Adriana Lozada shares facts about the prevalence of postpartum mood and anxiety disorders, or PMADs. She encourages us to acknowledge the combined mental health impact of postpartum experiences during the COVID-19 pandemic, plus she gives suggestions on the signs to look out for that can indicate a need for further support.
How has COVID-19 shaped your perinatal experience? How have you summoned your resilience? Share your insights with us on Instagram @birthfulpodcast.
Related Birthful episodes:
- Childbirth PTSD, with Cheryl Tatano Beck
- This that you are feeling? That’s grief (with a side of anxiety), with Parijat Deshpande
- Postpartum Depression, with Kathleen Kendall-Tackett
- “I keep it to myself”: A qualitative meta‐interpretive synthesis of experiences of postpartum depression among marginalised women, a study published in Health and Social Care in the Community
- Perinatal Mental Health, from the Maternal Health Task Force at the Harvard Chan School Center of Excellence in Maternal and Child Health
- Perinatal mental health series, published in The Lancet
- Screening for Perinatal Depression Committee Opinion, from the American College of Obstetricians and Gynecologists
- COVID-19 Perinatal Mental Health Resources, from the International Marcé Society for Perinatal Mental Health
- Support and Resources for Parents and Families, from The MGH Center for Women’s Mental Health Perinatal and Reproductive Psychiatry Program
- Pregnant and Worried about COVID-19? from Yale Medicine
- “Worried about negative thoughts as a new parent? You’re not alone” by Amy Brown
- “The Unrelenting Agony of Being a Depressed New Dad” by Joe Keohane
If you are pregnant during the pandemic, you can also help provide valuable information for research by participating in The Perinatal Experiences And COVID-19 Effects (PEACE) Study, being done in collaboration by researchers at Brigham and Women’s Hospital and Harvard Medical School. They hope to discover insights in the areas of mental health and wellbeing during these unprecedented times.
Let’s Tackle Postpartum Mood and Anxiety Disorders
Adriana Lozada: I’m Adriana Lozada and you’re listening to Birthful, and I’m here today just like I am every other week, on my own, taking about 10 minutes to talk to you one on one about a topic that I want to dive deeper into. This week, it’s perinatal mood and anxiety disorders and COVID. Now, when we think of mental health struggles during postpartum, we usually think only about postpartum depression, and it makes sense, because it’s super common. About one in seven moms and one in ten dads or partners get postpartum depression. And I’m using gendered language for parts of this episode, because that’s how the research was done.
And so, postpartum depression is so common that many people use just the word postpartum as shorthand for postpartum depression, but they’re not the same thing. Postpartum is just the postpartum period, and postpartum depression is a mental health disorder. So, it’s not the same thing and if you are using it as a shorthand, then I invite you to stop.
Now, instead of just postpartum depression, what we need to think about are perinatal mood and anxiety disorders, and you’ll see that as PMADS for short. That’s the acronym. So, we’re gonna talk about the broader spectrum, not just postpartum depression, and a second concept that I also want to bust is that these mental health struggles show up only after you’ve had the baby, because as the acronym I just shared suggests, these mental health disorders can show up at any time during the perinatal period. So, anywhere from pregnancy to postpartum.
So, what are some of the disorders included in this umbrella? Certainly, depression, which can happen during pregnancy or postpartum, but also anxiety, which is even more common than depression. And the stats for that are about 6% for pregnant women and 10% of postpartum women will develop anxiety at some point during this perinatal period. Then there’s also the postpartum obsessive compulsive disorder, which is another form of anxiety, and the estimate for that one is about 3% to 5% of new mothers and some new fathers will experience postpartum OCD. But OCD can also happen during pregnancy, so for example, according to Postpartum Support International, perinatal OCD tends to bring up repetitive, intrusive images and thoughts that are very frightening and can feel like they come out of the blue.
But these images are not delusional, and so they have a very low risk of being acted upon. Now, if what people are experiencing are hallucinations, or delusions, or paranoia, then that would fall into the category of postpartum psychosis, which is super rare, and it occurs about in one or two out of a thousand deliveries, and the onset of it is quite quick and sudden. Usually, within the first two weeks postpartum, which is not necessarily true of the disorders that show up during postpartum. Those can take several weeks and can last even years.
Now, other perinatal mood and anxiety disorders include bipolar mood disorders and postpartum post-traumatic stress disorder. The incidence of postpartum PTSD is about 9% and its causes tend to be the real or perceived trauma during delivery or postpartum. And I have a whole episode on postpartum PTSD that I will link in the show notes for this short.
Lozada: What I think that is really important here is to understand how common these perinatal mood and anxiety disorders are, and that it’s very important to take them seriously. So, the truth is we have a perinatal mental health crisis in our hands and while we are starting to talk more about them, we really need to get rid of the stigma and talk more openly about it, even more so because not doing so is causing a lot of harm. In fact, postpartum depression is the number one cause of maternal death within the first year after birth in the U.S. But we can change that, and we need to change that, and awareness has certainly been increasing both by the public and the healthcare providers with more and more of them including screenings for perinatal depression during their appointments.
