Maternal Mental Health: Symptoms and Resources
Happy Maternal Mental Health Day! As a therapist specializing in Maternal Mental Health, this is like my professional holiday. A day to celebrate how far we have come in recognizing, diagnosing, and treating mental health issues in the perinatal period, and a day to push forward in spreading the word about Maternal Mental Health and creating space for more outreach and inclusivity.
So, to celebrate this day, I am going to write an article for you detailing the symptoms that can impact mothers in the perinatal period and give you lots of resources for more information. I used a ton of the resources from the Postpartum Support International's website's sections on Maternal Mental Health Disorders, and encourage you to check out their website at www.postpartum.net. I have listed all of my resources at the bottom if you would like to dig deeper into the material.
Also know that ALL of these diagnoses are treatable. They are temporary. There are people that are happy to talk with you and work with you to be well. So you, your baby, and your family can experience happiness together. Please also note that you may not be able to see these symptoms in yourself. Your symptoms may start slow. Or you may be hiding them out of fear. Your partner/doctor/pediatrician/etc. may see the signs before you do, you may just feel "off" or lost. Know that there is help for you. Looking for answers and talking to someone is the first step. Call 1-800-944-4PPD(773) for help now. That is the PSI warmline. Leave a message and someone will call you back to talk with you. 365 days a year.
Ok, first thing...
First, the perinatal period refers to the period starting with pregnancy and ending up to one year after delivery. Some state that the postpartum period can linger up to three years after birth. The medical definition defines the perinatal period as specifically pregnancy to one year post-birth.
Risk factors for women include a previous history of mental illness. For example, a mother who has a history of anxiety is more likely to experience an anxiety disorder in the perinatal period. Similarly a woman with a history of depression is at higher risk to experience perinatal depression. A woman with a history of bipolar disorder or schizophrenia is at high risk to develop postpartum psychosis, which is a psychiatric emergency and warrants hospitalization to treat.
Other risk factors include social stressors. This includes having a lacking support system, trouble in the relationship with their partner, having financial stress, having a child that needs care in the NICU, a recent life change (move, job change, relationship change, death of a loved one, etc.), trouble with breastfeeding, and I would also say surviving and birthing a baby through a Pandemic would fit in here.
The Baby Blues
There is a high prevalence rate of what is referred to as the "baby blues". As many as 80% of new mothers experience this syndrome. The symptoms can start a few days after birth and usually only last about 2 weeks and then go away. Symptoms include dysphoric mood, crying, irritability, feeling overwhelmed and anxious. These symptoms can be due to the huge change that having a newborn creates in your life. There is a huge change in the hormones in your body. Your estrogen remains high, your progestrone plumits, and your polactin remains high to produce milk. Prolactin is also thought to impact dopamine. You can read more about this here. You are probably not sleeping much which can also lead to mood changes and increased cortisol which causes feelings of stress. Adding on top of this the new responsibilities of caring for a tiny, crying human 24/7, you are bound to experience some mood swings and feel down. This is normal. If this lasts longer than two weeks, or the symptoms get worse, this may be a sign for you to reach out to a loved one, your OBGYN, Midwife, or General Practitioner for more help.
This is the disorder that is most talked about in the public. This is one of the only two diagnoses that are in the DSM V (the Diagnostic and Statistical Manual, 5th ed.). More about what the DSM says here. The prevalence of postpartum depression is as high as 15-20% of new mothers. Symptoms of Postpartum Depression (PPD) include feeling angry or irritable, lack of interest in the baby, appetite and sleep disturbance, crying and sadness, feelings of guilt, shame, or hopelessness, loss of interest, pleasure, or joy in things you once enjoyed, and possible thoughts of harming the baby or yourself. For more see this article from PSI here.
Postpartum Anxiety Disorders
The prevalence of perinatal anxiety ranges from about 6 to 10%, and anxiety can be comorbid (occur at the same time) with postpartum depression. Symptoms of general perinatal anxiety include: constant worry, feeling that something bad is going to happen, racing thoughts, disturbance in sleep and appetite, inability to sit still, and physical symptoms such as hot flashes, dizziness, and nausea. For more information read here. Other anxiety disorders that can occur in the perinatal period are: postpartum panic disorder and postpartum obsessive compulsive disorder. These have additional identifiers outside of general anxiety.
