Pre­na­tal coun­sel­ing crit­i­cal to health of mom and baby

Stud­ies show dan­ger­ous ef­fects of stress on de­vel­op­ing in­fant

Santa Fe New Mexican - - FAMILY - By Cindy Lamothe Spe­cial to The Wash­ing­ton Post

Peo­ple fre­quently con­sider go­ing to ther­apy be­fore they make a ma­jor life tran­si­tion, such as get­ting mar­ried or chang­ing ca­reers. But what about when em­bark­ing on a mon­u­men­tal shift such as par­ent­hood?

Women, who are ad­vised to ex­er­cise and watch what they eat while they are preg­nant, don’t al­ways think of psy­chother­apy as an im­por­tant part of their pre­na­tal care reg­i­men, but it can be crit­i­cal to the well-be­ing of mother and baby, both dur­ing and af­ter preg­nancy.

For many peo­ple, preg­nancy is seen as this happy time full of ex­cite­ment and ea­ger an­tic­i­pa­tion, yet ma­ter­nal men­tal health dis­or­ders such as de­pres­sion and anx­i­ety im­pact 15 per­cent to 20 per­cent of women dur­ing preg­nancy and the post­par­tum pe­riod.

“Mother­hood is an iden­tity shift,” says Jes­sica Zucker, a clin­i­cal psy­chol­o­gist in Cal­i­for­nia who spe­cial­izes in women’s re­pro­duc­tive and men­tal health. She ex­plains that when a woman goes through these ma­jor life tran­si­tions such as get­ting mar­ried, ex­pe­ri­enc­ing a death in the fam­ily or hav­ing a baby, it tends to bring out a lot of com­plex feel­ings.

And while the an­tic­i­pa­tion of a child’s birth of­ten elic­its pos­i­tive emo­tions, it can also cause a woman to feel am­biva­lent. She may be torn be­tween want­ing her child and feel­ing like she is los­ing her in­de­pen­dent iden­tity. She may also worry about the im­pact mother­hood will have on her mar­riage, fi­nances and friend­ships.

“Psy­chother­apy can help ex­pec­tant moms mit­i­gate some of this stress and ex­press their con­cerns or anx­i­eties about be­com­ing a par­ent,” says Ra­mani Dur­va­sula, a pro­fes­sor of psy­chol­ogy at Cal­i­for­nia State Univer­sity. More­over, it can pro­vide a non­judg­men­tal and sup­port­ive sound­ing board where new moms can talk openly about for­bid­den top­ics, such as fear and re­gret.

Stud­ies have shown that when women ex­pe­ri­ence stress, anx­i­ety and de­pres­sion, it af­fects them as well as the de­vel­op­ing baby. Ac­cord­ing to the March of Dimes, pro­longed ex­po­sure to high lev­els of stress can cause health prob­lems, such as high blood pres­sure or heart dis­ease, and may in­crease the chances of hav­ing a pre­ma­ture baby.

But in many cases, the stigma associated with ma­ter­nal men­tal health keeps preg­nant women from seek­ing ther­apy be­cause there is added shame in think­ing “this is sup­posed to be the hap­pi­est time in your life, which cre­ates the con­cept that you only go if some­thing re­ally bad hap­pens,” Zucker says.

Ac­cord­ing to an as­so­ciate pro­fes­sor of psy­chi­a­try and ob­stet­rics from Columbia Univer­sity, Cather­ine Monk, we should in­tro­duce ther­apy as part of rou­tine pre­ven­tive care on a uni­ver­sal level to off­set that stigma. Her rec­om­men­da­tion is based on re­search she and her col­leagues have done on the ef­fects of de­pres­sion on women and their fe­tuses. The re­sults sug­gest that, in fact, there’s a third path­way by which the risk of men­tal ill­ness trav­els in fam­i­lies.

“It’s not just shared genes or how chil­dren are raised in their en­vi­ron­ments — it’s how the woman is feel­ing dur­ing preg­nancy,” she says.

To bet­ter un­der­stand these con­nec­tions, re­searchers had preg­nant women come into a lab, where they ap­plied “stres­sors” — such as do­ing math tasks for five min­utes — while mon­i­tor­ing their blood pres­sure and heart rate.

They dis­cov­ered that the fe­tuses of the women who lived in high-stress cities, such as New York or Wash­ing­ton, D.C., showed an in­crease in heart rate when their mothers were go­ing through the chal­lenge, as op­posed to those fe­tuses whose moms lived in less stress­ful cities. Monk ex­plained that when the mother’s heart rate and blood pres­sure change in re­sponse to stress, that acts as a stim­u­lus to the fe­tus.

“Just like if you’re sit­ting down some­where and some­one opened the door and burst in, you would have a re­ac­tion,” she said.

In an­other study from ear­lier this year, data was col­lected from 61 ex­pec­tant moms be­tween the ages of 18 and 45. Par­tic­i­pants were asked to fill out mood ques­tion­naires and give daily sam­ples of their saliva to de­ter­mine cor­ti­sol lev­els.

In track­ing the ef­fects of ma­ter­nal dis­tress on the fe­tus, the re­searchers found that dur­ing preg­nancy, even the rel­a­tively com­mon life ex­pe­ri­ences of feel­ing un­able to “con­trol im­por­tant things in your life” and “cope with all the things you have to do” are associated with al­ter­ations of DNA func­tion­ing in the pla­centa that can af­fect fe­tal devel­op­ment.

“Man­age­ment of life stress may be an ef­fec­tive in­ter­ven­tion strat­egy,” the re­searchers con­cluded in their pa­per.

Monk is quick to point out that dis­tress is al­ways hap­pen­ing on both a psy­cho­log­i­cal and phys­i­cal level — they’re one and the same. “We could add men­tal health care to rou­tine pre­na­tal care,” she says. “Let’s start ear­lier in preg­nancy to pre­vent these de­pres­sions, and help women be phys­i­cally, men­tally and emo­tion­ally as healthy as pos­si­ble.”

Ex­perts agree that ther­apy can be an ef­fec­tive way to help mon­i­tor a woman’s men­tal health, note shifts in her mood and anx­i­ety, and en­sure that she gets ad­di­tional sup­port as needed both dur­ing preg­nancy and af­ter de­liv­ery.

“There are few times in life when psy­chother­apy is more use­ful than dur­ing preg­nancy,” says Dur­va­sula, who recommends it as a part of stan­dard pre­na­tal self-care, along with ex­er­cise and nutri­tion. This kind of pre­ven­tive men­tal health care dur­ing preg­nancy can ben­e­fit ex­pec­tant moms, all of whom are on the verge of an enor­mous life tran­si­tion. Cindy Lamothe is a bira­cial ex­pat based in An­tigua, Gu­atemala, with an in­ter­na­tional back­ground in jour­nal­ism and com­mu­ni­ca­tions. Her writ­ing has been fea­tured or is forth­com­ing in the At­lantic, Quartz, Guer­nica,, the Rum­pus, the Es­tab­lish­ment and Medium, among oth­ers. Find her on Twit­ter @CRLamothe.

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