Antenatal Depression, part I

If you've read the posts below, you will know that I haven't found pregnancy to be the easiest thing I've ever experienced. I won't reiterate every single point I've made already, but let's just remind ourselves that it was the physical discomfort that had been the top of my list of 'hard things about pregnancy', things that as a Proselytiser for 'Truth In Pregnancy' I felt you should know.
Now, however, I have a new offering: mental health. It is not well-known that women can suffer from depression and anxiety throughout pregnancy. When you look into it however you find that it is suggested that around 10% of all pregnancies are accompanied by serious depression. Some even suggest that around two-thirds of pregnant women will suffer depressive episodes at some point during their pregnancies. These are quite big numbers, and do not reflect the relative lack of recognition accorded to the syndrome. We all know about postnatal depression, the 'baby blues', that see women lose their stability when faced with the care of a newborn child. But I for one had never heard of antenatal depression, or if I had, would have ascribed it to women who faced unplanned or unwanted pregnancies. Indeed, unplanned or unwanted pregnancy is a major trigger for antenatal depression, but it is by no means the only one. So what could pregnant women who want to be pregnant have to be depressed about? Turns out I was, as so often the case, inexperienced, uninformed and about to embark on a steep learning curve.
So first things first: what is this antenatal depression? Well, duh: it is depression experienced during pregnancy. In some ways it presents in very similar ways to other types of depression, leading to feelings of worthlessness, an inability to lead a normal life, and even to self-harm or harm to an unborn baby. But it can be harder to diagnose than other depressions, for the following reasons.

1) Breaking news! Depression can be hormonally related.
Those of us who have had the pleasure of experiencing emotionally-charged PMT, or Pill-induced mood swings, will know that hormones are prime agents in the regulation of mood, and in some cases mental health. When pregnant and during in the first trimester especially, a woman is treated to not only an increase in hormone levels overall but also to a new mixture of them swirling around. These are, after all, what encourage the baby to grow and develop. It follows that one of the casualties of this process will be her ability to maintain equaninimity in the face of, oh, I don't know, an attempt to show her affection, let's say. Or someone giving the 'wrong' birthday present. Or someone being ill on her birthday. That sort of thing. The sort of thing that might (depending on the individual and of the individual's time of the month) be passed off as 'life' and all its charm normally, but in pregnancy takes on the hue of being Very Distressing Indeed, and which are greeted with a variety of responses, such as hissing, spitting, weeping, 'you-don't-really-care' speeches, or locking herself in the toilet to avoid all eye contact. Under such circumtances, it is difficult to tell whether the root cause is simply hormonal imbalance, or a deeper malaise involving self-doubt, self-loathing, fear and anger.

2) Pregnancy actually involves many of the same physical symptoms as depression.
The checklist for depression includes problems sleeping, problems concentrating, extreme fatigue, changes in appetite, loss of libido, and difficulty achieving everyday tasks. Sound familiar? For many women in their first trimester, this describes their situation pretty well, and is considered 'normal' in the context of an otherwise troublefree pregnancy. 'It will pass', the doctors, the books, the fellow mums-to-be all say. Which leaves very little lee-way for an alternative response, which might be something along the lines of 'Perhaps you need some help...'

3) Pregnancy is supposed to be this glowing, wonderful time of contentment and hope.
I have written about this before, and it is the reason for my self-proclaimed title of Proselytiser for Truth In Pregnancy. The idea that women enjoy being pregnant is endemic, even or especially among women who have had babies themselves. I am not sure if that is 'aftermath glow', by which I mean an anticipation of the happiness of a child in our lives in the future, or whether it is altogether more vague than that, a sort of universal 'wah' that mythologises and idealises the pregnant body. Either way, the expectation is that women will be over the moon about being pregnant, especially if they are not too young, too old, too sick, etc. Even if women are not the ideal candidate for pregnancy, should they decide to continue with a pregnancy it is generally assumed to be a source of happiness and positive expectation. This leads to a situation where the expectant mother's mental health is not given the support it may need, as so few people are on the lookout for potential problems.

So there you have it. Depression does happen in pregnancy, and it is often overlooked for various reasons. It is not often acknowledged by experts either: even the BeyondBlue website has only one information sheet buried in among many others devoted to postnatal depression. There is one website in Australia that specialises in both antenatal and postnatal depression: see http://www.panda.org.au/index.html

And what do I have to do with all of this? Well, folks, if you thought I was laying the groundwork here for some kind confessional post, you were absolutely right. But that will have to come another day. Right now, I have to eat some lamb carry, struggle with basic tidying, and head out for the daily highlight of a swim in one of the hotel pools. I will be back, however, with Part II soon.