Pregnancy and childbirth are one of the most sensitive stages of a woman's life. However, as healthcare services continue to prioritize only the physical aspects, the mental health associated with it is being overlooked.

Due to social perceptions, lack of resources and lack of information, problems such as stress, anxiety and depression experienced by pregnant and postpartum women have not been identified in time. This has started to affect not only the mother, but also the child and the entire family.

A 34-year-old woman had had two miscarriages. This is why she was under a lot of mental pressure during this pregnancy. The thought of ‘I have to have a baby now anyway’ was constantly bothering her. The fear of getting older, delaying her career and worrying about what would happen to her job after pregnancy increased her anxiety. Now she has returned to normal after counseling.

Another 29-year-old woman also has the same problem. She faced depression after giving birth. Financial shortage, unstable behavior of her husband, already having other children at home and rejection from her family due to inter-caste marriage further weakened her mental condition. During the postpartum period, she began to have suicidal thoughts repeatedly. If she had not received treatment, the situation could have been even more dangerous. Eventually, she was diagnosed with anti-depressants.

A 23-year-old woman who had given birth had a different problem. She did not feel like taking care of her child, and sometimes even had thoughts of harming her child. Her husband would beat her up for not looking after her child. The marital relationship was deteriorating. The husband did not understand the situation of postpartum depression, which led to violence. Now, she is gradually improving with medication and counseling.

A working woman had to quit her job after giving birth. After giving birth, she stayed with her family. After returning home, she had to do all the work herself, and on top of that, the new routine of leaving work was stressing her. Because of that, her mental state was deteriorating. She was not only going through postpartum depression, but also personal and family dysfunction.

The above four incidents are only representative. These incidents show the mental health conditions faced by women during pregnancy and childbirth. The examples show that pregnancy and childbirth are not just physical issues, but are an essential part of mental health related to motherhood.

Mental health problems in mothers

Despite the increasing debate and advocacy on mental health in recent times, there has been little discussion about mental health related to pregnancy and childbirth. Such mental health problems can affect the growth and development of the fetus in the womb.

It can also have a negative impact on the physical, intellectual and emotional development of the child. Experts say that if not identified and treated on time, such problems can take the form of psychosis, self-harm, suicide and other complex health problems. This can negatively affect child care and create difficulties in the development of the intimate relationship between mother and child. Problems can also occur in marital life and family relationships.

Many people may experience stress due to various physical and social changes during pregnancy and childbirth, which is considered normal to some extent. If such stress continues for a long time and begins to negatively affect physical health, daily activities, family and marital relationships, and even the workplace, it may be a sign of mental health problems related to pregnancy or childbirth.

Lack of necessary support from husband and family, getting pregnant at a young age or in adolescence, unplanned or unwanted pregnancy, being affected by violence now or in the past, financial deprivation, experiencing personal or family tragedy, having mental health problems before pregnancy, and sad or frightening experiences in previous pregnancies (miscarriage, health problems of the newborn, death of the child or other complications) can cause mental problems during pregnancy and childbirth.

According to Dr. Pratishtha Ghimire, a psychiatrist working at the Mental Health OPD of Paropkar Maternity Home and Gynecology Hospital, many pregnant and postpartum women suffer from anxiety and depression. The hospital has started an OPD service for mental health services for pregnant and postpartum women since Asoj 20, 2081. This service is available only in this hospital at the government level. 6 to 7 people come to the OPD for consultation daily, and 15 to 20 mothers who have already given birth are given psychosocial counseling every day.

The hospital has been working on daily conversations with service recipients, training midwives about such symptoms, training in stress management, counseling and treating referral cases, and screening mothers who have had children in the intensive care unit.

While cases of stress and anxiety are seen during pregnancy, cases of anxiety and depression are more common in OPDs after delivery. Many come with symptoms such as fear, panic, restlessness, negative thoughts about the future, fear that something has happened to the baby, sleeplessness, and a feeling of heaviness in the body, says Dr. Ghimire.

According to psychologists, mental problems are increasing as women cannot bear the social pressure to become the 'so-called best mother'. In some cases, it has been found that they even have thoughts of suicide. 'Many women do not want to ask for help. They cannot say it even if it is difficult. They are more stressed out by the fear that they will be considered a bad mother or blamed for not fulfilling their duties when they express their mental problems,' says Dr. Ghimire.

