The pain of childbirth isn’t always confined to labour. For some women, medical complications can cause anxiety, depression and post-traumatic stress disorder well before, and after, their child’s birth. Lynne Roberts reveals how her own traumatic birthing experience, led her to undertake cutting-edge research into the effects of gestational hypertension and pre-eclampsia on the mental health of women.
Our society generally assumes pregnancy and the birth of a child are happy and positive experiences. While this is true for the majority of cases, for some, like me, the experience can be traumatic.
Hypertension in pregnancy (HIP) is the most common medical complication in pregnancy – it can be either a pre-existing condition or a disorder that develops during the pregnancy. There are two hypertensive disorders specific to pregnancy – gestational hypertension (GH) and pre-eclampsia (PE) – which together affect approximately five to eight per cent of all pregnancies.
GH, raised blood pressure in the second half of pregnancy, is usually a benign condition with good maternal and fetal outcomes. PE, however, is hypertension that develops in the second half of pregnancy and involves other organs such as the kidneys, liver and central nervous system.
PE is a more significant disorder associated with increased maternal and fetal morbidity and mortality. Women who have had PE are two to three times more likely to develop hypertension, cardiovascular disease or kidney disease later in life.
In the Australian Institute of Health and Welfare’s Maternal Deaths in Australia 2008-2012 report, HIP was reported as the third leading cause of maternal death directly related to pregnancy. And, as the only known treatment for PE is for the baby to be born, it’s also a leading cause of pre-term birth.
Pre-term birth was my experience. In August 1993, severe PE led to my son being born by emergency caesarean section at 30 weeks gestation (10 weeks early). I spent the next three days in the intensive care unit at one hospital while my son was transferred to the neonatal intensive care unit at another.
I came home after a week, but my son spent the first eight weeks of his life in hospital. It was an incredibly worrying and scary time, aggravated by the separation of myself and my child.
Ever since, I have made great efforts to understand HIP and to improve the care women receive. For 13 years I have worked as a Research Midwife at St George Hospital, prior to this I spent seven years working as a clinical midwife in a multi-disciplinary team caring for women with complicated pregnancies.
However, it is now, through my PhD project, being done through the Faculty of Health’s Centre for Midwifery, Child and Family Health, that I have an amazing opportunity to really make a difference in the health of women who experience GH or PE.
For these women, complications like fetal distress, emergency caesarean section, pre-term birth and admission (of either the mother, the baby or both) to intensive care units is common. While this stress may contribute to increased levels of depression, anxiety, or post-traumatic stress disorder (PTSD), research is scarce.
About one in six pregnant women experience psychological problems, commonly depression and/or anxiety, in the year following the birth. However, it has been reported that women who experience a complicated pregnancy, like those with PE, are at a higher risk for depression and anxiety and face a higher prevalence of PTSD.
It’s currently very difficult to know whether any increase in the mental health issues in women with GH or PE pre-dated their pregnancy, are a consequence of the pregnancy, are due to the processes involved in managing the complication or the often-associated pre-term birth. I’m hoping to find answers to these questions.
Currently, I’m coordinating a large longitudinal study, known as the P4 Study, at St George Hospital. This research will investigate the physical and mental health of women who had GH or PE and the health and development of their babies. The physical health data will inform guidelines for follow-up of women who had GH or PE, while the mental health component of the study is my PhD project.
For this, I am comparing, at six months postpartum, the level of depression, anxiety and PTSD symptoms amongst women who had normal blood pressure in pregnancy to those who had either GH or PE. I’m also seeking to gain insight into the different experiences of HIP by interviewing women and listening to their stories.
I want to discover what has helped women during their experiences and what could be improved upon. The care of women with HIP often focusses on the immediate physical health issues, but I propose that their care should also include emotional and social support.
Quite simply, I’m hoping to fill the current gap in knowledge and improve the care that women who have HIP receive in an effort to improve their experience and reduce their mental health morbidity. After all, gaining a better understanding of the psychological consequences of complicated pregnancies is a public health concern.
Prolonged mental health disorder can affect both a woman and her infant. Depression, anxiety, and PTSD may be debilitating and impair a woman’s capacity to function in her normal life, including caring for her child.
Persistent maternal depression and anxiety may also affect the infant’s development in the cognitive, emotional and social domains, and the development of the mother-infant relationship. Mothers and their children deserve better than this.