May is Maternal Mental Health Awareness Month...

May is Maternal Mental Health Awareness Month. Though we don't often hear a lot about mental health during pregnancy and the early postpartum period,  perinatal mental health issues (including postpartum depression, anxiety,  and other mood and thought disorders) are considered the most common complication of childbirth. Up to 20% of new moms will experience a significant mental health issue during pregnancy or in the first year postpartum. In honor of Maternal Mental Health Awareness Month, and all the moms and families out there who have experienced perinatal mental health issues, here is some information that could help you, or someone you know.

• Mental health issues don't always start after baby is born. Many women first experience mental health issues during pregnancy. Moms with a history of mental health issues are more likely to experience a perinatal mood disorder, but even moms with no history are at increased risk during the childbearing year.

• Postpartum Depression is not the only mood disorder affecting new moms. While up to 15% of new moms experience postpartum depression, 6-10% experience pregnancy and postpartum anxiety disorders, and some moms experience postpartum OCD, PTSD, or bipolar mood disorders. Postpartum anxiety can look very different from postpartum depression. Instead of exhibiting low mood or sadness, moms with anxiety may seem very alert, worried, and panicked.

• Postpartum psychosis, a rare, but very serious illness, affects less than 1% of new moms. Despite what you may see on TV, postpartum psychosis, in which moms experience delusions or hallucinations, is very rare. It is however, always an emergency if a mom is experiencing these symptoms and immediate treatment is important.

• There are a wide variety of treatment options that can help mood and anxiety disorders get better.   For some women increased self-care and social support may be enough to see a reduction in symptoms. For others talk therapy may be the best option. Some women may to use medication to see a reduction of symptoms. Luckily, there are many safe medication options for women who may be breastfeeding.

• Postpartum mood disorders don't only affect new moms. Having a baby is an important adjustment for everyone in the family. It is estimated that up to 10% of new dads may experience postpartum mood or anxiety disorders as well. It is important that anyone experiencing symptoms  for more than two weeks gets help, since it won't just go away on its own.

• Some great online resources to learn more or to find help:
• Postpartum Support International: www.postpartum.net
• Postpartum Progress: www.postpartumprogress.com

Postpartum Depression and Mood Disorders

By Ella Clark

What is Postpartum Depression?

Anyone who has recently been pregnant, experienced miscarriage, stillbirth, recently adopted a child, or are the partner of someone who has recently been pregnant or adopted a child, can experience symptoms of postpartum depression (PPD).  While PPD is known to impact people of all backgrounds, many still experience symptoms without knowing what they are feeling has a name, and can be treated.  Still others may avoid seeking treatment because of negative stereotypes associated with mental health care.  Learning to recognize the symptoms before PPD sets in makes it easier to recognize the difference between the more normal stressors of new parenthood, and something more serious.  

Baby Blues v. PPD

As mentioned by Massachusetts General Hospital’s Center for Women’s Mental Health web page “about 85% of women experience some type of mood disturbance” after birth, including baby blues.   Though both baby blues, and PPD exhibit similar symptoms, PPD is generally considered more severe, and according to Postpartum Support International’s (PSI) website, only about 15% of those who have given birth develop PPD.  While baby blues generally only last for several days, if you notice symptoms that continue for two weeks or more you are likely experiencing PPD.  

Childbirth Connection’s website has provided a list of PPD symptoms to look for in new parents, and those who have recently been pregnant:

Crying easily

Sleep disturbances

Irritability

Anxiety

Lack of energy

Inability to focus

Sad mood

Loss of appetite

Inability to care for yourself

Obsessive or intrusive thoughts

Panic attacks

Thoughts of suicide

Thoughts of killing your baby

Because many of the symptoms of PPD interfere with daily life, and are in some cases potentially life threatening, it is important to seek help sooner rather than later.   

PPD Risk Factors

While anyone could develop PPD, PSI’s site reminds readers that some may be at a higher risk of developing symptoms, depending upon their personal, and family history.  A few of the known risk factors of PPD include:  

History of mental illnesses such as depression or anxiety in yourself, or family members

Lack of social support

Experiencing financial stress

Relationship stress

Difficult or traumatic pregnancy or postpartum period (could be related to difficulty breastfeeding, an unexpected c -section, an ill child, stillbirth, etc.)

Recent changes or major life events (marriage, moving, death of a loved one, change in employment, etc.)

Twin birth

Past difficulty with fertility or loss of a child

Illness in a parent

Post traumatic stress disorder

As described below, those who have survived any form of abuse, especially childhood sexual abuse (CSA), or have experienced and survived war are at an increased risk for developing PPD.  