Many people's problem: Anxiety

According to the World Health Organization (WHO), around 10 percent of pregnant and 13 percent of postpartum women worldwide are affected by some form of mental health problem. The situation is even more serious in developing countries. There, 15.6 percent of pregnant women and 19.8 percent of postpartum women experience mental health problems.

In severe cases, the mother's pain can be so severe that she may even commit suicide. In addition, affected mothers cannot properly fulfill their daily roles and responsibilities. As a result, the growth and development of children may be negatively affected. However, treatment of mental health problems during pregnancy and motherhood is possible.

In Nepal, the rate of suffering from mental health problems during pregnancy and postpartum is high. According to WHO statistics, 15.6 percent during pregnancy and 19.8 percent during postpartum period, due to which maternal suicide has become one of the leading causes of death among women of reproductive age. Similarly, intentional self-harm accounts for about 6 percent of total maternal deaths.

How to recognize the problem?

Since there is little discussion and debate on this issue, women only reach the hospital when complications arise. Women can experience mental problems for 3 months to a year after giving birth. Dr. Trishna Bista, a psychiatrist at the Lagankhel-based Mental Hospital, says that 99 percent of women experience 'postpartum blues'. That is, they feel happy and sad at times, restless, irritable, and have 'mood swings'. She says that to experience postpartum depression, you have to go through a moderate to severe stage.

'There may be complex symptoms such as wanting to harm the child and oneself, showing strange behavior, playing games in one's mind, and having strange feelings,' says Dr. Bista. According to her, if the symptoms have been felt for more than two weeks, one should see a health worker as soon as possible. Symptoms include being very worried and thinking, losing interest in things that used to be fun, feeling hopeless, helpless and worthless, feeling scared, panicking, and being anxious. She suggests that if you have trouble sleeping, not wanting to eat, not being able to cope with normal stress in life, blaming yourself for any adverse situation, feeling like crying or crying, feeling constantly tired, having thoughts of harming the child or yourself, or having difficulty doing regular activities at home and at work, you should see a health worker.

Mental and physical changes naturally make it more difficult for women than before. Dr. Bista says that the appearance of mental problems after childbirth also depends on the nature of the woman before that. 'Was she prone to panic, stress, and inability to resolve problems? It also depends on her behavior and nature. Along with social and economic conditions, the relationship between husband and wife also increases the possibility of mental health problems,' she said.

Support from husband and family is needed

Women need the support of not only their husbands but also all members of the household during pregnancy and childbirth. Although women have to take all the responsibility physically, experts say that family members should support them in other matters.

Dr. Pratishtha Ghimire says, 'When things are difficult, they should be understood and listened to. When new responsibilities are added, a mother's daily life changes. Mothers should be allowed to sleep and rest. Along with the child, the mother should also be taken care of. Also, pregnant and postpartum women should learn to ask for help.'

She suggests that since it can feel difficult to stick to a regular schedule, she should also engage in other activities. 'You should walk outside, eat nutritious food, meditate and do yoga. Hormones are changing. I should be determined that I can deal with some of the normal symptoms on my own. I should understand how to accept the changes that have come in me,' she says.

According to experts, it is easier for women to deal with such problems if they have the support of family members, especially their husbands. Working women especially have to compromise on many things. Earlier, when they lived in joint families, the father/mother would look after the children, which made things easier for the couple. Dr. Trishna Bista says, 'We say that only women go through mental problems after having a child, but men also experience it. Both have disturbed sleep, and their eating and drinking habits and their entire daily routine change.'

It is not only women who have compromised in the parental role, men are also fulfilling that responsibility. If women do not support them, men can also face problems. In this situation, both should support each other. 'Set realistic goals,' suggests Dr. Bista, 'you cannot achieve everything in life. You have to compromise on something. Try to give yourself time too. Learn to enjoy the moment you have. Learn to say that I have this problem.'

At first, the main attraction during pregnancy is the woman. It is the subject of everyone's inquiry. After having a baby, all the attention goes to the baby, which can make the mother feel lonely. This problem is also seen in many women. Dr. Bista says, 'Don't give birth to a child until you are mentally ready. Don't give in to the influence and pressure of society.'

According to Dr. Ghimire, there is still not enough public awareness about the possibility of mental health problems during pregnancy and the days after. 'Mental health itself is not a priority, and mental health during pregnancy and childbirth is even more neglected. If you don't take it seriously and consider it normal, accidents can occur,' she says.