Understanding Maternal Mental Health Challenges
Daniela Piñate dedicates a significant portion of her days to listening to women who face emotional upheavals during pregnancy or in the postpartum period. Many confide in her about feelings of guilt, sadness, anxiety, or fear, while others struggle to articulate the subtle changes they experience. Through her initiative, Madre Terapia, based in Mexico, she offers support and information, guiding those in need towards specialised psychological or psychiatric care.
Eight years ago, Daniela found herself in a similar predicament. Originally from Venezuela, she was living in Ecuador at the time and had just welcomed her first child. “It was a much-anticipated baby, and I had a dream pregnancy,” she recalls in an interview. However, following childbirth, she began to struggle with sleep and noticed a profound shift in her emotional state, losing the joy and laughter that once defined her. The motherhood experience she was living was starkly different from what she had envisioned.
“I was turning into a zombie,” she reflects. Despite this, she continued to care for her daughter, feeding, changing, and soothing her. Observing her husband and sister interact with the baby, she felt a heartbreaking absence of the tenderness she had expected to feel. “Not being able to experience that was incredibly hard for me,” she admits.
Days later, due to a health complication, her daughter required admission to intensive care. It was there that a neonatologist noticed Daniela’s disconnection. “I wasn’t crying; I felt like I was merely surviving,” she remembers. The doctor suggested that she might be experiencing postpartum depression.
The Prevalence of Perinatal Mental Health Issues
One night, while her baby remained hospitalised, Daniela returned home and awoke with a troubling thought: she believed her daughter and husband would be better off without her. In the midst of this crisis, she attempted suicide. After confiding in her partner, they sought help together. She received psychiatric treatment, was hospitalised, and began her recovery journey.
According to Laura Jiménez Aquino, a physician specialising in perinatal psychiatry, women are at heightened risk of developing mental health disorders during three key life stages, one of which includes pregnancy and the postpartum period. The World Health Organisation estimates that one in five women will experience some form of mental health condition during pregnancy or within the first year after giving birth. Nonetheless, accurately diagnosing these issues remains challenging.
Jiménez Aquino estimates that in Mexico, three out of ten women develop perinatal mental health disorders, with a staggering 75% going undiagnosed and untreated. There is currently no national measurement system, and available statistics stem from studies conducted within specific hospital settings. While depression is often the focal point of discussions, experts note that anxiety is even more prevalent yet frequently normalised.
Breaking the Silence Around Maternal Experiences
Recognising these issues can be complex, as symptoms often mirror the hormonal changes accompanying this life stage. Compounding this is societal expectation: a new mother is typically perceived as joyful and grateful. When feelings diverge from this narrative, many women resign themselves to the belief that “this is just how motherhood is.”
Jennifer (a pseudonym for anonymity) is a 33-year-old woman living in Mexico City who worked as a gym trainer until just three days before her son was born. “My pregnancy was beautiful,” she shares. However, after childbirth, the abrupt change in pace left her sleep-deprived and unable to return to work. As days passed, she began experiencing anxiety attacks and panic episodes.
“Every time I breastfed my baby, I felt overwhelming sadness or found myself crying,” she explains. Her lactation consultant mentioned the possibility of experiencing Dysphoric Milk Ejection Reflex (D-MER), a condition that can induce sudden emotional distress in some women while breastfeeding. Despite discussions with her gynaecologist, paediatrician, and family doctor about hormonal factors or potential postpartum depression, Jennifer has yet to receive a definitive diagnosis, leaving her confused about her feelings. Guilt soon followed; she often questioned, “If I love my baby, why do I feel this way?”
Gender Expectations and Maternal Mental Health
When Jennifer attempted to express her feelings to her family, she received dismissive comments suggesting that “this happens to all mothers, and they just have to endure it,” or “why are you sad when you have everything?” In contrast, her peers offered understanding, sharing that they too would have appreciated non-judgmental support during similar experiences.
