Your brain on pregnancy, p.4
Your Brain on Pregnancy, page 4
History of Mental Health Problems
Having a previous mental health problem is the strongest predictor of experiencing depression, anxiety, and stress during pregnancy.60, 61 Research shows that if you’ve experienced anxiety or depression before you became pregnant (including as a child or teen), you are six to eleven times more likely to develop depression during pregnancy. When practitioners gather health history, they commonly ask the three general questions. If you’re concerned about having this risk factor, take a moment to answer the questions on the following pages.
SELF-ASSESSMENT
Your Emotional Health History
Simply respond with Yes or No, and then give yourself 1 point for each Yes.
I have had a bout of depression or anxiety that lasted two weeks or more at some time in the past.
I have experienced depression or anxiety with a previous pregnancy or after delivery.
My mother, father, or a sibling has experienced (or been diagnosed with) depression, anxiety, or another mental health problem.
Your Results
If you scored 0, you have no personal or family history of depression or anxiety, so your risk is low. The higher your score, the greater the impact of your personal and family history becoming a risk factor for depression or anxiety during pregnancy or after you have your baby. Having a previous episode of depression, anxiety, and stress may signal the need to invest time and effort in neuro-regulating strategies, such as the BEE Protocol in Chapter 7.
Lack of Support
A lack of support, such as not having a trusted friend or group of friends, almost triples the risk of depression, anxiety, and stress.62 And this makes sense, because new neurobiological research reveals that when we are connected to others in a safe relationship, our autonomic nervous system is calmed and regulated. As a neonatal nurse, I would often put a newborn baby on their mother’s bare chest and then notice on the electronic monitors the slowing and regulating of the baby’s heart and respiratory rates. I was amazed to learn that the same principle applies to adults! In fact, in my counselling practice, I would sometimes give couples a homework assignment to hug once per day for two minutes because the simple act of hugging engenders physiological co-regulation—and trust. Because low support can be so detrimental, and strong support so resiliency enhancing, I invite you to complete the Maternity Social Support Scale as a check-in on your social support.
SELF-ASSESSMENT
The Maternity Social Support Scale63
The following six questions ask about the quality of your relationship with your partner and close friends to help you assess the degree of social support you currently have. You can fill this out any time, but ideally at least once during your pregnancy and again within the first few months after delivery. Life will change dramatically after you have your baby, and it’s a good idea to check in and identify whether your level of support continues to meet your needs.
Answer each of the questions with one of the five responses: always, most of the time, some of the time, rarely, and never. Then add up the responses for your total score.
For each of the following statements, please tick the box which shows how you feel about the support you have right now:
A. I have good friends who support me.
Always
Most of the time
Some of the time
Rarely
Never
5
4
3
2
1
B. My family is always there for me.
Always
Most of the time
Some of the time
Rarely
Never
5
4
3
2
1
C. My husband/partner helps me a lot.
Always
Most of the time
Some of the time
Rarely
Never
5
4
3
2
1
D. There is conflict with my husband/partner.
Always
Most of the time
Some of the time
Rarely
Never
1
2
3
4
5
E. I feel controlled by my husband/partner.
Always
Most of the time
Some of the time
Rarely
Never
1
2
3
4
5
F. I feel loved by my husband/partner.
Always
Most of the time
Some of the time
Rarely
Never
5
4
3
2
1
Your Results
YOUR SCORE
THE MEANING OF YOUR SCORE
YOUR NEXT STEPS
6–18
Low social support
Overall, you feel you don’t have enough social support, which may be difficult for you as you move through pregnancy and into parenthood.
19–24
Medium social support
Overall, you have medium social support. Your relationships with your friends, family, and partner offer some emotional and practical support, but you may feel at times that you could use more.
25–30
Adequate social support
Overall, you have adequate support. Most of the time, you feel that your relationships are supportive and that you are well-prepared for your transition.
Questions A and B focus on the support of your friends and family. If you scored 3 or below on these questions, you likely lack strong support from this circle. Relationships are two-sided, and one person can’t improve the relationship as much as they may desire to. Consider whether there is anything you can do to build those relationships.
