By PANDA (Perinatal Anxiety and Depression Australia)
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Antenatal depression image credit Creatista | Dreamstime.com
 
Emotional changes often go along with the physical changes of pregnancy. But antenatal depression is different from other emotional changes. It includes negative emotions that last longer than two weeks and interfere with your ability to function in everyday life.

Emotions during pregnancy

Pregnancy is a time when there can be many expectations about how you should feel. People might say things like ’You must be so happy’, or ’How exciting for you’.

But you might be experiencing some uncertainty too. For example, the timing of the pregnancy might mean that career or long-term goals will be delayed or might create financial problems. If you feel uncertain about your new role as a parent or have fears about the pregnancy or how you will cope with labour and birth, this might add to feelings of guilt about being unhappy, because everyone might expect you to be happy.

These emotions are not unusual, and are part of the common changes in emotion associated with pregnancy.

If you’re feeling suicidal, disoriented and unable to handle daily life, or if you’re having panic attacks, talk to your doctor or midwife straight away. You can also phone Lifeline on 131 114, 24 hours a day, 7 days a week. Seeing a counsellor or psychiatrist is not a sign of weakness – it’s a sign that you are taking steps to keep yourself and your baby safe and healthy. 

First trimester: emotions and mood changes

Mood swings tend to be most pronounced in the first 12 weeks of pregnancy, alongside the many physical changes such as fatigue, nausea, vomiting and breast tenderness.

Emotions can be unstable, and feelings of low mood are not uncommon. These mood swings can range from great joy to deep despair. Sometimes you might become tearful without knowing the cause.

Changes in the hormones oestrogen and progesterone can contribute to mood changes early in pregnancy.

Video Changes during pregnancy: first trimester

This video is about the physical and emotional changes you can expect in the first trimester of pregnancy. Mums and dads tell us what the first 12 weeks were like, how they felt and what they worried about. A midwife says it’s important for expectant mums and dads to look after themselves.
 

Second trimester: emotions and mood changes

The second trimester is generally more smooth.

Morning sickness generally passes and worries about miscarriage tend to lessen. From about the 20th week of pregnancy you might be able to feel the baby move. This realisation that the baby is real can bring feelings of excitement about the pregnancy.

There is often an increase in energy and wellbeing in the second trimester.

Video Changes during pregnancy: second trimester

In this video some mums describe how they felt during the second trimester of pregnancy. A midwife says nausea and tiredness might ease. Women will look more pregnant and feel that the pregnancy is really happening. One dad says seeing his partner’s belly helped him start forming an attachment to the baby.
 

Third trimester: emotions and mood changes

The third trimester often brings anxiety about the birth, especially if you have had a previous difficult birth, or if this is your first child and you don’t know what to expect. During the final weeks of pregnancy, these anxieties and fears might increase.

You might also be concerned about the reality of becoming a parent and changes in relationships with others, including family members. You might experience sleeplessness, and it might be difficult to find a comfortable position. Some women feel particularly vulnerable to rejection, loss or insult at this time.

Video Changes during pregnancy: third trimester

In this video parents and a midwife talk about physical and emotional changes in the third trimester of pregnancy. Mums often have indigestion and back pain and need more rest. Check-ups are more frequent and baby moves around more. One mum says she became less scared of the birth and more excited about meeting her baby.
 
Antenatal appointments are your chance to talk about your health, lifestyle and wellbeing, both physical and emotional. If you’re worried about becoming a parent or there are problems in your relationship, including family violence, it’s a good idea for you to talk about this too. In fact, most antenatal services ask you about domestic violence during pregnancy. This is so you can get support if you need it.

Antenatal depression symptoms

For about 10% of pregnant women emotions like fear, anxiety, concern and unhappiness experienced during pregnancy can become overwhelming and hard to shift. They are different from the usual emotional changes if they last longer than two weeks and interfere with your ability to function in everyday life.

Antenatal depression is often overlooked because it’s hard to identify and is less well understood than postnatal depression.

You might be experiencing antenatal depression if you experience:

  • inability to concentrate and difficulty remembering
  • difficulty making decisions or achieving everyday tasks
  • anxiety and panic attacks
  • emotional numbness
  • extreme irritability
  • a desire to avoid family and friends
  • sleep problems
  • extreme or unending fatigue
  • a desire to eat all the time or not to eat at all
  • weight loss or weight gain not related to pregnancy
  • loss of interest in sex
  • a sense that nothing feels enjoyable or fun any more
  • feelings of failure or guilt
  • persistent sadness
  • thoughts of death or suicide.

Pregnancy can stir up some strong, deep and unexpected emotions and issues for women and men. In fact, men can experience antenatal depression too.

