Sometimes when new mothers experience mental disorders, it leads to feelings of guilt about being “a failure” and the development of (usually unfounded) worries that it might lead to removal of the child. This may relate to the idealisation of motherhood in society; that there has arguably become an expectation that women experience “uninterrupted joy and rewarding sacrifice”.
And while there is not yet enough research on the impact of COVID-19 on maternal mental health, many aspects of the pandemic – such as social isolation, reduced face-to-face healthcare, worry over infection – may have made the last year particularly hard for new mothers.
Mental disorders during pregnancy or the year following childbirth – which together are known as “perinatal” mental disorders – affect around one in five women. In fact, those mental disorders that don’t involve symptoms of psychosis are one of the most common of all possible complications of childbearing.
The most common mental disorder childbearing women experience is depression, often with anxiety. Despite the common societal notions about motherhood, the evidence suggests that childbearing is not protective against depression. At any point during pregnancy and the first three months after birth, around one in ten women will experience it.
Although the term “postnatal depression” has become increasingly familiar over recent years, around a third of cases start in pregnancy. Of women depressed in pregnancy, around a third will have been depressed before they got pregnant.
There is no single cause for perinatal depression. Many factors are thought to contribute but the pathways are not fully understood.
The major psychological contributor is a prior history of depression. The biggest social contributors are experiencing domestic violence, low socioeconomic status and major negative life events. Biologically, women with genetic predisposition, chronic physical illness and more children appear to be at higher risk as well.
Aside from the distress of depression itself, untreated persistent depression can be associated with long-term implications for the physical, emotional and cognitive development of the child, although these effects are not inevitable.
Although rare, suicide among new mothers is a leading cause of death in the year following childbirth, particularly among women who are experiencing mental illness.
Despite this, it is important to note that most current evidence is based on data that wasn’t collected by following women and children longitudinally over time, so inferring cause and effect is difficult. The mechanisms of any link between perinatal depression and child development are poorly understood. The idea that a woman’s behaviour may negatively impact her child has been highlighted as a facet of “mother blaming culture” – the pathways involved are of course far more complex.