Mental health care starts in the womb

Maternal depression and anxiety is a global societal concern that has also been found to impact a woman’s children. It can affect learning capacity and emotional wellbeing, and researchers now understand that treating depression starts with baby still in the womb.

Professor Jeannette Milgrom, is Executive Director of the internationally recognised Parent Infant Research Institute (PIRI), which is part of Austin Life Sciences based at Austin Health and affiliated with the University of Melbourne.

She recently published the first ever paper that shows treatment of depression and anxiety during pregnancy rather than waiting until after the birth produces better early infant outcomes.

“It’s really good news because antenatal depression (depression that occurs before birth) has been neglected compared with postnatal depression. This is despite the substantial evidence that the effects on the developing foetus can be associated with longer-term childhood behavioural disorders such as attention deficit disorders,” Professor Milgrom says.

The effect of a mother’s depression after childbirth (postnatal depression), can also be devastating for the infant. 

“It’s been well established that the early parent-infant relationship provides a critical foundation for learning abilities and self-management of emotions,” Professor Milgrom says.

“When maternal depression and anxiety takes hold it makes it very difficult for mothers to be emotionally available to babies and the baby then also withdraws.  

“When the mother recovers the baby is often disengaged, which can then make her feel bad and the cycle can start again. 

“Thanks to decades of focused research we can now effectively manage antenatal and postnatal depression.”

This is fortunate indeed, as experts estimate that one in 10 women suffers from moderately severe postnatal depression, which means clinically diagnosed cases.

“We were one of first research teams to show the impact of postnatal depression on the infant and the need to treat that relationship in addition to maternal mental health.

“We asked the question: Can we turn this around? How can we understand more about what causes depression? How can we prevent it and how can we treat maternal mental health as well as the parent-infant relationship? In other words can we make a difference or – rather – let’s make a difference!” 

Professor Milgrom and her team applied their research with many international collaborators and did in fact ‘turn it around’. They have made a difference in the field of parent-infant welfare with their copyrighted on-line interactive programs such as MumMoodBooster, an internet postnatal depression treatment which has now been adopted in other countries.

“Anecdotally we know there are many more mothers who don’t accept help for a range of reasons such as stigma, shame or being told they will snap out of it,” Professor Milgrom says.

The PIRI program called PRIMER helps nurses prepare and motivate postnatal women to take action for their emotional and health needs.

Professor Milgrom’s research team has also shown that antenatal depression is also a powerful indicator of postnatal depression.

“Our antenatal program Beating the Blues Before Birth is a method we’ve developed to effectively treat mother and protect the infant into the birth period.”

In a recent Lancet article which Professor Milgrom co-authored, a summary of the evidence for risk factors was outlined. Expecting parents face a series of new challenges and stresses: physical, emotional, social, and sometimes cultural. Some mothers are more susceptible to depression and anxiety due to family history, the lack of partner support or simply too much stress.

So treating mental health can essentially start in the womb and continue after childbirth. 

“This work is so rewarding when we see the parent-infant interaction change because you know you are changing the trajectory for that infant and their mother,” she says

www.mdhs.unimelb.edu.au