Postpartum Panic Disorder
This disorder is identified as having the trademarks of a general anxiety disorder with the addition of panic attacks. A panic attack is marked by experiencing shortness of breath, chest pain, claustrophobia, dizziness, heart palpitations, and numbness and tingling in the extremities. Some people think that they are going to die or are suffering from a heart attack the first time they have a panic attack. It is important that you know that a panic attack will come like a wave and will resolve. It is not life threatening, although in the moment it can feel that way.
Postpartum Obsessive Compulsive Disorder (OCD)
The prevalence of Postpartum OCD is 3-5%. The first symptom of this disorder is obsessive or intrusive thoughts. These thoughts are persistent and repetitive and can be thoughts or images about the baby. In the PSI training I attended, the presenter explained intrusive thoughts like this...
Imagine you are driving on the highway. The car in front of you merges and you are now behind a semi-truck that is carrying dozens of logs. What is the thought that pops into your mind. Everyone in the audience said "those logs are coming through my windshield!" It is the perfect example of an intrusive thought. It is an unwanted, morbid, violent image that pops into your head. That is what can happen to a mother. She has an image or thought pop into her head, often of harm coming to her baby.
The next symptom is compulsions. So these can be compulsions to keep the baby from coming to harm, checking to make sure the baby is breathing, etc. Ultimately they are actions that are driven by the fear that the intrusive thoughts have stirred. Now checking the baby itself is not a symptom, but in OCD the mother's checking behaviors, or compulsions, are so intense that they compromise her ability to care for her baby. Mothers feel horror about the obsessions and either may be afraid to be left alone with the baby or may be hyper-vigilant in taking care of their baby. Lastly, mothers know that their intrusive or obsessive thoughts are bizarre and are very unlikely to act out any harm towards their baby. For more information you can read here.
This diagnosis is rare and occurs in every 1-2 out of a thousand births. A mother is at risk for this condition if she has a history of bipolar disorder or a psychotic disorder. The onset is within the first two weeks of delivery. Symptoms include: delusions, hallucinations, bizarre behavior, increased irritability, hyperactivity, decreased need for or ability to sleep, paranoia, rapid mood swings, and at times difficulty communicating. This is a medical emergency because the mother is experiencing a break with reality. Delusions and hallucinations are real to her, and her judgment is impaired. Where a mother with perinatal OCD may feel horror at the thought of harm coming to her baby, a mother with postpartum psychosis may feel that in harming her baby she is saving it. With this disorder there is about a 5% suicide rate and a 4% infanticide rate because of these symptoms. For help now see crisis resources below. PSI also has a Postpartum Psychosis Coordinator to provide additional assistance to women and families who are not in an emergency situation.Contact Felice Reddy, at 919-213-0537, or by email at firstname.lastname@example.org.
If you or someone you love is experiencing suicidal thoughts, homicidal thoughts, or is exhibiting symptoms of postpartum psychosis, crisis resources available to you are:
-go to your nearest Emergency Room
-reach out to the National Crisis text line: text HOME to 471471
-call the National Suicide Prevention Hotline at 1-800-273-8255
or visit their website at www.suicidepreventionlifeline.org
1. Anxiety During Pregnancy and Postpartum. Retrieved May 6, 2020, from https://www.postpartum.net/learn-more/anxiety-during-pregnancy-postpartum/
2. Depression During Pregnancy and Postpartum. Retrieved May 6, 2020, from https://www.postpartum.net/learn-more/depression-during-pregnancy-postpartum/
3. Klepchukova, A. How Long Will it Take to Settle Your Hormones Down After Birth? Retrieved on May 6, 2020, from https://flo.health/being-a-mom/recovering-from-birth/postpartum-problems/hormones-after-birth
4. O'Hara. M.W. & Wisner K.L. Perinatal Mental Illness: Definition, description, and aetiology. Best Practices & Research in Clinical Obstetrics & Gynaecology, Volume 28(issue 1), pages 3-12.
5. Postpartum Hormonal Changes & How They Affect You. Retrieved on May 6, 2020, from https://www.medela.us/breastfeeding/articles/postpartum-hormonal-changes-how-they-affect-you
6. Postpartum Psychosis. Retrieved May 6, 2020, from https://www.postpartum.net/learn-more/postpartum-psychosis/
7. Pregnancy or Postpartum Obsessive Symptoms. Retrieved May 6, 2020, from https://www.postpartum.net/learn-more/pregnancy-or-postpartum-obsessive-symptoms/
8. Stone, K. What the New DSM Says About Postpartum Depression and Psychosis. Retrieved on May 6, 2020, from https://postpartumprogress.com/what-the-new-dsm-v-says-about-postpartum-depression-psychosis