This document summarizes key information from videos and literature on maternal mental health and well-being during pregnancy and postpartum. Some of the main points covered include: how stress and depression during pregnancy can negatively impact fetal development; the importance of screening for mental health issues and providing counseling and support to pregnant women; and the need for comprehensive maternal health services that address both physical and mental well-being of the mother to promote optimal development of both mother and baby.

1. Pregnancy and Maternal Care

2. Summary: Video 1
• Deals with a young woman from Khayelitsha.
• Her pregnancy was unplanned.
• She finds herself isolated and depressed, with suicidal
thoughts.
• She is lucky to attend Mowbray MOU, where she was
screened as part as their Mother’ s Mental Health
Project.
• She receives counselling & support and recovers well.
• In her testimony she emphasizes the fact that speaking to
a stranger felt good and non-threatening
• The listening skills and advice received was very helpful.
• By the time she delivers her baby she is a happy and
proud mother.

3. What is mental wellness?
Not just the absence of illness, but:
Social connectedness,
Positive relationships,
Self esteem,
Resilience,
Purpose in life,
Personal growth,
Environmental mastery,
Autonomy

4. Risk Factors for Mental Health Problems
Lifelong
• Poverty
• Domestic violence
• Sexual abuse
• Alcohol & substance
abuse
• Stressful life
experiences
• Physical illness
• Food insecurity
• Fragile circumstances:
conflict, migration,
natural disaster
• History of mental health
problems
Perinatal Period
• Adolescent pregnancy
• Unwanted pregnancy
• Lack of support from partner /
in-laws
• Being unmarried
Postnatal Period
• Abortion/miscarriage/stillbirth
• Infant sick, developmental
problems, etc.
• Lack of social support
• Girl child

5. Protective Factors
for Mental Health Problems
• Having more education
• Having a permanent job
• Having a kind, trustworthy
intimate partner
• Companionship in labour
Fisher et al,
Systematic Review Bull WHO 2012

6. Summary: Video 2
• Discusses the negative effects of stress in pregnancy.
• Cortisol and adrenaline (‘stress hormones’) released into the
maternal circulation, get to the foetus circulation.
• Brief exposure of the foetus to stress hormones causes no harm.
• Chronic exposure to stress hormones depresses the electrical
activity in the areas of the joy, happiness and curiosity.
• Prolonged exposure to toxic stress affects the baby’s brain,
changing its architecture and wiring.
• Children from stressful pregnancies are withdrawn, cry a lot and
have a more aggressive behaviour.
• A child that is sad, fearful and lacks curiosity does not respond to
the stimulation required for full brain development

7. Add slide on frequency of mental
health problems

8. Impact of Maternal Mental Health Problems
Antenatal depression
• Poor uptake of health and social
services
• Poor physical health & poor
nutrition
• Substance & alcohol abuse
• Foetal development
• Birth outcomes
• Childhood development
problems: behavioural,
cognitive, motor &
psychological
Independent from impact of
postnatal depression
Antenatal anxiety
• Pre-eclampsia
• Intra-Uterine Growth Retardation
• Preterm birth
• Low apgar
• Foetal programming effect (HPA
axis) – long term consequences:
physical, cognitive, social, mental
health
Greater impact for offspring than
depression?
Separate and additional impact to
depression
ALSPAC study: Avon Longitudinal Study
of Parents and Children

9. • The mother’ s food security and
nutrition choices are very
important.
• Iron and folate micronutrient
supplements are critical.
• Preparing for Exclusive
Breastfeeding is the most natural
way to foster mother-infant
attachment.
Nutrition

10. How does the ‘attachment’ relationship develop?
• The 1st connection with the world is through the body and senses
• Learning is optimized by the emotional warmth and safety of the
interconnectedness
• Fathers and siblings play an important role in their love and care
10
SAFETY
LOVE

11. Implications for Services
Antenatal Birth to 6 months 7 months to 2 years
General
Health &
wellness
Booking < 20weeks;
4 ANC visits;
PMTCT;
Educate, screen, refer
problems of alcohol,
tobacco, drugs;
Psychosocial risk
screen & mental
health screen
Postnatal care
Effective Family Planning
PMTCT
Immunisations
Management of disease
(pneumonia /diarrhoea)
Developmental screening
Hand washing & hygiene
Immunisations
Management of disease
(pneumonia / diarrhoea)
Developmental screening
Hand washing & hygiene
De-worming
Adequate
nutrition
Balanced diet
Micronutrients
Optimal weight
Breastfeeding
counselling
Support Exclusive
breastfeeding
Growth monitoring
Prevent malnutrition
Breastfeeding
Complementary feeding
Micronutrients
Growth monitoring
Prevent malnutrition
Supplementary feeding
Stimulation
& Support
Psychosocial support
Parenting information
Promotion of
caregiving practices
Parenting information
Promotion caregiving
Early learning (home)
Birth registration, Child
Promotion caregiving
Early learning (home)
Parenting information
CSG

12. Summary of lessons learned - 1
• The mother’s relationship with the baby starts in
pregnancy
• When a pregnant woman is depressed the foetus also
feels sad and that affects its future growth and
development
• 1 in 3 women in SA suffer from depression
• Screen pregnant women for psychosocial & mental
health problems
• Missing maternal depression is a huge ‘missed
opportunity’
• Pregnant women that are depressed need care
• Prematurity, low birth weight and various types of child
development problems can be prevented

13. Summary of lessons learned - 2
• The uterus provides the first safe and secure environment
for the child to grow and develop
• Mothers themselves need a supportive environment to
provide loving and safe care for the child
• Antenatal and postnatal services needs to focus on the
health and well-being of both mom and baby
• Currently little attention is paid to the mother well-being
and how she interacts with her child
• The mother’s effectiveness as a parent depends on the
support she gets from the father, extended family, employer
and the community at large

14. Summary of lessons learned - 3
• Promote early bookings
• Comprehensive risk assessments to identify toxic stress &
refer:
– Mental Health problems?
– Substance abuse, alcohol, smoking?
– Food insecurity?
– Is counselling & social support required?
– Parental readiness?
• Map your intersectoral service departments /NGOs & refer
• Ensure effective family planning (birth spacing of at least 2
years)
• Teenagers vulnerability: stress, depression, birth complications
and increased child mortality
• Exceptional compassion is needed towards adolescent
mothers

15. Creating the right conditions is likely to be
more effective and less costly than
addressing problems at a later age
It is easier to build strong children than
to repair broken men.
Frederick Douglas

16. Acknowledgements:
Simone Honikman, Janet Giddy, Elmarie Malek, Michael Hendricks,
Wayne Wright (videos) Desmond Hendricks (sound)
Thank you!