Health Information Woman Health

She's pregnant! How can I take care of her feelings?

Index

• She's pregnant
• The journey from pregnancy to birth
• Antenatal emotional changes
• Postnatal emotional changes
• Main risk factors of postnatal depression
• Early identification
• Preventing antenatal or postnatal depression
• I need to take care of myself too
• Ways to seek help
• Related information

She's pregnant …

• As a father-to-be,

  you might worry about your partner's health and safety during her pregnancy.

• As a new father,

  you might be so overwhelmed by the baby care routines that you have no time to attend to your partner's emotions, or even your own.

• As grandparents,

  you could be carefully preparing lots of nutritional food for the new mother.

• As a friend,

  you would advise the new mother to take more rest.

Whether you are her family member or friend, taking care of the mother's physical health as well as her mental health before and after giving birth is equally important.

Research shows that, if the mother maintains healthy mental well-being throughout pregnancy, she will be more capable to cope with the emotional and physical changes during pregnancy and the stress in baby care. With the mother's healthy mental well-being, the fetus will develop healthily into a child with more stable emotions and behaviours. Furthermore, the father will be better able to cope with the changes after the birth of the baby. Hence the new parents can build a happy and healthy family together.

This booklet will help you understand the emotional changes a mother undergoes before and after giving birth, and how to seek help in times of need.

The journey from pregnancy to birth

From getting pregnant to giving birth, the father's and the mother's thoughts and feelings could be positive or negative with various manifestations. Such thoughts and emotions are all natural and there is no such thing as right or wrong.

The starting point : We'll have a baby soon!

• Keen anticipation (Finally, our love has come to fruition!)
• Annoyed (My mother-in-law said, “You should…”; I am not supposed to eat…? I should eat more healthy food…?)
• Nervous (Natural delivery or cesarean section?；Will the baby be cared by my mother-in-law or myself?；Should I hire
  a maid or Pui Yuet?)

I'm in labour!

• Sweet (My wife is bringing a new life to the world! It's a daunting task and she's doing a wonderful job!)
• Excited (After this long wait, my baby is finally here!)

Baby is born!

• Sweet (Look, baby is smiling! Look, baby is moving!)
• Missing baby (I can't wait to finish work and go home to see my baby!)
• Irritated (Why is my baby crying all the time? Baby won't stop crying no matter what I do.)
• Confused and helpless (People got a lot to say about caring for my baby.Taking care of a baby is not easy indeed!)
• Anxious (My life is turned upside down! I have zero time and space for myself.)
• Disappointed (After delivering the baby, my wife seems to have lost interest in sex completely…)

Time flies! Our baby is already a few months old!

• Satisfied (Baby is 6 months old! Her reactions are super cute!)
• Heart-warming (Despite the incredible challenge of caring for a baby, just watching him grow up every day makes it all worthwhile. All the challenges are left behind.)

Antenatal emotional changes

Father: My wife and I have always wanted a baby. How can she possibly be depressed?

Mother: I have heard a lot about postnatal depression, but nothing about antenatal depression!

• Pregnancy is full of excitement and anticipation. Nevertheless, we should not overlook other emotions a mother might experience during different stages of pregnancy and after giving birth. Some of these emotions include anxiety, confusion, helplessness and irritability.
  
• Apart from postnatal challenges, mothers might also experience emotional problems at antenatal stage.
  
• Let's take a look at the antenatal emotional problems and their effects, as well as tips for caring for the mother's mental health during pregnancy.

Antenatal mood problems:

• Pregnant women often experience a number of physical changes, even discomfort, so her lifestyle needs to be adjusted accordingly. This adjustment might also affect her emotions. She may be worried about the fetal development or the childcare arrangement after delivery. Along the journey of pregnancy, mothers sometimes suffer from various emotional disturbances. It's important for family and friends to pay attention to the mother's emotions.
• Generally speaking, it is common for people to have different emotional responses to changes in life. However, if any low mood or anxiety persists for more than 2 weeks and the mother's daily functioning is significantly affected, she might be suffering from antenatal depression.

The effects of antenatal mood problems:

• If a woman suffers from emotional problems, her mental state, daily functioning, work performance and even relationship with her partner might be affected.
  
• Antenatal emotional problems could have potential impact on the development of the fetus. Mothers suffering from antenatal depression may have a higher chance of miscarriage or preterm birth. Furthermore, research findings suggest that mothers who have antenatal depression or anxiety during pregnancy are more likely to have babies with difficulties in emotional regulation and behavioral control.
  
• Mothers with antenatal depression or anxiety may also have a much higher risk of postnatal depression.

Caring for pregnant women:

Family and friends may go to the chapters on "Early identification" and "Preventing antenatal or postnatal depression" for details on caring for the emotional health of mothers-to-be.

Postnatal emotional changes

Mother A: I feel exhausted all the time and have poor appetite… Sometimes I worry about the baby not eating enough, not feeling well… Am I suffering from postnatal depression?

Mother B: I am fine. Everybody feels agitated and irritated after giving birth. I just need to get some sleep and rest, then I will be fine!

