One in five women experience a mental health issue during the perinatal period – this is known as the time from the start of pregnancy up until a year after giving birth.
The multidisciplinary Specialist Perinatal Mental Health Service (SPMHS) at University Maternity Hospital Limerick (UMHL) was established to raise awareness about the prevalence of mental health issues that women can face during this period.
Clinical psychologist Dr Niamh O’Dwyer and occupational therapist Aideen Higgins, who are both married to farmers, are part of the team working with women who are experiencing these challenges.
The service also includes a perinatal consultant psychiatrist, mental health nurses, a social worker and mental health midwives.
“Anxiety and depression are the main issues that we see,” says Niamh.
“While every woman presents differently, anger and frustration can also be symptoms of a decline in wellbeing.”
Both speak of how there can be mixed feelings for women who are pregnant or who have just had a baby.
“Most of us expect to feel excited and happy when we’re pregnant and after our baby is born,” explains Aideen. “But it doesn’t always happen like that; joy and worry can co-exist. Sometimes women are afraid to say that they don’t feel right.”
Women who have wanted to be pregnant for a long time may also be surprised that they feel like this too.
“I’ve met women who say ‘I’ve been through IVF and really want this baby so why is this happening’?’” adds Niamh. “That situation can make asking for help difficult but it is important for women to seek support.”
Women are referred to the SPMHS if issues related to their mood are identified at their first antenatal check.
“Worrisome thoughts and/or tearfulness would be an indicator,” says Niamh.
“They will be referred on to us, the multidisciplinary team, if appropriate, but referral can be made at any time during the pregnancy or up to six months after the baby is born.
“Sometimes women can be fine initially, and manage the period of the ‘baby blues’ but find their mood alters in the months after the baby is born. They can still check in with our service even though they have left hospital, by asking their GP or public health nurse to refer them. We would also see women in hospital before and after delivery to offer support.”
What to look out for
Caring for a new baby can be a lot of work but struggling to keep up with day-to-day tasks can signal a problem, as can a woman withdrawing from family and friends.
Points of transition can be where problems become most noticeable, Aideen says.
“For example, finding out about the pregnancy can elicit joy and/or anxiety, there can be worries about delivery, or anxiety when you’re bringing the baby home. Life changes like this can challenge our coping skills.”
As a clinical psychologist, Niamh’s work involves helping women to find out where their feelings are stemming from and how to process them. Following this, there is collaborative work on identifying strategies to help them move forward.
“We work as a team to make sure the woman starts to build her own skill set to manage anxiety when it arises,” Niamh says.
From left: Aideen Higgins,senior occupational therapist and Dr Niamh O'Dwyer, senior clinical psychologist with University Maternity Hospital Limerick's specialist perinatal mental health service.
“This ‘toolkit’ involves building awareness about your thinking patterns and when your mood is declining. It also advocates walking, getting fresh air, sleep hygiene, good nutrition and taking time out for yourself so that you build up confidence.”
As an occupational therapist Aideen helps women with the practical aspects of their lives, discussing daily tasks like self-care, getting household tasks done, looking after the baby and ensuring leisure time.
“We would set small goals each week but we’d always be building so that the mum has strong foundations in place,” she says.
“We run things like walking groups with the team social worker too, connecting mothers. This peer support can be a rich source of intervention. Mothers realise that there are other mothers feeling like them and they actually bring each other on. The message is very much that ‘you’re not alone’.”
Specialist mental health services are very important for women who have experienced mental health problems before pregnancy too and they are closely monitored all the way through.
“They would be assessed frequently and supported,” says Niamh, “and we would also work with their community mental health team. It’s a collaborative approach.”
Calving season
Both professionals understand the issues for new mothers living on a farm, especially when their child is born during busy farming periods.
“I had my baby in the middle of calving season so that wasn’t easy,” says Aideen.
“It can be more difficult for mothers when their partners are farmers or working in jobs like hospitality. Also partners who are self-employed, who don’t have the ebb and flow of a nine-to-five, Monday-to-Friday job – that can be challenging.”
“We see it in women living in the countryside, it can be difficult to get support from partners at busy times on the farm,” Niamh agrees. “The key factor for perinatal women is her support network and that includes her partner.”
“We’d ask partners and family members to find out what the mother needs,” says Aideen.
We see it in women living in the countryside, it can be difficult to get support from partners at busy times on the farm
“Although a partner can’t partake in some aspects such as breastfeeding the baby, there are other tasks they can do. Just acknowledging that this is a really challenging few weeks for the new mother but that the busy time will come to an end can be helpful too.”
