On Monday, May 3, Tara Kellogg of Chrysalis Health and Shannon Wisely, Fort Myers licensed mental health counselor, discussed maternal mental health “When Motherhood Hurts” at the beginning of maternal mental health awareness week.
What is Maternal Mental Health?
It is a newer term that has been created to replace the more well-known, but outdated term “postpartum depression,” which is not exactly accurate. We now know that women can struggle at any time during pregnancy, as well as the first postpartum year. For some women, their struggles don’t always look like depression. Some women can have anxiety, PTSD and it doesn’t always fit that term of postpartum depression. The clinical term is perinatal mood and anxiety disorders.
What are Perinatal Mood and Anxiety Disorders?
Perinatal means any time during pregnancy and the first postpartum year. Woman with perinatal mood and anxiety disorders have a good prognosis with treatment, that can include therapy and/or medication and make full recoveries. Perinatal depression and anxiety are very prevalent. The numbers we know are about 20% of women in the perinatal period will develop depression or anxiety. There is a difference between “baby blues,” a period of adjustment to becoming a mother which is normal when hormones are leveling out. When it’s interfering with your level of functioning as a parent or within your family, or symptoms persist for more than a few weeks and get worse, that’s when you need to reach out for help from your doctors. Fathers and partners can also suffer “baby blues,” which is more of an adjustment disorder.
- Perinatal Depression: Can show in many ways. For some it can look like loss of interest, feeling sad, feeling isolated, struggling to concentrate and focus, loss of appetite and sleeping issues. For some women, it can look like anger.
- Perinatal Anxiety: Anxiety can coexist with depression. Anxiety is excessive worry, panic and fear of things that weren’t an issue before. Anxiety is often manifested in physical symptoms like shallow breathing, racing heart, etc.
- Perinatal Obsessive-Compulsive Disorder: Characterized by scary, intrusive thoughts that compel women to certain behaviors to cope. Fears can be about the baby, themselves or other loved ones.
- Perinatal PTSD: Some women suffer from birth trauma such as an unexpected event during pregnancy or delivery.
- Perinatal Psychosis: The mother enters a state of psychosis. This requires emergency treatment, but prognosis is good with treatment.
Risk Factors for Perinatal Mood and Anxiety Disorders
While hormones are a factor in these disorders, that’s not the only factor. Researchers have identified some risk factors. Women with these risk factors won’t necessarily develop Perinatal Mood and Anxiety Disorders. Risk factors include:
- Pre-existing mental health disorders, particularly women who have had postpartum issues previously.
- Family history of mental illness, hospitalization or suicide.
- Feeling anxious or depressed during pregnancy.
- Extreme mood changes during premenstrual cycles.
- Miscarriage, birth trauma, health complications, birth defects within the infant, or perinatal infant loss.
Other risk factors include: personal or family history of substance abuse, inadequate emotional and physical support, history of trauma (birth or non-birth related), major life stressors (such as financial, relocation, death of a loved one), health problems during pregnancy, multiple births and personal or family history of thyroid disorder.
Risk to Children
Evidence has shown that children living with a parent with severe anxiety and depression are at risk for adverse outcomes. This impacts the new baby and other children in the family. It can affect the parent-child relationship bond, which can result in delayed cognitive and language development. At the extreme, it could result in a detachment disorder with some children, or they develop behavioral problems like acting out and declining academic performance.
Children can also benefit from mental health services. As children grow older, there could be higher levels of depression and anxiety in later years. It’s important to be aware of the impacts to the whole family. There’s no shame in asking for help. Impacts on mental health can affect physical health. Maternal mental health issues often suffer from additional stigma. There’s a belief that motherhood is all about joy and a mother’s strength. Many women are afraid to tell anyone what they are feeling when they struggle. They feel shame that they are unable to deal with it on their own.
Screening Tools for Maternal Mental Health
Two tools have been specifically developed to assess perinatal mental health. The Edinburgh Postnatal Depression scale and the Postpartum Depression Screening Scale. The problems with screening tools: some women deny or underreport their true feelings because of stigma. The questions also might miss certain symptoms, including symptoms of psychosis and mania. They are not 100%, but better than nothing. The tools are used by some providers to make referrals to get patients help. It’s important to know the risk factors and to notice the signs and symptoms and to encourage mothers to seek help right away.
- Signs and Symptoms Handout
- PSI, Postpartum Support International has warm, online support groups and doctor referrals at postpartum.net or 800-944-4773
- Shannon Wiseley, LMHC, cell, 517-398-3232
- Chrysalis Health, community mental health agency that has a branch in Fort Myers with virtual counseling for the whole family. Chrysalis takes private and Medicaid insurance as well as has a sliding scale. Tara Kellogg, LMFT, 954-587-1008
Questions and Answers
Q: What are some important ways to support the mental health of a friend and/or family member who is a new mom?
Answer: The most important thing is that sometimes we focus so much on the physical aspects of pregnancy when women are pregnant. My first response would be to ask her how she’s doing emotionally and connect with her on that level.
Once the baby arrives, focus tends to go from the mom’s body to the baby. Ask her how she’s doing, feeling and adjusting. Offer any help if you can to let her take a shower or nap or provide her a meal. This is always appreciated by a new mom. Make it a safe place to be real, for her to be able to say, “it sucks sometimes” and that’s OK. You can also suggest she can talk to a professional, and that’s OK. If you notice something that feels off or your friend tells you they are not feeling right, it’s OK to suggest professional help. Let her know it’s OK to get help. Just be a friend and be there.
Q: Has PPD or other perinatal/postnatal mental health concerns increased during COVID-19?
Shannon: All mental health concerns have increased or have been more diagnosed during the pandemic. In my practice, I’ve seen the fear of contracting the virus during the pandemic or fear for the baby of illness. Another aspect is the isolation. Since we live in a transient area, a lot of families are here by themselves. Their support system may live in another state, so I see a lot of families unable or delayed to get here to be with the new parents. That really is a huge struggle that takes a toll on these new moms. They need that support so much during those first weeks and first months. Not having that, or being afraid to have support in their homes, is a big issue. I’ve noticed different concerns that have arisen since the pandemic started.
Q: For someone who is planning to start trying, what recommendations or resources do you recommend preparing for prior to getting pregnant or during pregnancy?
Shannon: I work with couples to do pre-family counseling either before or during pregnancy to see where the parents are at, what their beliefs are, what are their ideas about parenting, which can totally change when you are in it. Helping sort through some of those things, especially if there is any kind of trauma or previous depression and anxiety is important. Dealing with that before you get pregnant can help mitigate any perinatal mood or anxiety disorders that could arise.
Tara: Early intervention is the key. While you can’t plan for everything, have those open conversations. There’s pre-marriage counseling. There can also be pre-parenting counseling. People grow up differently, have different parenting styles, so there may be stumbling blocks. It helps to be prepared and to support each other.
Q: Can you have residual symptoms after overcoming Postpartum Depression?
Shannon: Can you have triggers after overcoming postpartum depression? Anything is possible. Sometimes things can trigger certain feelings. Say a woman has had a really difficult time with postpartum depression. Maybe she can see a friend with similar symptoms. It can bring up those old wounds. It can happen. As far as it being a lifelong issue, it’s not the same as bi-polar disorder or something where you need to be in treatment for a long period of time. It’s not like that.
Tara: Is it postpartum depression or major depressive disorder? There’s a difference. Some people who have had signs of depression may not have been diagnosed but were living with depression before giving birth. If you continue to have symptoms that interfere with your functioning after the baby, it could be that you are living with depression or anxiety in general. You may have been living with a diagnosis prior to giving birth. If you talk to a professional, you can find out.