• Is it normal to experience emotional fluctuations after giving birth? At which point it would be considered as postnatal depression? What are the symptoms of postnatal depression?
  
• Let's learn about the prevalence, symptom and management of various postnatal mood problems.

Mothers may have a higher risk of suffering from mood problems due to the hormonal changes, role changes, the challenges in baby care and family issues after childbirth.

There are 3 categories of postnatal mood problems:

1. Postnatal Blues
2. Postnatal Depression
3. Postnatal Psychosis

Each of them has its prevalence, clinical presentation, level of severity and management.

1. Postnatal Blues
   • Emotional disturbance affects 40 - 80% of postnatal women.
     
   • It usually appears within 3 - 5 days after childbirth.
   • Symptoms include mood swings, frequent weeping, insomnia and irritability. It is a transient state and symptoms are relatively mild.

   Management: With proper care and support, the symptoms often disappear spontaneously within days.

2. Postnatal Depression
   • The prevalence of postnatal depression is about 13 - 19% globally. In Hong Kong, one out of ten postnatal women suffers from postnatal depression.
     
   • The postnatal depressive mood may emerge without notice, and may gradually become severe. The onset of symptoms is
     usually within 6 weeks, but can also occur any time within a year after childbirth.
   • If the following symptoms persist for more than 2 weeks, the likelihood of suffering from postnatal depression is high:
     
     • In a low mood most of the day, almost every day, such as feeling depressed and sad, crying without apparent reason
       
     • Loses of interest in things she used to be interested in (even loses interests in the baby)
     • Loss of appetite
     • Insomnia or early morning awakening
     • Fatigue and loss of energy for most of the day
     • Difficult to concentrate and make decision
     • Feeling guilty, worthless and hopeless
     • Excessive worries and irritability

   Management: If the condition is identified early with timely treatment and support from the family, most mothers can recover from postnatal depression.

3. Postnatal Psychosis
   • This is a rare condition which only affects 0.1 - 0.5% of postnatal women.
     
   • The symptoms are usually severe and presented abruptly within 2 weeks after delivery.
     
   • There are 3 main types of symptoms:
     • Auditory hallucinations (hearing non-existing voice)
       
     • Bizarre thoughts of being harmed by others
     • Ideas of self-harm or harming the baby

   Management: Postnatal Psychosis is a psychiatric emergency. Urgent referral to a psychiatrist or attending Accident and Emergency Department of hospital is necessary.

Main risk factors of postnatal depression

Father A: My wife had postnatal depression before. Now that she's pregnant again, will she experience it again?

Grandma: My daughter has always been tough. I don't think she will have postnatal depression.

Father B: My mother is coming to help, and we have a Pui Yuet and a maid – we really have a lot of help! We don't have to worry about our finances either. How can my wife possibly suffer from depression?

• The exact cause of postnatal depression is unknown. Research has shown there are multiple factors that could increase the risk of postnatal depression in women.
  
• Some of these factors can be prevented, or managed through early identification and proper treatment.
  
• Let's take a look at the main risk factors of postnatal depression.

Clinical factors

Psychosocial factors

• Anxiety-prone personality
• Lack of social support
• Significant problem in couple relationship
• Significant problem in in-law relationship
• Domestic violence
• Financial difficulties

Factors related to pregnancy, delivery and the baby

For example,

• Complications before and after delivery
• Emergency cesarean section
• Previous miscarriage and difficult conception
• Unplanned pregnancy or feeling ambivalent towards pregnancy
• Baby born with severe congenital diseases or preterm birth

Early identification

Father: Honey, you will be fine if you don't worry too much.

Grandma: My daughter is nervous all along. So, no need to pay too much attention to her!

• The comforting words from the new father or the grandparents are meant well, but they might have overlooked the possibility that the mother is suffering from antenatal or postnatal depression.
  
• If family members are more aware of the mother's condition, antenatal or postnatal depression can be identified early, thus proper help can be sought. By doing so, further worsening of mother's mood problems can be prevented and the well-being of the family will not be affected.
  
• Let's learn about how to identify early the signs of antenatal and postnatal mood problems.

As her partner, family member or friend:

• You can pay attention to the differences in the mothers' thoughts, emotions, behaviours and physical conditions before and after childbirth.
  
  • Her mind:

    She might have persistent negative thoughts, including questioning her ability, over-reacting to others' comments, easily affirming people's criticism directing against her, holding a negative view on the baby or on the future, over-worrying and excessively anxious ideas, etc.

  • Her emotions:

    Low mood, lack of energy, pessimistic, worried, anxious, feeling helpless, scared, nervous, doubtful, restless, irritable and mood swings, etc.

  • Physical condition:

    Insomnia, poor appetite, etc.

  • Her behaviors:

    Restlessness, having temper tantrums at trivial things, crying for no apparent reason, inappropriate behaviours such as constantly checking on the baby‘s breathing or on whether the baby is unwell.

• You can take the initiative to communicate with her to give her the chance to share with you her feelings and thoughts.

