Reproductive Phases

Reproductive Phases

If you have an existing mental health challenge or disorder and are thinking about becoming pregnant, understanding ways to manage the impact of your illness whilst pregnant or breastfeeding builds confidence.

Having a diagnosed mental health challenge or disorder does not mean that women should not have children.  However, it does mean that a higher level of support may be needed to ensure that the woman keeps well during pregnancy and following the birth.

How can a pre-pregnancy consultation help?

If you have already been diagnosed with a mental health challenge or disorder, such as

  • Bipolar Disorder
  • Schizophrenia
  • Major Depressive Disorder
  • Anxiety Disorder

or you experienced postpartum psychosis in a previous pregnancy, it will help you to plan your care during pregnancy and following the birth with your healthcare provider(s).  You, your family and your healthcare providers will then share in the plan for how best to support you during this time.

If possible, talk to your healthcare provider before you become pregnant, but if not, as soon as you know you are pregnant.  Your healthcare provider may refer you to a specialist such as a Reproductive Mental Health psychiatrist for additional help in planning your care.

What advice will I be offered?

You may want to raise your own concerns or worries but the healthcare provider can help you with the following

  • Understanding how the pregnancy and postpartum period will affect your mental health challenge or disorder.
  • Planning for pregnancy and becoming a mother, including putting psychological and other supports in place.
  • What changes may be needed in medications before pregnancy, during pregnancy and in the postpartum period. This will include a discussion on risks and benefits of treatment.
  • Planning for delivery of the baby.
  • How to optimize sleep after the delivery.
  • Breastfeeding when taking medications.
  • Maintaining psychiatric follow-up after the baby is born.

Worried?

If you have been diagnosed with a mental health challenge or disorder and you are thinking of becoming pregnant or you have discovered that you are pregnant and are worried about the effect of your mental health or any medications you are taking on your baby, talk to your healthcare provider as soon as you can.  It is never too late to do so.  

Any woman may experience a mental health challenge or disorder during pregnancy but some women are more at risk than others.  Learn about the kinds of mental health challenges or disorders that women may face and where to find more detailed information.  

Pregnancy and change

Women experience many changes during pregnancy and it is common to find it challenging to deal with all the social, economic, emotional and physical changes that occur at this time. Most women will need some support from family and friends to work through these changes and to get ready for the birth of the baby. Some will find it harder than others, and may need additional support from community groups and health care providers.

The effect of pregnancy on mental illness

In the past, it was thought that pregnancy protected against mental illness. However, we now know that women already diagnosed with a mental illness may still experience symptoms during their pregnancy. Often, women report that their symptoms of

  • Major Depressive Disorder
  • Anxiety Disorders, (including Panic Disorder, Generalized Anxiety Disorder, and Obsessive-Compulsive Disorder)

continue or can have their onset during pregnancy.

Bipolar Disorder and the psychotic disorders, including Schizophrenia, are less likely to have their onset in pregnancy. Symptoms of Bipolar Disorder, especially manic or mixed episodes, are more likely to begin or re-occur in the postpartum period.

This is also true for psychotic disorders where the postpartum period is a time of higher risk for experiencing symptoms of psychosis for those women who are at risk.  

How do I know if I may be experiencing mental illness?

Sometimes, it may be hard to know whether the physical changes of pregnancy are symptoms associated with mental illness because they are so similar. For example, feeling very tired, having difficulty in sleeping, change of appetite, and loss of energy are all common at various stages of pregnancy.  They are also common symptoms of depression .  Talk to your healthcare provider if you are at all concerned and they will help establish the cause of how you are feeling.

Who is at risk?

Women with a personal or family history of mental health disorders may have a higher risk of perinatal mental illness and ideally, should plan their pregnancy. This could include an individualized treatment plan developed by the women and her healthcare providers. The treatment plan may include education of the woman and her family about symptoms to look out for during pregnancy and after the birth, self-care (with an emphasis on good sleep habits, healthy eating, regular exercise, time for oneself, and establishing a support network), and different forms of psychotherapy.

