This study provides valuable insight into women’s lived experiences and psychological needs with MHDP. It reinforces the importance of understanding and supporting the mental health of pregnant women, which has implications for both mother and child.
Reddish, A., Golds, L., & MacBeth, A. (2024). “It is not all glowing and kale smoothies”: An exploration of mental health difficulties during pregnancy through women's voices. Psychology and Psychotherapy: Theory, Research and Practice, 00, 1–21. https://doi.org/10.1111/papt.12527
Key Points
- The lived experiences of women with moderate mental health difficulties during pregnancy (MHDP) were explored using Interpretive Phenomenological Analysis, identifying five superordinate themes: 1) Feeling the ‘wrong’ feelings, 2) Societal pressures and a desire for greater acceptance, 3) Searching for answers despite a lack of resources, 4) What made a difference, and 5) Experiences and expectations of service provision.
- Factors like societal stigma, lack of awareness, perceived judgment, and unrealistic portrayals of pregnancy significantly impact women’s distress levels and reluctance to seek help for MHDP.
- The research provides valuable insights into women’s needs during pregnancy, but has limitations such as potential sampling bias and retrospective data collection.
- Understanding the unique experiences and needs of women with MHDP is crucial to developing appropriate perinatal mental health services and support.
Rationale
Psychological distress caused by mental health difficulties during pregnancy (MHDP) is common, impacting 7-20% of women, and can have significant effects on both mother and baby (Biaggi et al., 2016; Grote et al., 2010).
While perinatal mental health services in the UK are evolving, women’s subjective experiences of MHDP and their needs are less well understood (Smith et al., 2019).
Existing qualitative research has focused more on the postnatal period or specific diagnoses rather than gaining a holistic understanding of moderate-to-severe MHDP (Dolman et al., 2013; Megnin-Viggars et al., 2015).
This study aimed to address these gaps by exploring the lived experiences and psychological needs of women with moderate MHDP.
Method
This qualitative study used Interpretive Phenomenological Analysis (IPA) to explore the life experiences of participants and how they make sense of them.
Semi-structured interviews were conducted with 11 women recruited via a regional Perinatal Mental Health Service in Northern Scotland.
Interviews were transcribed and analyzed following IPA methodology, with the researcher noting descriptive, linguistic and conceptual comments, developing themes, and discussing them with the research team to ensure consistency.
Analysis
Researcher primarily analyzed the data by coding verbatim transcripts, noting descriptive, linguistic, and conceptual comments.
Themes were developed and explored in relation to each participant’s narrative, then grouped to understand patterns across all transcripts.
The third researcher independently analyzed multiple transcripts, and the researchers discussed themes to establish consensus.
A reflective log was used to identify and minimize the influence of biases on coding interpretations.
Written theme descriptions were discussed by the research team to ensure consistency with the interviews. The agreed sample size was 8-12 participants based on guidance and constraints.
Reflexivity
The research approach focused on the phenomenological perspective, guided by a social constructionist stance.
The primary researcher, a white female trainee clinical psychologist, had experience supporting distressed individuals but not specifically during pregnancy.
She kept a reflective log to manage potential biases. The research team, including a female PhD researcher and a male clinical psychologist with perinatal mental health expertise, discussed themes and reflections throughout the analysis process.
The latter two researchers did not conduct interviews directly.
Sample
The 11 women had experienced moderate distress due to MHDP (e.g. depression, anxiety, eating disorders). Seven were from an urban setting and four from rural. Most (n=9) had given birth prior to the interview.
One was aged 18-25, four were 26-34, and six were 35-40. Further demographics were not collected to maintain anonymity.
Results
Five superordinate themes represented the women’s lived experiences of MHDP:
1. Feeling the ‘wrong’ feelings
This theme encapsulates the intense emotional experiences and daily impacts on functioning that the women faced during their pregnancies.
Participants described feeling out of control, exhausted, and as if their distressing feelings would never end.
They often felt disconnected from their pregnancy and experienced guilt and shame for having thoughts they perceived as wrong or abnormal.
The quote “It was awful, it was anxiety I had panic attacks… it was like drowning” (P3) powerfully conveys the overwhelming nature of these emotions.
2. Societal pressures and a desire for greater acceptance
The influence of societal expectations emerged strongly in this theme. Participants felt they did not live up to the idealized image of a happy, glowing pregnant woman and experienced stigma and judgment when they deviated from this norm.
This led to feelings of isolation and reluctance to disclose their true emotions.
The quote “You’re just meant to feel happy when you’re pregnant. People expect you to be um happy and glowing” (P1) illustrates the pressure women felt to conform to unrealistic standards.
Searching for answers despite a lack of resources
This theme highlights the women’s attempts to make sense of their experiences despite limited awareness and information about MHDP.
Participants often looked for biological or situational explanations and reflected on past mental health difficulties.
However, they found that MHDP was rarely discussed or acknowledged compared to postnatal depression, leaving them feeling lost and unsupported. The quote “Nobody had heard of it before.
Everybody’s heard of postnatal depression” (P1) captures this lack of recognition and resources.
What made a difference
While many participants felt they had few sources of alleviation for their distress, this theme outlines the factors they identified as helpful or potentially beneficial.