Factors that contribute to antenatal depression

Pregnancy hormones might contribute to the emotional ups and downs that affect most pregnant women.

Here are some other factors that can contribute to the development of antenatal depression:

  • Family or personal history of depression: if depression runs in your family, or if you have had past episodes yourself, you might be more likely to become depressed.
  • Stopping prescribed medication: there can be a worsening of symptoms if you stop taking medication for a pre-existing mental illness because of the pregnancy, especially if you stop suddenly.
  • Relationship difficulties: difficulties between you and your partner or significant others, or fear of a lack of support when your baby is born, can have a major impact on your emotional wellbeing.
  • Stressful life events: any major life change, such as a move to a different home, divorce, job loss or death in your family can contribute to depression.
  • Problems with the pregnancy : a pregnancy with a lot of medical checks, problems or illness, such as severe morning sickness or pain, can take its emotional toll.
  • Infertility or previous pregnancy loss: if you experienced difficulties getting pregnant, or have had a miscarriage or stillbirth in the past, you might worry about the safety of this pregnancy.
  • Unplanned or unwanted pregnancy: the timing of the pregnancy might cause significant stress if you weren’t planning the pregnancy or you aren’t in a relationship.
  • Past history of abuse: pregnancy can trigger painful memories in women who have survived emotional, sexual, physical or verbal abuse.
  • Lack of social support: feeling unsupported when you’re facing the changes that parenthood will bring, or social isolation, can contribute to depression.
  • Financial difficulties: financial problems can significantly increase the amount of stress you feel during pregnancy.

Effects of antenatal depression on the baby

There is a growing body of research that indicates that being stressed, anxious or depressed during your pregnancy is not ideal for your baby.

Changes to the baby’s heart rate and its responses to stress are thought to result from severe and untreated antenatal depression, but more research is needed.

Consideration for the wellbeing of the baby needs to be given when making decisions about the treatment of antenatal depression to avoid these impacts.

Antenatal depression: what you can do

Early treatment of depression and anxiety is the most effective path to recovery. Putting up with your feelings for too long can make it harder to shift them as the birth gets closer.

Here are some things you can do:

  • Take it easy. You don’t need to need to set up a special room for the baby, clean the house, or work as much as you can before you go on maternity leave. Make some time for yourself, read a book, have breakfast in bed, or go for a walk. If you already have children, arrange for family or friends to look after them for a while so you can have some time to yourself.
  • Eat well and exercise. Taking care of yourself is an essential part of taking care of your baby. It can be hard to eat well or exercise when you feel sick and uncomfortable. Try small frequent meals throughout the day and regular gentle exercise like walking or swimming.
  • Include your partner if possible. Your partner might be able to detect that you have changed, even before you realise or admit that something is wrong. Your partner is likely to be worried about the pregnancy and how life will be, alongside concern for you. It’s a good idea to talk openly with your partner, because you need your partner’s support. Your partner can provide support only if you share how you’re feeling. Encourage your partner to find out about antenatal depression and how best to support you.
  • Talk about how you’re feeling. Give your friends and family the chance to be supportive by talking to them about your fears and worries. Once you start talking, you might be surprised how many people have had similar experiences. You might like to involve them in planning some support, like help with meals and shopping, for after the baby is born.
  • Let your midwife and doctor know. Tell the people who are caring for you during your pregnancy about your thoughts and emotions. They can help you to understand what is happening, give or arrange support and check in with you at different points during pregnancy.
  • Seek counselling. If you’ve tried to work through things on your own but nothing seems to work, seeing a counsellor could help. You need to find someone you feel safe with and can trust.
  • Talk with your doctor about antidepressants. You might benefit from antidepressant medication, especially if your wellbeing and your baby’s wellbeing are at risk. You might be hesitant to take medication during your pregnancy, but there are some antidepressants that are safe for pregnant women. Talk to your doctor or midwife about the possibilities.
  • Find out about postnatal depression. You won’t automatically develop postnatal depression, but it can happen, so it’s important to know what to look for if emotions like fear, anxiety, concern and unhappiness continue after the birth of your baby. Again, let your midwife and doctor know how you’re feeling so they can help you find the supports you need.

What will happen after the baby is born?

Antenatal depression does not mean that you will have postnatal depression. About half of women who suffer from severe depression during pregnancy go on to develop postnatal depression.

Therapy from a counsellor or psychologist during pregnancy can greatly reduce your chance of developing postnatal depression. Putting in place a support network – which might include family, friends, your doctor, a counsellor and perhaps a support group – before the birth can make the time following birth much easier.