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Perinatal Mood and Anxiety Disorders

By February 10, 2023August 16th, 2023Integrated Care Clinic

What we need to be talking about more with new moms

Have you ever noticed that there is such a strong emphasis on the giving birth part during a pregnancy, but then a shocking lack of information and support for what comes next. I don’t mean the ins and outs of your baby’s poop color or the different breastfeeding positions, I’m referring to the mental and emotional changes a woman goes through. Baby has so many appointments, checking in on them, in the beginning of their life, but who is checking in on mom? Where is the support and information to help a new or seasoned mom navigate the overwhelming and sometimes isolating and lonely aspects of motherhood? Also, what is normal distress and anxiety as a new mom versus what might require more intense help? 

When you’re given this tiny human to take home, it can feel like being pushed off a mountain with no tools or net to help you come safely to the ground. Thoughts like: ‘Am I going to be what they need?’ and ‘What if I make a mistake?’ might be swirling around in your head on top of already being sleep deprived and exhausted from the birth process.

So if you’re pregnant, a new mom, a mom of 3, a partner, a loved one of someone that has a child, or anyone in between and you’re reading this, my hope is that the information below will shed some light on those other questions. The common mental and emotional changes a mom might go through and also the signs and symptoms to be aware of and might require additional help and resources. 

Is it normal to experience distress during postpartum?

Motherhood is entirely new territory and with that can come a ton of doubts and questions about what’s normal versus potentially something more serious. Let’s discuss the normal range of distress that can occur during this time.

An important concept to understand is maternal preoccupation. It can start as early as late pregnancy and continues well into the first year postpartum. D. W. Winnicott, a renowned pediatrician and parent-infant therapist, stated maternal preoccupation was a state where the mother identifies closely with her infant so as to intuitively understand and meet her baby’s needs. However, he also suggested this heightened sensitivity can leave you sensitive to everything, including opinions and criticism from others and from yourself.

Then there is the balancing act that comes with your transition to motherhood as well. Navigating societal, career, and financial pressures that were not there before while still trying to take care of your baby. 

All of this leads to the conclusion that distress is normal during this period. In fact, 85% of women experience significant emotional distress during or after pregnancy. And that is because motherhood is not easy. You are not only keeping a tiny human alive and healthy, but also trying to accept the fact that you don’t have all the answers (which is also totally normal by the way) and re-discovering who you are and what your life will look like moving forward.

How common are intrusive thoughts with new mothers?

Another very common and normal experience, but that deserved its own section is intrusive thoughts. Something that is incredibly distressing and not talked about enough. 

To give you some perspective, 90% of all new parents have intrusive thoughts. They are way more common than you might think but unfortunately there is fear of judgment and feelings of shame around experiencing them so not a lot of people speak up about them. These thoughts could range from thinking you’re not feeding your baby enough to your baby not breathing at night while they are sleeping. 

While normal among the majority of new parents, intrusive thoughts are also found in all perinatal mood and anxiety disorders (PMADs). Therefore, if intrusive thoughts are paired with other symptoms mentioned later, that might be an indication to the presence of a PMAD.

One other thing that is important when discussing intrusive thoughts is the difference between ego-dystonic and ego-syntonic intrusive thoughts.

Ego-dystonic: distressing thoughts that are inconsistent with mother’s values, beliefs, and behavior. Mother’s fear harming the baby; however, there is no higher risk of harming the baby,

Ego-syntonic: intrusive thoughts that make sense and DO increase risk of harming the baby; could also be a sign of postpartum psychosis 

What is the difference between baby blues & PMADs?

Before diving into the specific perinatal mood and anxiety disorders (PMADs), there is one important distinction to cover: baby blues versus PMADs.

Baby blues are not a mental health disorder and incredibly common. Up to 80% of women experience baby blues and the onset is usually within the first week postpartum. Symptoms can include: tearfulness, mood swings, irritability, and feeling overwhelmed. 

PMADs are diagnosable mental health disorders and impact 15-20% of women. There can be a range in onset. Symptoms typically develop within 2-3 months after delivery but can develop as early as during pregnancy and as late as one year postpartum.

The main difference is that mothers are still able to function and begin creating a bond with their infant with baby blues and symptoms typically resolve within 2-3 weeks postpartum and does not usually require treatment.

However, if symptoms do not resolve by 3 weeks postpartum, further assessment is needed.

Below are detailed descriptions of each PMAD. There are similarities and differences between PMADs and their mood and anxiety disorder counterparts. Both will be explored in order to provide more clarity around identifying these signs and symptoms in yourself or a loved one. 

What is postpartum depression?

The most common PMAD and occurs in 7-15% of women.

The significant symptoms of Major Depressive Disorder (MDD) include: low mood, anhedonia, changes in weight or appetite, sleep disturbance, psychomotor agitation or retardation, fatigue / low energy, feelings of worthlessness or excessive inappropriate guilt, diminished ability to think or concentrate or indecisiveness, recurrent thoughts of death (suicidal ideation, plan, or attempt).

How it can look in the perinatal period: low excitement or joy about baby, difficulty bonding with the baby, everything feels like a burden, can’t sleep even when baby sleeps, feels like worst mom in the world, intrusive negative thoughts (ego-dystonic) like: “I never should have had a baby”, “I don’t know what’s best for myself or my baby”,  “Everyone is better at this than I am”, or “My family would be better off without me.”

If you have been experiencing any of the symptoms above, you may be asking yourself “Should I see someone about this”? or “Is my postpartum depression severe enough to go to therapy or get on medication?” Please ask yourself the following questions:

  • I have been so unhappy that I have had difficulty sleeping.
  • I have felt sad or miserable most of the time.
  • I have blamed myself unnecessarily when things went wrong most of the time.
  • I have hardly at all looked forward with enjoyment to things.
  • I have felt scared or panicky for no very good reason quite a lot.
  • I have been so unhappy that I have been crying most of the time.

