Maternal Mental Health – The 4th Trimester.

2018 is the 2nd year of a week-long, global social media campaign running 30th April – 5th May 2018.

Maternal Mental Health Awareness Week hopes to drive social change with a goal toward improving the quality of support & care for women struggling emotionally, socially and psychologically with the challenges of Motherhood.

Since 2016, a multidisciplinary group of International Maternal Mental Health activists, academics, clinicians and people with lived experiences have come together once a year to raise awareness to the topic of Maternal Mental Health and to drive demand for greater maternal mental health services universally.

Research shows that 15% – 25% women will experience Perinatal & Postpartum mental health issues, ranging from psychological distress to more severe psychiatric disorders. (NICE, 2014)

Maternal MHD can be caused by Biological factors (e.g. hormones) or Psychosocial stressors (e.g. lack of support) and when left undiagnosed or untreated, can have devastating effects on the mother, baby, surrounding family and society.

Arising in Pregnancy –

  • Adjustment Disorders
  • Depressive Disorders – 10 –15% women
  • Anxiety Disorders – e.g. General Anxiety Disorder; Obsessive Compulsive Disorder, Panic Disorder, Phobias

Arising in Postpartum –

  • Baby Blues – 80% of mothers will experience this in the first 3- 14 days after delivery. It is most often attributed to hormone imbalances, leaving the new mother experiencing sadness, crying episodes, hypersensitivity, mood swings. It commonly subsides without need for professional help.
  • Postnatal Depression – 10 – 20%. Pregnancy related Clinical Depression can range from mild to moderate or severe. Typically arises from 4 –6 weeks post birth as a worsening of the Baby Blues or may manifest more slowly over a period of several months.

Symptoms of PND

  • Deep despondency
  • Tearfulness
  • Feeling that you can’t cope with your baby
  • Exhausted but unable to sleep
  • Poor appetite
  • Excessive anxiety about your baby

Postnatal Anxiety & OCD – 15%

Symptoms of PAOCD

  • feelings of fear and worry which begin to ‘take over’ your thinking
  • feeling irritable, restless, tense or constantly ‘on edge’
  • racing heart/strong palpitations – sometimes panic attacks
  • reoccurring worrying thoughts such as that you are not doing things right and/or that something terrible will happen
  • unable to sleep – even when you have the opportunity
  • avoiding situations for fear something bad will happen
  • Unable to eat / have little appetite
  • Puerperal Psychosis – 1 /500 to 1 /1000 deliveries. Major psychotic disorder, more typically in first time mothers.


Drug treatments usually involve anti-depressants, which are not addictive. These drugs work slowly and improvement is gradual, but if you don’t feel better after a few weeks, ask your doctor for a stronger dose or a different drug. If you find your depression is worse just before or during your period, it may be worth asking about progesterone therapy.

Mothers with puerperal psychosis need to be treated by a psychiatrist. It may be possible to be treated at home, but hospital admission is usually necessary. Some hospitals have specialist mother and baby psychiatric units. Treatment is usually with anti-psychotic and anti-depressant drugs.

Maternal Mental Health in Ireland

Each year, in Ireland, some 40,000 women are diagnosed with Perinatal & Postpartum mental health illnesses and / or emotional crisis surrounding conception, pregnancy, childbirth or loss of a baby. Perinatal refers to the period immediately before & after the birth – approximately week 20 of pregnancy to week 4 after birth. Postpartum refers to the 12 months following the birth.  Research in Ireland shows 1 in 4 women suffer in the perinatal period and 1 in 3 suffer in the postpartum period.     (source

Finding Help

New Motherhood can quickly become an overwhelming experience, out of which for some, there can be seen little respite.

Asking for help can often be a challenging step. We have all heard the sage advice to accept help when it is offered. Especially in those first few months adapting to a new baby. Reaching out to family and friends, can be that first step.

However, for some, more specific and professional help is needed and it is advised to touch base with your family doctor (or attending obstetrician if recently pregnant) or your Public Health Nurse – or asking someone close to you, to do so on your behalf.

Suggested resources in Ireland are listed below and aim to offer guidance and support to both women and their families deal with these issues. NURTURE is an Irish charity, offering Mental Health support to women through / after pregnancy. They have counsellors nationwide. – Irish voluntary association with 92 Mental Health Associations nationwide, promoting positive mental health for all individuals and communities. – Nationwide support group, offering information, advice and friendship to those experiencing Postnatal Depression. – Parent-to-Parent voluntary support forum, offering advice all things pregnancy & postpartum.