Both professionals noted that not all women who find this period challenging will need a mental health service. Making good connections with their GP, public health nurse and community supports can be enough.
“Seeking support does not reflect in any way on you as a parent,” they both say. “If we don’t care for ourselves, we won’t be able to care for our families.”
Michelle Daly
Author and communications consultant Michelle Daly Hayes from Limerick is the mother of two boys, Luke (11) and Cole (6). She had the benefit of support from the SPMH service on her second child.
She had experienced mental health challenges, particularly anxiety, for 15 years prior to being pregnant but could still function day-to-day. However, traumatic births on both occasions meant that she suffered from Post Traumatic Stress Disorder (PTSD) each time.
Private counselling, medication and GP and family support helped her through after her first child, but she was glad that the new perinatal mental health service was there for her when she became pregnant with her second child in 2018.
“It was a pretty traumatic birth again due to haemorrhage but I didn’t have that same level of anxiety afterwards,” she says.
“The new service swung into action for me early in the pregnancy. They were my safety net,” she says.
Following support during the pregnancy and after the birth, her midwife, Maria, linked her up with Maeve, a Community Mother, who visited her several times.
“She told me about services in the community like parenting classes and baby yoga – things I didn’t know existed.”
She now urges women to reach out for help. “We always think everyone else is coping better than us but the reality is a lot of women struggle. You never know what’s going on behind those Instagram posts.”
She says depression doesn’t always look like someone crying all the time.
“It takes many forms including a woman seeming distant or detached or not wanting to go out. It can also be a woman who is overactive and obsessed with cleaning the house or baby.
“I’m the one who gets busy and overwhelms myself and then has a crisis. You need to be aware if someone is behaving any way oddly.”
Michelle would like to see the service broadened out. “A crisis helpline where if someone wasn’t well they could self-refer would be helpful,” she says.
Specialist perinatal mental health services are now available in all maternity hospitals.Limerick Maternity Hospital was the first to provide this service outside of Dublin.Specialist perinatal mental health service teams include clinical psychologists, perinatal consultant psychiatrists, mental health nurses, occupational therapists, social workers and mental health midwives.Women can still check in with the service even though they have left the maternity hospital. This can be done by asking their GP or public health nurse to refer them.See hse.ie/eng/services/list/4/mental-health-services/specialist-perinatal-mental-health/ Read more
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One in five women experience a mental health issue during the perinatal period – this is known as the time from the start of pregnancy up until a year after giving birth.
The multidisciplinary Specialist Perinatal Mental Health Service (SPMHS) at University Maternity Hospital Limerick (UMHL) was established to raise awareness about the prevalence of mental health issues that women can face during this period.
Clinical psychologist Dr Niamh O’Dwyer and occupational therapist Aideen Higgins, who are both married to farmers, are part of the team working with women who are experiencing these challenges.
The service also includes a perinatal consultant psychiatrist, mental health nurses, a social worker and mental health midwives.
“Anxiety and depression are the main issues that we see,” says Niamh.
“While every woman presents differently, anger and frustration can also be symptoms of a decline in wellbeing.”
Both speak of how there can be mixed feelings for women who are pregnant or who have just had a baby.
“Most of us expect to feel excited and happy when we’re pregnant and after our baby is born,” explains Aideen. “But it doesn’t always happen like that; joy and worry can co-exist. Sometimes women are afraid to say that they don’t feel right.”
Women who have wanted to be pregnant for a long time may also be surprised that they feel like this too.
“I’ve met women who say ‘I’ve been through IVF and really want this baby so why is this happening’?’” adds Niamh. “That situation can make asking for help difficult but it is important for women to seek support.”
Women are referred to the SPMHS if issues related to their mood are identified at their first antenatal check.
“Worrisome thoughts and/or tearfulness would be an indicator,” says Niamh.
“They will be referred on to us, the multidisciplinary team, if appropriate, but referral can be made at any time during the pregnancy or up to six months after the baby is born.
“Sometimes women can be fine initially, and manage the period of the ‘baby blues’ but find their mood alters in the months after the baby is born. They can still check in with our service even though they have left hospital, by asking their GP or public health nurse to refer them. We would also see women in hospital before and after delivery to offer support.”
What to look out for
Caring for a new baby can be a lot of work but struggling to keep up with day-to-day tasks can signal a problem, as can a woman withdrawing from family and friends.
Points of transition can be where problems become most noticeable, Aideen says.
“For example, finding out about the pregnancy can elicit joy and/or anxiety, there can be worries about delivery, or anxiety when you’re bringing the baby home. Life changes like this can challenge our coping skills.”
