Before jumping into blogging about topics on the fourth trimester, I thought a great first topic would be Perinatal Mood and Anxiety Disorders (PMADs)! When I speak on PMADs, we are referring to a range of mental health conditions that can affect individuals during the pregnancy and postpartum phase.
My hope is that each person reading this has a provider on their team that is educated in perinatal mood disorders and practices in an inclusive, trauma-informed manner. In addition, I am very passionate about providers supporting this population to have the additional education to ensure that we are screening our clients properly and referring to supports that could be beneficial early-on. PMADs do not only affect birthing parents, so this information is also for non-birthing parents, anyone who has experienced infant loss, adoptive parents and other support systems.
It truly takes a village and Winnipeg has an ever-growing, loud group of supporters continuing to spread awareness.
So how do we educate ourselves on what to watch for? I hope to simplify that in one place for you.
Baby Blues vs Postpartum Depression
The “Baby Blues” are quite common, affecting around 80% of new mothers within the first few days after delivering baby. Although common, it is important to not minimize the intensity that these symptoms can present themselves with in new parents. The Baby Blues are impacted by adjusting to sleep deprivation and hormonal changes. These symptoms usually resolve within 10 to 14 days and are not considered a mental health disorder. Alternately, think of these symptoms as a normal adjustment during a very large transition in your life, encompassing all of the emotional, physical and hormonal changes occurring.
Symptoms can include:
● Irritability or impatience
● Mood swings
● Weepiness (i.e., crying spells with no obvious reason)
● Changes in or difficulty sleeping
● Feelings of grief, loss or regret
● Restlessness, feeling on edge
● Difficulty with concentration, memory
When discussing a postpartum plan, I encourage all of my clients to include a check in around the 2 week mark, whether that be with their mental health provider or a member of their support team (i.e., partner, parent, friend) to ensure that symptoms are not increasing in intensity or lingering, as symptoms longer than 2 weeks are no longer considered the Baby Blues.
Postpartum Depression
Postpartum Depression is estimated to affect 17.9% of Canadians (Gheorghe et al., 2021). Postpartum depression is most commonly seen within the first two months postpartum, but can begin anytime during pregnancy and up to a year postpartum.
Symptoms can include:
● Persistent low mood or sadness
● Irritability or rage
● Loss of interest or pleasure in activities
● Forgetfulness (i.e., difficulty making decisions or concentrating)
● Appetite changes (+/- weight changes)
● Insomnia
● Fatigue or low energy
● Feelings of worthlessness, guilt or shame
● Thoughts of death and/or suicide (loss of interest in life)
Perinatal Anxiety
Postpartum Anxiety affects approximately 13.8% of Canadians (Gheorghe et al., 2021). Anxiety among fathers is currently studied less, with a meta-analysis finding a range of prenatal anxiety ranging from 4-16% prenatally and 3-18% postpartum (Leaech et al., 2016).
Symptoms can include:
● Intrusive thoughts*
● Fear of doing something “wrong” that will cause harm (racing and/or fearful thoughts)
● Physical symptoms (i.e., nausea, heart palpitations, muscle tension, chest pain)
● Panic attacks
● Insomnia
● Hypervigilance
There are a variety of topics that perinatal anxiety can focus on outside of baby’s health and safety, such as changes in your relationship, parental readiness, identity change and/or loss and future scenarios, to name a few.
*Intrusive thoughts are defined as unwanted, repetitive and distressing thoughts (i.e., leaving for a coffee date with baby in hand and getting a mental picture of tripping down the stairs and losing grip of them)
Perinatal Obsessive Compulsive Disorder
Perinatal Obsessive Compulsive Disorder is OCD that develops in the pregnancy or postpartum period. A BC Study estimated an effect of around 2.2% of the population (Fairbrother et al., 2021).
Symptoms can include:
● Intrusive Thoughts (often anxiety driven, occurring on their own or as a part of the OCD)
● Disturbing thoughts or images about harm to baby (including violence or sexual thoughts)
● Obsessive worries, often about health or safety of baby
● Compulsives, mental or physical (i.e., repetitive checking, cleaning, reassurance seeking, counting)
● Task avoidance due to fear of causing harm (i.e., bath time); +/- hyper-protective of baby
It is important to note that most intrusive thoughts are not dangerous. The distress and avoidance that often accompanies them can often be a sign that the individual is not at risk of acting on them. My hope is that awareness can continue to reduce stigma that prevents individuals from seeking available support. Individuals can learn to manage these thoughts and find symptom reduction!
