Experience of pregnancy and delivery among women with mental disorders
Theme: Perinatal mental health
How is it to be a mother if you have a mental disorder? What challenges can one meet? In this article we discuss existing data about the experience of women with mental disorders during pregnancy and delivery. The most striking concerns for them were related to stigma, baby’s welfare, and possibility to stay with a baby, they also describe their emotions related to that and attitude towards provided care.
Supporting women through the perinatal period is important, and beneficial for women, children, and families on the individual level and for society in general. Women with mental disorders carry an additional burden due to risk of psychotropic medication side effects, higher risk of obstetric complications and custody questions (Miller, 2009, Jablensky et al., 2005). Research about the experiences of women with mental disorders during pregnancy and delivery is limited, in the Nordic countries, and elsewhere.
We did an extensive literature search for qualitative studies on this topic (via PubMed, Google Scholar, backward citation searching, and contacting some perinatal psychiatry experts) and found that data about women who suffer from non-severe and prevalent forms of mental disorders like neurotic and stress-related disorders, mild forms of depression is lacking, and there is however scarce data about women with schizophrenia, severe depression and alcohol and drug misuse disorder. Most of this qualitative research mainly from Anglo-Saxon countries, and one publication from Norway aimed to evaluate satisfaction with care by women who got ante-or postnatal care in psychiatric settings with specific attention to specialised “Mother-baby units” (Taylor et al., 2021). The most prominent topics which were raised from the conducted studies are stigma, child, women’s emotional state, positive and negative attitude towards provided care.
Stigma is experienced by these mothers from different sides. They feel that they are negatively judged by care providers based on their previous behaviour (Taylor et al., 2019), that relatives relate to them as “unfit mothers” and want to take over their responsibilities over pregnancy related decisions and the baby. This mindset is fuelled by feelings of shame, fear, anxiety, guilt and longlines. Moreover, many women self-stigmatise themselves bearing a dual identity of a mother and a person with mental illness (Dolman et al., 2013, Millett et al., 2018). Consequently, the strong apprehension to lose autonomy over their lives and a baby hamper their motivation to seek help. At the same time many women find that the new “mother” identity gives them hope and inspiration for improving their mental health. Children bring sense to their lives, like it is highlighted in one of the interviews. “I am happy that I have my daughter. It makes you put more effort into getting well if you’ve something to get well for” (Diaz-Caneja and Johnson, 2004) Thinking about a baby, his or her future and how a mother could protect their dual relationships is one of the main concerns of pregnant women with a mental disorder. Sometimes women are afraid to get pregnant due to the hereditary risk, others underline that they want their children to have a normal childhood and not be stigmatized as a child of a ”crazy woman”. These mothers want to provide perfect care to their children but are not sure that this may happen due to the relapse periods. That makes them upset and discouraged thinking about the future. Like in one of the interviews done by Edwards and Timmons a woman said, “I had this vision of, picture of how I would be as a mother and I didn’t live up to that expectation, so it made me feel quite bad” (Edwards and Timmons 2005).
Generally, women appreciate the psychiatric service they got and named it as a “life-line” which helped them to cope (Myors et al., 2014). Women value attentive approach from the staff, their deep knowledge in the field of perinatal care, awareness about the work of other services which can provide care and help solving practical issues or interpersonal problems. Mothers with mental illness assert that they need special care which includes creating an environment where mother can get service being not separated from the baby, involving family members, providing information both about the psychiatric disorder and treatment process and advice on parenting and managing disorder through the most demanding first years after childbirth. Sometimes consistency of care is absent, but in the opposite case women feel that they always have someone behind their back and feel like care providers were their friends. Peer-support is requested by mothers for being not isolated and “obtain guidance about coping with parenting” (Diaz-Caneja and Johnson, 2004). Summarising, a non-judgemental paradigm in communication and a wide approach to care should be the main principles of service for new mothers with mental disorders.
It is questionable sometimes whether existing medical services can provide this level of care. But we can do at least something that does not require a lot of funds. These women need an explanation of what will happen with them and with their children, get information about obstacles they may meet in their new life after a child is born and advice on how they can cope with it and where to find support. It is important to include other family members in the process and they can be not only fathers of a child but also other people. Depends on the culture and women’s family situation that can be her parents, siblings and even friends. Moreover, the non-judgemental approach costs nothing and is deeply appreciated by women and their family members. □