Pregnant and depressed

The relationship of a mother with her unborn child is paradoxical. Two bodies in one, one inside the other. A symbiotic relationship, with the mother as the life force for the child. Willy nilly, the mother is drawn into a union with another being, that literally feeds on her. It is a time of change, spiritual and physical. The mother’s body will never again be the same as it was before. Nor will her mind. The "silver cord" that binds her to her baby will never be severed.

This is a time when fact and fantasy play together. As the woman’s body alters to accommodate the new life, she imagines the child she carries. When the child is born she has to relinquish the fantasy baby. The real and the unreal change places.

The Conception – real and symbolic changes

The circumstances of the conception, of course, play an important part in how the woman will enjoy her pregnancy. It may come as a surprise, or be the fulfilment of a childhood dream. It may feel like an invasion of her being, or as a wonderful gift that fills an aching emptiness. This may be a first pregnancy, or an extension to the family, the first pregnancy with a new partner, or a "replacement" baby after a miscarriage or previous loss. It may be the sequel to a "one night stand" or the result of a rape. It may be a longed-for result of fertility treatment.

The woman may have planned the pregnancy, as an attempt to undo the past, or re-frame the future. She may have become pregnant in order to please someone else, or to beat her biological clock, or as an attempt to improve her marital relationship. It may be a pure, creative urge, or the result of wanting to feel "special". She may have a steady partner, or she may not. Whatever the background to the pregnancy, the impact is huge, physically, psychologically, socially and spiritually.

New Body, New Self

No longer can she call her life her own; she is the curator of another, the creator of new life. Her being has been taken over. Wondrous and scary, such responsibility limits with each passing day her freedom of choice. The baby is omni-present, affecting her biological and spiritual being at every level – what she eats, her thoughts, her sleep, all her activities … A new identity in every way.

And with the new identity, the woman is herself reborn. New fears and anxieties are triggered, many of them dating back from her own pre-verbal experiences. And with these, inevitably, are concerns about the well-being and perfection of the unborn child, and apprehension about the birth experience, about doing it right, about being a good enough mother.

Emotionally and physically, the woman is changing as her hormones and other bodily functions adapt to the stresses of the pregnancy. She may or may not be in good health, or have an "easy" pregnancy. Certainly, she will feel tired, and often uncomfortable, and be what psychologists call "emotionally labile", her moods swinging from tears to laughter, from feeling powerful and in control to incredibly needy and dependent.

As the baby grows, her body and her appearance change, even her balance and her hair are different. She may have the well-vaunted "glow" of pregnancy, or she may not. The trimesters each bring their characteristic challenges and rewards, the nausea, fatigue and emotionality, the wonder of feeling the first flutterings of life, the discomfort of being jabbed in the ribs and woken in the night, the slow, inevitable move towards recognising the baby as separate.

And relationships change, as the woman joins the "in" group of those women who have given birth. She and her partner are pregnant; they are grown-up, will have to accommodate new roles. Their sex lives will be different, and will continue to be so for some time after the baby is born. (It is very unlikely that sexual relations will be "back to normal" six weeks after the baby is born, in spite of the popular myth. It may take many months before the mother feels that her libido is as it was before; the new father may take a while before he feels comfortable with his "mothering partner".)

Other women treat the pregnant woman differently. If she is the first of a group of friends to become pregnant, it may isolate her to some extent. She enters a new level of relationship with her own parents, no longer just an, albeit adult, child/daughter. If her parents are deceased or far away, the chances are that she will miss them greatly at this time. She is very vulnerable.

Vulnerability

At a deep, unconscious level, it seems, memory traces of primitive experiences are awakened, often impossible to explain logically, and surfacing in dreams and inchoate memories. The spiritual awareness of the life force, of the beginnings and ends of life, of what we are in this world, of what the future holds, of what our religious and philosophical beliefs tell us – all this are triggered during pregnancy. And these react on us as we deal with other people in our daily lives, whether or not we are conscious of it. Again, our relationships with friends, partners and parents are affected by our differentness.

Tender psychological issues are touched on: feelings about her body image may resonate on reasons for the experience of eating disorders, for example. Primitive, childish fears or memories of abandonment often resurface at this time. The pregnant woman needs, more than ever before, to feel safe and secure and supported by those around her.

She will have dreams about this baby, imagining how it will look, what talents it will have, worrying, perhaps about the possibility that it will not be perfect. More than anything, the woman will want to be the best mother in the world. To do it right. Even at this stage, the fear of making mistakes and the consequent guilt will probably haunt the pregnant mother. No wonder she feels fragile at times. No matter how happy she is to be pregnant, she will also be scared: that’s part of the paradox.

Case History:

For 90% of women, pregnancy is a time of hopeful expectation, of excitement, and preparation for the birth of a new member of the family.

"When I found I was pregnant at last, I just couldn’t believe it. From the time I was a child, all I had wanted was a baby of my own. While my friends were assembling scrapbooks of horses, gymnasts and Princess Diana, I collected pictures of babies. I loved my husband. We had a lovely home, enough money. We were ready to have a family.

I expected the dreaded morning sickness, and it didn’t come. Only in the evenings, while I was preparing dinner, did I occasionally feel a touch of nausea. Apart from this, I felt fine physically, except for feeling tired a lot of the time. Why, then, was I not happy? Why did I wake in the wee small hours, rigid with panic? Why did I feel scared and resentful when my husband called to say he had to work late at the office? Or was stopping off for a quick visit to his mother? Or went, as always, to play golf on Sunday morning? Why, after so many years without her, did I miss my mother? (She died when I was fifteen, after a long, painful illness.)

"It’s just my hormones. I shouldn’t be feeling like this. I must be abnormal. I feel so ashamed…. Better not tell anyone".

I lost my appetite, but the baby grew. My gynecologist was concerned that I was not gaining enough weight. Still I was tired, but could not sleep. I lay awake, worrying that the baby might have something wrong with it; that my husband would leave me; that he was having an affair; that he didn’t love me, now that I was losing my figure. He could do nothing right, no matter how he tried to please me. I was irritable, and withdrawn, and felt low, low, low.

I knew that it wasn’t meant to feel like this. Why was I being punished? I prayed, but nobody heard me. I went through the motions of doing what I had to do. I felt like a robot. And I cried. I cried for myself, and for my baby. Poor little baby. It did not deserve a mother like me."

What are the facts?

It is estimated that at least one in ten women are the victims of ante-natal, or ante-partum, depression. If depression during pregnancy is so common, why is it not talked about? The popular view, as we all know, is that it is a time of fulfilment for a woman, of preparation for the "happy event". And so it is for many of us; but for the unfortunate one-in-ten, it can be one of the most disappointing experiences of her life.

Who is vulnerable for ante-natal depression?

Opinions are divided, but it seems that many factors interact.


What to do?

Understanding PND

Help for Family and Friends

Help for Depression in Pregnancy