When you embark on your journey to start a family, many things rush through your head: the physical aspects of trying for a baby, the emotional leaps and dips as you navigate through trying to conceive, and so on. All of which lead to the day when, hopefully, you get that positive pregnancy test.
It’s an exciting journey, but for some women, it’s also one that is filled with mixed emotions, including anxiety and sadness. This is especially true if you have a history of mental health difficulties. According to the charity, The Maternal Mental Health Alliance, it is estimated that one in ten women will experience significant depression and/or anxiety during the perinatal period, which is defined as pregnancy and the first year of baby’s life.
The UK-based mental health charity, Mind, also found that up to four in ten new mums reported a mental health issue such as significant stress, anxiety, and depression both during and after pregnancy. It also found that nearly half of those women were too embarrassed to say anything or found it too difficult to tell a mental health professional how they were feeling.
If this sounds like you, please don’t suffer in silence! It’s important that you recognise these feelings so that you get the right help and support for the well-being of yourself and your baby.
The start of my journey with perinatal anxiety
As I embarked on my journey to have my third son, my mind was filled with many questions: Will the boys like being big brothers? Will I even be able to have a third pregnancy? What will the baby look like? But what I never questioned was the state of my mental health during the process. Not once did I stop and wonder if my mental health would be compromised on my journey to become a mother for the third time.
But it was.
The scary part was that, until a stranger heard my story, I didn’t realise that my mental health was in danger. It took me telling somebody else about the issues I had faced in previous pregnancies and the worry I was feeling about this pregnancy to realise that I was suffering from more than just the usual worries. It was at that point I was able to seek the help I needed here in Doha.
That is why, ever since that moment, I have shared my story. To remind others that it is OK to feel scared, anxious, or depressed. That, while hormones do play a big part in emotions during pregnancy, it might be something more. That perinatal anxiety is more than just feeling a bit blue, a bit anxious, a bit scared. It is real. And it is not talked about enough.
It is OK to not be OK.
My story begins back in 2012, when I had a traumatic delivery while giving birth to my first child. A category one emergency C-section with my life endangered, the time it took from the doctors filling my room to my son being lifted out of me was just seven minutes. He was born blue and unresponsive. Luckily, he was also born just in time. Birth trauma, never dealt with and packed away in a compartment in my brain, and left there as I carried on with raising a new baby.
It continued in 2015 when I was pregnant with my second son and adamant I was going to get the healing birth I deserved after the trauma of my first. That was not the case as, yet again, I had another emergency C-section that showed I was within hours of haemorrhaging from an undetected rupture.
Once again, I boxed up all the negative feelings and worries associated with my second birth and pushed them all to the back of my mind to be dealt with another day.
Except I never dealt with them. The next time they surfaced, I found out I was pregnant once more. In 2018, while pregnant with my third son, my mental health began to slowly unravel due to my previous birth traumas. I carried on regardless for the first fourteen weeks—during which I was involved in a pretty severe car accident—and then I finally fell apart.
At that point, I was referred to the Maternal Mental Health team at Sidra Medicine and diagnosed with perinatal anxiety.
What is perinatal anxiety?
Anxiety is a feeling of unease, worry, or fear that can be mild or severe. Everyone feels anxious, sometimes, but some people find it hard to control their worries. Perinatal anxiety is experiencing this during pregnancy or the first year of your baby’s life.
Anxiety symptoms vary from person-to-person and can have both physical and mental effects on you.
Some of these, according to Tommy’s (the UK’s leading baby charity) and Mind, can be but are not limited to:
- Feeling restless
- Having trouble concentrating
- Feeling anxious for large periods of time and being unable to control those feelings
- Feeling very worried
- Panic attacks
- Feeling a sense of dread
- Feeling as though you are constantly on edge
- Having difficulty in falling or staying asleep
- Being irritable
- Sweating and hot flushes
- A racing, thumping, or irregular heartbeat
- Derealisation: feeling disconnected from reality
- Depersonalisation: feeling disconnected from yourself.
Personally, the symptoms I experienced leading to my diagnosis included flashbacks to previous trauma, excessive worry about my third pregnancy, and feelings that I was “pushing my luck” and that I wouldn’t have the happy outcome I previously had. In addition to having a sense of dread, I also had difficulty sleeping.
How is perinatal anxiety diagnosed?
The Edinburgh Postnatal Depression Scale (EPDS) is used as an initial gauge to assist in the identification of possible mental health issues in pregnant and postnatal women. It is a set of ten screening questions that can indicate whether a parent has symptoms that are common in women with depression and anxiety during pregnancy and in the year following the birth of a child.
