Pregnancy and giving birth to a daughter or a son are among the highest points in any woman’s life and they are life-changing. A parent is something you become and it takes time. Caring for an infant can be stressful and exhausting.
Studies confirm that anxiety and stress incidence are influenced by numerous social factors; physiologically, however, they involve the endocrine system. During different stages of pregnancy, the composition of the hormones in circulation varies considerably, beginning with chorionic gonadotropins; these changes also affect progesterone, oestrogens, prolactin, endorphins, relaxin, oxytocin, and prostaglandins. In the period following childbirth, further shocks are caused by the rebalancing and changes in concentration of these same hormones.
Post-partum depression and temporary disorders
Within a few hours of giving birth, 50% of new mothers begin to suffer from temporary mood disorders, which usually stabilize quite quickly. These can manifest as sadness, crying, emotional lability, loss of appetite, trouble sleeping, loss of interest in normal activities, feelings of inability to care for their infants, and concern about their infants’ well-being. These symptoms, which are considered normal, are known as the “baby blues” (Earls, 2010; Gavin et al., 2005; Reck et al., 2006; Sriraman et al., 2018).
On occasion, this vulnerability can linger for longer than two weeks and give rise to the complex condition of postpartum depression (Earls, 2010; O’Hara et al., 2013; Schiller et al., 2015; Sriraman et al., 2018). It is one of the most dreaded repercussions of the end of pregnancy and it is not uncommon. It affects one in eight new mothers, manifesting within the first year and no earlier than one month after childbirth. New mothers who suspect they might be depressed should ask for help as soon as possible, because the condition can get worse or last for several months, with possible strong impacts on the newborn child and on the rest of the family as well. It brings about physical, mental and emotional changes, which include low self-esteem, irritability and significant deterioration in social relations (Slomian et al., 2009; Wisner et al., 2013), circumstances which could have a negative impact on the mother-child relationship (Righetti et al., 2002; Murray et al., 1996) and lead to “frightening” recurring thoughts, such as a fear of hurting one’s child.
International recommendations underscore the importance of rapidly identifying and treating these conditions in non-stigmatising settings that respect the woman's life-cycle. Facing these problems alone is not the right thing to do, because there are many ways to recover your positive energy. In some cases, the new father might also need psychological support and should be encouraged to seek help as soon as possible. It is a good idea to talk about this with your family doctor or obstetrician. Many obstetricians are trained to recognise the signs of postpartum depression and provide help and support, and they can recommend specialists to help you to overcome it. As the Italian Higher Institute of Health (ISS) has pointed out, depression is an illness like any other; there is no need to feel guilty about being depressed, because it can happen to anyone. Being depressed doesn't mean you are a bad mother or that you are at risk of losing your child.
Post-partum depression: treatments
Different types of pre- and postnatal therapies have been developed in recent years to improve the well-being of new mothers and, through the right help and support, which can include mutual-help strategies and psychological and/or pharmacological therapies, prevent disorders from arising. The U.S. Food and Drug Administration (FDA) recently approved the first drug for treating postpartum depression, a pill developed by Sage Therapeutics and Biogen.
Alternative therapies for treating postpartum depression
Side-effect-free holistic therapies, from yoga to meditation, to massage, have proven their effectiveness. Thanks to growing scientific evidence, the method of using music to help improve emotional states—whether actively, through making music, or passively, through listening—is gaining attention as a relaxation technique (Carolan et al., 2012; Persico et al., 2017; Wulff et al., 2020). The results include positive effects on internal hormone production, such as a lower level of cortisol (the “stress hormone”) and a higher lever of oxytocin (the “happiness hormone”, which has a positive influence on bonding). Longer-term treatments have given new mothers a greater sense of self-sufficiency and of connection with their infants.
The benefits of singing for new mothers
Particularly, the simple and universal act of singing, during the prenatal period and postpartum, has been shown to be a protective factor against the disorders that can arise. It can also reduce newborns’ episodes of crying and lower new mothers’ stress levels, bolstering the relationship between mother and child following birth.
Singing boosts respiratory capacity and blood oxygen levels. The proper use of the muscles in the diaphragm should be encouraged, as it provides a sort of abdominal massage in and of itself. This is a holistic discipline, whose roots stretch back into the history of humankind. It allows us to access areas deep within our bodies, activate the parasympathetic system, which is responsible for homoeostasis, cathartically releasing negative emotions, which, if allowed to calcify, can give rise to psychosomatic disorders, as Claudia Pastorino, professor at the Languages of Song Laboratory at the University of Genoa, has explained.
Among the many studies on the benefits of music in fighting postpartum depression is one important trial, whose results were published in the British Journal of Psychiatry. It was conducted by a group of English researchers, including Daisy Fancourt, psychobiologist at University College London. A sample group of 134 new mothers affected by depression were divided into three groups and involved in different activities over the course of ten weeks: the first group engaged in sessions of creative play; the second took part in group singing workshops; and the third were provided with standard care, such as family support, antidepressants and psychotherapy.
The fastest improvement was observed in the mothers who attended the group singing workshops with their newborns, where they learned a selection of songs in different languages. Their symptoms of depression decreased by 35% in one and a half months. Rosie Perkins, a behavioural science researcher and one of the study's other authors, stated that, "Postnatal depression is debilitating. For a mother to be able to successfully treat it with her child by her side, in such a short period of time, is an outcome that offers hope for getting through one of the most difficult times that a woman can experience during her life".
A new european study
To better understand the practical implications of art and healthcare therapies in different settings, the WHO Regional Office for Europe has implemented a new research protocol based on this clinically proven technique, originally developed in the United Kingdom. The protocol was implemented in three WHO European Member States (Romania, Italy and Denmark) to determine whether this method could be used in other cultural contexts. The study, carried out by individuals trained ad hoc by Breathe Arts Health Research and the WHO, assisted by healthcare professionals, involved women with symptoms of depression (scoring higher than 10 on the Edinburgh Postnatal Depression Scale) with children 9 months old or younger. The perceived impact on participants’ mental health was examined using different measurement scales (the EPDS, the MSPSS and the WHO-5) at weeks 0, 6 and 10, as well as through focus groups and interviews. The lessons learned from this project, and its implications, will be used for the development of similar art and healthcare initiatives and for their integration into healthcare systems.
On 6 October, the WHO will present the results of the “Music and Motherhood” study at its office in UN City in Copenhagen, during the course of a day of international studies in collaboration with Jameel Arts and Health Lab, where the potential of culture and of the arts to innovate and support healthcare systems and improve health and well-being will be explored.
This is one of the outcomes of the journey begun by the WHO in 2019, when it presented Report 67/2019, a scoping review without precedent in terms of the sheer volume of the studies it took into consideration. In so doing, it illustrated how, at a time when healthcare systems are coming under growing amounts of pressure, a cross-sector approach to the arts and health can provide opportunities to increase the efficacy of healthcare systems by fostering and enhancing their relationships with culture. Such integration can only be achieved through the use of social prescribing, a means of connecting patients with an array of non-clinical community-based services to improve their health and well-being.