A woman’s mental health during pregnancy and in the postpartum period is often referred to as perinatal mental health.
While you may have heard of postpartum depression or psychosis in the news or on television, perinatal mental health includes a spectrum of disorders that appear during pregnancy and in the days, weeks, and months after your a baby is born – up to a year after your child’s birth. When mood and anxiety issues appear in the perinatal period, they are like thieves – they can steal a mother’s joy, satisfaction, and ability to stay present in her role as mother and with her child(ren).
Here are two stories from women about what it feels like to face perinatal depression and anxiety.
Explore the perinatal mental health disorders below to learn more about what you may be experiencing. As you are reading, the important thing to know is that…
You are not alone. You are not to blame. With help, you will be well.
Perinatal Depression impacts 1 out of every 5 women and is the leading medical complication of the postpartum period.
Symptoms of depression can include: feeling down, depressed and hopeless most days in any two week period; loss of interest in activities you used to enjoy; difficulty concentrating/making decisions; changes in sleep; changes in appetite; irritability/anger; having negative thoughts about yourself (guilt/shame); frequent crying; and thoughts of harming yourself or your baby.
Effective treatment for perinatal depression includes therapy, medication management, or a combination of both.
Receiving treatment during pregnancy can reduce symptoms and help women avoid depression in the postpartum period.
Symptoms of general anxiety can include: a sense of fear or dread that something terrible is going to happen; feeling nervous, anxious and on edge; worrying too much about different things; not being able to relax; not being able to control or limit worry; feeling easily irritated/annoyed; hyper-vigilance; difficulty concentrating; nausea, heart palpitations, sweating, and fatigue.
Effective treatment for perinatal anxiety includes therapy, medication, or a combination of both.
Perinatal Panic Disorder
Symptoms of panic disorder include the sudden onset of intense fear and/or discomfort that reaches a peak within minutes. During the attack women will feel some combination of the following: pounding heart; sweating; trembling/shaking; sensations of shortness of breath, choking, chest pain/discomfort; nausea/abdominal discomfort; feeling dizzy/unsteady; sensations of chills, heat, numbness, or tingling; a sense of things not being real or being detached from oneself; fear of losing control or “going crazy,” and fear of dying.
Panic Attacks are terrifying events when you don’t know what’s happening to you. Therapy can help you identify panic attacks and learn to manage them. With repeated management of panic attacks, you will find they decrease in frequency and intensity over time and eventually go away for most people.
Perinatal Obsessive-Compulsive Disorder (OCD)
OCD involves the existence of obsessions, which increase anxiety, followed by compulsions, which a person engages in to try to decrease anxiety.
Obsessions include repeated, intrusive and unwanted thoughts, urges, or mental images that cause distress. Obsessions often have themes such as fear of contamination or dirt, needing things to be in order, aggressive or horrific thoughts of harming yourself or others, and unwanted thoughts centering on aggressive, sexual, or religious subjects.
Examples of obsessions can include fear of being contaminated, fear that you left the stove on or didn’t lock your doors, fear that you did something that will hurt someone else, fear that you will harm someone you love (like your baby), fear that you will lose control in public, fear that you will molest children, stress caused by things not being in order, tidy, or organized, or images of harming others (including your baby).
These thoughts and images cause distress which a person then tries to decrease by engaging in compulsions. Compulsions are repetitive behaviors you feel driven to perform and are meant to prevent or reduce anxiety or prevent something bad from happening. Engaging in compulsions only brings temporary relief and can interfere significantly in functioning.
Compulsions can include washing and cleaning, checking, counting, orderliness, following a strict routine, demanding reassurance. Examples include checking with someone to make sure you aren’t “crazy” and that you won’t hurt your baby, avoiding things that could harm someone (knives, water, ropes, etc.), checking doors to make sure they are locked, chanting/praying, arranging things, etc.
For severe postpartum OCD with thoughts of harming yourself or your baby, medication can be extremely helpful. Certain types of therapy, including exposure therapy, are also helpful for postpartum OCD. Postpartum OCD can be very distressing for mothers, especially if they have thoughts of harming their babies. The important thing to consider is that if these thoughts cause significant distress then it is most likely postpartum OCD and not psychosis. If you are suffering with postpartum OCD, please seek help so that you can find relief and start enjoying your life and your baby.
Postnatal Posttraumatic Stress Disorder
Symptoms typically include a traumatic pregnancy or childbirth experience that include feelings of intense fear, helplessness, or loss of control during the event followed by re-experiencing of the events (thoughts, dreams, body sensations), avoidance of things that remind you of the event (thoughts, people, places, details of the event, etc.) and persistent increased arousal (trouble sleeping, hyper vigilance, exaggerate startle response, etc.).
To find out more about this topic, please visit the birth trauma section of this website.
Perinatal Bipolar Disorder
Of women who experience postpartum depression, 22% are suffering from a bipolar depression.
There are several types of bipolar and related disorders, but they all share the symptoms of mania, hypomania, and depression that alternate in varied degrees of intensity and duration.
Mania is more severe than hypomania and causes more problems with functioning but both can include symptoms like: being abnormally upbeat, jumpy, or wired; increased goal directed activity, energy, or agitation; exaggerated sense of well-being and self-confidence; decreased need for sleep, unusually talkative; racing thoughts, distractability; poor decision-making (shopping sprees, sexual risk-taking, foolish investing, etc.)