The right, perinatal trained practitioner will be able to distinguish if these thoughts are what we call ego-dystonic (thoughts that feel wrong, distressing and not in line with the personal set of morals and identity) or ego-syntonic (thoughts that feel ‘right’ or ‘logical’ and in line with what they are wanting to act on).
Perinatal Trauma
A reality that can occur but is often talked about less is a trauma response after birth, with 4-6% being affected by PTSD and 45% self-reporting after a difficult birth (Ertan et al., 2021).
Symptoms can include:
● Flashbacks or nightmares
● Panic attacks
● Avoidance of memories (i.e., hospitals, babies, medical terminology)
● Dissociation (i.e., difficulty remembering parts of birth)
● Hypervigilance, jumpiness, irritability
● Detachment (from others or difficulty bonding with baby)
● Hypo/hyper arousal leading to feelings of helplessness or panic
I purposefully listed the category as “perinatal” trauma, not birth-related trauma, to not exclude any factors that can contribute to an acute stress response (occurring within a few days of a traumatic event, lasting up to a month) or PTSD (lasting longer than a month, presenting a few days after or up to 6 months after traumatic event).
The Perinative Collective outlines 3 categories for practitioners to be aware of when seeing individuals who may have experienced perinatal trauma: pre-pregnancy factors, birth experience factors and relational trauma.
This can include:
● Fertility struggles, miscarriage, previous loss, past sexual traumas, domestic violence
● Emergency procedures, loss of privacy or dignity, lack of consent or autonomy, fear for your life or babies, birth outcomes such as disability, stillbirth or NICU stays
● Partners who witness traumatic births
Disclaimer: this is not an exhaustive list of PMADs an individual can experience
It is important to have a therapist who is trained in Perinatal Mental Health! The two most common certifications are therapists who have a CC-PMH or PMH-C beside their name. We are trained to differentiate between perinatal mood disorders and very normal, very emotionally trying times.
I want to leave you with something tangible. I’m sure that we have all heard the term “mother hen,” referring in one way or another to an individual who cares for others. I like to extend and reframe this term with one of my favorite tools: NESTS. Instead of focusing solely on who else you need to care for, let’s take a moment to check in with YOU (and think on those barriers)!
N – Nutrition
● Am I eating daily? (What are the current barriers?)
● Am I drinking enough fluid? (No, coffee is not going to count in this hydration check)
● Am I getting the nutrients I need? (Do I know what they are?)
E – Exercise (Movement)
● What physical activity do I enjoy? (This does not have to be intense activity. Walks, yoga, living room dance parties- they all count)
● What stops me from engaging in movement? (Are there any limitations to what I can safely, physically engage in? Do energy levels often halt the idea of movement?)
● How can I schedule time for movement? (With, or without, baby. Let’s be real- not everyone has a support system. Ideally, if support is available- how can we plan around it? If not, what movement is possible with the baby?)
S – Sleep
● Can I get 4 hours of uninterrupted hours of sleep within a 24 hour period?
● Do I sleep/rest* when the baby is sleeping?
● Am I comfortable asking for support so I can prioritize sleep?
T – Time For Self
● What do I value most about time with myself? (Has this shifted since baby came home?)
● What activities do I find most relaxing*/fulfilling?
*Rest is not just sleep! Dr. Saundra Dalton-Smith speaks on 7 types of rest: physical, mental, sensory, creative, emotional, social, spiritual)
● How can I take short breaks for ‘down time’ during my day? (‘Down time’ can be defined as a moment where baby is settled and we walk over to the microwave to heat up the breakfast and coffee we forgot about for the third time today)
S – Supports
● Do I have people in my life that make me feel good?
● Who are the people I can express myself honestly around?
● Who are the people who can support you: functionally, emotionally, informationally? (Is creating or maintaining boundaries ever a barrier to seeking support from anyone listed?)
Stay tuned! More topics coming up include transitioning from partners to parents, tools to help regulate during the postpartum period, navigating infertility, and more!
