Hormones run amok during pregnancy and postpartum. The body is adjusting to being pregnant, growing a human, no longer being pregnant, adjusting to lactation needs, far less sleep, likely less adequate nutrition, the responsibility of caring for a newborn, relationship adjustments, reimagining of self as a parent (“matrescence”), and shifts in community support. It’s a lot to handle in a year! 1 in 5 birthing people experience some form of perinatal mood disorders, and likely higher as it is often under reported.
WHAT ARE PMADS?
Perinatal mood and anxiety disorders can develop during pregnancy and at any point in the first year after birth. It encompasses more than postpartum depression and can range from anxiety to OCD to psychosis. PMADs are more than the “baby blues”, a common feeling of sadness, irritation, and exhaustion occurring in the first two weeks after birth. The concern for feelings of sadness beyond 2 weeks is when a conversation with a health care or mental health professional may be helpful.
- Low mood, sadness, tearfulness
- Loss of interest, joy, or pleasure in things you used to enjoy
- Agitation or anxiety
- Lack of energy or feeling slowed down physically
- Difficulty concentrating
- Appetite or sleep disturbance
- Feelings of guilt, shame, or hopelessness
- Possible thoughts of harming the baby or yourself
While abdominal separation is common, it can be minimized with proper care and trained support people.
- Constant worry
- Feeling that something bad is going to happen
- Feeling like you can’t turn your brain off
- Disturbances of sleep and appetite
- Physical Symptoms like dizziness, heart palpitations, and nausea
Feeling like a worried mama bear can be a common response in new parenthood. The urge to protect your baby goes into hyperdrive. Concern arises if the feelings are intrusive and interfere with your ability to function. 10% of newly postpartum people experience anxiety and 6% experience anxiety while pregnant.
- Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images regarding the baby. These thoughts are very upsetting
- Compulsions, where the mom may do certain things over and over again to try to reduce her fears and obsessions. This may include things like needing to clean constantly, checking things many times, counting or reordering things.
- A sense of horror about these obsessions
- Fear of being left alone with the infant
- Hyper-vigilance in protecting the infant
3-5% of postpartum people experience symptoms of OCD, even with no prior history of OCD.
- Delusions or strange beliefs that feel real
- Hallucinations (seeing or hearing things that aren’t there)
- Feeling confused
- Feeling disconnected from reality
- Decreased need for or inability to sleep
- Paranoia and suspiciousness
- Difficulty communicating at time
While occurring very rarely, only 0.1-0.2% of postpartum people, psychosis is very serious and requires immediate medical attention. Very rarely do people experiencing postpartum psychosis harm themselves or their babies but does require urgent medical care. Call 911 or seek immediate care from a hospital or doctor if you or someone you know is exhibiting symptoms.
WHO IS AT RISK?
Anyone. There is no single factor causation for PMADs. People who have never experienced any form of depression, anxiety or OCD may develop a PMAD during the perinatal period. People of every socioeconomic status, race, sexuality, gender identity may experience PMADs. No matter how you gave birth or how you feed your baby will inoculate you from potential PMADs. However, each of these things may attribute to stress, anxiety, fears, breaks in support that can be risk factors to developing a perinatal mood and anxiety disorder. Common triggers for PMADs can be financial insecurity, previous loss, fertility challenges, past personal or family history of depression or anxiety, substance abuse, relationship challenges, unstable housing, inadequate emotional support from partners or family, anxiety about the well being of the baby. Even if you have any of these factors, there is no way to predict who will experience a PMAD.
SUPPORT AND CARE
Understanding symptoms and how common PMADs are can help in seeking support, treatment and reducing stigma. The more we know about these common disorders, the more likely those experiencing these very treatable and temporary conditions can improve their quality of life and experience of parenthood. It is important for partners to know the signs as well since it can be challenging to recognize them on your own when you are in a difficult emotional state.
Oftentimes your baby’s pediatrician may be the only medical professional that you see regularly. Don’t be afraid to speak up if you are recognizing signs of a PMAD. You can also reach out to your own OB or midwife, do not wait until the 6 week postnatal visit if you are concerned about your well being. If you do not feel comfortable speaking to the pediatrician or your OB, there are many resources available for therapists, many of whom now do virtual sessions. Talk therapy, medication, and other forms of treatment can be effective in treating PMADs.
If you, or someone you know, may be experiencing symptoms of a PMAD, there is help. You are not alone, you are not a bad parent, and it can be improved upon.
The Motherhood Center (NYC, virtual)