A short piece on maternal mental health, in light of maternal mental health awareness last month

Posted by Richard Maddicks

6th June 2023

Written by JJ Wellock and Cian Hancock, Assistant Psychologists.

There is nothing more beautiful than hearing your baby’s cry for the first time. It is the true realisation that you are now a parent and your whole life has just changed forever. Although, skip a few days ahead and that cry has you googling “when do babies start sleeping for longer than an hour?”; in the hope that there is some cheat code that will give you a well-deserved rest. I’m sorry to say, I looked extensively in those newborn days and there are none.

However, crying is an innate behaviour which infants have, to alert their caregiver(s) that they require a need to be met. A cross-cultural fMRI study on 43 new mums found consistent activation in areas of the brain strongly associated with speech and movement (Bornstein et al, 2017). Other studies have also found activation in the amygdala (responsible for emotional response) in mothers who heard their own and other infants’ cries (Kim et al, 2011; Piallini et al, 2015). The resulting action means the infant gets fed, a clean nappy, rocked, or sometimes in my case, the mother joins them crying in the early hours.

All joking aside, prolonged infant crying has been found to cause mental distress in parents. A study with 98 first-time mothers were asked to either listen to a baby either crying or cooing for ten minutes (Fairbrother et al, 2014). Around 23% overall had intrusive negative thoughts of harming the infant, whilst others in the crying condition reported urges to leave them, rather than comfort them. We can then assume that hearing an infant cry initially can provoke a caregiving response, but prolonged crying can induce frustration and therefore more negative thoughts.

A well-researched mechanism which may underpin mental distress is emotion dysregulation. Literature widely suggests that people who struggle to regulate their feelings in response to highly emotive situations, for instance prolonged crying, could form negative or critical self-beliefs, for example about one’s role as a mother. This is not to say that mothers who cannot cope with their baby crying will develop a mental health problem, rather it’s likely that this occurs in combination with other factors such as an intolerance of uncertainty, environmental chaos, and a pre-existing psychopathology. Importantly, a diagnosis alone is not a risk factor for negative child outcomes (Kowalenko et al., 2013).

Furthermore, it is understandable that mothers may be more protective in particular situations, but flexible responding is crucial to support child development – even in times of uncertainty, for example not knowing when your baby will stop crying (Guite et al., 2009). And this is really difficult, not only for a first-time mum but for all mothers. When the goal of regulating emotions becomes centred around accurately processing infant’s cues, it seems hardly surprising that mothers can become distressed (Eisenberg et al., 1998; Sher-Censor et al., 2017).

With such huge life changes and a need for fast adaptation, it is no wonder that maternal mental health issues are common. More than 1 in 10 women in the UK each year experience perinatal mental health related disorders (Nottinghamshire Healthcare NHS Foundation Trust, 2023). Unfortunately, many of these women are apprehensive about seeking support, possibly due to a fear of their baby being taken away or fear of being misunderstood. 66% of the costs of perinatal depression and anxiety to the UK (£6.6 billion per year) are associated with its impact on children, due to adverse behavioural and emotional outcomes (Bauer et al., 2016). Where it is largely misunderstanding and misconception which forms a barrier for women to seek help, only awareness, research and open conversations can break it down. It is so important for everyone to support our mothers, who do so much.

Here are some resources for further information and ways of accessing further support.

References:

• Bauer, A., Knapp, M., & Parsonage, M. (2016). Lifetime costs of perinatal anxiety and depression. Journal of Affective Disorders, v. 192, pp. 83-90. DOI: 10.1016/j.jad.2015.12.005
• Bornstein, M. H., Putnick, D. L., Rigo, P., Esposito, G., Swain, J. E., Suwalsky, J. T., … & Venuti, P. (2017). Neurobiology of culturally common maternal responses to infant cry. Proceedings of the National Academy of Sciences, 114(45), E9465-E9473.
• Eisenberg, N., Cumberland, A., & Spinrad, T. L. (1998). Parental Socialization of Emotion. Psychological Inquiry, 9(4), 241-273. DOI: 10.1207/s15327965pli0904_1
• Fairbrother, N., Barr, R. G., Pauwels, J., Brant, R., & Green, J. (2015). Maternal thoughts of harm in response to infant crying: an experimental analysis. Archives of Women’s Mental Health, 18, 447-455.
• Guite, J. W., Logan, D. E., McCue, R., Sherry, D. D., & Rose, J. B. (2009). Parental beliefs and worries regarding adolescent chronic pain. Clinical Journal of Pain, 25(3), 223- 231. DOI: 10.1097/AJP.0b013e31818a7467
• Kim, P., Feldman, R., Mayes, L. C., Eicher, V., Thompson, N., Leckman, J. F., & Swain, J. E. (2011). Breastfeeding, brain activation to own infant cry, and maternal sensitivity. Journal of child psychology and psychiatry, 52(8), 907-915.
• Kowalenko, N. M., Mares, S. P., Newman, L. K., Sved Williams, A. E., Powrie, R. M., & van Doesum, K. T. M. (2013). Family matters: infants, toddlers and preschoolers of parents affected by mental illness. Medical Journal of Australia, 199(3), 14 – 17. DOI: 10.5694/mjao11.11285
• Nottinghamshire Healthcare NHS Foundation Trust. (2023, April 28). Maternal Mental Health Awareness Week 2023. https://www.nottinghamshirehealthcare.nhs.uk/latest-news/maternal-mental-health-awareness-week-2023-6206
• Piallini, G., De Palo, F., & Simonelli, A. (2015). Parental brain: cerebral areas activated by infant cries and faces. A comparison between different populations of parents and not. Frontiers in psychology, 6, 1625.
• Sher-Censor, E., Dolev, S., Said, M., Baransi, N., & Amar, K. (2017). Coherence of Representations Regarding the Child, Resolution of the Child’s Diagnosis and Emotional Availability: A Study of Arab-Israeli Mothers of Children with ASD. Journal of Autism and Developmental Disorders, v. 47, p. 3139–3149. DOI: 10.1007/s10803-017-3228-8