Perinatal Mental Health: Where to find help in Malta
What are perinatal mental health problems?
A 'perinatal' mental health problem is one that you experience any time from becoming pregnant up to a year after you give birth. Having a baby is a big life event. It's natural to experience a range of emotions during pregnancy and after giving birth. But if any difficult feelings start to have a big effect on your day-to day life, you might be experiencing a perinatal mental health problem. This may be new a mental health problem, or an episode of a problem you've experienced in the past.
What causes perinatal mental health problems?
There are many reasons that you might develop a mental health problem. Usually it is a combination of factors that cause a perinatal mental health problem.
These factors might include:
• previous experience of mental health problems
• biological causes
• lack of support
• difficult childhood experiences
• experience of abuse
• low self-esteem
• stressful living conditions
• major life events
• complications during labour
How common are perinatal mental health problems?
1 in 5 expecting or new mothers and 1 in 10 expecting or new fathers will experience perinatal anxiety and/or depression symptoms. Other perinatal mental illnesses like postnatal psychosis are less common than anxiety or depression, but all perinatal mental illnesses respond well to treatment and there’s strong hope for recovery.
What is the impact of perinatal mental health problems?
Left untreated, perinatal mental illnesses can have long-lasting impact on parents, partners, babies and families, and therefore timely detection and treatment is fundamental.
Key to the early access of effective mental health support is to be able to recognise the signs of not coping and to find the courage to ask for help.
What's the difference between the 'baby blues' and postnatal depression?
The 'baby blues' is a brief period of low mood, feeling emotional and tearful around three to 10 days after you give birth. You are likely to be coping with lots of new demands and getting little sleep, so it is natural to feel emotional and overwhelmed. This feeling usually only lasts for a few days and is generally quite manageable. Postnatal depression is a much deeper and longer-term depression. This usually develops within six weeks of giving birth and it can be gradual or sudden. It can range from being mild to very severe.
What is perinatal anxiety?
Lots of people are aware that you can become depressed after having a baby. But many people also experience anxiety during pregnancy and after giving birth. In fact, it is common to experience depression and anxiety together.
Why is it difficult to recognize or admit to being depressed or anxious during pregnancy or postpartum?
It is hard to recognize or identify perinatal depression or anxiety for several reasons. First, a new mother might not recognize depression or anxiety because she is tired, overwhelmed, or simply adjusting to life with a baby. Maybe she thinks that this is just part of being a new mother. It’s hard for new moms and families to know what is ‘normal mom stuff’ and what is a symptom of depression or anxiety.
Second, moms and their families might feel ashamed or embarrassed. When the expected glow of pregnancy or postpartum does not arrive, mothers tend to blame themselves and feel embarrassed. They fear admitting to negative feelings during the perinatal period may lead to their children being taken away or they will be labelled as bad mothers.
Third, each woman experiences a unique situation and unique symptoms. Some new mothers are sad and teary; some feel overwhelmed and irritable; some bond well with their babies while others feel distant; some sleep all the time while others have insomnia. The up-and-down nature of symptoms also makes it difficult to recognize or admit perinatal depression or anxiety.
What kind of treatment would work?
Treatment plans are different for each woman, but might include increased self-care, social support, talk therapy or counselling, and treatment of symptoms, with medication when necessary.
Self-care includes proper rest, good nutrition, assistance with baby and other children, and caring for personal needs such as exercise, relaxation, or time with partner/spouse.
Social support includes talking with others, either on the telephone, online, or at a support group, who understand and provide encouragement.
Talking with a counsellor or therapist who understands perinatal mood and anxiety disorders can be extremely beneficial.
Finally, medications are available to address both anxiety and depression.
What services are available locally?
There are various organisations, support services and health professionals who can support your mental health during pregnancy and after having a baby.
These may include:
• your GP
• your Midwife or Obstetrician
• Perinatal Mental Health Clinic at Mater Dei Hospital
• Psychiatric Emergency Service at Mater Dei Hospital
• NGOs: Parent-Infant Mental Health Alliance
Perinatal Mental Health Clinic
The Perinatal Mental Health Service provides specialist care for women experiencing a range of mental health illnesses during the antenatal and postnatal period. This team consists of psychiatrists, midwives, obstetricians, psychologists, community psychiatric nurses, social workers and occupational therapists. The clinic accepts self-referrals and referrals from any healthcare professional (HCP) and healthcare service.
This service provides pre-conception counselling for women with severe and complex mental illnesses who are planning a pregnancy. As part of the interventions offered, this team assesses and diagnoses mental health illnesses, advises on safe medications during pregnancy and lactation, provides psychological therapies, and promotes the mother-child relationship and attachment. Family, carers and other professionals are involved in the treatment planning of the woman and her baby. This team works closely with primary care, maternity, obstetric, and secondary care mental health services and local authorities as appropriate. Input and support is also provided to admission teams, both in the general and psychiatric hospitals.
Perinatal-Infant and Early Years Mental Health Service is a specialised parent-infant service with expertise in supporting and strengthening the early relationships between parents or carers and their babies. This team consists of skilled mental health professionals with expertise in parent and infant mental health. The aim is to help parents overcome parenting difficulties and build on their existing strengths to promote sensitive, responsive and appropriate interactions and attachment relationships. This team works with the parent-infant dyad and focus is on the parent-infant relationship.
NGO: Parent-Infant Mental Health Alliance
The Parent-Infant Mental Health Alliance (PIMHA) is an independent, non-governmental, non-profit, voluntary organisation dedicated to women and families affected by perinatal mental health problems in Malta to ensure they have access to high quality, evidence-based and comprehensive care during the perinatal period.
The main aims of the Alliance include being an advocate for service-users at the local Perinatal Mental Health Clinic, raising public and political awareness on perinatal and infant mental health with the aim of influencing policy, and educating healthcare professionals and the general public on issues related to perinatal and infant mental health.
PIMHA is offering an online peer support group for new and expecting parents. The peer support group is a meeting where pregnant women and mothers with young children, as well as fathers, come together in a safe place to exchange ideas, share experiences, give and receive information and at the same time, offer and receive support in breastfeeding, child rearing and women’s health. The sessions are conducted online once a month and are provided for free for our members.
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Website: https://pimhamalta.com/
Written by Dr Edith Agius
