Perinatal, Infant and Child Mental Health

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Introduction

Matters of transition to motherhood are one of the most complex and underdeveloped areas of modern science. Recent years, however, have witnessed a growing interest in the psychological aspects of pregnancy and childbirth. Expecting a child is one of the most significant biological events in any woman’s life. Although this period is generally positive, women still require certain adaptation. Increased internal conflict and acute emotional tension during pregnancy may lead to poor mother-infant attachment. Specific mental state conditions of a woman, such as stress, depressive moods, psychopathological traits, and exacerbation during different periods of pregnancy, may also harm the child’s further development. This paper aims to analyze various aspects of the transition to motherhood and factors that may affect maternal mental health.

Emotional, Physical and Social Changes of Transitioning to Motherhood

The life program of any human being, built into the genome, which determines appearance, character, and health is derived from parents when their cells merge at conception. Apart from the genetic program, the future development of a child is predetermined by various events that women experience before and after childbirth. Childbearing females undergo several changes during the prenatal period. In particular, a history of mental illnesses, such as depression, is a significant risk factor of experiencing a “traumatic childbirth” (Ababneh et al., 2017, p. 4). Besides, a considerable number of women experience negative feelings such as anxiety, anger, sadness, when adapting to the changes during the transition.

Apart from emotional challenges, future mothers undergo a process of rapid physical development. In addition to apparent body changes, women experience hormonal surges and sleep deprivation. In terms of social changes, childbearing females face a shift in their role in society and within a family unit. The pregnancy period can open new possibilities for much more intimate connections with the partner but also provoke various complications. Increased stress levels often lead to distancing and separation or avoidance of sexual relations during pregnancy. Thus, such a shift in the emotional, physiological, and social status of women in transition to motherhood may result in the development or worsening of mental health issues.

Factors Affecting Mental Health in the Prenatal Period

Maternal psychological well-being is affected by various mental and physiological changes. However, specific earlier life events may contribute to more frequent depressive moods and the deterioration of mental health overall. It is reported that emotional trauma and prior sex abuse and other forms of childhood maltreatment may challenge a positive transition to motherhood (Christie et al., 2017). Recent studies suggest that some women fear that the process of labor may be comparable to the previous sexual trauma, thus, provoking feelings of anxiety and depression (Ababneh et al., 2017). Moreover, abuse history puts women at a higher risk of developing postpartum stress disorders (Christie et al., 2017). Family stressors such as conflicts with a partner, disagreements on parental matters, and others may also relate to new onsets of depression symptoms and the development of prenatal and postpartum psychological issues. Aarestrup et al. (2020) state that the perinatal period is the beginning of a “mother’s prenatal involvement with her developing child” (p. 2). Thus, identifying the need for mental health treatment is of the utmost significance for both the mother and the infant.

Substance misuse is quite often associated with violence, maltreatment, and overall health deterioration. Researchers determine that it is also interconnected with sexual trauma as the latter is related to increased consumption of alcohol or nicotine during pregnancy (Christie et al., 2017). Apart from affecting the proper development of a fetus, prenatal use of drugs, tobacco, and other illicit substances contributes to behavioral issues and exacerbation of already present mental health problems. Untreated substance abuse, along with associated with it psychological matters, results in subsequent dysfunctional mother-infant relationships.

Attachment Issues and Mental Health

Mental health issues during and after pregnancy can significantly affect a woman’s relationship with her infant. Several recent studies reported that stress disorders associated with traumatic childbirth resulted in poor mother-child bonding or increased mothers’ hostility towards their newborns (Beck & Casavant, 2019). Maternal mental issues are related to women’s fear of developing an attachment to the child even after the delivery (Ababneh et al., 2017). According to one of the studies, the difference between the effect of major maternal psychological problems and frequent anxiety moods during pregnancy on mother-infant attachment is crucial (Sliwerski et al., 2020). While a clinically diagnosed depressive disorder has a significant influence on mother-child bonding, self-reported symptoms of phycological stress are considered unrelated.