Medications and pregnancy

Women with more serious mental illnesses who have required medication prior to pregnancy, may find it is possible to wean off the medication before or during pregnancy but sometimes, may need to remain on medication. A woman should not suddenly stop taking medications on discovering she is pregnant.  This may result in a re-emergence of her symptoms. It is important that all decisions about medications are discussed between the woman and her healthcare providers to ensure optimal health of both the expectant mother and her baby.

Getting treatment as soon as possible

It is important that women who experience mental health disorders during pregnancy receive treatment quickly so that symptoms do not continue or worsen in the postpartum period. Untreated mental illness in pregnancy and postpartum can have long term consequences for the mother, mother-baby relationship and the baby, including effects on the baby’s cognitive, emotional, and behavioural development.  There are a range of treatments available that do not always involve medications.

If you are concerned at all about your mental health before pregnancy, during pregnancy or after the baby is born, talk to your healthcare provider about how you are feeling.  It is not a normal part of pregnancy to feel emotionally unwell for long periods of time.

The first year after a baby’s birth can present joys and challenges. Whilst the ‘Baby Blues’ is a common experience for women, there are more specific mental health challenges or disorders that some may also experience.  Find out more and learn about the kinds of treatments that are available. 

Up to one year following the birth of a child is called the postpartum period.  The perinatal period, a phrase also used, refers to the whole of pregnancy and childbirth, up to the end of the baby’s first year. 

Emotional disorders during the postpartum period can occur any time from labour up to one year following the birth of the baby.  They can be helped by a range of possible treatment options which may not always include medications.  A discussion between the woman and her healthcare provider can decide the most appropriate treatment for her.

Causes and Triggers

There is no one cause of mental health challenges or disorders. In the postpartum period, there is a significant drop in levels of hormones which can trigger changes in women who are vulnerable to developing mood symptoms.  Sleep deprivation is another common trigger. A woman may be vulnerable because of a personal or family history of mental health challenges or disorders.

In addition, the experience of mothering is a major change of role and responsibility in a woman’s life, often accompanied by changes in personal, social, and economic circumstances. Most women (and their partners) have some difficulties coping during this time of adjustment and find support from family, friends, healthcare providers, neighbourhood groups and family doctors invaluable.  However, some women encountering emotional difficulties need more support and should not hesitate to talk to their healthcare provider if they are concerned.

What mental health disorders might occur after the baby is born?

Postpartum Blues or Baby Blues are experienced by up to 80% of women. Temporary emotional distress within the first three to five days after the birth of the baby is very common and is not referred to as a disorder.  It usually passes within a week or two.  Women can feel restless, irritable, tearful, discouraged, sad and helpless. 

Major Depressive Disorder is the most common mood disorder during the postpartum period.  Women feel constantly low or sad with changes in sleep or eating habits not due to caring for a new baby.  They may also experience feelings of guilt, worthlessness or being overwhelmed. If the symptoms last for more than two weeks, they may be suffering from a Major Depressive Disorder.  Rather than seek support, women may withdraw socially and emotionally from family and friends and may need encouragement to seek help. 

Anxiety Disorders may also occur in vulnerable women.  Generalised Anxiety Disorder, Panic Disorder, Obsessive Compulsive Disorder and Post Traumatic Stress Disorder may occur alone or in combination with a depressive disorder. 

 The postpartum period is a vulnerable time for new onset or a relapse for women previously diagnosed with Bipolar disorder or a Psychotic disorder.  Planning your care with your healthcare provider during this time will be very important to ensure you get the support you need.  Postpartum psychosis is a rare but serious mental health disorder which may occur very suddenly either shortly after birth or within 2 – 4 weeks following the birth and requires immediate treatment.

Getting treatment as soon as possible

It is important to seek treatment as soon as possible so that symptoms do not continue or worsen.  Untreated mental illness can have long term consequences not only for the mother, but also her relationship with her baby and also the baby's development. 

