Postpartum Depression is the most common talked about Perinatal Mood and Anxiety Disorder (PMAD) however it is only one out of several mental health issues that people experience in the Perinatal period. And these issues are not only experienced in the Postpartum period but throughout the entire Perinatal period.
The Perinatal Period includes prenatal (people are thinking about having a baby, trying to have a baby and/or going through fertility treatments), pregnancy and postpartum (after baby is born, up to a year after the birth, however some consider this period longer).
Please note there will be some gendered language in this post.
Trigger warning: intrusive thoughts, suicide, trauma.
Defining terms such as PMAD and Perinatal are important for education however I also like to talk about how these things look and feel in real life. As a therapist and a mom who's experienced Postpartum Anxiety and Depression I will be sharing how these things can feel so that if you relate you might be able to put some language to your symptoms.
Defining, diagnosing and understanding can be useful in seeking help, getting the appropriate treatment and recovering.
Let's get to it: What is a PMAD?
As the poster from Postpartum Support International states; 1 in 7 mothers experience depression or anxiety during pregnancy or postpartum. They also report that 1 in 10 fathers experience depression or anxiety after the birth of a child. These are American statistics however from what we know there isn't a big difference in prevalence. Anecdotally, I would say that I am seeing a higher prevalence of anxiety in postpartum parents. What this means is that this is not a rare, uncommon occurrence, it's just that we're not talking enough about it to know that your friend, loved-one or neighbour also experienced a PMAD. A lot of times the conversation centres on Postpartum Depression. This is quite common however it's only one piece to the puzzle.
PMAD's include depression, anxiety, OCD, Bipolar Disorder, PTSD and psychosis anytime in the perinatal period. Someone can experience this when they are trying to have a baby and it's not happening as quickly as they thought, or someone is going through fertility treatments, during pregnancy, after delivery and anytime in that postpartum period. Most clinical definitions of the postpartum period state up to a year postpartum however I feel this can be beyond the year mark and I would say can last until you finish having children and they are out of the toddler stage. When people experience a PMAD in the postpartum stage it doesn't always happen right after delivery. Signs and symptoms can show up anytime, even up to a year postpartum (again this range could be longer). And they do not always manifest in the birthing person; a partner, grandparent or other family member or caregiver can experience a PMAD and parents who adopt or welcome baby via surrogacy can also experience a PMAD.
What are the signs and symptoms of a PMAD?
Feeling irritable or angry
Feeling sad, depressed or more tearful than usual
Not finding joy in things or activities you normally find joy in
Feeling anxious or panicky
Struggling to eat or overeating
Struggling to fall asleep or difficulty staying asleep
Experiencing panic attacks
Mania or very low mood
Repeated checking, excessive hand-washing, extreme fear of germs or baby's death
Experiencing intrusive thoughts of baby getting hurt or of you hurting baby
Struggling to connect with baby or experiencing a lack of interest in baby or your older children
Difficulty in maintaining personal hygiene
Isolating from friends and family
Feeling like you're losing control
Trouble concentrating or focusing
Feeling hopeless
Extreme guilt
Thoughts of harming yourself or your baby
Flashbacks to the traumatic event, avoiding places, people or things that remind you of the traumatic event such as the hospital or doctor's office
Experiencing these symptoms for more than 2 weeks and past the "Baby Blues" stage
Psychosis includes seeing or hearing things that other people are not seeing or hearing, feeling very energetic; not needing to sleep, feeling paranoid or suspicious. Postpartum Psychosis is a medical emergency and if you or your loved-one is experiencing psychosis please call 911 or head to your nearest emergency room.
A Note about the Baby Blues
The "Baby Blues" is not a PMAD and is quite common. Let's be real, having a baby is a shock to the system and a very tough transition, not to mention physically challenging for the birthing person. So feeling weepy and exhausted and struggling to adjust to being responsible for this new being after the birth makes sense. The Baby Blues very clearly starts within a couple of days of birth and lasts 2 weeks. If your symptoms extend beyond two weeks this is not the Baby Blues and could be developing into a PMAD. I have had clients tell me that their OB told them at 6 weeks postpartum that they were still experiencing the Baby Blues, when in reality they were living with Postpartum Anxiety.
Why does this happen?