Poor mother-infant relationship negatively impacts the future long-term development of a child. Disorganized type of attachment caused by maternal mental health issues may influence brain development and subsequently cause emotional and cognitive-behavioral problems (Cortes Hidalgo et al., 2019). Lack of bond between a mother and a child during the first two years is interconnected with future abilities to form healthy relationships thought life. Compelling research conducted among orphans adopted at different ages showed that only 22% of children fostered between ages two and three and a half were developing appropriately in psychological terms (Winston & Chicot, 2016). Therefore, timely intervention by health care professionals and corresponding mental treatment sessions are vital to ensure that future mothers can establish adequate attachment with children. A positive bond, in turn, leads to the healthy emotional, physical, and mental development of a child.

The Importance of Screening Tools and Support Networks

Preventive healthcare screenings are needed to provide insights into childbearing women’s mental health and establish effective responses. Aarestrup et al. (2020) state that the perinatal period is when the maternal-fetal attachment is developed; therefore, timely screening of possible mental disorders is crucial for the well-being of both a mother and a child. However, it has been determined that the isolated treatment of stress pathologies does not result in the improvement of future parental behavior. Consistent support during pregnancy and postpartum is required to establish a healthy maternal routine and influence the relationships with the child and between partners. Paternal involvement during pregnancy may minimize maternal mental health issues and, therefore, significantly decrease the rates of premature birth and fetal growth impairment.

However, it is vital to consider that depressive symptoms are common not only in expectant mothers but also in fathers. Current research on paternal depression suggests that its symptoms and effects are mostly consistent with maternal ones. Untreated mental health issues in fathers influence communication with mothers during pregnancy and postpartum parental behavior as well. Therefore, preventive healthcare screenings should be conducted for both partners to minimize the negative effect on pregnancy and future child development. According to Aarestrup et al. (2020), healthcare support networks are responsible for identifying the need for mental health treatments, providing individual consultations, and referrals to psychiatric examinations, if necessary. Vulnerable childbearing women may receive home visits by a health care nurse before and after birth. Postnatal care relies significantly on community support networks in terms of breastfeeding issues and maternal sensitivity matters. Healthcare nurses also provide consultations on techniques, strategies, and potential challenges during the breastfeeding period. Therefore, a combined effort of support groups, Child and Family Health Nurses, and partner reassurance contribute to a healthy emotional state of a mother during and after pregnancy.

Strength-Based Approach

While pregnancy may bring many positive emotions, many women experience several negative thoughts, exacerbation of mental health issues, and depressive moods. When such conditions occur during pregnancy and postpartum, soon-to-be parents often turn to books and other sources of information on childbirth and parenting and become overwhelmed by a variety of opinions and advice. In such cases, the role of health care professionals, including continuous care and support by a Child and Family Health Nurse, is vital. Apart from the benefit of obtaining scientifically approved information on pregnancy and parental issues, nurses may be able to provide referrals to mental health professionals if needed, as well as immediate care.

Medical support and interventions by healthcare specialists require an established and unified plan. The development of strength-based approaches to address various maternal problems occurs across a large number of hospitals and childbirth centers. Cross and Cheyne (2017) outline that the strength-based strategy entails a medical practitioner to apply such skills as rapport building, motivation encouragement, more open communication with new parents, and setting up of common goals. According to the results of a study conducted in Scotland among expecting and new mothers and midwives, the feedback on maternity services provided was overall positive (Cross & Cheyne, 2017). However, certain inconsistencies in nursing care were noted as well. On their end, midwives quoted a lack of adequate training to implement a practical strength-based approach when providing maternity services (Cross & Cheyne, 2017). Thus, since the therapeutic relationship between health care practitioners and women is crucial to maintaining physical and mental health during and after pregnancy, a consistent strength-based approach should be developed and implemented.