And so, why am I doing this episode right now? It’s always really good to bring awareness and talk about the perinatal mood and anxiety disorders, but the reason for doing it right now is because we are in the midst of a potential mental health storm. On one hand, we have all the information that I just gave you, and on the other you have the upcoming holiday season which can be overwhelming and triggering for many, and when you add all the challenges and stressors brought on by the COVID pandemic, we really need to acknowledge what we are experiencing and be proactive.
So, how do we do that? How are we to be proactive? So, first of all, focus on what you can control and try to let go of what you can’t. Regarding COVID, you can control washing your hands. You can control wearing your mask. You can’t control what’s happening outside your home, so focus on what you can control. Focus on the people that come around you and setting up those boundaries. And then do have a grounding practice or habits that ground you in the present moment. We hear a lot about the power of the breath and certainly focusing on breathing can be helpful, but sometimes the levels of anxiety that we are experiencing and the constant stress, the sustained stress is such that our bodies can’t focus on the breathing. That’s too much. We feel like we have a tiger about to attack us. We’re not gonna stop to breathe.
So, a practice that I really like is one that helps you ground yourself without tuning internally, but sort of tuning out externally. So, this practice goes like this: You first focus on five things you can see, then four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. And so, you basically use all your senses to bring you into that calm and connection and grounding you in the present moment.
Lozada: Another thing you can do, be proactive, is to really lower the bar and do less. I am giving you permission to do less because right now the world is asking us to absorb and deal with a lot. So, do less, be more. And then also get back to the basics. Get sleep. Eat well. Hydrate. Take care of your basic necessities first. Then, after you’ve done that, regarding these perinatal mood and anxiety disorders, first know the signs and use the resources available for self-assessment and be open with your care providers about what you are experiencing. Collect content information for help lines, organizations, and recommended mental healthcare professionals that you can reach out for help if you need it.
There are a growing number of resources out there and just some of my favorites are Postpartum Support International and the International Marcé Society for Perinatal Mental Health. And both of them have created resource pages dedicated to COVID-19 perinatal mental health resources, including online support groups, help lines, provider directories, articles, and so much more. So, Google is your friend, or I will link in the show notes.
You can also do a Google search for the Edinburgh Postnatal Depression Scale, which allows for self-assessment, and it is very widely used. Now, this doesn’t mean that it’s a diagnosis tool, but it can shed light into how you’re feeling and help you determine if you need to reach out for help. And it’s also a great tool to take, once you fill it out, to take to your care provider to then share what you’ve been feeling, to start that conversation.
Now, I want to talk a little bit about intrusive thoughts, and the thing is people experiencing perinatal mood and anxiety disorders often say that they don’t feel like themselves, or their significant others may say, “I don’t recognize my partner.” That is a red flag that something serious might be going on, and it’s reach out for help. It’s a time to reach out for help.
The difficulty with perinatal mood and anxiety disorders is that some of the symptoms can also be things that are expected during pregnancy or postpartum. And a lot of new parents may have scary thoughts, where they feel that something bad is going to happen to the baby, and that alone, just having that thought, doesn’t mean that you have a disorder. Know that you’re not alone, but also that you can ask for help and have your feelings validated and have somebody who is more knowledgeable about the situation tell you if those intrusive thoughts are common and how to deal with them, or if they’re part of a bigger picture of symptomatology, pathology, and get you the help you need.
The truth is we could talk about this for hours. I could talk about this for hours. But hopefully this will give you the motivation to pay attention to your mental health and set things in place, so you can have more enjoyable pregnancy and postpartum experiences. Also, I’d like to repeat that dads or partners can also experience perinatal mood and anxiety disorders, so partners, if you’re listening, make sure you address your mental health, as well. And finally, if you’re pregnant you can also help provide valuable information for research by participating in the perinatal experiences and COVID-19 effects study being done by researchers at Harvard Medical School, and the link for that is pstudy2020.com with P standing for perinatal experiences and COVID-19 effects.
Heads up that there won’t be any new Birthful episodes for the last two weeks of 2020. Instead, we will be airing more of our Best of Birthful episodes, which are great lessons and a fabulous way to catch up on previous episodes. I hope that you have a nurturing and nourishing holiday season, whatever that looks like this year, and that 2021 takes all the stress and anxiety of 2020 and swaps it for tons of pleasure and joy.
You can connect with Birthful on Instagram @BirthfulPodcast, and to learn more about Birthful and my birth and postpartum preparation classes, go to Birthful.com. A new birth series is starting in January.
Lozada: Birthful was created by me, Adriana Lozada, and is a production of Lantigua Williams & Co. The show’s senior producer is Paulina Velasco. Virginia Lora is the managing producer. Cedric Wilson is our lead producer. Kojin Tashiro mixed this episode. Alie Kilts contributed to this episode.
Lozada, Adriana, host. “Let’s Tackle Postpartum Mood and Anxiety Disorders.” Birthful, Lantigua Williams & Co., December 8, 2020. Birthful.com.
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