Santa Fe New Mexican

Prenatal counseling critical to health of mom and baby

Studies show dangerous effects of stress on developing infant

- 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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