Addressing Mental Health in Pregnancy Head-On — From an Orthodox Christian Perspective
I believe there is a big misconception about mental health during pregnancy. Either you’re happy to be pregnant, and everything is easy, or you’re unexpectedly pregnant, and everything is a crisis. But my goodness, it’s just not that simple. Normal hormonal fluctuations can cause massive individual changes for each woman. Different coping strategies and support systems, overall health, and specific needs of pregnancy influence how you handle mental health changes.
More often than not, discussions about mental health consist of a “simple form to fill out” short-listed symptomology of clinical postpartum depression and anxiety without any further assessments or discussion. The typical 5-minute obstetric appointment does not allow for a relaxed discussion about psycho-social support and/or lack thereof.
It’s difficult to know what “normal” or typical is when we are experiencing so many changes (physical, emotional, relational, professional, etc). And knowing how to support our emotional needs, what is outside the normal range, and when to ask for help can feel daunting. Stay curious, not fearful, and ask friends, family, and social supports to assess if what you are feeling may need additional clinical support.
Having a broad base of social support is vital, and there are many support systems already in place, including friends, church, family, etc. Post Partum Support International (postpartum.net) is one group that offers information and online support groups.
As Orthodox Christians, we know we are both physical and spiritual beings. If we do not meet the needs of our spiritual life, it’s no wonder that our mental and physical health suffers. My prayer is that this section gives you the tools to evaluate your current mental health and know whether or not you have systems in place to support you, or if you need more support.
As your pregnancy progresses, you may find you need more emotional support, and that’s ok! Use this section as a guidepost to discern your specific needs and know what’s “normal” and what may warrant further investigation.
Normal hormone fluctuations and their influence on mental health
As progesterone, estrogen, and HCG rise throughout your pregnancy, they influence an intricate dance of other hormones that work to accommodate your growing baby. Thyroid hormone, insulin, glucose, cortisol, endorphins, oxytocin (plus many others) all shift in ways that you will not experience any other time than when you’re pregnant. These shifts can be sudden and scary. Getting more information and help is important.
It would be nice to say, “if you’re healthy, your pregnancy will be easy.” That isn’t always the case. There is a delicate balance of nutrients, circumstances, life stressors, and more that all influence how your pregnancy goes. So, while your body was designed perfectly to adjust to the hormones and physical changes of pregnancy, some women don’t find that to be the case.
What’s within normal limits?
It’s perfectly normal not to struggle emotionally during pregnancy! Many women talk about how lovely their pregnancies are and how easy they seem to adjust to them. They thrive with the extra progesterone, and some chronic illnesses or autoimmune diseases might even go dormant for a time.
There is a normal amount of questioning that comes with pregnancy – Is my baby growing well? Am I nourishing myself properly? Will I be able to handle the sensations of labor?
You should question your wellness when these simple questions about the unknown turn into an obsession and leave you paralyzed with fear and anxiety. It’s one thing to have a thought that is totally out of left field, and you're able to laugh and move on, vs. a thought that won’t leave you alone and prevents you from living a normal life.
Are certain women more susceptible to a mental health crisis?
Mental health disorders are multifaceted. You may have never encountered an anxious thought, and then suddenly, you’re pregnant and feel like you're drowning in racing or intrusive thoughts, and you feel paralyzed in decision-making. But more likely, you’ve struggled with some sort of mental disorder prior to pregnancy, and now, it’s rearing its head again. In fact, women who struggle with anxiety, depression, OCD, etc., before pregnancy, are 30% more likely to experience a recurrence during pregnancy.
Stressful life events or living situations, death of a loved one, trauma, financial instability, or grief can all increase the chances of prenatal mood disorders. Additionally, physiology influences your susceptibility to mood disorders, such as genetics, nutritional stores, and hormonal imbalances.
Ideally, women come to pregnancy in full health and vitality with every nutritional marker in balance. But, that’s very unlikely when over 80% of women have some sort of hormonal imbalance, 37% of women have anemia, and 5-50% of pregnant women are vitamin D deficient. And the more we study mental health, the more we are learning that nutritional deficiencies influence mental health management. There is a direct link between gut health and mental health. Of course, this isn’t the only influence, but it does play a role in mental health.
One study states, “Deficiencies in nutrients such as protein, B vitamins, vitamin D, magnesium, zinc, selenium, iron, calcium, and omega-3 fatty acids have a significant impact on brain and nervous system function, which can affect the appearance of depressive symptoms. However, it is important to remember that diet in itself is not the only factor influencing the risk of or helping to treat depression. There are many other aspects, such as physical activity, sleep, stress management, and social support, that also play an important role in maintaining mental health.”
So, to put it simply,
Prior history
Family history
Stressful living situations
Traumatic events
Death of a loved one
Grief
Nutritional deficiences
Hormonal imbalances
etc…
All play a role in whether or not you develop a mood disorder during pregnancy. And while this list can appear overwhelming, it gives a map for how to support yourself during pregnancy to get the best outcomes, regardless of your situation.
How to support your mental health in pregnancy
The human brain is a complex organ, one that often leads researchers and clinicians to ask more questions than find answers. God’s beautiful handiwork is not easily understood, but that doesn’t mean we are without tools to support our mental health.
First and foremost, your spiritual life should be in order. What does this look like? It means living a sacramental life within the Church. You attend the services, you seek regular confession and communion, you partake in the life and community of the church, you follow a prescribed prayer rule from your spiritual father, you TALK to your spiritual father regularly, and your husband does all of the above (whenever possible).
