Many women experience shifts in their emotions during pregnancy and after childbirth. These changes range from mild to more severe and play a key role in the development of perinatal (i.e., occurring during or after pregnancy) mood and anxiety disorders (PMADs). PMADs are typically caused by a combination of factors: e.g., changes in hormones, a prior history of a mood or anxiety disorder, the physical toll of labor and delivery, lack of sleep, and the mental and physical stress or caring for a newborn. Often mothers with PMADs blame themselves and feel a tremendous sense of guilt and even shame. Seeking mental health treatment and support as soon as possible is critical, especially since the impact of not seeking treatment extends beyond the mother to the baby and the rest of the family unit.
I am certified in the treatment of PMADs through Postpartum Support International (PSI), one of the largest worldwide organizations devoted to meeting the various needs of women and their families during pregnancy and postpartum. I have additional expertise working in coordination with other maternal health care providers, such as OB/GYNs and psychiatrists with a specialty in perinatal medication management. I treat pregnant and postpartum women dealing with depression, anxiety, trauma/PTSD, and other challenges like infertility, miscarriage and pregnancy loss, premature birth, and having a child diagnosed with a birth defect or illness.
- Postpartum Depression – 75-80% of new moms have the “baby blues,” or mild depression mixed with happier feelings. This “emotional roller coaster” usually begins 2-3 days postpartum and lasts no more than two days to two weeks. Some women (an estimated 15%) develop postpartum depression (PPD), and 50% of “postpartum” major depressive episodes actually begin prior to delivery. Women that experience depression during pregnancy and postpartum often have severe anxiety and even panic attacks. In extreme cases, psychotic features can be present during a major depressive episode, e.g., command hallucinations to kill the baby or delusions that the baby is possessed. Women with a history of depression in the perinatal period or outside of pregnancy are at increased risk for developing perinatal depression.
- Anxiety – Anxiety during pregnancy and postpartum can take various forms. For example, anxiety is a typical symptom of postpartum depression. Other common anxiety disorders during pregnancy and postpartum are panic attacks/panic disorder and obsessive-compulsive disorder, or OCD. Overall, symptoms of these disorders in pregnancy and postpartum are similar to their presentation in general. However, often the focus of the symptoms is specific to aspects of the perinatal experience. For example, women experiencing panic attacks can worry about harmful effects on the developing fetus, or interpret symptoms as indicative of trouble with the pregnancy. In OCD, obsessions can include thoughts of harming the baby or fear of contaminating the fetus or baby. Typically such thoughts are extremely upsetting to the mother and can lead to compulsions such as avoidance of the baby so as not to harm him or her, or extreme washing behaviors to prevent the feared contamination.
- Trauma/PTSD – Women with a history of trauma, particularly sexual abuse or assault, are more vulnerable to experiencing symptoms of PTSD during the perinatal period. The experiences of obstetric exams and procedures, labor and delivery, and breastfeeding can reactivate trauma memories and symptoms. During the perinatal period, women can experience new trauma such as miscarriage, pregnancy loss, still birth, and a complicated labor and delivery process.
- Other Pregnancy- and Postpartum-Related Stressors – The process of having a child can obviously involve other significant stressors: infertility, miscarriage and pregnancy loss, premature birth, and having a child with medical or developmental complications. All of these experiences bring enormous stress and anxiety, and often involve grief from the loss either of what was or of what could have been. Having a premature birth and a child with special needs are areas of particular professional expertise for me.
*Source: Postpartum Support International