Although pregnancy has typically been considered a time of emotional well-being, the World Health Organization states that 10% of pregnant women and 13% of women who have just given birth experience a mental disorder. A recent study showed that about 20 % of mothers in developing countries experience clinical depression after childbirth. This is much higher than the previous figures on prevalence coming mostly from high income countries. Suicide is an important cause of death among pregnant and post- partum women. Psychosis is much less common but may also lead to suicide and in some cases even harming the newborn.
Particularly vulnerable are pregnant women in developing countries since they are more exposed to risk factors which increase their susceptibility to develop mental health problems. Some of these include poor socioeconomic status, less valued social roles and status, unintended pregnancy, and gender-based violence.
Another susceptible group is women with histories of psychiatric illness who discontinue medications during pregnancy. In a recent study which followed a group of women with histories of major depression in pregnancy, of the 82 women who maintained antidepressant treatment throughout pregnancy, 21 (26%) relapsed compared with 44 (68%) of the 65 women who discontinued medication. This study estimated that women who discontinued medication were 5 times as likely to relapse as compared to women who maintained treatment. Although data accumulated over the last 30 years suggest that some medications may be used safely during pregnancy, knowledge regarding the risks of prenatal exposure to psychotropic medications is incomplete. Thus, it is relatively common for pregnant patients to discontinue or to avoid pharmacologic treatment during pregnancy.
Is it possible to be your own therapist?
If you are struggling with something like normal relationship challenges, residual pain from childhood, low mood, high anxiety, irritability, and intense stress, the answer is “yes”. There is a way to help yourself heal from painful experiences without seeking professional treatment. It’s called self-therapy, and it comes in many forms. (Note: more “traditional” strategies to treat depression in pregnancy have already been discussed in The Pulse here and here).
The three areas of mental health: body, heart, and mind
Emotional pain impacts the body, heart, and mind. Therefore, self-therapy strategies have been developed to address all three of these areas. Interestingly, it’s been found that targeting just one area (for example, the mind) will inevitably affect the other two (the body and heart)
Relaxing your body will reduce stress, lower anxiety levels, elevate your mood, and help reduce pain, illness, and stress-related physical symptoms. When your body relaxes, your mind relaxes, which makes it easier to process and endure stressful experiences. Labor coaches know this well: If, during a contraction, you tighten your body, they will encourage you to drop your shoulders, slacken your jaw, and unfurrow your brow. Doing this sends an instant message to your body to relax, which can thereby turn excruciating pain into tolerable pain.
Relaxation is also a necessary starting point for most types of emotionally based therapeutic strategies. Therefore, it is an excellent idea to have a few relaxation strategies in your “therapeutic toolbox”, such as:
- Breathe your way calm. Sit in a quiet place – preferably at a set time, like first thing in the morning or before bed. Then start to focus on your breathing patterns. A breath that is longer on the exhale and shorter on the inhale will have relaxing properties. You can also try other patterns, such as inhaling to a count of four, holding for a count of two, and then exhaling for a count of eight. Another option is to simple breathe in a comfortable breath and, when breathing out, think the number one (in words, image, and/or sound).
- Unwind with creative downtime. Have you noticed the plethora of adult coloring books in the market recently? There is a reason. Coloring, as with most art forms, can be very therapeutic. Other good hobbies: knitting or crocheting, which have been shown to reduce levels of the stress hormone cortisol.
- Relax your muscles on demand. This calming technique focuses on relaxing the body, muscle group by muscle group. Here is a typical relaxation “script” that yields faster and deeper results the more one uses it:
Sit or lie with eyes closed (preferable at bedtime).
Say the following instructions silently to each section of your body. Don’t proceed to the next muscle group until you start feeling that body part relax.
- Head, relax.
- Forehead, let go and relax.
- Eyelids, relax.
- Mouth and lips, relax.
- Chin, relax.
- Neck, unwind, let go and relax.
- Shoulders, drop and relax.
- Upper back, relax.
- Heart, relax.
- Lower back, let go and relax.
- Arms and hands, relax.
- Stomach, unwind and relax.
- Hips, relax.
- Legs and ankles, relax.
- Feet and toes, relax.
Now, you will start to count down from 10 to 1, entering a deeper, more relaxed state with every count:
- 9 letting go more and more
- 7 deeper and deeper into relaxation
- 4 more and more deeply relaxed
- 1 enjoying the sensation now of deep and restful relaxation.
Pause here to just “float” for a few minutes before slowly bringing yourself back up to an alert state by counting up from 1 to 5, allowing more and more energy to enter your body with every count:
- wriggling toes now
- stretching fingers
- raising eyebrows to ceiling
- stretching whole body
- very slowly and gently opening eyes.
Daily use of this technique is a great way to create strong neural pathways. When enough such pathways have been established, the entire relaxation process above can be replaced by a single cue word (like “relax”) or by counting from 3 down to 1.
What therapists do in a professional setting – and what you can learn how to do at home – is to dismantle negative cognitions. Our emotions often get hijacked by perceived threats and an activation of fight-or-flight chemistry. Our cognitions become distorted under these conditions, to the point where one false impression or incorrect notion is built on top of the next until it can be hard to discern what’s real. When this occurs, the first step is to calm the heart and body. Once you’re in a more peaceful state, you can start to resolve the issue using the mind.
Let’s say, for example, that you’re feeling hurt because you developed stretch marks in your abdominal area (I wrote a post in The Pulse on this topic here). The thoughts start to build: first surprise, then a feeling of looking ugly, maybe embarrassment and anger, followed by self-loathing, and so on. With stress chemistry, you will probably suffer confusion, distress, and emotional pain.
To calm your system, you might write out the problem, or breathe deeply and slowly until your body is fully relaxed. Maybe some low impact exercise will shake the adrenalin out of your system. However you get there, once feel calm, you can begin to analyze what happened.
If, however, calmness doesn’t help you process your feelings, and no matter what you do, the emotional pain actually reaches deep into your heart, tugging up every last rejection you ever experienced, then healing is more likely to require the sophisticated toolkit of a professional therapist.
There are many ways to heal the heart, but they all start with contacting the emotions. Simple questions like, “How do I feel right now?” or “How do I feel about all this?” can begin the journey of self-exploration. Welcoming these feelings as they come (even painful ones), naming the emotions, and accepting them are crucial steps.
Many people are afraid of their emotions – their natural tendency is to reject their troubled feelings by thinking things like “There’s nothing for me to feel upset about… there’s no reason for me to feel this way… I just need to learn to get over it…” This pushes feelings further down into the body – where they can fester and cause disease.
Welcoming our feelings, on the other hand, starts with the assumption that all feelings make senses to the part of us that feels them and all feelings deserve compassionate attention.
The techniques of self-therapy described in this article can help you release the emotional pain, as well as straighten any cognitive and behavioral issues you may have, as a result of your pregnancy. When you make inner peace with yourself, you are likely to be far calmer with yourself and with others. Of course, I have only touched a few of the many techniques of self-therapy. Other psychological techniques include self-hypnosis or guided imagery. In The Pulse, you can also find a very interesting article on hypnobirthing as part of natural labor. Mind-body strategies include Chinese-based therapies. Physical therapies include herbal medicine, aromatherapy, body work, acupuncture, and a wide range of other treatments.
And it doesn’t end there. New self-therapy techniques are being invented constantly to help you heal from the pain of the past, the stress of the present, and the worry of the future. For most women, pregnancy and delivery are very difficult periods physically and emotionally. Give yourself the help you need.