It is important to note that the EPDS is not a diagnostic tool, but rather a screening tool that aims to identify those who may benefit from follow-up care and a mental health assessment.
Maternal Mental Health in Doha
Doha’s centre of excellence for perinatal mental health services can be found at Sidra Medicine. It is the only facility in Qatar with a dedicated perinatal mental health service, and all Hamad Medical Corporation (HMC) referrals go there. Their maternal mental health team help provide women, infant, and family-centred assessments, treatments, and care for pregnant women who are struggling with mental health issues.
There are several ways to get a referral to Sidra’s Maternal Mental Health program. The two most common are:
- A referral from your current healthcare provider (government or private)
- Self-referral by phone (4003-3333) or a visit to the outpatient clinic
Following your referral, you will then meet with a clinician to explore why you have been referred to the perinatal mental health department. After a detailed assessment, you will be provided with feedback regarding diagnosis and treatment recommendations.
What happens next?
Finally, you have a diagnosis, and you now have a name for what’s been keeping you up at night—but what happens next?
Each treatment plan is specific to both the patient and the mental health issue that is being treated. These can include talking therapies and/or medication.
My treatment for perinatal anxiety
Under Sidra Medicine, I met with both psychiatrists and psychologists. From my very first appointments, it was decided that I would not benefit—at that stage—from medication. At that stage, I was signed off from the psychiatrist and placed under the care of a psychologist. I was assessed throughout the whole process and, should my mental health have deteriorated further, I would have been referred back to a psychiatrist to be prescribed medication.
As it happened, my perinatal anxiety was managed with regular cognitive behavioural therapy (CBT) sessions. CBT is a talking therapy that can help you manage your problems by changing the way you think and behave.
During this process, we put together a range of tools I could use when I was feeling especially anxious. I explored the previous birth trauma I had experienced and changed my mindset on how I viewed the current period. I also spent time talking through the specific triggers that I had.
Self-care for perinatal anxiety
From my regular sessions, it became quickly apparent that I had the ability to help myself when anxiety was threatening to overtake me. From here, I was able to create a “toolbox” of coping strategies to employ when I felt overwhelmed.
Here are some of the tools I personally used:
1. Physical Activity
Not only does this act as a great distraction, but it also helps to burn up the anxious energy you may be producing. Even as I became heavily pregnant, I found that taking the time to take a short walk cleared both my mind and my anxiety.
2. Meditation and breathing exercises
While in CBT, my psychologist practised mindful breathing exercises with me.
One such exercise involves closing your eyes, letting your body relax, and imagining a place where you feel comfortable. It could be your favourite park, the beach, your bed—whatever feels right for you. At that point, you start taking slow and deliberate breaths. In through your nose for a count of five, hold for a beat, and then breath out through your mouth for a count of five.
3. Focusing on something else
Rather than focusing on my upcoming C-section and all the things that could potentially go wrong, I would shift my focus onto something small. This could be the pattern on a rug or the texture of something I was wearing, slowly taking it all in. In doing so, I would give myself a moment to calm the anxious thoughts crowding my mind.
4. Writing it down
Rather than keeping things bottled up, becoming bigger and bigger in my mind, I began to use writing as a tool. It helped to focus my thoughts, and having my anxieties out there on paper made them seem surmountable.
Accepting that you are not superwoman and taking time to sit and rest is just as important as washing the dishes. It may feel unnatural, but you need to take the time to rest your body and mind.
By employing these various strategies, and with the help of my team at Sidra, I made it through to 37+4 weeks pregnant and gave birth to a healthy baby boy via elective C-section. He was the healing birth I didn’t know I needed. Although I remained under my mental health team until he was eight weeks old, I now feel stronger than I did before.
If you have been affected by any of the issues discussed in this article, please reach out to your doctor, who can give you the appropriate referral for you to access help.
Finally, for those of you like myself who had experienced perinatal anxiety and were worrying about the effect that it was having on their unborn baby, I’d like to leave you with a quote from Professor Janet A. DiPietro. Professor DiPietro is a research author and development psychologist in the Johns Hopkins Bloomberg School of Public Health in Baltimore, and she says:
“I’d like all pregnant women to heave a big sigh of relief—they hear all these awful stuff about everything they do. Now they can stop worrying about worrying. The reason to avoid stress is not because it’s hurting the baby, but because it is hurting you.”