Becoming a parent for the first time, can bring with it a wide range of emotions, these can include elation, worry, joy and stress. The transformation from becoming a woman to a mother, can include physical, emotional and psychological changes and can be one of the most vulnerable periods that a woman experiences in her lifetime.

Depression and anxiety can affect 1 in 10 women during pregnancy, and 1 in 6 women during the first year after birth (beyondblue.org.au). Women who have experienced depression and anxiety during pregnancy and the postnatal period may have experienced mental health conditions before; alternatively, it can be the first time they have experienced a mental health episode. Risk factors may include fertility difficulties, complications in pregnancy, physical and/or psychological birth trauma, previous experiences of trauma and lack of support from family. 

In our society, pregnancy and motherhood are often represented in idealised ways. If a woman or her partner’s expectations are very different from reality, it can result in adjustment difficulties. Having realistic expectations of what pregnancy and motherhood involve, may reduce the risk of depression and anxiety. 

One of the ways to prepare for parenthood, may be to develop a Postnatal Recovery Plan. In conjunction with your partner and health care professionals, a Postnatal Recovery Plan can include self-care strategies for the first 40 days, to ensure there is adequate time to rest, recover and replenish. It can also include a resource list of health professionals (eg lactation consultants, community health, counsellors, GP) who can assist with feeding, settling, adjustment to parenthood, changes to your relationship and physical health issues.

Perinatal anxiety and depression is not your fault. You’re not a bad person, you’re not a bad mother and you are not alone. Sleep deprivation alone, can cause significant impacts on your general health; coupled with the trauma of birth, social isolation and an adjustment to motherhood, this can cause difficulties coping with your new role as a Mum.

Relationships can take a big hit in the perinatal period. Over 95% of couples experience increased conflict in the first year after birth. Giving each other time and space to learn how to be a parent, and being compassionate to each other’s needs, can be a helpful strategy in managing conflict. Giving each other time to bond with the baby, is equally as important as giving each other time to rest. By being involved in caring for the baby, this gives both parents an opportunity to develop competence and confidence in their new role.

Symptoms of perinatal depression and anxiety can vary but the signs to watch out for are:

1. Sleep disturbances (trouble sleeping even when the baby sleeps), including insomnia, early morning waking, excessive sleep.
2. Changes in appetite (not eating or overeating)
3. Persistent and generalised worry
4. Feelings of inadequacy, worthlessness, emptiness or failure as a mother.
5. Feelings of anger, guilt, resentment, shame and irritability
6. Thoughts of suicide

It is not so much the presence of these symptoms, but more so the duration and intensity. If the symptoms are more persistent (generally lasting more than two weeks), it may be time to talk to a health care professional. Your GP is a great place to start the conversation, as they can inform you of a referral pathway and rebates available, to get you linked with a mental health professional.

Here are some strategies you can put in place during pregnancy and the postnatal period, to reduce your risks and help prepare you as best you can:

1. Establish realistic ideas of pregnancy/post baby life – re-evaluate what can really be achieved with a new baby in the house. The bare minimum may be all you can achieve some days.
2. Establish a relationship with a health professional. Talk to your GP, initiate a referral to see a Social Worker or Psychologist to engage in talk therapy, engage with your local Community Health Centre and be aware of health services you may require in this period.
3. Avoid major upheavals – if possible, avoid changing jobs, moving house, renovations. This can be a source of major stress. 

4. Discuss expectations of pregnancy and parenthood with your partner. Many factors can influence a person’s ideas about parenthood. Discussing these expectations, as well as your own childhood experiences can help in coming to a shared understanding of how you would like to raise your family, which can reduce the chance of any disappointments or surprises.
5. Get your finances in order – losing an income for a period of time and the extra costs of a new baby can result in added stress. Know the position the finances are in beforehand. 

6. Gift substitute – suggest to friends or family a service instead of a gift. eg. cleaner, pre-made meals.
7. Division of tasks – work out who is doing what in your household. Looking after a baby AND carrying the mental load for the family can cause significant overwhelm. 

8. Postnatal Recovery Plans – these are as important as birth plans, but not as common. Plan for rest, recovery and replenishment in the first few months after having a baby. Enlist the health of a personal and a professional tribe of people who can support you at this time.
9. Remember, no one is doing it any better than you. Unfollow anyone on social media who is making you feel like you are not doing a good job. There is no template for motherhood – we are all winging it.

Written by Eliza Pike, one of Mindstar's Mental Health Professionals and director of Blackbird, a counselling and support service to assist women with the emotional adjustment to pregnancy, birth and the postnatal period.