Psychotherapist Alejandra Buggs Lomelí, founder of the Centre for Mental Health and Gender, highlights the significant impact that gender mandates—societal expectations regarding how women and men should behave—have on maternal experiences. “When we feel we aren’t fulfilling our maternal roles efficiently, we become our harshest critics,” she remarks.
This pressure stems from an idealised image of motherhood, perpetuated through films, television series, and social media, where the expectation is that a woman will effortlessly manage all aspects of caregiving, even when she has a partner.
Addressing the Gaps in Maternal Mental Health Care
Maria Fernanda, a 35-year-old gynaecologist living in Mexico City, had previously endured a significant mental health crisis before having her first child. Diagnosed with generalised anxiety and major depression in 2018, she had experienced suicidal thoughts and hospitalisation. After stabilising her mental health through treatment, she decided to conceive, maintaining psychiatric care throughout her pregnancy.
Despite her medical history, her healthcare providers never inquired about her emotional state. “I don’t know if they assumed everything was fine,” she reflects, highlighting a critical gap in detection. Even when mental health issues are known, the question of how a woman is feeling often goes unasked during consultations.
Since 2016, the official Mexican guideline regulating care during pregnancy, childbirth, and the postpartum period mandates that healthcare professionals identify signs of depression or other mental health disorders. However, the guidelines lack specific questions or questionnaires to facilitate this process.
The Importance of Proactive Mental Health Care
Bruma Palacios Hernández, a clinical psychologist and coordinator of the Perinatal Mental Health Lab at the Autonomous University of the State of Morelos, emphasises the need for healthcare specialists to utilise prenatal consultations, postnatal check-ups, and even paediatric appointments to inquire about the mother’s sleep patterns, worries, and overall caregiving experience.
One tool available for this purpose is the Edinburgh Postnatal Depression Scale, designed in the UK in 1987. This brief questionnaire consists of ten questions regarding how women have felt over the past week. It can be completed quickly and serves as a screening tool for potential cases. The scale has been adapted for various languages and countries.
However, possessing these tools does not guarantee recognition of the issues at hand. Buggs cautions that it is crucial to examine our own gender biases in evaluation, diagnosis, and especially intervention. Jiménez Aquino adds that the current approach remains reactive, reliant on women reaching a crisis point before the system responds. Ideally, a shift towards a preventive model is necessary.
Understanding the Spectrum of Perinatal Mental Health Disorders
Maria Fernanda describes feeling overwhelmed by the demands of motherhood and work after childbirth. She struggles to find rest and likens herself to “a broken alarm clock.” Although she discontinued her medications three months ago, she intends to resume psychiatric care soon. Her own mental health experiences now shape her approach in consulting other women; she routinely asks about their emotional wellbeing during and after pregnancy, always providing them with options for mental health specialists.
According to Jiménez Aquino, perinatal mental health encompasses a range of disorders beyond depression and anxiety. Common conditions include post-traumatic stress disorder, obsessive-compulsive disorder, sleep disturbances, eating disorders, and, less frequently, psychosis. Some disorders may predate pregnancy and resurface or worsen during this time, while others may emerge for the first time.
Symptoms vary by disorder but may include persistent sadness, loss of interest, intense anxiety, intrusive thoughts, traumatic memories, significant changes in sleep or appetite, and mood fluctuations. The severity, duration, and impact on daily life, self-care, or baby care are crucial factors in determining when discomfort necessitates professional evaluation.
Redefining Maternal Recovery and Support Systems
The definition of perinatal mental health continues to evolve. While the DSM-5-TR specifies “onset in the peripartum” (the period surrounding childbirth) for certain episodes beginning during pregnancy or within the first four weeks postpartum, it also describes perinatal depression as potentially present during pregnancy or up to a year after the baby’s birth.
In Mexico, the postpartum period is defined as the six weeks following childbirth. Palacios notes that for a long time, the concept of physical recovery implied that women would return to their pre-pregnancy state. “Many colleagues suggest that after the confinement period, women return perfectly to their pre-pregnancy condition. This is an unrealistic expectation in emotional, psychological, and cognitive terms,” she asserts.
During this time, processes such as attention, memory, and brain function undergo changes, some