Women may be concerned about breastfeeding if they need to take medications.  This will be an important part of the discussion between the woman and her healthcare provider so that if they are needed, the safest appropriate medications are chosen for a breastfeeding woman.

Are you concerned about your mental health?

Talk to a healthcare provider about how you are feeling.  There are many different kinds of treatments that can help, not always involving medications. With the right kind of support, women can overcome their mental heath challenges and begin to enjoy their babies.  

Pregnancy loss is a unique and often lonely event in a woman's life. Healing is helped through understanding and dealing with both physical and emotional changes.  The Reproductive Mental Health Team talk about their work in this area. 

A Lonely Event

Pregnancy loss is a unique and often lonely event in a woman's life that can trigger profound grief.  Healing is helped through understanding and dealing with any physical and emotional changes. Pregnancy loss can occur in several different ways.  It may be a miscarriage (if the pregnancy is less than 20 weeks); a still birth (if the pregnancy is more than 20 weeks); a recurrent pregnancy loss; a neonatal death or a termination (either early or late).  

Beginning Recovery

Physical recovery occurs quite quickly while emotional response and recovery can be more varied. Some women experience little or no emotional disturbance while others experience feelings of sadness, depression, anger, guilt or self-blame.  The grief symptoms usually decrease in intensity over the first 12 months and will gradually resolve with time. 

Support

Women may not always have support from family and friends or it may not be enough. There may be skilled people or a support group in your community; ask your doctor or community health nurse.  ln hospital, there will be contact with nurses, possibly a hospital social worker or a Spiritual Carer who can help.  After you go home, you will receive a telephone call to see how you are coping.

How some women feel

Women may experience many feelings at this time which may include numbness, shock, confusion, exhaustion, disbelief, anger, fear, isolation, loneliness, pining, yearning, self-blame or guilt feelings, sadness, and even depression. The intensity of these feelings can range from mild to quite overwhelming. Recent studies show there is often no order or sequence to grief and that different feelings surface at different times throughout the grieving period.

As all losses are not the same, neither are all reactions to grief.  Women may have other losses or needs occurring in her life at the same time and she may require support and information.  Future family planning decisions may be difficult at this time and may be best left for when grief is less intense.  Women should be encouraged to take time out and make arrangements for private time and rest.

Partners

Partners also suffer and can experience many emotions and feelings at the loss of a pregnancy. They can feel isolated and helpless when the focus of attention is with the hospitalized woman experiencing the physical loss.  Partners are often expected to remain strong to provide support and their own feelings of sadness and loss may be hidden in the process. It is important that each partner is given the opportunity to express their loss without blame. 

Couples experiencing grief over a pregnancy loss often discover that their responses are different from one another. This is normal but it can place a strain on a relationship if not recognized. Talking about differences can be helpful.

Partners may also play an important role in talking to other family members (including children) about what has happened and what will happen in the immediate future. It is helpful to discuss together how to handle questions from children, family and friends before speaking with them.

Children

Children are unprepared for loss. They need both patience and support in helping them to understand. How much a child can understand depends on their developmental readiness. Generally children deal best with loss if they are given information that is appropriate for their age. There are booklets especially prepared for children.  A social worker may be available to help you prepare your other children for this loss.

Treatment

The Reproductive Mental Health Program assesses women who have experienced pregnancy loss and developed complicated grief reactions or grief that has developed into a Major Depressive Disorder or an Anxiety Disorder, including Post Traumatic Stress Disorder (PTSD).  Treatment options may include short term Grief Counselling with a Nurse Clinician or Clinical Counsellor.  Medication treatment for patients with more severe illnesses may be offered.

Finding it difficult to become pregnant is an emotional as well as a physical issue.  This section looks at how the Reproductive Mental Health team work with women when there are mental health challenges associated with infertility. 

A decision to have a baby is often an exciting one for women and their partners but between 10 -15% of couples discover that they are infertile and may have difficulty having children.