Peer support, self-compassion, and a non-judgmental space to share their feelings were key elements. Some women found short-term relief through coping strategies like mindfulness or focusing on their children.
The quote “It was very, very helpful talking with them because I didn’t have to hide, I didn’t have to pretend that I’m happy” (P3) emphasizes the value of authentic, supportive connections.
Experiences and expectations of service provision
The final theme centers on women’s encounters with and perceptions of perinatal mental health services. Specialist services, when accessed, were generally appreciated for their understanding and normalizing approach.
However, participants highlighted the need for systemic changes, including earlier intervention, clearer pathways, and better integration between services.
The lack of open discussion and promotion of mental health support during pregnancy was also noted.
The quote “…pregnancy it’s still something that, it’s not discussed or even, like even in the antenatal clinic it’s not advertised about mental health during pregnancy there’s nothing on the walls or, or even like I think there maybe was one poster in one room about a support group, but other than that there’s no leaflets or um nothing to promote um positive mental health like I think, there’s nothing advertising it” (P8) encapsulates the invisibility and inaccessibility of MHDP support experienced by many women.
Insight and Depth
This study provides a rich understanding of the lived experiences of women with MHDP. It highlights the dissonance between expectations and realities of pregnancy that can compound distress, and the pervasive role of stigma as a barrier to seeking support.
The findings emphasize the importance of awareness, acceptance, and access to needs-matched care in the perinatal period.
Strengths
- The study had methodological strengths including the use of IPA to gain an in-depth understanding of lived experiences.
- Recruitment from both urban and rural settings.
- Reflexivity practices to manage potential researcher bias.
- The themes were grounded in participants’ narratives and discussed thoroughly by the research team.
Limitations
- Potential sampling bias was present as participants were recruited via one specialist service, and most had already given birth, introducing possible recall bias.
- No participants with severe MHDP (e.g. psychosis) opted in, possibly due to clinician judgment or self-selection.
- Limited demographic data was collected to protect anonymity but restricts transferability of findings. Data collection also occurred pre-COVID-19 pandemic, so it did not capture the impacts of this context.
Clinical Implications
The study has important implications for perinatal mental health services and wider society. It highlights the need for greater awareness and acceptance of MHDP, early access to needs-matched care, and more open discourse to normalize and destigmatize MHDP.
- Services need to normalize the range of emotions women experience during pregnancy to address feelings of dissonance.
- Lack of awareness and acceptance of mental health difficulties during pregnancy are barriers to women seeking help. Stigma leads to delays in accessing treatment and isolation.
- Unrealistic societal expectations of pregnancy negatively impact women’s wellbeing and help-seeking behaviors. Clinicians should encourage discussions about expectations and promote a realistic image of motherhood.
- Peer support is highly valued by women and should be made available earlier in the pregnancy journey. The Scottish Government’s action plan for developing perinatal mental health services includes access to peer support.
- A wider range of treatment options, including psychological therapies, should be available or accessible through clear pathways. Clinicians should make women aware of these options beyond just medication.
References
Primary reference
Reddish, A., Golds, L., & MacBeth, A. (2024). “It is not all glowing and kale smoothies”: An exploration of mental health difficulties during pregnancy through women’s voices. Psychology and Psychotherapy: Theory, Research and Practice, 00, 1–21. https://doi.org/10.1111/papt.12527
Other references
Biaggi, A., Conroy, S., Pawlby, S., & Pariante, C. M. (2016). Identifying the women at risk of antenatal anxiety and depression: A systematic review. Journal of Affective Disorders, 191, 62–77.
Dolman, C., Jones, I., & Howard, L. M. (2013). Pre-conception to parenting: A systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Archives of Women’s Mental Health, 16(3), 173–196.
Grote, N. K., Bridge, J. A., Gavin, A. R., Melville, J. L., Iyengar, S., & Katon, W. J. (2010). A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Archives of General Psychiatry, 67(10), 1012–1024.
Megnin-Viggars, O., Symington, I., Howard, L. M., & Pilling, S. (2015). Experience of care for mental health problems in the antenatal or postnatal period for women in the UK: A systematic review and meta-synthesis of qualitative research. Archives of Women’s Mental Health, 18(6), 745–759.
Smith, M. S., Lawrence, V., Sadler, E., & Easter, A. (2019). Barriers to accessing mental health services for women with perinatal mental illness: Systematic review and meta-synthesis of qualitative studies in the UK. BMJ Open, 9(1), e024803.
Keep Learning
- How do societal expectations and portrayals of pregnancy impact women’s mental health and help-seeking behaviors? What role does stigma play?
- What factors make the perinatal period a uniquely vulnerable time for mental health? How can services and society better support women’s psychological needs during pregnancy?
- The study found women valued peer support and non-judgmental listening. How could these elements be better integrated into perinatal care?
- Many women reported a lack of awareness and information about perinatal mental health. What strategies could be used to increase public and professional understanding of MHDP?
- The study had a limited sample in terms of demographics and geography. How might the experiences of other groups (e.g. minorities, different cultural backgrounds) differ? What additional research is needed?
- The findings suggest a need for more holistic, needs-matched care beyond just medication. What might this look like in practice? What barriers exist to providing comprehensive perinatal mental health support?
