1 in 5 new mothers and 1 in 10 new fathers will experience perinatal depression and anxiety.

To determine the likelihood of perinatal depression and anxiety, health care professionals will look at a range of things, including ‘psychosocial’ risk factors – that is, how someone’s social environment affects their mental health. Whether or not a mum has partner and/or good family support, financial stressors, and a history of abuse or loss are some of the most significant risk factors. Of note, women who have experienced childhood sexual abuse AND who have experienced a traumatic birth are more likely to develop postpartum depression or anxiety. 

It may come as a surprise to some, but obstetricians make up the first line of defence when it comes to the wellbeing and mental health of expectant mothers. In fact, a skilled obstetrician can have a big impact on the emergence and severity of perinatal depression and anxiety altogether.  

Your obstetrician is more than just a provider of physical care.

It’s an obstetrician’s job to monitor both your physical AND your emotional wellbeing throughout pregnancy. They are a safe person for you and your partner to talk to, and there’s lots they can do to help if you happen to experience depression or anxiety.

In general terms, your obstetrician will:

• be on the lookout for symptoms of perinatal depression or anxiety
• refer you to extra support services, should he/she think you need them
• inform clinical hospital staff about your status before you deliver your baby
• check-in with you again at your 6-week postnatal visit.

Your obstetrician has your back. Here’s more ways they can help. 

Treat common pregnancy conditions that exacerbate poor mood.

An obstetrician will routinely monitor their patients for, and treat, many conditions of pregnancy, including those which are known to affect a mother’s mood. A few of the main culprits are:

• anaemia - a lack of oxygen-carrying red blood cells which can trigger a physiological anxiety response
• low vitamin D - caused by insufficient exposure to the sun and long periods indoors (eg lockdown!), a deficiency has been known to mimic depression and anxiety
• thyroid changes – abnormal thyroid function can produce symptoms of depression, anxiety, mood swings and irritability.

They also tend to encourage eating fish twice a week to prevent deficiency in omega-3 fatty acids. Omega-3s may reduce symptoms of depression in the perinatal period.

Support the transition to parenthood.

Whether it’s your first or not, each pregnancy brings change - in identity, relationships, expectations, body image and more. It’s really normal to feel fearful - of the unknown, losing control, being unable to fix things, losing the baby (especially with precious IVF babies), of partners being harmed, and even about attachment to the baby. You can and should discuss your transitioning feelings with your obstetrician. Again – they’re there for body as well as mind. 

Support mums with previous birth trauma.

Up to 1 in 3 women have experienced some form of birth trauma. And the need for obstetricians to provide ‘trauma-informed care’ is ever increasing. Trauma-informed care is a partnership between obstetrician and expectant couples that promotes communication and security in the new pregnancy.

Allowing patients to debrief past experiences (including past terminations and pregnancy losses) is one of the most critical aspects of trauma-informed care. Obstetricians can offer explanations where there are questions, validate a couple’s experience, and encourage an open dialogue.

Your obstetrician can then work with you to identify things that may cause you to re-experience the past trauma, and implement strategies to help you feel safe. They can:

• be mindful that physical examinations/procedures may be triggering for you
• obtain your verbal consent before any examinations/procedures
• give you time to mentally prepare for examinations/procedures
• ensure you have a single room for privacy after birth
• ensure postnatal hospital staff know to knock and wait before entering your room, are aware of your status, and endeavour to provide trauma-informed care.

The good news is that most people recover from birth trauma without professional help.

Support partners with previous birth trauma.

It is a partner’s role, if not their instinct, to protect the family unit. Obstetricians are there to provide information and support to partners with birth trauma. Watching common birthing procedures, such as an episiotomy or the manual removal of a placenta, can be very confronting for partners and even traumatising.

Over the course of the COVID-19 pandemic, many partners have been excluded from attending antenatal appointments due to some of the necessary COVID-19 restrictions at hospitals and practices. Obstetricians are acutely aware that these same people may have unresolved trauma.

Refer to professional support.

Prevention is better than cure. This is especially true with regard to mental health disorders. The earlier depression and anxiety are treated, the better the outcomes.  

If your obstetrician identifies signs of or high risk factors for depression or anxiety, they can refer you to counselling with a private psychologist or, in more severe cases, a psychiatrist. Patients who meet specific criteria may be referred to free community psychological support services.

Your obstetrician will also encourage you to engage with early childhood services once your baby is born.

Other useful resources.

Your ‘blue book’ has a list of important services that can support you during pregnancy and in the postnatal period. The following more specialised resources are highly recommended:

• Mind the bump and Headspace mindfulness apps
• Gidget Foundation – resources and counselling for perinatal anxiety and depression
• Blue Knot Foundation - for survivors of childhood abuse
• Australasian Birth Trauma Association – resources and peer support
• Mensline – counselling for male partners by male counsellors
• Centre for Perinatal Excellence (COPE) – especially the ‘First 2000 days of life’ resources