Perinatal Mood & Anxiety Disorders: Signs, Symptoms & Support

For the majority of women, the weeks and months following the birth of a child are a physical and emotional whirlwind. Just some of the words used to describe the early stages of motherhood include wonderful, chaotic, sleepless, lonely, painful, joyous, exhausting, life-affirming, overwhelming, rewarding, confusing and magical, and sometimes all of these words describe a single day caring for an infant!

Following birth, a confluence of factors come together making it an extremely emotional time for mothers. Women are recovering from the monumental job of growing and delivering a baby, their levels of estrogen and progesterone dramatically fall and they are often sleep-deprived caring for their newborn. Combined with societal expectations of ‘bouncing back’ and being the perfect mother, it is no wonder that many women experience the baby blues, a short period of low mood following birth when a woman may feel emotional, irritable and anxious.

For some women, this period of low mood is more prolonged and more pronounced. Perinatal depression, also known as postnatal depression, is the most common obstetric complication in high income countries, with one in five women experiencing it. And yet, only half of women seek treatment.

Whether this is because they believe these feelings are a ‘normal’ part of new motherhood, they hope it will clear up naturally, they feel ashamed of not feeling joyful and fulfilled, or because they fear they will be regarded as an unfit mother, too many women are suffering in silence.

So let’s take an honest look at what perinatal depression looks and feels like, and the help that is available.

What are Perinatal Mood & Anxiety Disorders?

There are a variety of mood disorders that can affect women in the perinatal period, which covers pregnancy and the year following birth. Most people have heard of postnatal depression, but it is possible to develop a range of mental health conditions during this vulnerable time before and after the birth of a baby, including anxiety, obsessive compulsive disorder, post-traumatic stress disorder and bipolar disorder. In extreme cases a woman may develop postpartum psychosis following birth.

Signs & Symptoms

The signs of Perinatal Mood and Anxiety Disorders or PMADs, are not always easy to spot in yourself or a loved one. Generally, the symptoms are consistent with the symptoms of these conditions at other times in life although they often relate to the baby. For example, a mother with anxiety will often experience anxious thoughts relating to the health and wellbeing of their baby.

Signs and symptoms of the various mood disorders include:

• Depression Anger, lack of interest in the baby, a loss of appetite, sleep disturbances, feelings of guilt or hopelessness.
• Anxiety Constant worry, intrusive thoughts, sleep disturbances, dizziness and nausea.
• Bipolar Disorder Mood swings, rapid speech, delusions and impulsivity.
• Obsessive Compulsive Disorder (OCD) Obsessions, compulsions and hyper-vigilance.
• Post Traumatic Stress Disorder (PTSD) Flashbacks, avoidance, irritability, panic and feelings of extreme alertness.
• Postpartum Psychosis (PPP) Delusions, hallucinations, mania, severe depression and paranoia.

Postpartum psychosis (PPP) is a rare but extremely serious form of mental illness that begins typically in the first few weeks following the birth of a child, although it can develop at any point in the first year. It is estimated that 1-2 in every 1,000 women are affected after giving birth, but incidences are higher amongst people who have a history of mental illness. PPP should be treated as a medical emergency as the condition can worsen rapidly and can pose a threat to the safety of the mother and her baby. Women suffering PPP require expert inpatient care, but the illness is treatable with a combination of therapy and medication.

Is it the Baby Blues?

At least two thirds of new mothers experience the 'baby blues', characterised by low mood, fatigue and tearfulness in the first days after giving birth. However, the baby blues typically dissipate within two weeks of birth. If such feelings persist beyond two weeks, this is not the typical baby blues.

How Common are PMADs?

PMADs do not discriminate. Women of every ethnicity, culture, age and income level can be affected. It is difficult to gauge the depth of PMAD suffering, in part because there is a reluctance to talk about it out of a sense of shame, fear of being regarded as a bad parent, or worry that the baby will be taken away from them.

There are no specific statistics for Cayman but according to the World Health Organization around one in five women will experience a mental health condition during pregnancy or in the first year of their child’s life. Women of colour are more likely to experience a PMAD and less likely to seek help and support for their experience.