Questions C, D, E, and F focus on the quality of your relationship with your partner. If you scored between 1 and 2, consider seeking support for you and your partner, such as individual or couples’ counselling. If you scored 3, you and your partner may want to seek outside help, or you can use the strategies in the following section on pushback factors to strengthen your relationship so that it’s mutually satisfying and supportive.
Other Risk Factors
Much work in the past decade has focused on the link between our attachment pattern (how we relate to others and expect others to respond to us) and mental health. In pregnancy and postpartum, we are interested in two sides: a mother’s own early attachment patterns and her attachment to her baby.
Our attachment pattern is formed when we’re young and follows us into adulthood, framing the way that we view and act in relationships and how we tend to cope with stressors in our lives. The two broad kinds of attachment are insecure and secure attachment.
Someone with a secure attachment pattern will reach out to their partner or a close friend or family member for comfort and support in times of difficulty and naturally expect (and trust) that they’ll be available and willing to help.64 They’ll have a natural ease and trust in their relationships, feel comfortable being alone, and be able to manage conflict and relationship troubles.
Conversely, when someone with an insecure attachment reaches out for help, they’ll want excessive closeness, seek continual reassurance, and fear that the person won’t be able to give them what they need. They may find it hard to trust people and are generally wary in relationships—both in what they give and receive. They often feel insecure being alone because their self-worth comes primarily from their relationships. Studies show that people with insecure attachment tend to have disrupted stress systems and so are more physically and emotionally taxed under stress.65
As I see that fact on the page in black and white, it seems like a massive understatement, because we now suspect that the disrupted stress system didn’t begin at the macro level of the brain and nervous system—it began at the cellular level with the more than one hundred thousand sensory proteins on every body cell that read our environment for danger.66 Because the trajectory of these embryonic cells sets the foundation of growth of our entire body, it’s critically important for the cells of the embryo to grow in a uterine environment that is flooded with nurturing goodness stemming from a mother at low stress, threat, and danger. When those cells grow in a toxic environment, the embryo’s sense of safety and trust is disrupted, and new thinking is that insecure attachment begins at this early, cellular level. The good news is that we can shift these early effects, and the first step is to recognize when we are dysregulated.
There are other, less common and lower risk factors for prenatal depression, anxiety, and stress, such as infertility treatment. Between 10 percent to 14 percent of women who have undergone infertility treatment experience depression, anxiety, or stress in pregnancy.67 However, most studies, ours included, show that they rarely continue into pregnancy unless women have other risk factors, such as partner conflict.68
Other studies have shown that about 16 percent to 22 percent of women who had a pregnancy loss experience depression, anxiety, or stress post-loss and are at increased risk for mental health problems in subsequent pregnancies.69, 70 One study from Denmark reported that 41 percent of women who had a previous pregnancy loss experienced high stress compared to 23 percent of pregnant women who never had a loss.71 Pregnant women who are hospitalized for high-risk pregnancies tend to have higher rates and greater severity of depression (20 percent) and anxiety (39 percent).72, 73
Having risk factors for mental illness isn’t good or bad. It’s part of the fabric of your life—your story. While you can change some of these, you can’t change all of them. That’s why it’s important to build your emotional health, which we’ll discuss throughout the book, so that you have a line of defense when difficult things happen in life. You can also lower your risk and even prevent depression, anxiety, and stress with pushback factors.
Pushback Factors for Mental Health Problems in Pregnancy
As always, there is hope to be found in what can be difficult facts. Significant risk factors, such as our relationship with our partner, tell us that there is something about those experiences that are critical for our well-being. When we have their negative aspects (such as partner conflict), they are risks.74 When we have their positive aspects (such as partner support), they are strengths. The four risk factors that I’ve discussed—partner troubles, experiencing stress, having had a mental health problem in the past, and inadequate social support—are, when strengthened, the greatest source of resilience you can possess. They can act as pushback factors because they can reduce our risk of depression, anxiety, and stress.