If you agreed with more than 4 of them, please consider reaching out to me to schedule an initial appointment. 

What is postpartum anxiety?

This occurs in 7-10% of women.

The significant symptoms of General Anxiety Disorder (GAD) include: restlessness, feeling keyed up or on edge, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance.

How it can look in the perinatal period: distress feels urgent to mom, mom can’t distract herself from her concerns, mom can’t relax even when baby sleeps or is in another’s care, mom is wound up, irritable, and uncomfortable in her own skin, intrusive negative thoughts (ego-dystonic).

If you relate to any of the above symptoms of postpartum anxiety, then the following are some questions to ask yourself:

  • Almost always fear that harm will come to the baby.
  • Often feeling overwhelmed.
  • Almost always have repetitive thoughts that are difficult to stop or control.
  • Often have difficulty sleeping even when I have the chance to sleep.
  • Almost always wanting things to be perfect.
  • Often being “on guard” or needing to watch out for things.
  • Almost always avoiding things which concern me.

If more than 4 of them are true for you, please consider reaching out to me to schedule an initial appointment. 

What is postpartum OCD?

This occurs in 3-5% of women.

The significant symptoms of Obsessive Compulsive Disorder (OCD) include: obsessions, unwanted intrusive thoughts or images that cause significant distress, and compulsive behaviors that reduce distress triggered by obsessions.

How it can look in the perinatal period: difficulties bonding with baby, intrusive thoughts usually focus on baby’s safety and mom often fears that she will harm baby, these intrusive thoughts (obsessions) are distressing and means they are ego-dystonic and pose no risk of harm to baby.

If you are currently experiencing distressing, unrealistic, and irrational intrusive thoughts about your baby, their safety, and/or fear that you will harm your baby accompanied by compulsions such as: reassurance seeking, ordering and arranging, and/or repeating routine activities, please consider reaching out to me to schedule an initial appointment for further assessment.

What is postpartum PTSD?

This occurs in 6-10% of women.

The significant symptoms of Post-traumatic Stress Disorder include: traumatic experience that threatens their own or loved one’s life, avoidance of trauma-related thoughts/feelings or external reminders, mood disturbance, irritability, angry outbursts, difficulty concentrating, physical arousal, hyper-vigilance, exaggerated startle response, sleep difficulty, recurrent intrusive memories of traumatic event, nightmares, and/or flashbacks.

How it can look in the perinatal period: pregnancy or birth complications leave mom fearful of her or her baby’s life, vivid memories, “re-experiencing” the associated distress, attempts to avoid reminders/triggers which is particularly concerning if baby is trigger, and/or intrusive negative thoughts (ego-dystonic).

You may be wondering if or when you should seek help if the above information is resonating or sounding familiar to you. Please consider the following statements:

  • Traumatic experience(s) that threatened you or your baby’s life (eg., pregnancy or birth complications.
  • Vivid memories and/or flashbacks of the traumatic event(s).
  • Avoiding thoughts and/or feelings related to the traumatic event(s).
  • Feelings of hypervigilance, physical arousal, exaggerated startle response
  • Mood disturbance (eg., anger outbursts, irritability)

If the above statements ring true for you, please consider reaching out to me to schedule an initial appointment.

What is postpartum psychosis? 

The most rare; only occurs 0.1-0.2% (1-2 out of 1000) of women.

The signs and symptoms to look for include: rapid shifts in mood, decreased need for sleep, confusion, withdrawn, or erratic behavior, delusions, hallucinations. This PMAD also includes an increased risk of suicide and infantside and is considered a psychiatric emergency and treatment usually requires hospitalization.

Onset for postpartum psychosis is within the first days or be as late as 2-3 weeks postpartum.

If you are experiencing symptoms of postpartum psychosis, please call your pediatrician or physician immediately or go to your nearest emergency room if you feel unsafe. 

Asking for help

There can be a lot of shame surrounding asking for help. This isn’t universal to motherhood, but can become even more prevalent during this time. No matter how many times you might be offered help or told that it’s okay to need help, it’s often interpreted as ‘you’re not a good enough mom’. If you’ve felt like this yourself, I promise you, you are not alone. You also don’t have to go through this challenging journey of parenthood alone either.

Thoughts like: ‘I just have to be stronger and push through’ or ‘I should be able to handle this’ might be dominating your brain right now, and here’s the thing, those thoughts are not facts. Asking for help from friends and family or seeking professional help are both signs of STRENGTH. It might be hard to believe that right now, but it’s true.

A startling and hard truth is that PMADs do not just impact you in the postpartum period, they are the most common complication of pregnancy. Even more common than gestational diabetes, preterm labor and low birth weight. However, PMADs are also more likely to go undiagnosed or untreated. So please don’t let shame stop you from seeking the help you deserve.

What if I need more support?

If you need more support throughout your pregnancy or postpartum, please reach out to schedule with a provider at Integrated Care Clinic. We specialize in maternal mental health and received extensive training through the Seleni Institute on Perinatal Mood and Anxiety Disorders. We can help you navigate this overwhelming distressing time so you can get the support you need and be able to refocus on cultivating the kind of relationship you want with your growing family.

One last thing, if you’re thinking that needing help means you’re not a good enough mom, that is the FARTHEST thing from the truth. The truth is that motherhood takes a village and we would like to be a part of your village.

Seleni Counseling and Support, PLLC.

Edinburgh Postnatal Depression Scale (EPDS)

Perinatal Anxiety Screening Scale (PASS)

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