PPD and Survivors of Childhood Sexual Abuse

Kathy Morelli explains in the Science and Sensibility article “Childhood Sexual Abuse as a Risk Factor for Postpartum Depression-- Part 1”  12-20% of women have experienced some form of childhood sexual abuse (CSA), which has been shown to increase a person’s risk of developing PPD.  Survivors of this form of abuse are known to have an increased rate of mental illnesses such as anxiety, and depression, as well as physical symptoms such as painful menstruation, pelvic pain, and pain during sex.  Morelli goes on to explain that experiencing long term stress, and fear during childhood can actually affect the makeup of the brain, especially portions of the brain associated with memories.  In part 2 of Morelli’s exploration of CSA and PPD “Childhood Sexual Abuse as a Risk Factor for Postpartum Depression-- Part 2: The Educator’s Role”, the author explains that physical, and emotional feelings of pregnancy, birth, and the extreme focus on the sex organs, may trigger memories of abuse in survivors.  These triggers, along with the increased stress of learning how to parent children, can create  an environment in which PPD is more likely to develop.  

PPD and War Veterans

According to Walker Karraa’s Science & Sensibility blog entry “Giving Birth after Battle: Increased Risk of Postpartum Depression for Women in Military” 16,000 active duty women give birth in the United States of America every year.  Throughout the article, Karraa references research published in the journal Medical Surveillance Monthly Report, which has shown that women who have served, and experience PPD are at greater risk for suicide compared to women who have served but do not develop PPD.  The Journal of Women’s Health, also noted by Karraa, reported that people who gave birth but have never been deployed, experienced PPD 10-11% of the time, while those who have given birth, have been deployed, and went through “combat-like experiences” develop PPD 16-17% of the time.  The risk factor for developing depression was even higher for those who deployed recently after giving birth.

Postpartum Psychosis

Another, more severe form of PPD, known as postpartum psychosis may also occur in some new parents. It’s important to remember that postpartum psychosis is very rare, and the symptoms that set in are both noticeable, and sudden.  Both Postpartum Progress and Massachusetts General Hospital Center for Women’s Mental Health  have listed symptoms related to Postpartum Psychosis:

Increased energy levels, feeling like you do not need sleep though you are tired

Feeling overly confident, that you’re mentally sharper, that you understand everything

Thinking that yourself or your child has special abilities

You are seeing or hearing things that others cannot

Voices may be telling you secrets or giving you orders

A loss of trust in others, or an extreme suspicion of those who you may have previously trusted

Trouble focusing, or remembering how to do things you used to enjoy

Loss of time, or an inability to track time

Strange physical sensations

A sharp increase in fighting with others

Feeling like someone or something is controlling your behavior

Feeling you have little to no control over your actions

Rapidly changing moods

Treatment and Prevention

It is vital for those working with pregnant, or otherwise expectant parents to focus some of their time on teaching clients, and patients to identify the symptoms of PPD.  Simply discussing PPD, and its effects, not only raise awareness about PPD, but also decreases some of the stigma associated with seeking treatment.  

Some with PPD have found comfort in meeting with, not only their doctors, but other parents who currently face similar difficulties.  Fortunately, the Lamaze Family Center of Ann Arbor offers several options for those seeking this type of support, with a monthly Pregnancy and Postpartum Support Group, weekly Mother’s Group, and monthly Miscarriage & Newborn Loss Support Group.  

Can You Prevent Postpartum Depression?

Though preventative exercises may help guard some people against experiencing PPD, there will still be some who will develop PPD, through no fault of their own, despite taking steps to prevent the development of PPD.  Listed below are some tips Kate Kripke has provided in the article “Can You Prevent Postpartum Depression?” on Postpartum Progress’s website, for those interested in trying to prevent this form of depression.

Take care of yourself through

proper nutrition

keeping hydrated

giving yourself down time every day

Practice good sleep hygiene

getting enough sleep

building a good sleep environment

creating a sleep schedule

Keep moving

Take time to build strong relationships with those around you

Become aware of your thoughts and feelings

Reduce stress through

meditation

mindfulness

deep breathing

Personal Accounts of PPD

While academic articles focusing on clinical descriptions of PPD offer valuable information on diagnosing this form of depression, there is no better way of learning what to look for than from those who have personally experienced PPD.  Below are a few links to blog entries, and interviews with people who have dealt with PPD.   

Lindsay Hunter  

“Post-Partum Regression”

Lebogang

“Black with Postnatal Depression: My Therapist Had Never Treated a Black Woman”

Elizabeth R.

“Same Sex Parents Get Postpartum Depression Too”

Addye

“Postpartum Depression: It Doesn’t Just ‘Happen’ to White Women”

Rebecca Hawkes

“The Day I Couldn’t Get Out of Bed: Post-Adoption Depression”

“Five for Friday: Five Things I Did to Get Through Post-Adoption Depression”

Partners

“Postpartum Depression: When Dads & Partners Don’t Seem To Get It”  

Postpartum Depression PSI FAQ

Hotlines/Chatlines:

Safe House Sexual Assault Help Line

734-995-5444

Suicide Hotline

1-800-273-8255

Suicide Chatline

Ozone House Crisis Line

734-662-2222

Military Vet Crisis and Family Crisis Line

1-800-273-8255 (1)

Active Military and Family Crisis Line

1-800-342-9647

Veterans Crisis Chat Service

Other Resources:

Safe House of Ann Arbor Sexual Assault Support Services

Lamaze support groups

Teens and Young Adults Classes

Postpartum Support International (PSI)

PSI Tools For New Moms

PSI Michigan resources

Cochrane Library Research on Postpartum Depression

References

"Baby Blues or Postpartum Depression?" Childbirth Connection: Information for Women on Pregnancy & Childbirth. Web. 24 Sept. 2014. <http://www.childbirthconnection.org/article.asp?ck=10528>.

