Mental health and challenges of motherhood

Motherhood is a social status of universal significance, but childbirth, which is the basic prerequisite for attaining the status, may be a stressful process which, in some cases, could adversely affect the mind, the body or both.

Despite the frequency of childbearing in everyday life, it remains a significant event, heavily charged with emotion and surrounded with superstitions and irrational feelings. Evidence for the development of major mental illness following childbirth has been recognised since ancient times.

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Hippocrates reported some cases among his maternity patients in the pre-Christian era. In Africa, we have many awkward beliefs about women who develop mental illness following childbirth – such as being possessed by the evil spirit capable of contaminating the generational lineage with mental illness, since it is believed that she will transmit it to the newborn baby through breast milk. This has led to unwarranted dissolution of many marriages and unnecessary death of newborn babies who are permanently separated from the so-called ‘demon possessed’ mothers. Scientifically, many theories have been put forward to explain the incidence of mental illness after childbirth and prominent among them is the role of hormones consequent on pregnancy, which have very strong effects on the mood, which may explain the predominance of mood disorders after childbirth.

However, there are other types of behavioural disturbances following childbirth which are not mood-related and as such the hormonal theory cannot explain. Pregnancy is a stressful experience which has often been described as a situation in which the mother carries a parasite that thrives on her physiological facilities and poses grave physical and emotional challenges. Apart from anxiety as a prominent symptom during pregnancy, women who have had to be admitted on several occasions during pregnancy are at risk, just as folks with significant obstetric events like difficult delivery spanning hours or those with surgical intervention producing abnormal, sick or dead babies can come down with behavioural problems.

At a time when obstetric care was predominantly poor, complication with infections was prominent, which gave rise to clinical situations in which mothers were seeing strange beings in clear consciousness and hearing voices after childbirth, apart from other associated behavioural disturbances.

Psycho-social factors such as poor quality of marital relationships, characterised by inadequate emotional and financial support at the time of childbirth, and disputed paternity of the child are potent risk factors. Teenage mothers and single mothers are more at risk and mothers having babies for the first time should be properly monitored.

Preference for the male sex, even after having six children in our strongly patriarchal society, may be the reason for behavioural disturbances in a woman that has just delivered a baby girl. Motherhood is essentially a big challenge that requires a lot of emotional, psychological and physical preparations because this event rattles any woman and makes grave demands.

The hormones play a prominent role, but for a good number of cases, the stress of childbirth, the outcome of the delivery, the level of support for the nursing mother and the quality of the marital relationship are crucial factors.

There is a common belief that this period usually marks the first time husbands have the first extramarital affair since the woman is not as desirable as before, and also not emotionally available because the baby is the new object of affection. Consequently, husbands get distracted emotionally and intimacy gets the greatest blow, as bedrooms may be temporarily separated as significant alienation occurs.

Transient, self-limiting manifestations of maternity blues characterised by crying spells, unreasonable anger and restlessness which usually resolve within a few days are common. Most disturbing behavioural disturbances in this cohort include the depressed type characterised  by undue sadness, withdrawal from the care of the baby, feelings of worthlessness and hopelessness, as some may actually make attempts to kill the baby who is perceived as the stumbling block to their enjoyment.

A few of them may have frank psychotic manifestations like aimless wanderings, hearing voices of unseen individuals giving instructions that the baby be killed and laughing to self. There is a crucial need for high quality obstetric care which will furnish our midwives with adequate information concerning the risk factors mentioned above, so that early, proactive psychological and other supportive services may be instituted with the assistance of the mental health team.

Some of the risk factors mentioned are amenable to counseling and supportive psychotherapy. When frank cases occur; prompt referral to the psychiatrist is very important because early intervention is very crucial.

Children nurtured by women with behavioural issues, when not timely attended to, may develop significant cognitive and psycho-social deficits later in life. Maternal mental health, in my opinion, is the central agenda for the achievement of our millennium development goals.

- Adeoye Oyewole (adeoyewole2000@yahoo.com)

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