Why therapy during pregnancy should be required

For many people, pregnancy is seen as this happy time full of excitement and eager anticipation, yet maternal mental health disorders such as depression and anxiety impact 15 to 20 percent of women during pregnancy and the postpartum period.

“Motherhood is an identity shift,” says Jessica Zucker, a clinical psychologist in California who specializes in women’s reproductive and mental health. She explains that when a woman goes through these major life transitions such as getting married, experiencing a death in the family or having a baby, it tends to bring out a lot of complex feelings. And while the anticipation of a child’s birth often elicits positive emotions, it can also cause a woman to feel ambivalent. She may be torn between wanting her child and feeling like she is losing her independent identity. She may also worry about the impact motherhood will have on her marriage, finances and friendships.

“Psychotherapy can help expectant moms mitigate some of this stress and express their concerns or anxieties about becoming a parent,” says Ramani Durvasula, a professor of psychology at California State University. Moreover, it can provide a nonjudgmental and supportive sounding board where new moms can talk openly about forbidden topics, such as fear and regret.

Studies have shown that when women experience stress, anxiety and depression, it affects them as well as the developing baby. According to the March of Dimes, prolonged exposure to high levels of stress can cause health problems, such as high blood pressure or heart disease, and may increase the chances of having a premature baby.

But in many cases, the stigma associated with maternal mental health keeps pregnant women from seeking therapy, because there is added shame in thinking “this is supposed to be the happiest time in your life, which creates the concept that you only go if something really bad happens,” Zucker says.

[I took antidepressants while I was pregnant. It wasn’t a choice.]

According to an associate professor of psychiatry and obstetrics from Columbia University, Catherine Monk, we should introduce therapy as part of routine preventive care on a universal level to offset that stigma. Her recommendation is based on research she and her colleagues have done on the effects of depression on women and their fetuses. The results suggest that, in fact, there’s a third pathway by which the risk of mental illness travels in families.

“It’s not just shared genes or how children are raised in their environments — it’s how the woman is feeling during pregnancy,” she says.

To better understand these connections, researchers had pregnant women come in to a lab, where they applied “stressors” — such as doing math tasks for five minutes — while monitoring their blood pressure and heart rate.

They discovered that the fetuses of the women who lived in high-stress cities, such as New York or Washington, D.C., showed an increase in heart rate when their mothers were going through the challenge, as opposed to those fetuses whose moms lived in less stressful cities. Monk explained that when the mother’s heart rate and blood pressure change in response to stress, that acts as a stimulus to the fetus.

“Just like if you’re sitting down somewhere and someone opened the door and burst in, you would have a reaction,” she said.

In another study from earlier this year, data was collected from 61 expectant moms between the ages of 18 and 45. Participants were asked to fill out mood questionnaires and give daily samples of their saliva to determine cortisol levels.

In tracking the effects of maternal distress on the fetus, the researchers found that during pregnancy, even the relatively common life experiences of feeling unable to “control important things in your life” and “cope with all the things you have to do” are associated with alterations of DNA functioning in the placenta that can affect fetal development. “Management of life stress may be an effective intervention strategy,” the researchers concluded in their paper.

[For this mom, self-care includes therapy]

Monk is quick to point out that distress is always happening on both a psychological and physical level — they’re one and the same. “We could add mental health care to routine prenatal care,” she says. “Let’s start earlier in pregnancy to prevent these depressions, and help women be physically, mentally and emotionally as healthy as possible.”

Experts agree that therapy can be an effective way to help monitor a woman’s mental health, note shifts in her mood and anxiety, and ensure that she gets additional support as needed both during pregnancy and after delivery.

“There are few times in life when psychotherapy is more useful than during pregnancy,” says Durvasula, who recommends it as a part of standard prenatal self-care, along with exercise and nutrition. This kind of preventive mental health care during pregnancy can benefit expectant moms, all of whom are on the verge of an enormous life transition.

“I look at pregnancy as this nascent time — you’re growing something mysteriously in your body,” Zucker says. “And because you’re embarking on creating part of the next generation, it’s such an opportune time to look back at your own history.”

Cindy Lamothe is a biracial expat based in Antigua, Guatemala, with an international background in journalism and communications. Her writing has been featured or is forthcoming in the Atlantic, Quartz, Guernica, MSN.com, the Rumpus, the Establishment and Medium, among others. Find her on Twitter @CRLamothe.

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