When someone develops a PMAD, they often ask why me? I've heard so many mothers say "I'm broken". It is no one's fault that they develop a mental health issue. We can never know for certain what causes a PMAD however there are definitely some risk factors and experiences that can contribute to the development of a PMAD such as:
Experiencing a great deal of stress during pregnancy such as moving, losing/changing jobs, or financial stress
History or mental health issues such as anxiety, depression, Bi-Polar disorder, OCD
Fertility challenges and treatments including not conceiving
Unwanted or unplanned pregnancy
A traumatic birth; including almost dying or almost losing the baby, watching your partner or baby almost die or experience a traumatic delivery
A NICU stay following delivery
Obstetric violence
Miscarriage, neonatal loss, infant loss, pregnancy release (abortion) whether choosing to or having to because of a pregnancy loss or complication
Challenges with breastfeeding
History of PMS (Premenstrual Syndrome)
Experiencing abuse in the Perinatal period
Not having support from friends and family
Physical health issues including Thyroid issues, Gestational Diabetes or Endocrine imbalances
Complications during pregnancy that increase fear for baby's health and safety
Hormone imbalances, rapid increases and decreases in hormones throughout the Perinatal period
Parenting, trying to have a baby or having a baby during a pandemic.
What does this look like in real life?
Now that we've covered the clinical definition, what does all of this feel like in real-life. Sometimes people feel like they're just not themselves. Or they can't get to sleep at night even if the baby is sleeping, or they just can't stop staring at or listening to the baby monitor. It can feel like you're constantly worried about your baby's health and wellbeing, obsessing over their weight, how much they're drinking or eating or you're terrified of SIDS. Some parents are terrified of their baby's getting germs, which they feel could lead to baby getting sick and dying.
Maybe you had a difficult delivery but no one on your care team asked how you are doing and so you felt very unsupported and you've been feeling low and down or anxious ever since the delivery. You notice that you avoid driving anywhere near the hospital or where you delivered and you experience physical symptoms such as racing heart, sweating, dizziness or flashbacks. These flashbacks seem to knock you off kilter all day. Or you watched your partner have a traumatic delivery and you felt helpless and are struggling with excessive worry or irritability.
Maybe you are struggling with breastfeeding and all of the doctor's appointments to weigh baby and check on their progress are so overwhelming. In whatever you're experiencing you're feeling like "a bad parent". Shame and guilt are suffocating you and you're doubting your abilities to care for this little one. Sometimes you might think to yourself "my family would be better off without me" or "it would be easier if I just wasn't here".
I knew something was wrong with me when I just could not stop crying and feeling so guilty about every thing I was doing. I didn't feel like I was participating in my own life. Life felt so heavy, like I was surrounded by a thick fog. Nothing felt enjoyable, I couldn't laugh and I didn't want to talk to anyone or leave my house. I also felt very anxious most of the time, I had intrusive thoughts of dropping my baby down the stairs and I couldn't connect with my older kids. I thought to myself "this can't be Postpartum Depression (PPD) because I'm not really depressed and I love my baby". Because I had only heard of PPD and only knew the stereotypes of PPD; not connecting to your baby, feeling depressed and sad. I didn't realize that I did in fact have a PMAD.
When is it a good idea to reach out for help?
If you feel like you're living in chaos, you can't manage what you have on your plate and it feels like it's more than the difficulties of having a newborn baby then I would suggest reaching out. If you feel like you just can't get your sh*t together, you can't access the coping skills you know you have or you have thoughts of harming yourself or your baby then it's time to ask for help.
This part isn't easy but you don't have to suffer alone. There is treatment for PMAD's and support so that you can recover. Talk to your partner, a friend or family member and tell them how you've been feeling and what you've been experiencing. Sometimes just letting it out that first time can be such a relief.
The next step is to speak to your health care provider or find a therapist. If you talk to your OB or family doctor they can screen you for symptoms of PMAD's and recommend treatment. This can include medication and talk therapy. If you reach out to a therapist then they can also screen you for a PMAD and therapy can include talking about your specific symptoms and what can be helpful to manage them. A therapist can provide support in talking to your doctor about medication if that is what you feel you need. If you've experienced trauma anywhere in the Perinatal Period than you can discuss managing your post-trauma symptoms and then eventually processing the traumatic event. In my next blog post "Can I recover from a PMAD or Birth & Reproductive Trauma?" I will discuss what recovery can look like more in depth. And here's a hint...YES you can recover!
There are also online supports, other sources of information and support groups. I highly recommend checking out the support groups at Postpartum Support International where you can seek support from other people experiencing a PMAD.
That was a lot of information. Let's take a deep breath! If you feel you are experiencing any of the above please reach out to anyone of your supports. If you feel you have more questions about PMAD's or would like to ask about therapy please email me at christine@perinatalwellbeing.ca or call me at 289-274-8468.
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