Mental Health Risk Groups and Cultural Considerations

The most relevant factors related to the development of mental health issues during and after pregnancy are a history of sexual trauma, drug abuse, and prior psychological problems and psychiatric disorders. While a relatively significant number of studies and materials are available on the subjects above, such issues as poverty and culture-specific considerations still require more attention. Childbearing women in low-income areas are at a higher risk of developing stress disorders, which consequently affect a mother-infant relationship.

The effects of poverty on infants result in slower brain development. According to one of the studies, children up to 4 years of age from low-income families were found to have half a standard volume of gray matter (Blair & Raver, 2016). Besides, children living in poverty have elevated levels of cortisol; thus, they are more prone to stress, which results in a lower rate of self-regulation and cognition (Blair & Raver, 2016). Cultural diversity may greatly impact mental health and how depressive moods are perceived across countries. According to several studies, female gender discrimination is a decisive factor for the development of postpartum mental health disorders in women in several Middle Eastern and African countries (Evagorou et al., 2015). Moreover, the lack of medical information and intervention in undeveloped areas leads to a significant number of women with mental health issues remaining untreated.

Conclusion

Pregnancy is undeniably an exciting and meaningful event in any woman’s life. At the same time, the anticipation of a child’s birth, lack of partner support, physical challenges, social and cultural factors may attribute to the development of mental health issues, mild and severe. In addition, a history of maltreatment, sexual trauma, and drug abuse may lead to exacerbation of psychological disorders, which, in turn, causes attachment problems. Health care maternity services and the involvement of Child and Family Health Nurses play a crucial role in the identification and timely treatment of mental health issues women may experience both in perinatal and postpartum periods.

References

Aarestrup, A. K., Væver, M. S., Petersen, J., Røhder, K., & Schiøtz, M. (2020). An early intervention to promote maternal sensitivity in the perinatal period for women with psychosocial vulnerabilities: Study protocol of a randomized controlled trial. BMC Psychology, 8, 1–13. Web.

Ababneh, A. A., Al-Ja’freh, S. M., & Abushaikha, L. (2017). Traumatic childbirth: Incidence, risk factors, and its impact on mothers and their infants a scoring review. International Journal of Applied and Natural Sciences (IJANS), 6(6), 1–8. Web.

Beck, C. T., & Casavant, S. (2019). Synthesis of mixed research on posttraumatic stress related to traumatic birth. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 48(4), 385 – 397. Web.

Christie, H., Talmon, A., Shäfer, S. K., de Haan, A., Vang, M. L., Haag, K., Gilbar, O., Alisic, E., & Brown, E. (2018). The transition to parenthood following a history of childhood maltreatment: A review of the literature on prospective and new parents’ experiences. European Journal of Psychotraumatology, 8, 1–15. Web.

Cortes Hidalgo, A. P., Muetzel, R., Luijik, M., Bakermans-Kranenburg, M. J., El Marroun, H., Vernooij, M. W., van IJzendoorn, M H., White, T., & Tiemeier, H. (2019). Observed infant-parent attachment and brain morphology in middle childhood – A population-based study. Development Cognitive Neuroscience, 40, 1–9. Web.

Cross, B., & Cheyne, H. (2017). Strength-based approaches: A realist evaluation of implementation in maternity services in Scotland. Journal of Public Health, 26(4), 425–436. Web.

Evagorou, O., Arvaniti, A., & Samakouri, M. (2015). Cross-cultural approach of postpartum depression: Manifestation, practices applied, risk factors and therapeutic interventions. Psychiatric Quarterly, 87(1), 129–154. Web.

Sliwerski, A., Kossakowska, K., Jarecka, K., Switalska, J., & Bielawska-Batorowicz, E. (2020). The effect of maternal depression on infant attachment: A systematic review. International Journal of Environmental Research and Public Health, 17(8), 1–42. Web.

Winston, R., & Chicot, R. (2016). The importance of early bonding on the long-term mental health and resilience of children. London Journal of Primary Care, 8(1), 12–14. Web.

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