By Ijeoma UKAZU
Many women suffer endlessly without knowledge of the various emotional changes happening in their life. Women like Deborah (not real name) suffer through depression, mood swings and anxiety before and after delivery of their children.
Deborah recounts; “I was devastated, full of anger towards anything or anyone close to me. I could not hold the child I was so much expecting whilst pregnant. I could not touch or breastfeed my child until after 2 weeks of birth. I was feeling sad most of the day, had no energy, feeling worthless, hopeless, ashamed, restless. This happened in 2014 when I had my first child. Breastfeeding my child was an annoying task. My husband was confused about the development but figured I needed lots of love, prayers and sweet words. While all this was going on, I was taken to the hospital and was diagnosed to have postpartum depression.”
Why are women dying?
Findings from a Community Informed Maternal Death Review, ‘Why Are Women Dying While Giving Birth in Nigeria?’ discloses that women like Deborah can often suffer from mental health challenges. This is a silent epidemic that many women are unaware of and can negatively impact the quality of pre- and post-natal maternal health. The 18-month review was commissioned by Merck Sharp & Dohme, MSD for Mothers and implemented by Africare, Nigeria Health Watch and EpiAFRIC to provide an inquiry into the reasons pregnant women were dying in communities and proffer a community accountability mechanism for maternal deaths.
A World Health Organization, WHO, report says globally, about 10% of pregnant women and 13% of women who have just given birth experience a mental disorder, primarily depression. In developing countries this is even higher, 15.6% during pregnancy and 19.8% after childbirth. In severe cases, this may lead to suicide. In addition, affected mothers cannot function properly. As a result, the children’s growth and development may be negatively affected as well.
“Pregnancy and childbirth are very stressful events. The bodies and minds of women go through many changes during and after pregnancy. It may result in them feeling empty, emotionless, or sad all or most of the time for a long time during or after pregnancy. If they go through this stressful period unsupported, it may result in severe postpartum depression. I had managed such women in collaboration with a psychiatrist,” says Professor Oliver Ezechi, Consultant Obstetrician and Gynaecologist, and Director, Centre for Reproductive and Population Health Studies, Department of Clinical Sciences, Nigerian Institute of Medical Research, NIMR Lagos.
“Within the maternal health space, policy makers should prioritize mental health so that all obstetricians and midwives are trained and retrained to recognize early warning signs. Pregnant women and mothers should be educated during antenatal care on recognizing the symptoms of mental ill health,” he says in support of the primary recommendations of the report.
How important is maternal mental health?
WHO reveals that mental health problems such as depression and anxiety are very common during pregnancy and after childbirth all over the world. One in three to one in five women in developing countries, and about one in ten in developed countries, have significant mental health problems during pregnancy and after childbirth. For example, WHO says high rates of mental health problems in pregnant women and mothers have been reported from many countries in Africa including Nigeria.
“Pregnant women coming down with mental illness as a result of bottled-up fears from conception. First, second and third trimester can be depressing to some women including the nausea especially for first timers and when you don’t have people to talk to, you will keep bottling up some of these issues because you are unsure,” Dr. Juliet Ottoh, Clinical Psychologist, Department of Psychiatry, Lagos University Teaching Hospital, LUTH.
“There should be an awareness programme during antenatal visits. Pregnant women should participate in individual and group psychotherapy sessions,” she says in support of the finding of the report.
Beyond routine antenatal care
“Sometimes I don’t know if I will die when I give birth to the child. I am mostly worried about the day of birth. I feel worried every day, even now.” – a pregnant woman in Izzi, Ebonyi State.
Hospital visits by pregnant women should go beyond checking the vital signs and the heartbeat of the baby. There should be a mandatory mental health check streamlined into the antenatal care programme of all health facilities, as this would contribute to achieving safe motherhood goals. Health professionals should give room for expression of worries, uncertainty or concerns to avert post-partum depression that could lead to grave consequences.
A state of emergency should be declared in the mental health space with special priority on how it affects women during pregnancy and postpartum. A well thought out public enlightenment campaign on the burden, dangers of maternal ill health and how it is 100% treatable should be disseminated to the public.