Emotional Wellness During Pregnancy and Postpartum
When I work with postpartum individuals who are struggling, it often comes out that their symptoms of depression or anxiety really began during pregnancy. I relish the opportunity to connect with pregnant people proactively - particularly if there are known existing risk factors for perinatal mood disorders, like a previous history of postpartum depression, few social supports, and relationship stress.
In the postpartum year, babies and parents go through an astonishing array of changes. Parents experience hormonal shifts and physiological changes. Dreams for childbirth are not always realized. Expectations and the reality of early parenting often clash. For many, an intense and unexpected sense of isolation accompanies caring for a newborn.
It is not surprising then that somewhere between 50-80% of new parents that just gave birth experience the baby blues. Typically, these feelings of sadness, anxiety, and trouble sleeping are interspersed with more positive emotions, start soon after the birth, and resolve after a week or two.
For another group of new parents - between 10 and 20%, and closer to 30% for women of color - a more intense period of depression and/or anxiety develops. Periods of crying, anger, irritability, worry, troubling or scary thoughts, little appetite, and an inability to sleep even if the baby is sleeping can characterize postpartum depression and postpartum anxiety. These feelings last longer than a couple of weeks and can start anytime during the first year. An estimated 3-5% of new parents (though I suspect more) will have symptoms of Obsessive-Compulsive Disorder (OCD) like intrusive thoughts that are persistent and disturbing, compulsive behaviors such as checking things or cleaning, seeking reassurance from partners or google, fear of being left alone with the baby and hypervigilence. Parents with OCD recognize that the thoughts they are having are out of the ordinary and bizarre and have no desire to act on them.
Most of the research has been done on birthing cis women, but all parents are vulnerable to postpartum emotional complications. The latest findings suggest rates between 10-20% for non-birthing parents. Even less research has been done on transgender individuals undergoing pregnancy, birth, and lactation, but again, along with the existing known stressors of the childbearing year, transgender individuals often face ignorance, discrimination, and stigmatization which can increase risks for emotional complications.
Those who had a traumatic birth experience (including situations like an unplanned cesarean, a NICU stay for baby, experience of disrespect by medical staff, or triggering of a past abuse) can experience post-traumatic stress disorder (PTSD) symptoms of hypervigilence; inability to stop replaying the birth in their head or in conversation or avoidance of reminders of the birth experience; feeling numb or disconnected; flashbacks or nightmares; anxiety or panic attacks; trouble sleeping or irritability. And a traumatic birth is often triggering for the partner, who frequently has fewer outlets to process the experience.
A small percentage of women - 1 to 2 out of a 1000 deliveries, or 0.1% - will experience postpartum psychosis. This typically happens very soon after delivery and usually within the first 4 weeks. Symptoms can include hallucinations (visual or auditory); delusions - bizarre beliefs, often about the baby; a decreased need for sleep; paranoia or suspicion. The greatest risk factor for postpartum psychosis is a diagnosis or history of bipolar disorder or a history of psychosis. While this is a clinical emergency, postpartum psychosis is absolutely treatable and I've worked with women and families after an experience of postpartum psychosis to continue stabilization of symptoms, processing the experience, and recovery. If there is a concern about postpartum psychosis or risk of harm, contact 911 or go to an emergency room.
It is not surprising then that somewhere between 50-80% of new parents that just gave birth experience the baby blues. Typically, these feelings of sadness, anxiety, and trouble sleeping are interspersed with more positive emotions, start soon after the birth, and resolve after a week or two.
For another group of new parents - between 10 and 20%, and closer to 30% for women of color - a more intense period of depression and/or anxiety develops. Periods of crying, anger, irritability, worry, troubling or scary thoughts, little appetite, and an inability to sleep even if the baby is sleeping can characterize postpartum depression and postpartum anxiety. These feelings last longer than a couple of weeks and can start anytime during the first year. An estimated 3-5% of new parents (though I suspect more) will have symptoms of Obsessive-Compulsive Disorder (OCD) like intrusive thoughts that are persistent and disturbing, compulsive behaviors such as checking things or cleaning, seeking reassurance from partners or google, fear of being left alone with the baby and hypervigilence. Parents with OCD recognize that the thoughts they are having are out of the ordinary and bizarre and have no desire to act on them.
Most of the research has been done on birthing cis women, but all parents are vulnerable to postpartum emotional complications. The latest findings suggest rates between 10-20% for non-birthing parents. Even less research has been done on transgender individuals undergoing pregnancy, birth, and lactation, but again, along with the existing known stressors of the childbearing year, transgender individuals often face ignorance, discrimination, and stigmatization which can increase risks for emotional complications.
Those who had a traumatic birth experience (including situations like an unplanned cesarean, a NICU stay for baby, experience of disrespect by medical staff, or triggering of a past abuse) can experience post-traumatic stress disorder (PTSD) symptoms of hypervigilence; inability to stop replaying the birth in their head or in conversation or avoidance of reminders of the birth experience; feeling numb or disconnected; flashbacks or nightmares; anxiety or panic attacks; trouble sleeping or irritability. And a traumatic birth is often triggering for the partner, who frequently has fewer outlets to process the experience.
A small percentage of women - 1 to 2 out of a 1000 deliveries, or 0.1% - will experience postpartum psychosis. This typically happens very soon after delivery and usually within the first 4 weeks. Symptoms can include hallucinations (visual or auditory); delusions - bizarre beliefs, often about the baby; a decreased need for sleep; paranoia or suspicion. The greatest risk factor for postpartum psychosis is a diagnosis or history of bipolar disorder or a history of psychosis. While this is a clinical emergency, postpartum psychosis is absolutely treatable and I've worked with women and families after an experience of postpartum psychosis to continue stabilization of symptoms, processing the experience, and recovery. If there is a concern about postpartum psychosis or risk of harm, contact 911 or go to an emergency room.
The good news is that across the spectrum of perinatal mood and anxiety disorders, individuals who are able to get help feel better. And taking care of yourself means you will be better able to care for your family.
If you feel like you or a friend or family member is in need of support, you can find providers around the country through Postpartum Support International. In Seattle, please contact me. Even if I can't help you, I can usually help get you connected to an appropriate support or service.
PMH-C
You might be wondering what the letters PMH-C mean after my name; they represent my certification in Perinatal Mental Health. From the Postpartum Support International website: "In August 2018, the first Certification in Perinatal Mental Health became available through Postpartum Support International. The Perinatal Mental Health Certification Program creates a structure for professional education and evaluation, and a standardization of training and experience to inform families and payers of perinatal mental health specialists. The certification curriculum requirements build on existing evidence-based perinatal mental health certificate trainings, adding an advanced-training component."
(Sources: MGH's Center for Women's Mental Health, Postpartum Support International, the Seleni Institute, and Therapy and the Postpartum Woman by Karen Kleiman)