As a clinical psychologist, Niamh’s work involves helping women to find out where their feelings are stemming from and how to process them. Following this, there is collaborative work on identifying strategies to help them move forward.
“We work as a team to make sure the woman starts to build her own skill set to manage anxiety when it arises,” Niamh says.
From left: Aideen Higgins,senior occupational therapist and Dr Niamh O'Dwyer, senior clinical psychologist with University Maternity Hospital Limerick's specialist perinatal mental health service.
“This ‘toolkit’ involves building awareness about your thinking patterns and when your mood is declining. It also advocates walking, getting fresh air, sleep hygiene, good nutrition and taking time out for yourself so that you build up confidence.”
As an occupational therapist Aideen helps women with the practical aspects of their lives, discussing daily tasks like self-care, getting household tasks done, looking after the baby and ensuring leisure time.
“We would set small goals each week but we’d always be building so that the mum has strong foundations in place,” she says.
“We run things like walking groups with the team social worker too, connecting mothers. This peer support can be a rich source of intervention. Mothers realise that there are other mothers feeling like them and they actually bring each other on. The message is very much that ‘you’re not alone’.”
Specialist mental health services are very important for women who have experienced mental health problems before pregnancy too and they are closely monitored all the way through.
“They would be assessed frequently and supported,” says Niamh, “and we would also work with their community mental health team. It’s a collaborative approach.”
Calving season
Both professionals understand the issues for new mothers living on a farm, especially when their child is born during busy farming periods.
“I had my baby in the middle of calving season so that wasn’t easy,” says Aideen.
“It can be more difficult for mothers when their partners are farmers or working in jobs like hospitality. Also partners who are self-employed, who don’t have the ebb and flow of a nine-to-five, Monday-to-Friday job – that can be challenging.”
“We see it in women living in the countryside, it can be difficult to get support from partners at busy times on the farm,” Niamh agrees. “The key factor for perinatal women is her support network and that includes her partner.”
“We’d ask partners and family members to find out what the mother needs,” says Aideen.
We see it in women living in the countryside, it can be difficult to get support from partners at busy times on the farm
“Although a partner can’t partake in some aspects such as breastfeeding the baby, there are other tasks they can do. Just acknowledging that this is a really challenging few weeks for the new mother but that the busy time will come to an end can be helpful too.”
Both professionals noted that not all women who find this period challenging will need a mental health service. Making good connections with their GP, public health nurse and community supports can be enough.
“Seeking support does not reflect in any way on you as a parent,” they both say. “If we don’t care for ourselves, we won’t be able to care for our families.”
Michelle Daly
Author and communications consultant Michelle Daly Hayes from Limerick is the mother of two boys, Luke (11) and Cole (6). She had the benefit of support from the SPMH service on her second child.
She had experienced mental health challenges, particularly anxiety, for 15 years prior to being pregnant but could still function day-to-day. However, traumatic births on both occasions meant that she suffered from Post Traumatic Stress Disorder (PTSD) each time.
Private counselling, medication and GP and family support helped her through after her first child, but she was glad that the new perinatal mental health service was there for her when she became pregnant with her second child in 2018.
“It was a pretty traumatic birth again due to haemorrhage but I didn’t have that same level of anxiety afterwards,” she says.
“The new service swung into action for me early in the pregnancy. They were my safety net,” she says.
Following support during the pregnancy and after the birth, her midwife, Maria, linked her up with Maeve, a Community Mother, who visited her several times.
“She told me about services in the community like parenting classes and baby yoga – things I didn’t know existed.”
She now urges women to reach out for help. “We always think everyone else is coping better than us but the reality is a lot of women struggle. You never know what’s going on behind those Instagram posts.”
She says depression doesn’t always look like someone crying all the time.
“It takes many forms including a woman seeming distant or detached or not wanting to go out. It can also be a woman who is overactive and obsessed with cleaning the house or baby.
“I’m the one who gets busy and overwhelms myself and then has a crisis. You need to be aware if someone is behaving any way oddly.”
Michelle would like to see the service broadened out. “A crisis helpline where if someone wasn’t well they could self-refer would be helpful,” she says.
Specialist perinatal mental health services are now available in all maternity hospitals.Limerick Maternity Hospital was the first to provide this service outside of Dublin.Specialist perinatal mental health service teams include clinical psychologists, perinatal consultant psychiatrists, mental health nurses, occupational therapists, social workers and mental health midwives.Women can still check in with the service even though they have left the maternity hospital. This can be done by asking their GP or public health nurse to refer them.See hse.ie/eng/services/list/4/mental-health-services/specialist-perinatal-mental-health/ Read more
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