If these symptoms persist for more than 2 weeks either before or after the baby is born, and affect the new mother's daily functioning significantly, the mother should be encouraged to seek professional help as soon as possible.

Preventing antenatal or postnatal depression

Mother A: I love my husband helping in the house chores, changing diapers and bathing the baby without me asking.

Mother B: I wish everybody could see that I've already done my best. Sometimes I feel completely clueless about what the baby is crying for!

• Above are what some mothers hope their family and friends can understand. As her partner, parents or in-laws, what can we do to help prevent antenatal or postnatal depression for the mother? Let's take a look.

As parents and in-laws:

• We live in the modern era when new information leads to changes. The parenting practices are very much different from those in our old times. I will adopt an open mind to communicate with the younger generation and learn about their modern practices and lifestyles during pregnancy and ‘doing the month'. When the time is right, I may share my experiences and opinions with mutual respect. Having said that, I understand that they don't have to follow the practices in my times.
  
• Sometimes, I can also help out in caring the baby, so that
  the young parents can spend some relaxing intimate time together.

As partner, I can:

• Better prepare for the pregnancy, for example, make proper family and financial planning.
• Learn more about pregnancy, delivery and baby care with her to help reducing anxiety and setting realistic expectations for parenthood e.g. by participating in seminars and workshops on antenatal care and parenting.
  
• Work as a team with her to meet the demands of pregnancy, for example accompanying her to regular check-ups.
  
• Take initiative to share the responsibilities of household chores and baby care, so that she can take more rest.
  
• Take good care of her feelings. Try to understand the emotional changes she undergoes during pregnancy and after delivery. Allow her the time and space to express thoughts and feelings. Listen with patience and don't rush to give advice.
• Encourage her more; send her sweet words, text messages or notes to validate her efforts. For example, “I appreciate your efforts.” “Breastfeeding requires lots of energy and patience and you're doing a great job!”.
  
• Be considerate of her health conditions during pregnancy and after delivery and adjust your sex life accordingly.
  (For details, please refer to "Healthy Sex Life Before and After Childbirth" on the website of the Family Health Service, Department of Health http://s.fhs.gov.hk/svx7s)
• Encourage her to make time for leisure and rest, such as taking an afternoon nap, going for a walk, or meeting with friends.
  
• Sharing with other parents on experiences of pregnancy and baby care. It can also enhance social networking.
• Learn more about antenatal and postnatal emotional issues. Encourage her and accompany her to seek professional help in times of need.

I need to take care of myself too

Father A: Only women suffer from postnatal mood disturbances. How can men be affected, too? No way!

Father B: I am a strong and capable man, I can't possibly be affected by my emotions!

• Being a partner or a family member in taking care of an emotionally disturbed mothers-to-be or new mothers, it is common to feel stressed. Research findings show that if a mother suffers from postnatal depression, there is a higher chance for her partner to experience depressive mood too. Because of this, you should also take care of yourself while caring for your partner.

As a partner or family member, I need to:

• Set realistic expectations for myself. I am not a superman! It's impossible for me to solve all the problems or expect myself to be a “perfect father/ partner/ family member”.
  
• Accept my negative emotions. I may be upset too if she is suffering from antenatal or postnatal depression. For instance:
  
  • It's hard to believe that she is sick
    
  • Feeling guilty for her negative moods
  • Feeling frustrated about her reluctance to seek help
  • Worrying about her and the baby
  • Feeling helpless about the persistent condition of her mood problems…

  I need to accept all these feelings.

• Stay connected with friends and family. Finding someone I trust to share my feelings when needed could help me to relieve stress.
  
• Strengthen social support network and communicate with other parents. We will feel less lonely when knowing someone who face similar challenges.
  
• Maintain a healthy lifestyle. Don't smoke, don't drink. Make time for leisure activities and rest to relax.
  
• Focus on positive aspects and give myself credit. Try to appreciate myself and remind myself how much I've contributed to this family.
• Try to maintain the relationship with my partner. Sometimes, we could find a babysitter to allow us to enjoy some intimate time together.
• When I feel unable to relieve my stress, I should seek help from professionals.

Ways to seek help

Father: If my wife suffers from antenatal or postnatal mood problems, how can I seek help?

Grandma: My grandson is already 2 months old. His mother is still irritable, very nervous and cries a lot. Where can I go for help?

• You can make an appointment with a family doctor or her obstetrician for a preliminary assessment and management. If necessary, they will refer you to a specialist.
  
• Or you may arrange to see a private psychiatrist or clinical psychologist for professional assessment and treatment.
  
• You may also consider a social worker or a counselor for assessment or referral.
  
• If the mother suffers from mood problems after delivery, you may call the Maternal and Child Health Centre in your region to make an appointment with nurses for a preliminary assessment. Referral to appropriate services will then be made.

Related information

Counseling services and hotlines

Others

Listen and pay attention to the new mother

For emotional well-being tops all

Learn more about the whats and hows

Then seek help soon if mood problems persist

Listen and give encouragement to the new mother

The good dad will share the house chores

Grannies allow more space for the young parents

Together we will build a loving home