The spoken and unspoken expectations surrounding pregnancy and the postpartum period can feel overwhelming at times. Mothers are adjusting to the new role of being a parent, healing from the physical toll of pregnancy and delivery and caring for a newborn who has around-the-clock needs. In the first few years of life, I often hear moms talk about basic life skills as if they are some kind of “treat”. They may view a hot shower, going grocery shopping or simply having a minute to prepare for the day ahead as a luxury. New parents are oftentimes so busy taking care of their babies that they unintentionally neglect caring for themselves. This can be perpetuated by the incidence of a perinatal mood or anxiety disorder.
Perinatal mood and anxiety disorders (hereafter referred to as PMADs) include the more commonly discussed facets such as postpartum depression and anxiety but aren’t limited to those two diagnoses. PMADs encompass distressing feelings that occur during pregnancy (perinatal) and throughout the first year after pregnancy (postpartum). These feelings and thoughts can be mild, moderate or severe. Without treatment, symptoms may last a few weeks, several months or even years, depending on the severity. I’ve seen women who have suffered from undiagnosed postpartum depression and anxiety well into their children’s toddler years, even though it began during pregnancy or the first year after birth. Many moms don’t realize that the feeling of being utterly overwhelmed, checked out from life or so anxious they can’t eat or sleep well is not typical of motherhood. Although the “baby blues” (moments of overwhelm, tearfulness and a general sense of heightened emotional reactivity) are present in up to 80% of new moms, if these symptoms continue past the first 2-3 weeks postpartum, it’s important to schedule an appointment with your medical provider to determine if you are experiencing symptoms of a perinatal mood or anxiety disorder. During the baby blues, moms worry about minor things or things that are proportionate to the risk (ie. is this baby bottle too warm or is my baby on a safe sleep surface). In postpartum depression, moms begin to worry repeatedly if they’re a good mom in general.
The statistics certainly reflect how common PMAD’s are: At least 1 in 7 women experience a mood or anxiety disorder during pregnancy or postpartum. Mom’s aren’t the only ones affected. Up to 10% of new dads experience paternal depression during pregnancy or postpartum. This number increases to 50% when the mother also has perinatal/postpartum depression.
Partners may feel particularly helpless seeing their loved one so vulnerable. Many times, I hear partners comment how they “felt so helpless when my wife/partner was overwhelmed, crying and the baby wouldn’t stop crying. I could fix every other area of my life but I couldn’t fix this.” Partners may not be able to fix what the new mom is going through, but they can provide support and an extra set of eyes to check-in on the mom and make sure she’s adjusting to pregnancy and postpartum relatively well. New moms are so busy taking care of their own healing and the new life in front of them, they may neglect to care for themselves. Some new moms will show their struggles clearly, others will not. Just because a new mom seems to be carrying this new role well on the outside doesn’t mean it isn’t heavy. Take this as your cue to check in on the moms in your life… they need you.
Family and Friends: How to help identify the signs
How do we know if a mom is struggling? In the clinical world, we distinguish between the “baby blues’ and an actual perinatal mood or anxiety disorder by the time frame (baby blues subside after 2-3 weeks postpartum). In our culture, the terminology postpartum depression is becoming increasingly more salient, but it’s important to note that there are many different ways the postpartum period can trigger mental health concerns in a mom. Here are a few examples:
~Perinatal anxiety can look like not being able to sleep (even when the baby sleeps) because you are afraid of SIDS or the baby not breathing. Perinatal anxiety can look like never wanting anyone else to hold the baby.
~ Perinatal depression can look like drinking a whole bottle of wine at night when the baby is asleep to “check out” from the stress of the day. Perinatal depression can also look like having a very short fuse, getting angry and agitated at the people around you more frequently and snapping at them (most people don’t realize increased maternal anger can be a sign of post partum depression).
~Even though we hear a lot in the news about moms who hurt their babies from “postpartum”, the media grossly misrepresents perinatal mood and anxiety disorders. Cases where a mother actually hurts her baby are due to perinatal psychosis and it’s an extremely rare condition (about 1% of moms experience this and a VERY small percentage of that 1% ever hurt their babies). What’s much more common is something that can look similar called Perinatal obsessive compulsive disorder (OCD). This is when a mom has intrusive thoughts that are causing her distress, such as intrusive thoughts about accidentally dropping the baby or a car running into your stroller.
Sometimes intrusive thoughts can be difficult for friends and family to hear, but trained providers know that just because a mom has an intrusive thought, it doesn’t mean she will act on it. If a mom is struggling with perinatal ocd, she will be upset at the intrusive thought (clinicians use the term “ego dystonic”, meaning it’s not in line with the mom’s sense of self and the thought itself causes her distress). The distress surrounding the intrusive thought shows that she likely wouldn’t act on it. Unfortunately, some moms are afraid to reach out for help because they feel ashamed of having these thoughts or think someone may take away their baby. This leads to suffering that could’ve been mitigated with the correct support.
Questions to Ask a Loved One
Family and friends may wonder how they can reach out to the new moms in their lives. These three questions, presented in a supportive, non-threatening way, can provide some insight into your loved ones internal experience.
Being a new mom is hard and some days can feel totally overwhelming. In the past week, have you had more bad days than good?
Sometimes, new moms have thoughts that cause them stress. Do you have any thoughts that are scaring you?
God gave you this child because you are the right mom for your baby. However, sometimes transitioning into being a mom can take time. Are you having difficulty adjusting to your role as a new mother?
Answering “yes” to any of these questions doesn’t indicate a perinatal mood disorder but rather indicates a need for further screening from a medical professional. The good news is that PMADS are HIGHLY treatable through a variety of avenues. Parenting is a journey that requires support from family and friends and, at times, medical professionals. Getting off to a good start by prioritizing your mental and emotional well-being sets the stage for your child to attach and thrive. For more support, check out www.postpartum.net or, for GA residents, take our free Clear Path assessment today.