Hawkes, Rebecca. "The Day I Couldn't Get Out of Bed: Post-Adoption Depression." Sea Glass & Other Fragments. 1 May 2012. Web. 29 Sept. 2014. <http://www.rebeccahawkes.com/2012/05/day-i-couldnt-get-out-of-bed-post.html>.

Hawkes, Rebecca. "Five for Friday: Five Things I Did to Get Through Post-Adoption Depression." Sea Glass & Other Fragments. 4 May 2012. Web. 29 Sept. 2014. <http://www.rebeccahawkes.com/2012/05/five-for-friday-five-things-i-did-to.html>.

"Postpartum Psychiatric Disorders." Massachusetts Gnereal Hospital Center for Women's Mental Health. Web. 24 Sept. 2014. <http://womensmentalhealth.org/specialty-clinics/postpartum-psychiatric-disorders/>.

"Postpartum Support International." Web. 24 Sept. 2014. <http://postpartum.net/Default.aspx>.

"PSI Michigan Resource Guide." PSI Michigan. Web. 24 Sept. 2014. <http://postpartum.net/Get-Help/Support-Resources-Map-Area-Coordinators/PSI-Locations-United-States/PSI-Michigan.aspx>.

Stone, Katherine. "Postpartum Psychosis Symptoms (in Plain Mama English)." Postpartum Progress. Web. 24 Sept. 2014. <http://www.postpartumprogress.com/the-symptoms-of-postpartum-psychosis-in-plain-mama-english>.

Morelli, Kathy. "Childhood Sexual Abuse as a Risk Factor for Postpartum Depression-- Part 2: The Educator's Role." Science & Sensibility: A Research Blog About Healthy Pregnancy, Birth & Beyond. 5 June 2014. Web. 24 Sept. 2014. <http://www.scienceandsensibility.org/?p=8374>.

Morelli, Kathy. "Childhood Sexual Abuse as a Risk Factor for Postpartum Depression – Part 1." Science & Sensibility: A Research Blog About Healthy Pregnancy, Birth & Beyond. 3 June 2014. Web. 24 Sept. 2014. <http://www.scienceandsensibility.org/?p=8370>.

Karraa, Walker. "Giving Birth after Battle: Increased Risk of Postpartum Depression for Women in Military." Science & Sensibility: A Research Blog About Healthy Pregnancy, Birth & Beyond. 11 Nov. 2013. Web. 24 Sept. 2014. <http://www.scienceandsensibility.org/?p=7555>.

Postpartum Depression-The Most Common Complication of Childbirth

Did you know that between 10 to 20% of all women experience perinatal mood and anxiety disorders, often referred to as "postpartum depression?" That's about 1 in 8 women, which is why postpartum depression is sometimes cited as being the most common complication of childbirth.

The general term "postpartum depression" is used to describe a range of disorders, including postpartum depression, postpartum anxiety, postpartum obsessive-compulsive disorder, postpartum post-traumatic stress disorder, and postpartum psychosis. The symptoms associated with these disorders are more serious than the "baby blues" experienced by up to 80% of mothers. Unlike the "baby blues," which often go away after the first month or so postpartum, these more serious symptoms can last for months if left untreated.

A woman with postpartum depression might experience feelings of sadness, anger, guilt, irritability, changes in eating and sleeping habits, and lack of interest in her baby. Those with postpartum anxiety often experience extreme worries and fears, often over the health and safety of their baby. Women with postpartum obsessive-compulsive disorder have repetitive unwanted thoughts or feel the need to do certain things over and over to reduce their anxiety. Postpartum PTSD is generally caused by a traumatic childbirth experience and often includes strong feelings of anxiety and flashbacks to the trauma. Postpartum psychosis is very rare, but extremely serious, and those experiencing it may have hallucinations or delusions that lead them to consider harming themselves or their baby. The symptoms associated with any of these disorders can appear anytime during the first year after giving birth.

Although postpartum depression and anxiety disorders are relatively common, many OB-GYN's don't discuss the symptoms or warning signs with their patients, so women experiencing the symptoms may feel isolated or alone. The good news is that there are effective and well-researched treatment options that help women to recover. Treatment may include increased self-care, social support, therapy, and sometimes medications.

The Lamaze Family Center Ann Arbor is proud to partner with the Postpartum Depression Support Group of the Greater Ann Arbor Area to offer a free support group for women experiencing symptoms of postpartum depression and anxiety. The group meets on the 1st and 3rd Mondays of each month from 10:30 am to noon at the Lamaze Family Center (2885 Boardwalk). Women, their partners, babies, and other supports are welcome.

If you or sometime you know are experiencing symptoms of postpartum depression or anxiety, know that support is out there. For more information about the Postpartum Depression Support Group of Greater Ann Arbor, you can call 734-418-2683.