Second, you nourish your body to grow your baby and not run on fumes. There is more and more incredible research coming out on the intricacies of gut-brain health and how the two are closely linked. If you’re not nourishing your body properly throughout pregnancy, both you and your baby suffer. Start by asking your care provider for blood work and address any imbalances that may be present. It may be as simple as increasing your animal product consumption and taking a good vitamin D supplement. If more targeted work is required, blood work is a great place to start figuring out the root cause of any imbalances.
Third, your support system is vital. I understand we all come from different backgrounds. Perhaps you don’t have any family outside your husband, or your husband and you don’t share the same faith, or perhaps you're in a home where there are multiple generations, and no one agrees. This is tricky! Nuclear families with abundant support are very rare these days, but that doesn’t mean you can’t create the village you need. Support groups, church family, mom groups at the library, or ballet class for toddlers can prove incredibly supportive in times of stress.
Additionally, birth doulas are a resource who serve women in exactly this capacity. They are non-medical women (and sometimes men) who have a deep desire to serve pregnant women and their families. Even if you have a support system already in place, a doula is an incredible person on any birth team.
Exercise and movement are one of the most underrated mental health supports. 24 Of course, I’m not saying you need to pick up a new marathon habit or start a membership at the CrossFit gym down the street; rather, gentle, intuitive movement is the gold star of pregnancy – we already discussed the many benefits of exercise in weeks 13-17 highlight. So, please, don’t underestimate the power of regular movement during pregnancy.
Lean on the saints of the church in their wisdom. St. Paisios of Mount Athos talks about thoughts being “birds in the sky”; you don’t have to let them land and make a nest, you can simply acknowledge them and then let them go.
Prayer is essential to the Christian life and does more than just communicate your worries and fears to God. Prayer centers and calms the soul, offering nourishment and peace in an otherwise wild world. “Lord Jesus Christ, Son of God, Have Mercy on Me, a Sinner” is the prayer of the heart and one of the most powerful tools we have against anxiety, worry, and fear.
Positive affirmations should come after prayer. These are positive statements that may acknowledge the fear but flip it so that your brain can focus on the truth. For example: “I am worried about my baby's health. Right now, I know that my baby is growing because my belly is growing. I can be present in this moment.” Practicing positive self-talk is crucial for all of pregnancy, but especially when navigating labor and birth.
So what if you’re doing all of the above and it still isn’t enough? Sometimes you need a specialized psychotherapist and targeted support to find the healing you need. That is why God has given certain individuals a passion for the mental health industry. A good counselor, in conjunction with your spiritual father, may be the ticket to getting the support you need.
When to ask for more help
It can feel very humbling and uncomfortable to admit you need more support from specialized care. But you cannot pour from an empty cup, just as you can’t properly care for your growing baby while your life feels unstable. Seeking help is a vital step. Knowing when to ask for help is the first step.
No two women will share the same signs of needing more support, but there are common signs and symptoms of a mood disorder:
Persistent sad, anxious, or “empty” mood most of the day, nearly every day, for at least 2 weeks
Feelings of hopelessness or pessimism
Feelings of irritability, frustration, or restlessness
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in hobbies and activities
Fatigue or abnormal decrease in energy
Being restless or having trouble sitting still
Difficulty concentrating, remembering, or making decisions
Difficulty sleeping (even when the baby is asleep), waking early in the morning, or oversleeping
Abnormal changes in appetite or unplanned weight changes
Physical aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause and do not go away with treatment
Trouble bonding or forming an emotional attachment with the baby
Persistent doubts about the ability to care for the baby
Thoughts of death or harming oneself or the baby or suicide attempts
Feeling anxious all or most of the time
Not being able to control or manage your anxiety
Being restless
Feeling very worried (for example, about your baby)
Feeling a constant sense of dread
Finding it tough to focus your thoughts
Feeling like your mind goes blank
Feeling touchy
Feeling like you’re always on edge
Having trouble falling or staying asleep
A great place to start is speaking with your spiritual father. He should know your intricacies and where you might need further support. With his blessing, you can pursue clinical support if needed.
There are a few wonderful Orthodox resources available for finding a clinician –
Orthodox Christian Association of Medicine, Psychology and Religion (OCAMPR) “exists to foster interdisciplinary dialogue and promote Christian fellowship among professionals in medicine, psychology, and religion. Members pursue an understanding of the whole person, which integrates the basic assumptions of medicine, psychology, and religion within the Orthodox Christian faith. OCAMPR is for those who seek to understand and experience the best relationship between theology and the healing arts and sciences to offer their services in the light of Christ’s truth and the Church’s healing wisdom.”
If you can’t find an Orthodox counselor near you, more and more therapists are doing remote work, and your parish directory may know where to start.
Whether you find a counselor who is a Christian or not should not be the end-all, be-all. A good therapist listens, supports, and offers constructive guidance while honoring your whole personhood. Of course, this is most likely to be found with another Orthodox Christian, but it’s not impossible to find a good therapist outside the faith.
Final thoughts on mental health during pregnancy
Please remember we are fighting against a stigma regarding mental health struggles. The fact is, you do not have to, nor should you struggle alone. You can find healing and support so that you can live and thrive through your pregnancy, birth, and postpartum.
Don’t underestimate the power of your spiritual life, a nourishing diet, a close group of loved ones who offer support, and gentle, intuitive movement. It’s so easy to overcomplicate mental health support, but it doesn’t need to be. And don’t be afraid to reach out for more help.
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