This month, our Whole30 HMHB team is publishing resources and stories related to postpartum mental health. If you need immediate help, the National Suicide Prevention Hotline is a free and confidential network of more than 140 crisis centers nationwide. It is available 24/7 to contact in a crisis at 1-800-273-8255. You can call for yourself or someone you care about.

For additional help, call Postpartum Support International’s warmline at 800-944-4773. You’ll get a return call within several hours. You can also visit their website www.postpartum.net. Click here to connect with your closest coordinator to get info, support, resources, and referrals to providers trained to treat PPD in your area.

According to a 2013 study, between 14-20% of women in the United States suffer from postpartum depression. It’s a common experience, yet it can feel isolating and lonely.

We had the opportunity to speak with Ann Smith, Certified Nurse Midwife and President of Postpartum Support International (PSI) and ask her our questions related to postpartum depression. Together with her answers and the wonderful resources available on the Postpartum Support International website, we put together this two-part series full of answers to questions you probably have about postpartum depression and anxiety. For more information and support, connect with PSI on Facebook, Youtube, or Twitter.

What is a Perinatal Mood and Anxiety Disorder (PMAD)? Is it the same as Postpartum Depression? When does a PMAD begin?

Perinatal means the period of time throughout pregnancy as well as the baby’s first year. Research suggests that between 10% and 20% of pregnant women experience a new episode of depression during pregnancy, which is called antepartum depression.

While a PMAD can begin during pregnancy, it most commonly begins after the baby is delivered. This could be as early as the first 48-72 hours after birth. There’s often a lot going on in the first 24 hours, so you may not be aware of what you’re feeling emotionally until after things slow down.

Any mood disorder that occurs in the first year of a baby’s life is considered to be a perinatal mood disorder. It’s important to note that while it’s defined as happening in the first year, it may begin during the first year of a baby’s life, not be adequately treated, and continue beyond the first year of the baby’s life. If the mood disorder goes undiagnosed or untreated during the first year of life, it is still a perinatal mood disorder.

Perinatal mood and anxiety disorders are the most common complications of childbirth, and include depression, anxiety, and/or OCD during pregnancy and/or postpartum, as well as postpartum post-traumatic stress disorder, bipolar mood disorders, and postpartum psychosis.

These disorders are different than the “baby blues” which occur in about 75-80% of new mothers and resolves on its own without medical assistance. The “baby blues” is a normal adjustment period where moms may experience mood swings and weepiness during the first 2-3 weeks after giving birth.

What causes a PMAD?

There is no single cause for perinatal mood and anxiety disorders. Women who develop depression or anxiety around childbearing have symptoms that are caused by a combination of psychological, social, and biological stressors. Hormonal fluctuations can cause reactions in sensitive women.

Research shows that a variety of factors can increase your risk for developing a PMAD. You can read the full list here, but a few of them include:

  • A personal or family history of depression, anxiety, or postpartum depression
  • Inadequate support in caring for the baby
  • Financial or marital stress
  • Complications in pregnancy, birth or breastfeeding
  • Mothers of multiples or whose infants are in Neonatal Intensive Care (NICU)
  • Mothers who’ve gone through infertility treatments

If you have any of these factors, you should discuss them with your medical provider so that you can plan ahead for care should you need it.

Developing a perinatal mood and anxiety disorder is not your fault. You did not do anything to “get” a perinatal mood and anxiety disorder.

What are some of the signs that you have a PMAD?

It depends on which mood disorder you are experiencing. Below is a general list of symptoms from PSI’s website, which you can visit to learn more about the risk factors, symptoms, and treatment. Remember, these symptoms can begin during pregnancy or postpartum.

Depression: feelings of anger, sadness, irritability, guilt, lack of interest in the baby, changes in eating and sleeping habits, thoughts of hopelessness and sometimes even thoughts of harming the baby or herself. PMADs and PPD are often used interchangeably and refer to the same illness.

Anxiety: extreme worries and fears, a feeling of losing control, panic attacks, shortness of breath, chest pain, and/or numbness and tingling.

OCD: repetitive, upsetting and unwanted thoughts or mental images (obsessions), and/or the need to do certain things over and over (compulsions) to reduce the anxiety.

Postpartum Post-Traumatic Stress disorder: flashbacks of the trauma with feelings of anxiety and the need to avoid things related to that event.

Postpartum Psychosis: hallucinations (seeing and hearing voices or images that others can’t), distrust of those around them, periods of confusion and memory loss, or manic behavior. This severe condition is dangerous, and it is important to seek help immediately.

What is the line between feeling overwhelmed as a new mom and a PMAD?

If you’re questioning whether you have a PMAD or not, you are likely on the mild side, although some moms have more severe symptoms and don’t know what is causing them. If you truly have a PMAD, you’d do anything to feel better. If you’re moderate to severe, you may question if you’ll ever bond with your baby, you can’t sleep, and have no enjoyment of life. If you’re mild, you may have all of those symptoms, but they’re less intense. You may think things like, This is hard, I’m exhausted, I don’t know what to do next.

There is also something called Postpartum Adjustment Disorder (or Postpartum Stress Syndrome), which is a grey area that fits between just regular “motherhood is tough” and a mild perinatal mood disorder. You may think things like, This isn’t what I expected. I can’t do this. I don’t have a village. There’s nobody around me that mothers like me. My parents live on the other side of the country. My best friend doesn’t have a baby.

This is a grief reaction. It’s also a cultural problem, since we no longer parent in communities. The good news is this can be remedied by therapy, support groups, diet, or exercise. This impacts many women, and it can get better with the right help.

There are also some moms who just don’t like the newborn stage, but really enjoy life with a toddler. It’s okay to not enjoy every second of being a mom; however, if it’s affecting your quality of life (i.e., you can’t look forward to anything, there’s nothing you want to do), then you should consider seeking help.

What’s the difference between PPD and Postpartum Psychosis?

They are completely different illnesses. Postpartum Psychosis is not a worsening of depression. Women dealing with postpartum psychosis are psychotic right from the beginning. It’s often the first manifestation of a bipolar mood disorder.

The difference is that the person has had a break with reality. They are hearing, thinking, and/or seeing things that are not there. It’s often related to a deity (god, the devil). It can be confusing in cultures where there is a lot of conversation about God being in charge, since this may be less apparent. It’s particularly scary to hear someone talk about these things when they never have before. Psychosis can come and go (moms may appear normal and then appear ‘not there’). When it happens, it’s always a medical emergency – a trip to ER or call to 911 is warranted.

Postpartum Psychosis is a rare illness, compared to the rates of postpartum depression or anxiety. It occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately 0.1 – 0.2% of births. The onset is usually sudden, most often within the first two weeks postpartum.

Most times these women are admitted to inpatient care. Women are often hospitalized for a week or less. They get stabilized on medication and get started on therapy. It’s important for these women to find a place that specializes in perinatal mood disorder. Psychosis is treatable with the right help.

Stay Tuned for Part Two

We are proud to join this important conversation to end the stigma surrounding perinatal mood and anxiety disorders. We’re here for you, mama, no matter your season of motherhood, and we hope the resources we bring you this month are helpful. Connect with us on Instagram or by email with suggestions for resources you’d love to see in the future.

Join us next week as we bring you Part 2 of our series – addressing your questions related to seeking treatment for Perinatal Mood and Anxiety Disorders. Anything we missed? We’d love for you to join the conversation on Instagram and let us know your thoughts and further questions.


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