May 1st-5th is Maternal Mental Health Awareness Week: A time when we strive to raise awareness about the most common mental health challenges faced by mothers during pregnancy, postpartum, and beyond, as well as the resources available to support with coping and healing. An important step toward this goal is normalizing the conversation about maternal mental health and discussing the signs that may indicate the need for additional support.
During pregnancy, we tend to focus our preparation efforts on all things baby, with less time dedicated to talking about how to support the life-changing mental shifts that happen for mothers during this transition. However, we know that 15-20% of childbearing women will experience mental health challenges that cause significant impairment in their daily functioning following the birth of their baby. By definition, the “postpartum period” lasts from birth to one year, however most of us recognize that this period of adjustment extends well beyond the first twelve months. In addition, it is not uncommon for mothers to begin developing symptoms of mood and anxiety disorders during pregnancy as they anticipate and prepare for birth.
Most common Perinatal Mood and Anxiety Disorders (PMADs):
You may have heard mothers say “I really struggled with postpartum after I had my baby”. Mental health challenges in the period following birth are commonly referred to as “postpartum” and many think of depression as the primary set of symptoms that show up during this time. Although 10-15% of mothers will develop depressive symptoms following birth, other mental health disorders including Postpartum Anxiety, PTSD, OCD, and Bipolar Disorder are also important to look out for. In some cases, symptoms may overlap and diagnoses may co-occur – for example, mothers often experience symptoms of both Depression and Anxiety. Postpartum hormone changes, personal mental health history, and sleep deprivation that is characteristic of the newborn period can influence the onset and severity of symptoms that a mother experiences.
Let’s take a quick look at some of the signs of each:
“Baby Blues” (Approximately 80% of mothers following birth): Although “Baby Blues” is not considered a diagnosable disorder, it is important to mention because this term often gets used interchangeably or confused with Postpartum Depression. With Baby Blues, the typical onset is usually within the first week after delivery (often peaks around 3-5 days). Symptoms are typically mild and include irritability, mood swings, tearfulness, feeling overwhelmed or unlike yourself, and emotional reactivity. It generally resolves on its own, lasting no longer than a few weeks, and usually does not disrupt your daily functioning. If symptoms continue past the three-week mark, further assessment is recommended to determine if criteria for a PMAD are met.
*For the following diagnoses, onset may occur within 2-3 months following birth and up to one year postpartum. How these diagnoses and challenges look will vary from individual to individual. You may experience some of the symptoms, but not all, and symptoms may change over time. These descriptions are meant to provide general information and should not be considered exhaustive or the sole basis for diagnosis.
1. Postpartum Depression (10-15% following birth): Symptoms include depressed mood, feelings of guilt, irritability, anger, difficulty bonding with your baby, trouble sleeping even when the baby sleeps, intrusive negative thoughts, feelings of worthless or hopelessness, low motivation, loss of interest/pleasure in activities, and suicidal thoughts. Symptoms occur on most days and may interfere with your ability to complete daily tasks.
2. Postpartum Anxiety (7-10 % following birth): Symptoms include constant worry, racing thoughts, feeling on edge or unable to relax, persistently feeling like something bad may happen, nausea, difficulty sleeping, GI problems, loss of appetite, and negative intrusive thoughts. These symptoms can feel very distracting and make it difficult to be present to enjoy your family. This pattern of symptoms exceeds what is considered the typical worry and concern that accompanies parenthood.
3. Posttraumatic Stress Disorder (PTSD) (6-10% following a traumatic birth experience and/or NICU stay): This pattern of symptoms may occur after you’ve either experienced or witnessed a life-threatening situation involving you and/or your baby – often the trauma is the birth itself or unplanned medical intervention following birth. Symptoms include mood disturbance, avoidance of trauma- related thoughts/feelings/triggers, flashbacks, nightmares, hypervigilance, quick startle response, negative intrusive thoughts, feeling a sense of unreality/detachment, and preoccupation with your birth experience. If you have previously experienced pregnancy loss or infant loss, risk for PSTD in a subsequent pregnancy is increased.
4. Postpartum Obsessive-Compulsive Disorder (OCD) (3-5% following birth): Symptoms include obsessive thoughts (unwanted, intrusive thoughts usually focused on fears about hurting your baby or concern about germs) and compulsions (behaviors that are meant to stop the obsessive thoughts or prevent the fear from coming true such as constant cleaning, frequent reassurance seeking, or avoiding certain activities with your baby due to fear of harming them), feelings of overwhelm, irritability, difficulty bonding with baby, and trouble sleeping. Thoughts may begin after childbirth and progress rapidly during the postpartum period.
5. Postpartum Bipolar Disorder (2-8%): Symptoms include distinct periods of “lows” (i.e. depression) and “highs” (i.e. mania or hypomania – persistently elevated mood, rapid speech, overconfidence, irritability, decreased need for sleep, intense goal-directed behavior), with each period lasting several days in a row. In some cases, manic and depressive symptoms can occur together in what is called a mixed state. A family or personal history of Bipolar Disorder before pregnancy is a significant risk factor for developing bipolar symptoms during the postpartum period, therefore it is imperative to disclose this to your doctor for early screening if this applies to you.
Finding Support
With help, you CAN feel better and heal. These conditions are highly treatable and there is a large community of support waiting for you. Often, the hardest part of getting help is making the decision to reach out. This can feel especially difficult during the days of postpartum when you may feel more isolated than usual or assume that the distress you’re experiencing is “just part of the process”. You do not have to navigate this time alone.
Whether or not you meet the criteria for one of the mental health diagnoses mentioned above, the process of becoming a parent and growing your family brings significant shifts and challenges. It is not necessary for you to know whether or not you have a mental health diagnosis in order to seek support. Attending individual therapy or a peer support group can create space for you to process your experiences, build community, and develop tools to help you manage the many stressors that come with motherhood.
Postpartum Support International (PSI) is a great place to start if you are looking for resources. You can also reach out to Michelle Nelson Counseling for a free consult or for support with locating a provider.
o National Maternal Mental Health Line: 1-833-943-5746 (1-833-9-
HELP4MOMS)
o PSI Helpline: 1-800-944-4773
o PSI Online Support Group Meetings (visit postpartum.net)
o PSI Provider Directory (postpartum.net) – Locate mental health providers with training specific in issues related to pregnancy, postpartum, and pregnancy and infant loss.
You are not alone.
Website: www.counselingwithmichelle.com
Social media: @with_mama_in_mind