For example, if you are having a year filled with stressful life events—your mother was taken seriously ill, you lost your job and are experiencing financial difficulties, and you were just diagnosed with gestational diabetes—this accumulation of stressful life events can increase your risk for developing depression and anxiety. However, if your partner relationship was intimate, low-conflict, and supportive, your risk may decrease, and your resilience can increase.75
On a neurobiological level, pushback factors are anything that lower your risk for depression, anxiety, and stress because they maintain the nervous system in a regulated state. Those identified in the prenatal mental health and mental health literature in general include spending time in nature; play (e.g., sports, movies, reading); supportive relationships; feeling connected; restful sleep; exercise; hope, optimism; resiliency; and positive childhood experiences. In this chapter, I’d like to specifically focus on resilience, coping strategies, and social support.
Resilience
The research definition of resilience is the group of biological, psychological, social, and cultural factors that determine how we respond to a stressful situation.76 But neuroscience might define it as a well-regulated brain and nervous system that quickly re-regulates within the context of difficult life circumstances. As a pushback factor, resilience helps us to function in the face of debilitating stress.
Resilience isn’t borne out of an easy life with no challenges. In fact, there is a phenomenon called the Steeling Effect, which shows that people who experience some adversity in their lives have better mental health and are more satisfied with their lives than are people with either a lot of adversity or no adversity. In other words, too much stress or stress that lasts too long wears us down, and our resilience suffers. Too little stress doesn’t give us enough experience and practice dealing with adversity to build up our capacity to handle it in a good way. And some adversity is good because it makes us more resilient.
Tolerance to adversity is rooted in neuroplasticity. While significant adversity, such as multiple ACEs, can take our nervous system off-line so that it cannot re-regulate easily on its own, research by neuroscientist and pioneering stress researcher Dr. Bruce McEwen suggests that our brain actually adapts to moderate stress, causing our brain and nervous system to change and grow and promote regulation, or resilience.77
How does this show up in your life? With greater resilience, you adapt to challenging situations more readily. A situation arises, your brain and nervous system become activated, and then it settles quickly, and you engage in clear-thinking problem solving. This helps build confidence about your ability to handle change and stress so that uncertainty about life situations and future outcomes is less daunting. With this, the experience stimulates more neuroplasticity, forming healthy brain networks that help to increase your resilience even more. And our research shows that resilient mothers have resilient children.78
SELF-ASSESSMENT
The Brief Resilience Scale79
The following assessment measures your ability to bounce back when faced with challenges in the past month. You can use it any time, but ideally at least once during your pregnancy and again after you have your baby.
Answer each question with one of the five responses, add up your scores, then divide your total score by 6. For example, if your total score to the six questions was 17, you would divide 17 by 6 to get a final score of 2.83.
I tend to bounce back quickly after hard times.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
1
2
3
4
5
I have a hard time making it through stressful events.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
5
4
3
2
1
It does not take me long to recover from a stressful event.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
1
2
3
4
5
It is hard for me to snap back when something bad happens.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
5
4
3
2
1
I usually come through difficult times with little trouble.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
1
2
3
4
5
I tend to take a long time to get over setbacks in my life.
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
5
4
3
2
1
Total Score
Divided by 6
Your Results
YOUR SCORE
THE MEANING OF YOUR SCORE
1.00–2.99
Low resilience
3.00–4.30
Normal resilience
4.31–5.00
High resilience
If you discovered that your resilience is on the low side, it’s not because you don’t have the ability to manage life’s tough situations. Your score reflects a dysregulated nervous system that has probably been jarred by one or more significant challenges in your life, including being worn down by chronic stress, having symptoms of depression or anxiety that make it difficult for you to cope with problems, or not having had the opportunity to build helpful coping strategies. Later in the book, we’ll discuss the ways you can improve your resilience to enhance your ability to cope with and recover from stressful situations and make it easier to manage—and enjoy—your transition to parenthood.
Coping Strategies
Coping strategies are cognitive and behavioural efforts to manage specific external and/or internal demands that tax or exceed the resources of the person.80, 81 For instance, walking in nature or deep breathing are behavioural coping strategies—actions you take—to reduce your distress.