Depressive episodes look much like the depression outlined in the Depression section above.
It is important to work with your physician to ensure you are medicated properly during and after pregnancy if you have pre-existing bipolar disorder that you have managed with medication. Call your doctor as soon as you find out you are pregnant and let them know what medications you take and ask how they will manage your medications during pregnancy. If your physician is not comfortable managing your medication, I can connect you with a specialist.
If you think you might have postpartum psychosis, go to your nearest emergency room. Tell them you recently had a baby and feel like you may be suffering from postpartum psychosis.
Postpartum psychosis is rare; occurring in approximately 1 to 2 of every 1,000 deliveries.
The onset is usually sudden, most within the first 4 weeks, with symptoms including: delusions (strange beliefs) and/or hallucinations, feeling very irritated, hyperactive, decreased need for sleep, and significant mood changes with poor decision-making.
There is a 5% suicide rate and 4% infanticide rate associated with Psychosis and thus immediate treatment is imperative.
If you experience any of the following, you may have postpartum psychosis or postpartum depression with psychotic features. This list is adapted from postpartumprogress.org.
Symptoms Mom May Experience:
• You have more energy than you’ve ever had in your life. This is like nothing you’ve ever experienced, and you just had a baby! You feel great. You may even feel like you don’t need sleep because there are things that must get done. Conversely, you are exhausted, have no energy, and wish you could sleep but your mind just refuses to shut down.
• You feel like suddenly you understand EVERYTHING, like your brain is functioning on a new and different level. You are able to make connections you’ve never noticed before between people, places, and things. Everything in your whole life makes sense to you now.
• You keep hearing and/or seeing things that no one else does or that you know are not there. You may have what seems like voices in your head that won’t stop no matter what you do. The voices comment about your actions or tell you appalling things, even that you may need to hurt someone or do something you would never do otherwise. Perhaps you feel the radio, television, nature, or God is speaking directly to you and you alone or giving you secret messages.
• You believe that you can’t trust people or have become suspicious of your family and friends—people you always trusted prior to this. You may even feel like your family, friends, healthcare providers, or the government are out to get you. You may feel they are trying to get rid of you or stop you from doing what needs to be done. You also may feel that people (family, friends, strangers or outside forces) are going to purposely or accidentally harm you or your child.
• You believe you are suddenly unique and special in some way, have some greater purpose, mission, powers, or have been possessed. However, you don’t want to talk about it to anyone because you know, for whatever reason, they won’t understand. Or you feel these same things are true of your baby.
• You cannot remember how to do things you knew how to do in the past—like how to make a batch of cookies, read a map, program your phone, or find the doctor’s office. You may also have trouble focusing, like reading or doing math or following a plot on TV.
• You feel like you are losing track of time. Or time seems either very sped up or extremely slowed down.
• You may be having strange sensations, for example feeling like things are crawling on you.
• You are getting into conflict with those around you. Although there may be real issues between you and others, the fact is that you are getting into way more conflicts with others than you ever used to.
• People who care about you think there is something wrong with you or say that you are angry, sad, acting strange and/or weird. In any case, they note that you are different from how you used to be.
• You may feel as if you are being controlled by some outside force. This force may be telling you to harm someone. Or you may have strange violent urges that have nothing to do with choice. These urges can best be understood if you think of how it feels when you experience the urge to urinate. One has little control over whether one wants to urinate or not, it is just a powerful urge one is compelled to tend to. These strange violent thoughts may present themselves as possible solutions to a myriad of problems.
• You don’t like what is happening to you and are frightened to death. You know that something is terribly wrong and you don’t understand it. You think you’ve gone “crazy.”
• You are afraid you will never get better. You may even believe that the only way to get out of this or to protect the ones you love is to commit suicide or abandon your family.
If you are feeling this way, it is critical that you get help for yourself and your baby. You may be afraid to tell anyone how you are feeling because you aren’t sure what will happen to you or your baby if you disclose your thoughts and feelings. You may need to spend a short time in the hospital while you get through the crisis. Your family can bring your baby to be with you. Having postpartum psychosis is like having a heart attack. You need medical intervention but you will get better with professional help. There are countless women who have had postpartum psychosis and recover 100%. It is important that when you are feeling like yourself, you let someone know what is going on and seek medical attention so you can get through postpartum psychosis and come out on the other side to be healthy for yourself and for your baby.
The key is getting urgent help for how you are feeling before you lose all insight into the fact that you are ill, which is what happens with this illness.
Get yourself (or anyone you suspect of suffering from this) to an emergency room immediately and be open about being homicidal, suicidal, hearing or seeing things, and describing any other concerns or symptoms you have.
If you suspect that you or someone you love has postpartum psychosis, you/she should be accompanied at all times until a professional diagnosis is received and you/she are under the 24/7 care of a healthcare provider.
It is important that in addition to seeking therapy, you let your physician and/or psychiatrist know how you are feeling and what is going on with you. You can download this New Mom Checklist to take with you to the hospital or to a doctor’s visit to make it easier to talk with your doctor about what’s going on. Fill out the form and give it to your physician to make the conversation easier.
Letting someone know how you are feeling can be difficult but it is important that you let your physician know how you are feeling and what is going on with you. You can download this New Mom Checklist to take with you to the hospital or to a doctor’s visit to make it easier to talk with your doctor about what’s going on. Fill out the form and give it to your physician to make the conversation easier.