But the Lord asked Abraham, “Why did Sarah laugh, saying, ‘Can I really have a baby?’ And Sara laughed to herself, saying, “Now that I am withered, am I to have enjoyment – with my husband so old?” Genesis 18: 12-13 (The Israel Bible™)
What could be a happier occasion than giving birth to a healthy, full-term baby and taking him/her home from the hospital’s maternity ward?
Yet, about 10% of pregnant women and 13% of women who have just given birth, experience a mental disorder, mostly clinical depression.
In developing countries, the figure is even higher – 15.6% during pregnancy and 19.8% after childbirth. This is much higher than the previous figures on prevalence coming mostly from high-income countries. Hormonal changes and severe lack of sleep may be involved in triggering post-partum depression in women after giving birth.
Psychosis is much less common but may also lead to suicide and in some cases even harming the newborn. Depression causes enormous suffering and disability and reduced response to child’s need. Evidence indicates that treating the depression of mothers leads to improved growth and development of the newborn and reduces the likelihood of diarrhea and malnutrition among them.
After the birth, the depressed mother suffers a lot and may fail to adequately eat, bathe or care for herself in other ways. This may increase her risks of ill-health.
No one is immune. Women of every culture, age, income level and race can develop perinatal mood and anxiety disorders. Symptoms can appear any time during pregnancy and the first 12 months after childbirth.
In addition, because the affected mothers cannot function properly, the children’s growth and development may be negatively affected as well. Very young infants can be affected by, and are highly sensitive to, the environment and the quality of care and are likely to be affected by mothers with mental disorders as well.
Prolonged or severe mental illness hampers the mother-infant attachment, breastfeeding and infant care. The fathers suffer terrible anguish as well. In severe cases mothers’ suffering might be so severe that they may even commit suicide.
Maternal mental disorders can be treated – and effective interventions can be delivered even by well-trained, non-specialist health providers. Among the treatments for postpartum depression include talk therapy, including short-term cognitive behavioral therapy, and medications.
Yet the suffering by countless women and their families continues, mostly due to the lack of awareness.
World Maternal Mental Health Month/Week/Day is marked around the world every May, with the blessing of the UN’s World Health Organization.
Israel is one of the countries where the month is being marked, and “2019 is the third year that we in Israel have participated in the Month of Mental Health for Mothers,” said one of the Israeli coordinators of the events, developmental psychologist and senior researcher Saralee Glasser of the Gertner Institute for Epidemiology and Health Policy Research at Sheba Medical Center near Tel Aviv.
Virtually all women can develop mental disorders during pregnancy and in the first year after delivery, but poverty, migration, extreme stress, exposure to violence (domestic, sexual and gender-based), emergency and conflict situations, natural disasters, and low social support generally increase risks for specific disorders.
Midwives have a unique role in supporting women through pregnancy and into the early postnatal period. This should include meeting the woman’s needs in terms of her physical and mental health to support optimal health for mother and baby. The queue for seeing a psychologist or psychiatrist remains long, and many younger women are reluctant to see a doctor in a psychiatric institution for their problems.
Glasser said that a day is marked in many countries on May 1, but others choose to do so during a week or a whole month. Because numerous national events are held in Israel in May, it was decided to choose a whole month for activities so a single date would not interfere with them.
Among the various events that have been held in the past two years were phone hotlines, a meeting in the Knesset, local assemblies with the public and public health nurses. Unfortunately, the Health Ministry has not been actively involved in publicity on the issue. However, the four public health funds that provide medical services are required to screen new mothers for postpartum depression.
This year, on May 7, the National Insurance Institute is will hold a conference on postnatal and perinatal depression, including professional lectures and a play for all staff who are involved in mental health, disabilities, personnel committees, as well as members of national and regional councils. The next day, a special Knesset committee session will be held on the various aspects of pregnancy loss. On May 30 the Knesset Committee on the Status of Women and Gender Equality will hold a session on research about women’s preferences for treatment for postpartum depression.
According to a published study in which Glasser was involved, considering suicide among Israeli new mothers occurs in 1% or fewer, but there are higher rates among Arab women and immigrants from the Former Soviet Union.
“Postpartum suicidality in Israel is low relative to other countries. Although relatively rare and lower than among non-postpartum women, health professionals should be attentive to risk factors, such as past psychiatric disorders, suicide attempts and current emotional distress, particularly among higher-risk populations. The universal screening program for postpartum depression is a valuable opportunity for this, but increased resources should be allotted to implement and utilize it optimally.”