Infertility and Stress

Infertility can be a major stress for women and their partners.   Studies have found that more than 50% of women receiving infertility treatment felt that infertility was the most stressful experience of their lives.

Infertility and Mental Health Challenges

Women experiencing infertility and undergoing Assisted Reproductive Technologies may develop mood disorder symptoms:

  • Women who continually face the disappointment of not conceiving month after month show more frequent signs of grief, depression, and anxiety.
  • Most recently, research has shown a relationship between infertility and symptoms of depression.  One study found that women who are infertile for over 12 months are twice as likely to report symptoms of depression than women who conceive within 12 months from a decision to become pregnant.
  • Extremely high anxiety levels may affect the woman’s ability to conceive.

Treatment for Mental Health challenges and Infertility

At the Reproductive Mental Health Program, women with infertility are assessed for associated mood and anxiety disorders.  Short term psychological support for women undergoing infertility investigations and treatments may be offered and, where necessary, medications will be initiated and monitored.  There are often support groups in local communities to help women and their partners facing this issue which they find very helpful.

When to talk to your healthcare provider about how you are feeling

If you are being treated for infertility issues and are at all concerned about your emotions or mood, talk to your healthcare provider to obtain some additional support during this time. 

Many women are troubled by pre-menstrual symptoms which can affect work and social life and relationships. Learn about identifying and managing symptoms. 

Pre Menstrual Syndrome (PMS) Definition

Between ovulation and when bleeding starts, about 75% of women experience some discomfort and may be quite uncomfortable with headaches, cramps, tender breasts or other symptoms. Many find ways of coping with this.

However, 20-40% of women are troubled by their premenstrual symptoms which may be physical, behavioural or emotional in nature .  If there is a consistent pattern of bothersome symptoms, affecting how the woman functions in daily life, PMS may be diagnosed.

Treatment Options

Women have found a range of things to be beneficial in decreasing the effect of PMS symptoms

Self Care (taking time for yourself) is an important step.  Reducing feelings of unwelcome stress is particularly important during the premenstrual phase.  Clarifying the number of days in your cycle and when bleeding is likely to occur allows you to become aware of times you need to pay particular attention to yourself.

Examples of self care are:

  • getting enough sleep, rest and relaxation
  • doing some exercise
  • eating a healthy diet
  • doing something for you, for example
    • practicing yoga and/or mindfulness
    • reading
    • enjoying time with a partner, family or friends
  • Down time

Counselling and Psychotherapy. Individual counselling may be helpful in teaching women strategies to reduce unhelpful stress, increase self care and manage anger and irritability. Couples counseling can help improve the quality of communication in relationships.  Some women report that in their PMS phase, past unresolved issues re-surface; counseling can be beneficial in these circumstances. 

Supplements

Supplements are often considered by women suffering PMS, usually herbal, vitamin or mineral.  Learn more about the effects of these in the PMDD section of the Depression page.  Herbal supplements do act as drugs in the body and may interact with any other medications you are taking.  Talk to your healthcare provider before beginning to take supplements.

Premenstrual Dysphoric Disorder (PMDD)

PMDD is a more severe form of PMS and is only diagnosed when there are cyclical mood and behavioural changes which severely affect a woman’s day to day functioning and relationships.  Dysphoric means a sense of feeling disquieted, restless or depressed. 

Concerned about any premenstrual symptoms?  

Talk to your healthcare provider about any symptoms you are having difficulty coping with.

Did you know that 1 in 8 women will experience mental illness or an emotional disorder related to their reproductive cycle?

The BC Reproductive Mental Health Program helps women and their families dealing with mental illness or emotional difficulties occurring at different times or during different events in their reproductive years, including:

You will find information on mental illness or emotional disorders in all of these areas on this website along with guides and pamphlets in the Publications section that can give you more detail, worksheets or other resources to use.

  1. Pre-Conception
  2. Pregnancy
  3. Postpartum
  4. Pregnancy loss
  5. Infertility
  6. PMS or Premenstrual Dysphoric Disorder (PMDD)