For many new mothers, the perinatal period (starting at pregnancy up until a few weeks or months after delivery) is riddled with anxiety, depression and trauma, and yet these conditions are rarely spoken of and are considered “normal” experiences. Around 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression, according to this report by the World Health Organization. In developing countries, the numbers are even higher at nearly 16% and 20% respectively.

Reasons for poor mental health during this time can vary among mothers. Prof. Antje Horsch, Associate Professor and Director of Research at the University Lausanne, who has looked at several situations that could be traumatic during the perinatal period, including pregnancy loss or miscarriage, stillbirth, prenatal diagnosis (finding out that the baby has a problem before birth which sometimes leads to interruption of pregnancy) and traumatic childbirth, said that these things occur more frequently than we think. The leading cause of mortality during the perinatal period is maternal suicide, she said in an interview at our third edition of Winspiration, where Swiss researchers in perinatal care and psychoeducation (a therapeutic intervention that supports patients and their loved ones in navigating mental health conditions) discussed with Indian researchers and innovators challenges in perinatal care and explored collaborations to find potential solutions.

Cultural Taboo

Parents think that they are the only ones who experience detachment and depression and that they should be happy after the birth of their child, and if they’re not, there’s something wrong with them, Horsch said. “So they feel guilty, they blame themselves, they think they’ve done something wrong, and often think they can’t be good parents because of it.”

Poornima Mahindru, a Bengaluru-based clinical psychologist and psychotherapist mirrored Horsch’s view. “Culturally and socially, motherhood—or even parenthood—is glorified. So the mothers and fathers by default get into a loop of invalidating their own emotions and feelings. So either out of shame or guilt, they don’t talk about it or they get so engrossed in their changed world after childbirth, that this becomes secondary.”

In fact, Dr. Geetha Desai, Professor, Department of Psychiatry at the National Institute of Mental Health and Neuro Sciences (NIMHANS) said that women are so conditioned to not think of themselves that this practice has become normalised. “You’ve seen your mom say these things are not a big deal and so you also don’t make a big deal of it. Something else is always prioritised more than yourself or your health. So in some ways, it’s a very self sabotaging thing that is passed on from generations. So it is very scary because you’re doing it without realising that it’s absolutely okay for you to take care of yourself.”

Intergenerational Transmission

While behaviour can be passed from one generation to another, perinatal depression and trauma can also—and does—affect the baby. Mothers who have had a traumatic birth experience are less likely to initiate breastfeeding and have more problems with bonding with a baby compared to mothers who didn’t have a traumatic experience, Horsch said, adding that some aspects of infant development can also be impacted negatively and their tolerance towards stressful situations can be low.

Many studies on postpartum depression show that children whose mothers were depressed in the postpartum period, for instance, had lower academic achievement and were also more likely to themselves have depression or other mental health problems, Horsch said, adding that that the children had been followed up to university age indicating long-term effects.

Possible Solutions

Mahindru uses Cognitive Behaviour Therapy (CBT) as her go to technique, which is a kind of psychotherapy that helps people change their thoughts, feelings and behaviour. Mothers have a very small window of time so they don’t have the luxury to go too deep into the trauma and process it, Mahindru explained. “During pregnancy and birth, their interpersonal relationships are changing and it’s anyway very difficult for them to engage at this moment. If you go deeper, they are going to get overwhelmed”, she said.

But access to interventions from mental health professionals is limited. Only those who visit obstetricians-gynecologists (OB-GYNs) who are already aware of, clued into and understand the connection between perinatal health and mental health are able to advise timely interventions. Normally, it is the upper-middle and middle-classes that are able to benefit from such mediations but the vast majority of women in a country like India don’t have access to the kind of mental health support they require.

Horsch, however, is most interested in single-session interventions (SSIs) that can be offered to parents who have had a traumatic birth experience. An SSI is a planned, one-time meeting with a professional to address a specific issue rather than multiple visits spread over a period of time in traditional therapy. “We’ve been able to show that with a single session intervention, the development of Post Traumatic Stress Disorder (PTSD) related to birth can be prevented or can be treated. So that’s something I’m very, very, very passionate about”.

Another important factor, Horsch said, was working as an interdisciplinary team because many different professionals are important during the perinatal period starting from the midwives and obstetricians to paediatricians and mental health professionals. Timely screening for common mental health problems such as depression was another gamechanger, according to Horsch, that could prove beneficial. “This can be done by frontline professionals who are not mental health experts. And then, if there are difficulties, they can be referred on to mental health care experts for further assessment. We need to identify problems as soon as possible, because we have seen ourselves in our studies, and many other people have seen it as well, that very quickly you see the negative impact on the baby. And so the longer you wait, the longer the baby also will have been exposed to, and the more we would have to do to treat these difficulties.”

She added that even if a professional isn’t a mental health specialist, they should still be able to identify mental health problems and refer the patient to an expert.

Another possible solution was to develop a free app that would track the mother’s various health parameters—that would also break down all the important information in various languages and into bite-sized pictograms. In theory, this could work very well.

But as Desai pointed out, not every woman has access to a smartphone at all times and even if they did, the onus of entering data on the phone is on the woman and it’s one more task added to a list of things during a time that is not entirely comfortable.

Besides, lack of transparency around who has access to their data (many women in India worry that family members like husbands and mothers-in-law would get hold of their information and judge them) still makes many women wary, and speaking to a real person offers more comfort than entering data on a device.