Prenatal depression: “I no longer recognized myself”

March 13, 2020, as the world prepares to enter confinement, Diane learns of her pregnancy. This news provokes in her a feeling that she did not expect. “I was immediately afraid that everything would go wrong” confides this psychologist expatriated in the Netherlands. Overwhelmed by fatigue, she loses her appetite and feels great sadness. “I was very nauseous, I had quite violent mood swings. I was sad or upset for no reason,” she recalls. Deprived of her usual activities due to the pandemic, she lacks the resources to escape. “Nothing made me happy. I very often wanted to go to bed around 5 p.m. and I didn’t have the motivation to get out of it. I no longer recognized myself.”

During this period, Diane continues to speak online to her psychologist who alerts her to her condition and quickly puts words to this feeling, she is going through prenatal depression. A traumatic event that occurred three months earlier hangs over her early pregnancy. “I had a hemorrhagic miscarriage at eleven weeks pregnant. The care was complicated and I suffered a lot physically. I was terribly afraid that it would start again and suffer again,” she says. She performs an early ultrasound to reassure herself but maintains constant anxiety until the end of the first trimester. “I always wondered if what I was feeling was normal. As soon as I woke up without nausea or not as usual. I was worried that the pregnancy would end.” If her depressive state eased at the beginning of the fourth month, she kept a form of constant anxiety throughout her pregnancy. “Every day I wondered if I had felt my child move and had a hard time rationalizing.”

What is prenatal depression?

“Prenatal depression is a set of depressive symptoms that appear during pregnancy, either from the start or during pregnancy,” explains Claire Dahan, clinical psychologist. According to this perinatal specialist, mood swings, sleep disturbances and fatigue are common symptoms during pregnancy. However, alertness must increase when accompanied by intense stress and anxiety. “Loss of interest, pleasure, devaluation, guilt, dark thoughts, excessive loss of appetite and constant sadness with a lot of crying should alert. It is not so much the nature of the symptoms that must be looked at, but their intensity and frequency. Because if it is normal to be turned upside down during your pregnancy, intense sadness and massive anxieties must challenge us.

Do we know the causes of prenatal depression?

There are several causes for prenatal depression. First of all, it can be linked to a traumatic event. “Some causes are related to pregnancy such as threats of premature birth, hospitalization, pathological pregnancy, history of miscarriage and stillbirths,” lists Claire Dahan. But it can also be the loss of a loved one during this period, the breaking of the bond with the mother or a conflicting relationship. “Pregnancy, especially the first, refers to the first mother we knew, that is to say ours.” The psychologist adds that there are also risk factors such as precariousness, separation from the spouse, isolation.

The other cause can also be the pressure in front of the injunction to perfection. The fear of not being “a good mother” is a feeling that Claire Dahan observes a lot. She adds that quite simply the fear of the pain of childbirth or of a loss of freedom upon the arrival of a child is also frequent, underlining the ambivalence around the desire for a child.

She also sees many women undergoing assisted reproduction who, due to the difficulty of care and the time spent, have “overinvested” in their pregnancy. “They feel all the more guilty because they feel ‘not happy’ when the treatments have finally worked and the long-awaited pregnancy has arrived.” Not to mention that pregnancies in a course of PMA are extra-followed pregnancies therefore cause “an anxiety-provoking climate, more conducive to depressive disorders.”

A taboo subject

Whatever the cause, it requires a detailed diagnosis and above all a great deal of attention from health professionals. However, in a society that overvalues ​​motherhood and willingly encloses pregnant women in an injunction to happiness, fullness and fulfillment, prenatal depression remains a taboo. “Even if there has been an awareness in recent years, thanks in particular to the release of speech on issues of postpartum depression, prenatal depression remains less addressed” notes Elise Marcende, president of Maman Blues. The association, which was created in 2003, aimed to connect women and provide them with resources and information. The idea is to offer these women a caring space in which they can confide that they experience regrets and difficulties, without judgment or malicious remarks. “What is said on these forums comes a little scratch the beautiful image of motherhood where everything is beautiful and happiness without fault.” Support that many women do not find during the mandatory appointments that mark the pregnancy.

“I was sad, I slept badly and I felt rejected”

Alexandra had a “problem-free” pregnancy. She gets pregnant quickly after a joint decision with her husband. “It was a desired and calculated pregnancy if I can say so because I became pregnant five weeks after the withdrawal of my IUD”, confides the one who lives, at the time, in Paris. However, in the eighth month, when she began her maternity leave, she began to feel “very bad”. “I was convinced that I was going to give birth earlier and the last month has been terrible. I cried day and night, every day. I was sad, I slept badly and I felt rejected. Crushed by the feeling of having a lot of things to settle before giving birth, she flinches because she cannot concentrate. “I was so full of it, I felt overwhelmed. I felt very lonely but at the same time I put my cell phone on airplane mode to avoid being harassed by my relatives who called me constantly to find out if I had given birth.

Read also >> Perinatal grief: “Any miscarriage can be devastating”

During this period, her obstetrician focuses on the physical assessment. At the same time, she did take childbirth preparation classes, but they ended and the video and group sessions deprived her of a confidential discussion with a midwife. “I was aware that what I felt was weird but I found very little information on the internet.”

Alexandra finds her salvation by making a written list of the things that overwhelm her and talking to her spouse. “In my list, I determined what I could delegate to the maximum, it unloaded me physically, emotionally.”

Can prenatal depression cause postnatal depression?

According to Claire Dahan, prenatal depression can be a risk factor for postpartum depression. “It is all the more important to talk about it even to relatives because it makes it possible to realize that many people are concerned. Guilt being a major component of depression, talking about it to others and realizing that you are not the only person to feel an emotional storm, allows you to shed guilt and better accept your emotions.

The psychologist also reminds that there are techniques of hypnosis, meditation, sophrology, EMDR (when traumatic history) that help a lot. When the depression is severe and psychotherapeutic treatments do not work, the doctor may decide to set up drug treatment.

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