 Why talk about postpartum mental health?
It's thought that about 80% of women experience the “baby blues,” a short term (about two weeks) bout of sad-weepy-moodiness brought on primarily by hormonal shifts. A smaller percentage of women have more serious, but highly treatable, mental health concerns, commonly known as Perinatal Mood and Anxiety Disorders or PMADs. Neither the blues nor the PMADS are openly talked about (yet), likely because we're all walking around believing pregnant women and new moms are meant to be basking in the glow of impending or new motherhood. And there are are amazing, tender, hard-to-put-in-words, heart-bursting pieces of the experience. But, like with anything, pretending the hard parts aren't there when they really are just makes everyone secretly feel like they're doing life wrong, making us even less likely to be honest and open. It's not hard to see how easily the cycle is perpetuated, and the consequences are shitty at best (holding shame and self-judgment) and dangerous at worst (having untreated mental health issues that impact you and your child). So let's get educated first. Later, you get to decide if you would like to be honest about your own experience with those you decide are supportive and deserving of your story. Getting to know the tougher end of the spectrum. Below is information about the most common PMADS. These statistics and symptoms are taken directly from the Postpartum Support International (PSI)'s extremely informative website, edited to fit in one space so you don't have to click around. The links within will take you to more elaboratate descriptions in “plain mama English” on the Postpartum Progress website. More on both of these amazing organizations later. Depression: `Occurs in ~ 15% of postpartum and ~ 10% in pregnant women Perinatal depression is the most common complication of childbirth. Symptoms include:
Anxiety: Occurs in ~ 10% of postpartum and ~ 6% of pregnant women. It may be experienced alone or in conjunction with depression. Symptoms include:
OCD: According to PSI, "Postpartum Obsessive-Compulsive Disorder (OCD) is the most misunderstood and misdiagnosed of the perinatal disorders. You do not have to be diagnosed with OCD to experience these common symptoms of perinatal anxiety. It is estimated that as many as 3-5% of new mothers and some new fathers will experience these symptoms. The repetitive, intrusive images and thoughts are very frightening and can feel like they come “out of the blue.” Research has shown that these images are anxious in nature, not delusional, and have very low risk of being acted upon. It is far more likely that the parent with this symptom takes steps to avoid triggers and avoid what they fear is potential harm to the baby." Symptoms include:
Psychosis: Occurs in ~ 1 to 2/1,000 deliveries, or ~ .1% of births. Onset is typically sudden, usually within the first 2 weeks postpartum. Symptoms include:
Got it. Now what? Okay, now you know the general scoop on these disorders. So what if you notice symptoms in yourself or someone you love? Below are options depending on severity.. You can loosely think about what category you fall into and/or take this valid and reliable depression inventory, which has anxiety items on it as well (this won't screen for other PMADS). Of course, calling me (or abother practicioner in maternal mental health) is a reasonable option regardless of severity, but let's make sure you have the full range of appropriate options. Severe (it's real bad, even if it's hard to admit; score of 19 and above): Call your doctor and let her or him know what's happening for you. Yes, this will be hard. Yes you should do it anyway. There is no perfect time. If you have a hunch that it will help, make the call. *Important Note: Postpartum Psychosis is a medical emergency and needs to be treated right away. This means you need to get to an emergency room ASAP, and once there be real honest about what's happening for you, including all the scary and harmful thoughts. Until you've connected with the appropriate support, you should be accompanied at all times. And remember, as intense as this is, it's treatable. This level of scary won't last forever. Mild-Moderate (this is not normal for you and it's getting in the way of you feeling like yourself*; score of 13-18): Call me or another provider educated/skilled in maternal mental health. The recommended treatment for mild to moderate postpartum depression and/or anxiety is therapy. For moderate – severe, medication is recommended, and there is a variety of other non-medication options as well, such as light therapy and acupuncture. Note: If medication is presented as an option and your first thought is “but I'm breastfeeding,” I'm linking you to two sites that can give you sound information about that. There are some medications considered safe options while breastfeeding, which is good to know even if you decide it's not for you (i.e., you can help spread the word so other mamas don't make uninformed choices!). LactMed is the National Institute of Health's huge inventory of info on the subject and Mind Body Pregnancy is the brainchild of a San Francisco psychiatrist, passionate about getting this information out to the masses. Mild (symptoms are pesky and in the way of feeling like your best self*; score of 10-12): Call me or another provider educated/skilled in maternal mental health and/or create or check in with your personal wellness plan. Are you doing the things that you know work on better days, such as getting movement, talking with trusted friends, resting, eating well, praying, or whatever your specific tools are? Are you letting the helpers help? Do you need different ones? Do a quick assessment and see what you see. Remember, this is the biggest adjustment you've ever made, and it's challenging at its core. Of course feeling well is going to take more effort and resources. *even the concept of feeling like your best self should be taken in the context of adjusting to your new mama self. On Online Resources: Click wisely As you probably know, when it comes to the internet, the line between staying informed and getting overwhelmed is thin. For the sake of your emotional health, I recommend that you, first and foremost, tune in to your inner wisdom or that of someone(s) who knows you well enough to have a fair say in what's happening when your wisdom is overshadowed by overwhelm, self- criticism, sleep deprivation, or simply the hardcore newness of this whole thing. In terms of the web, it's my personal opinion that you focus on the aforementioned online maternal mental health resources. Postpartum Support International is like the kind, giving grandmother of this family, who tells it like it is, without a lot of “extra.” In addition to the basic information provided above, she has answers to your frequently asked questions, a warm line that you can call in times of need (not for use in a medical emergency.), and the numbers for who to call in your city, state, or country to find an appropriate resource. She's the one who teaches many of us clinicians about this work and also offers stories from countless women just like you on the PSI blog. Postpartum Progress is also a wellspring of information, but has more of the tone of your sassy aunt who's like “Oh honey, come here, I got you.” She's super smart and is on a mission to “create healthier families by raising awareness, reducing stigma, providing social support and connecting mothers to help for perinatal mood and anxiety disorders like postpartum depression.” The best way to see all she has to give is by starting here. One of the sweetest offerings is a year's worth of daily hope emails. Of course, of course be open to other resources that are helpful to you. What I caution against is Googling all your symptoms and noticing four hours and 17 chatrooms later that you still aren't quite sure what's happening or what you need. Okay, I think that's enough for now, yes? If you've gotten this far, go ahead and thank yourself for staying informed. It's truly half of the work, mama. Now, go take a nap. xoxo Yours in wellness, self-care and compassion, Shana Think I may be the right fit for you or a loved one? Feel free to email me at contact@shanaaverbach.com or call 415-963-3546 for a free 20-minute consultation call. Comments are closed.
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