If you were to ask the vast majority of mothers what comes to mind when they think about postnatal mental health problems, the first words out of their mouths would be "postnatal depression".
It's a common problem, affecting more than one in every 10 women within a year of giving birth, and is predominantly characterised by a persistent feeling of sadness, loss of interest, and lack of energy.
A quick internet search of "postnatal depression UK" pulls up around one million pages of information. The NHS, Royal College of Psychiatrists and Mind top the hits, providing accessible and evidence based advice for prospective and new mothers. Health professionals are <a class="break-all" href="https://www.google.com/url?q=www.sign.ac.uk/pdf/sign127.pdf&sa=D&ust=1494406555297000&usg=AFQjCNEQBjDQyA0joXd3L73tvmvHEGj5Dg" rel="nofollow noindex" target="_blank">advised by policy to ask brief questions to new mothers to identify possible depression after birth. As a result, mothers are generally in a good position to seek treatment if the signs and symptoms of postnatal depression arise.
However, through my research with postnatal women, I have realised that there is another aspect of postnatal mental health that I hear about just as frequently as depression: post-natal anxiety. Many of the mothers I have worked with share their experiences of 'worry', 'concern' and 'anxiety'. Childbearing, as a period of substantial biological and psychosocial change, can be expected to elicit some anxiety. This can serve to protect the baby and help a mother to cope with the unpredictable nature of the postnatal period. However, there is a tipping point.
When anxiety becomes irrational or excessive, and results in emotional and physical discomfort that affects day to day life, it is thought of as abnormal and pathological. Research has demonstrated that postnatal anxiety is linked to a <a class="break-all" href="https://www.google.com/url?q=www.ncbi.nlm.nih.gov/pmc/articles/PMC3100191/&sa=D&ust=1494406555296000&usg=AFQjCNFT9GL-uY2Y-CyegStj9QbKU2Gmew" rel="nofollow noindex" target="_blank">range of negative outcomes for mother and baby. In terms of the mother, those with postnatal anxiety are less sensitive towards their infants and feel like they cannot cope as well with their babies. Furthermore, their babies are at a higher risk of insecure attachment, delayed cognitive development, and lower social engagement.
Whilst postnatal depression and anxiety can co-occur, research studies examining postnatal anxiety demonstrate that it also occurs independently and at higher rates than postnatal depression. However, there is little information available to reflect this. An internet search for "postnatal anxiety UK" pulls up a quarter of the results that were generated for postnatal depression.
Worryingly, the NHS and NICE do not recognise postnatal anxiety as a distinct disorder, and consequently there is no current guidance which exclusively addresses postnatal anxiety for either health professionals or mothers.
The brief questions that health professionals use for postnatal depression have no mention of anxiety. We have since developed a new questionnaire (The Postpartum Specific Anxiety Scale) to reflect the anxieties that women commonly face in the postnatal period. Our research shows that the questionnaire reliably and accurately identifies women with a clinical diagnosis of anxiety, but it still needs more work before it can be implemented as a screening tool in the UK.
The deficits in information and screening of postnatal anxiety raise a number of concerns. Mothers who are both anxious and depressed can only be diagnosed with depression. Mothers with pure anxiety may be misdiagnosed with depression. Even worse, there is potential for both mother and health professional to assume that mothers are functioning normally simply because they are not depressed. All of these scenarios delay or prevent the appropriate management and treatment of symptoms of anxiety, which may have serious consequences for both mother and baby.
The evidence base for postnatal anxiety is starting to grow, but what should mothers know in the meantime?
First, mothers should be aware that symptoms of anxiety are often mislabelled as postnatal depression. Mothers should seek professional help if their quality of life or their experience of motherhood is being compromised, even if their symptoms do not correspond with those of postnatal depression. Finally, mothers may also benefit from understanding that symptoms of anxiety in the postnatal period may not be the same as anxieties occurring at other times of life; often they are specific to the mother and baby.
Ultimately, we need to make sure that mothers are aware of the condition, and that health professionals identify and screen for postnatal anxiety in the same manner as postnatal depression.
If you, or someone you know may be suffering from postnatal anxiety, speak to your GP or health visitor. If they can't help, they'll know someone in your area who can. Encourage your partner to seek help if you think they might be having problems. Don't struggle alone hoping that the problem will go away.
Click here find out more about the Mumsnet Campaign for Better Postnatal Care
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Guest posts
Postnatal anxiety: Under-recognised, over-shadowed, and misrepresented
24 replies
MumsnetGuestPosts · 09/05/2017 08:55
OP posts:
vickyfallon ·
11/05/2017 09:55
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