Why does maternal mental health matter?

It is widely accepted that mental health is a product of both biology and environment, and the ways in which the two interact. However, some may be surprised by how early in life this begins to be the case.   Recently,  studies have suggested that our experiences in-utero can begin to shape us neurologically in a way that can have lasting consequences (Talge, Neal, & Glover, 2007).

For the sake of simplicity, let's imagine a mother and baby.

This is Sandra.  Sandra would describe herself as usually being "a bit of a worrier", and is having a stressful time at the moment.  As a result, she is feeling quite anxious and depressed.  She is not alone.  Up to 13% of women experience depressive episodes during pregnancy or within their baby's first year (Swinson, 2005).

Sandra's current mental health is associated with a biochemical imbalance.  Her norepinephrine and cortisol (stress) levels are high, and her dopamine (reward and pleasure) levels are low.  She is feeling sick with anxiety and eating less than usual.

Inside Sandra is her unborn child, Billy.  Billy is exposed to his mother's hormonal imbalance, and his behaviour becomes dysregulated.  His levels of activity, sleep pattern, and movements are not typical of a foetus at this stage of development.  His heart rate is also different, and he responds less to vibratory stimuli.  As a baby of a depressed mother, Billy is at risk of being born prematurely with a low birth weight, with consequences for his later development (Gold & Marcus, 2008).

At birth, Billy's sleep pattern is not predictable or settled.  He is less responsive to the facial expressions of others, and his own facial expressions tend to be sad or angry.

Sandra is still feeling depressed, and varies between being withdrawn (emotionally, and physically), and being overly intrusive (fussing, or interfering with Billy in a way that makes them both feel irritable).  Billy is not sleeping well and Sandra is frustrated and exhausted.  Whenever she looks at Billy he looks miserable, and he seems more comfortable with her when she is sad than when she is happy  (Field, 1998).  

If things continue like this for Sandra and Billy, Sandra may feel more and more defeated and less able to parent Billy, who in turn will feel and show more distress. Intervention is needed.

One recent study found that something as simple as music and massage therapy for both mum and baby can reduce levels of cortisol and norepinephrine in both, leaving mum more receptive to being coached to engage with her baby in a more positive way, with a resultant improvement in their relationship.

New mothers suffering with mental health problems may also need the support of their partner, friends, family, or a healthcare professional, and may even consider taking medication to reduce their symptoms.  Existing mental health problems can be exacerbated by pregnancy and the transition to parenthood, and first episodes can also occur.  The evidence suggests the impact of maternal mental illness on an infant is buffered by the input of a stable caregiver, for example, the child's father.

Sandra and Billy try music and massage, and Sandra confides in a friend and her healthcare visitor about how she feels.  She is supported to try relating to Billy in a different way, and to enjoy her time with him more.  Her partner ensures she has time for herself, during which she naps or pursues a hobby.  Both Billy and Sandra feel less stressed, his sleep settles into a more organised pattern, and he steadily gains weight. Both parties are happier and more connected.  The intervention came at the right time for Sandra and Billy.

But what happens when the relationship between infant and caregiver continues to be difficult?  This is where attachment styles comes into play.

The Bear xXx