social relationships, especially with her partner and family. The consequences of postpartum depression symptoms may be short- and long-term, affecting the relationship with the partner and family and negatively influencing the development of infants and older children.
Preventive measures for pregnant women—tips for those providing care:
• Take a detailed history and identify risk factors (sometimes several visits are needed to avoid intrusive questioning).
• Encourage the patient to talk about previous pregnancies and births—this is an important source of information for risk assessment of mental disorders.
• Contact (with the patient’s consent) her psychiatrist—if she is under care.
• In case of doubt, propose a psychiatric consultation, facilitate it, and establish contact with the psychiatrist.
• Encourage individual or group psychotherapy and other non-medical forms of help (support groups for pregnant women).
• Ensure education of the expectant mother—recommend antenatal classes or individual consultations with a midwife.
It is worth paying attention to the last point—education of the expectant mother. In the pandemic era, it is recommended that antenatal education be “expanded” to include issues related to the impact of infection on the developing baby, the potential risk of congenital anomalies, and obstetric complications. Topics worth addressing also include breastfeeding when infection is suspected or confirmed. Legal issues and information on changing—often from day to day—regulations and recommendations regarding childbirth, including family births, are also important for expectant parents. Chaos and lack of guidance will intensify feelings of threat, anxiety, incompetence, and helplessness. A hallmark of distress is cognitive dissonance. What seemed impossible a week ago becomes reality, which the woman/family must face, even though they have never been in a similar situation or taught how to behave. Thus, the most common way to reduce the negative consequences of distress and maintain a sense of safety is access to information. Its credibility is crucial. For many people, including pregnant women, epidemic restrictions and prohibitions are incomprehensible. The sudden change in lifestyle becomes insurmountable for many, and some try to oppose it by breaking restrictions and prohibitions (e.g., quarantine or social distancing). Out of helplessness, they take destructive, aggressive actions and show panic behavior.