Emotional processing in childbirth : a longitudinal study of women's management of emotions during pregnancy and the association with postnatal depression

Background: Childbirth is popularly considered to be a time of happiness and fulfilment, yet many authors have reported that women express more negative feelings, including anxiety, apprehension, self-doubt and guilt requiring significant emotional and psychological adaptations during pregnancy and postpartum than at other times in their lives. Yet, despite evidence of emotional stresses challenging women in the perinatal period, one largely unexplored factor is how the management of this complex range of emotions impacts on maternal psychological health. If managed inappropriately emotions evoked by stressful events will intrude on the maintenance of everyday behaviour. The Emotional Processing Scale (EPS), a tool developed to measure the management of emotions and validated in a variety of countries worldwide, identifies poor processing. To understand maternal emotions more fully this study has used the EPS to explore relationships between emotional processing during the life-changing events of pregnancy and birth and the emergence of postnatal depression. Aims: The study aimed to examine the relationship between the way women managed their emotions during pregnancy, as measured on the EPS and the development of postnatal depression, as measured on the Edinburgh Postnatal Depression Scale (EPDS). It also investigated the possibility of predicting postnatal depression from scores on the EPS in conjunction with other recognised risk factors. Methods: A cohort of 974 pregnant women, aged 16 to 44, from the South of England were surveyed at 13 and 34 weeks gestation and 6 weeks postpartum. In addition to demographic information, standardised measures included the EPS, the Edinburgh Postnatal Depression Scale, the Short –Form 36 and the Rosenberg Self-Esteem Scale. Data were analysed using a variety of univariate and multivariate techniques to investigate the inter-relationships between these variables. Multiple and logistic regression models were built to determine which variables measured during pregnancy best predicted postnatal depression. Findings: Strong associations were found between poor emotional processing and the likelihood of developing postnatal depression. After adjusting for other recognised and established risk factors for depression, poor emotional processing in early and late pregnancy made a strong unique contribution to the prediction of postnatal depression and the odds of women with a high EPS scores in early and late pregnancy developing depression postpartum were 2.5 and 3.4 times greater than women with low EPS scores. Implications: There is a need for professionals to have a greater understanding of emotional processing. It is easily measured, and integration of emotions assessment together with supportive measures to facilitate women to manage their emotions more effectively into the existing framework of antenatal care could enable the strategy to be undertaken in a resource-efficient way. This could benefit families who might suffer from the detrimental impact of maternal perinatal emotional and psychological disturbances.