Why Maternal Mental Health Is Everyone's Business: A Letter to Clinicians

(This essay first appeared in the May/June SFCAMFT Newsletter)

Maternal Mental Health is everyone’s business.

Although specialized in nature with a specific clinical focus, maternal and perinatal (the pregnancy through postpartum period) mental health touches all of our work.

Untreated perinatal mood and anxiety disorders (PMADS) negatively impacts a mother’s quality of life and increases her risk for suicide. PMADS are linked to cognitive and behavioral issues in children, the same children with whom you sit eye to eye - talking, playing, and helping them process their worlds.

PMADS intersect with eating disorders, substance abuse, grief and loss, domestic violence, and severe mental illness. Actually we’d be stretched to find a therapeutic area with which it doesn’t collide.

Perinatal mental health can be improved or hindered depending on the level of supportive relationships within couples, families, and communities. And since each of us has a different understanding of what it means to be a ‘mother,’ perinatal mental health will be part of our countertransference experience. Whether our relationship with ‘mother’ is simple or complex, it is still often rife with strong and complicated feelings, and thus therapists must be aware of their responses.

Since knowledge is power and protection, the more we collectively know the better. What follows are a few myths and truths that will improve our understanding and support of our moms.

- Myth: Postpartum depression is the only mental health issue that arises in the perinatal period.

+ Truth: Depression, anxiety, OCD, PTSD, and Psychosis are all perinatal mental health concerns.

The ‘M” in PMAD refers to mood disorders, namely unipolar and bipolar depression. 50% of women with bipolar mood disorder are first diagnosed in the postpartum period.

The ‘A’ refers to a spectrum of anxiety disorders, including generalized anxiety disorder, panic disorder, obsessive compulsive disorder, and post traumatic stress disorder.

Postpartum psychosis is very rare (1-2 in 1000) and must be treated as an emergency.

While defining these disorders is out of the scope of this article, simply knowing there’s a spectrum can be a starting point for clinical considerations.

If you remember one thing only, it’s that each of these disorders is highly treatable.

- Myth: Postpartum Depression is a normal part of the motherhood experience.

+ Truth: Postpartum Depression is a common (estimated at 15%) and (again) highly treatable disorder.

When talking about depression in pregnancy and postpartum, well meaning clinicians will often say that this experience is “normal,’ presumably to help women feel at ease.

Unfortunately, this can lead to moms keeping symptoms private and not getting the help they need. This is an especially problematic message in pregnancy as being depressed or anxious in this phase is predictive of being depressed postpartum.

Overwhelm, ambivalence, fatigue, and transient crying spells are normal. About 80% of postpartum moms have the “baby blues” within the first couple weeks of having a baby, largely connected to sudden and intense hormonal changes.

A pervasive sense of sadness, guilt, irritability, and hopelessness, and even rage - which may show up anytime within the first year postpartum, and peaks around month three - may be signs of something more concerning and should be tended to with therapy and/or medication.

- Myth: You can tell by looking whether someone has postpartum depression or anxiety.

+ Truth: you can tell by screening whether someone has a postpartum depression or anxiety.

We all know that stigma is a huge barrier to mental health treatment overall. But being depressed or anxious during pregnancy or postpartum feels especially taboo for many, thanks to messaging around how glowing, joyful, and happy moms and moms-to-be are supposed to feel.

Women are often using energy they don’t have trying to hide their scary and painful internal experiences. Many women who have a PMAD present as outwardly put together, with bright smiles, not a hair out of place.

All healthcare clinicians can overestimate their ability to informally assess how someone is doing. And since early detection of a PMAD can significantly reduce the severity and duration, we need to deliberately look for depression and anxiety symptoms.

There are accessible and reliable screening tools that can truly help pick up the hidden data. The Patient Health Questionnaire-9 (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) are two such tools, and both are free and available online.

Resources:

So what do we do when we identify that a PMAD may be at play?

If you were to have one resource in your back pocket, I would highly recommend Postpartum Support International. You can learn more about all the PMADS on their website and you can find local perinatal trained providers by calling their area coordinators: https://www.postpartum.net/locations/california/

Other great local resources include:

UCSF Pregnancy and Postpartum Mood Clinic
CPMC Perinatal Health and Wellness Program
Homeless Prenatal

Whether through direct service or linking someone with the best resource, together we can weave a web of support for moms.

Yours in wellness, self-care and compassion,
​
Shana

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Are you a mental health or perinatal provider who wants to learn more or consult about perinatal mental health? Or think I may be the right fit for you or a loved one? Feel free to email me at [email protected] or call 415-963-3546 for a free 20-minute consultation call.