Intrusive thoughts, often centring around the baby coming to harm, are also very common. Around seven in ten women experience intrusive thoughts, and although they can be scary to experience, it is thought that these are an evolutionary development to help parents remain vigilant to danger.

Laura Kelly, who holds her Perinatal Mental Health Certification (PMH-C), stresses that while intrusive thoughts of harming oneself or one’s baby can be very distressing, it’s important to know that mothers rarely act on them. She says, “Most women are frightened by these thoughts. They don’t recognise themselves and are afraid to be left alone with the baby.”

Women who experience difficult births, preterm birth or stillbirth, and mothers whose baby required treatment in intensive care following birth are at greater risk of developing PTSD. Long-term physical and emotional symptoms following a traumatic birth experience are suffered by around 5 in every 100 women.

Causes of PMADs

There is no single cause of PMADs. There are both biological and psychological factors at play. The hormonal changes a woman experiences are one part of it and a lack of sleep and physical exhaustion are thought to play a significant role.

Some people are more at risk than others, especially those with a history of mental health issues, single mothers or very young parents. In addition, the following are also important in the development of PMADs:

• Social isolation and lack of support
• Marital or relationship instability
• Financial stress
• A history of abuse or trauma
• Unplanned or unwanted pregnancy
• Complications in pregnancy or birth
• Recent stress such as bereavement or illness.

Risks of PMADs

Left untreated, PMADs can become long-term conditions that impact the wellbeing of both parent and child. For the infant, the risks include low birth weight, pre-term delivery, insecure attachment and developmental problems. For the parent, the symptoms may impair their ability to function, impact their relationships and lead them to neglect the child. Perinatal depression can lead to long-term depression and suicidality. It is also worth noting, says Dr Walton, a clinical psychologist who has a special interest in perinatal mental health, that alcohol and drug abuse can be a consequence, as some may use these to self-soothe.

Treating PMADs

Treatment for PMADs falls into two categories, therapy and medication, with a combination of the two often being optimal. If you believe you are experiencing PMADs, your first port of call should be your midwife, OB/GYN or mental health practitioner.

There is now a small but growing number of mental health professionals in Cayman who are certified in perinatal mental health. Treatment typically includes interpersonal therapy and Cognitive Behavioural Therapy (CBT).

“Interpersonal therapy creates a safe space where parents can be heard and understood, and start to make sense of their difficulties”, Dr Walton says, “while CBT identifies the thoughts that lead to behaviours, and seeks to reframe these thoughts to be more solutions-focused.”

Medication is also a very effective way to relieve symptoms and make you feel like yourself again. Although many women worry about taking medications while pregnant or breastfeeding, this should not prevent you seeking help.

“Some medications are contraindicated but there are many that can be used safely and some that require additional monitoring of the baby during the pregnancy and after birth”, Dr Hole, OB/GYN at Integra, assures.

Support

Talk openly with your partner, family, friends and other mothers about your struggles. Discuss practical ways that you can be supported, whether that's help with grocery shopping, cleaning and laundry, or someone to watch your baby so you can get some exercise or catch up on sleep.

Ariel Grace, a doula and founder of The Mom Method, says "we know that consistent support, like that from a doula, can significantly reduce the risk of PMADs. Women with doula support report fewer symptoms of postpartum depression and anxiety and greater confidence in early motherhood.”

Ariel is also a great believer in the power of community and its importance to mothers at a challenging time in their lives, adding, “the real magic happens in the connections that are made at The Mom Method—countless moms have found lifelong friends through the programme. Community, movement and mental and physical support are not luxuries—they’re essentials for navigating this sacred and challenging season of life.

Personal Stories

Podcast and Reading Recommendations

• Australian Birth Stories
• Good Moms Have Scary Thoughts by Karen Kleiman
• The Fourth Trimester by Kimberly Ann Johnson
• Not Your Mother's Postpartum Book by Caitlin Slavens & Chelsea Bodie