Perinatal and Postpartum Mental Health

What is Perinatal and Postpartum Mental Health:

Perinatal mental health refers to the mental health during a woman’s pregnancy and the postpartum period. During pregnancy and after the birth of a child, mild changes to mood and anxiety can be experienced, with 15-20% of women experiencing significant symptoms. A combination of hormonal changes, life changes (i.e. sleep deprivation), relationship changes, societal pressures, and responsibility changes play a role in the impact on women during and after pregnancy. Women of every age, culture, race, and income level are at risk to develop perinatal mood and anxiety disorders. Symptoms can appear during pregnancy and/or in the first 12 months after childbirth. With informed care and support, the worsening of symptoms is not only treatable but mental health maintenance can be restored. There are several subtypes of perinatal mental health disorders including: Prenatal and postpartum depression; prenatal and postpartum anxiety; and prenatal and postpartum obsessive-compulsive disorder.

Prenatal and Postpartum Depression (PPD):

PPD is a mood disorder that develops during pregnancy or after the birth of a child where a woman develops feelings of intense sadness, hopelessness, and exhaustion. About 10% of women experience depression during pregnancy (a.k.a. antepartum or prenatal depression) and 15% experience depression after childbirth. Perinatal depression is the most common complication of childbirth.

PPD SYMPTOMS:

Crying and sadness
Appetite and sleep disturbance
Feelings of anger, irritability
Feelings of guilt, shame
Feelings of hopelessness
Loss of interest, joy, or pleasure in the things you used to enjoy
Lack of interest in the baby
Thoughts of harming the baby or yourself

Prenatal and Postpartum Anxiety (PPA):

PPA is a mental health disorder that is characterized by excessive worrying, racing thoughts, and feelings of dread. Sometimes the thoughts can be irrational in nature and/or impact everyday situations. About 6% of pregnant women experience significant anxiety and 10% of women experience PPA. Sometimes there is overlap with PPD.

PPA SYMPTOMS:

Excessive worry
Feeling that something bad will happen
Physical symptoms can include nausea, dizziness, hot flashes
Panic attacks- shortness of breath, chest pain, feeling of losing control, dizziness
Racing thoughts
Lack of concentration
Difficulty sitting still
Appetite and sleep disturbance

Prenatal and Postpartum Obsessive Compulsive Disorder (PPOCD):

PPOCD is characterized by unwanted, upsetting thoughts or mental images that repeat over and over (obsessions) and the need to do certain things sometimes repetitively to reduce the anxiety around the thoughts (compulsions). Postpartum women who experience these obsessions become filled with fear even though it is unlikely the thoughts will be performed. About 2-3% of pregnant and postpartum women experience OCD. Some women with OCD can care for their new baby, despite the discomfort of the symptoms. For other women, it can be very disabling and can have an impact on them and their families.

PPOCD SYMPTOMS:

Obsession Symptoms:

Excessive worrying about something you did or didn’t do – ex: worrying about not locking the doors, not sterilizing a baby bottle correctly, taking a medication that could harm the fetus
Intense fear about germs – ex: worrying that your baby will be harmed by contamination
Perfectionism – ex: trying to do everything “just right”
Thoughts (or images) of harming self or others- ex: accidentally or deliberately harming your baby, having sexual and violent intrusive thoughts

Compulsion Symptoms:

Checking – ex: repeatedly and excessively checking that your baby is breathing, checking that the oven is turned off
Reassurance seeking – ex: repeatedly and excessively asking other people that no harm or abuse has been committed
Avoidance – ex: avoid being alone with the baby for fear of harming the baby, avoid changing diapers for fear of sexually abusing a child, hiding sharp objects in the home
Correcting obsessional thoughts – ex: sanitizing your baby’s belongings excessively, counting or saying a special word to prevent bad things from happening

Other symptoms:

Feelings of anxiety, fear, guilt, disgust, and/or sadness

TREATMENT

Cognitive Behavioral Therapy (CBT) is an effective and well-researched treatment option to help women with PPD, PPA, and PPOCD. CBT gives an individual the skills to change their thinking and behaviors that play a role in depression, anxiety, and OCD. CBT not only uses assessment to learn more about the disorder and the individual herself, but also provides education to help understand and cope with the thoughts, feelings, and transition. With the support of a therapist, an individual will explore thought patterns and implement new behavioral practices. For example, Exposure and Response Prevention (ERP).

Prenatal and postpartum mood and anxiety disorders are treatable. If you may be suffering from one of these disorders, know that it is not your fault, and support is here for you. Working with a trained mental health professional can provide you with a safe, nonjudgmental space to talk about your feelings and set realistic goals to manage prenatal and postpartum mental health disorders.

For More Information:

2020mom.org
Postpartum Support International
PostpartumDepression.org
International OCD Foundation Resources Postpartum OCD Fact Sheet