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Written by Jacie Farris
According to the Centers for Disease Control, one out of nine women experiences postpartum depression. Unlike the “baby blues,” which lasts only a few days or weeks, postpartum depression can last for several months or years after a mother gives birth.
Postpartum depression is a mood disorder, and like other mood disorders, it can be characterized by sadness, crying, extreme fatigue, guilt, disconnectedness, loss of interest in enjoyable activities and hopelessness. However, postpartum depression also has its own uniquely identifiable traits.
Sara Pollard is a psychiatric-mental health nurse practitioner and mental health consultant with the Nurse-Family Partnership and serves as the Indiana co-coordinator of Postpartum Support International, where she is also a national trainer.
Pollard said, “Most people are familiar with the term postpartum depression or ‘postpartum,’ but in reality, it’s not just postpartum and it’s not just depression. Symptoms of depression and other mental health conditions (anxiety, bipolar disorder, panic disorder, posttraumatic stress disorder [and] obsessive-compulsive disorder) can occur during pregnancy and anytime during the first year after delivery. Collectively, we call these conditions perinatal mood and anxiety disorders. Symptoms of each disorder vary, but can include constant worry; racing thoughts; difficulty concentrating; panic attacks; strange or unusual thoughts that are unwanted, repetitive and difficult to stop; and behaviors or compulsions to decrease the thoughts (checking, cleaning and counting).”
About 15 to 20 percent of women experience symptoms of a perinatal mood and anxiety disorder (PMAD), according to Pollard.
Birdie Gunyon Meyer, coordinator for Indiana University Health’s Perinatal Mood and Anxiety Disorders Program, said that “it’s hard for women and their families to recognize a PMAD because they think only of crying or that it means I want to kill my baby.”
The birth of a baby is typically a happy occasion, which brings some confusion to the origin of postpartum depression and other perinatal mood and anxiety disorders.
“We don’t really know what causes mental health conditions during or after pregnancy,” said Pollard. “Hormones certainly play a role, but all women have hormonal changes during this time; yet, all women do not develop symptoms of a perinatal mood and anxiety disorder. “
According to Pollard, PMAD risk factors can vary, but might include a history of depression, anxiety or any other mental health challenges; poor social support; diabetes or thyroid disorders; mood changes during a female’s monthly cycle or when taking hormonal forms of birth control; and complications during or after childbirth.
She noted that teenagers and women living in poverty have higher risks for developing a PMAD. Meyer added parents of multiples, military families and single mothers to that list.
Mothers experiencing symptoms of mental health challenges should seek the advice of medical professionals. They can also contact Postpartum Support International at 1-800-944-4773 or www.postpartum.net for information and support.
“Mental health conditions are not necessarily preventable, although there are practices which promote general well-being, including eating a healthy diet, exercising and having supportive people in your life,” said Pollard. “While we may not be able to prevent a perinatal mood and anxiety disorder from developing, we can certainly prevent crisis through screening, patient and family education and early connection to available resources.”
Pollard’s organization, the Nurse-Family Partnership, is an international, evidence-based community health program that pairs mothers who are pregnant with their first child with registered nurses “for ongoing home visits aimed at supporting mothers and families in providing the very best start for their children during the earliest, most developmentally critical years.”
As an additional resource, Meyer said that all IU Health hospitals in Indiana that have delivery units make sure to screen for perinatal depression and anxiety before the mother is discharged, and they also offer information to the mother and her partner regarding PMAD statistics and symptoms. Meyer’s particular program has evaluation and resource tools (such as mental health specialists, home visitors and medication), and offers two support groups each week.
Meyer noted that there are practical barriers to getting treatment, including costs; time commitments; loss of pay from work; limited access and poor transportation; unreliable childcare; social stigma; denial and fear; and provider and consumer ignorance. With these issues in mind, it is important that mothers have a support system that can help them receive the assistance they need.
For individuals wanting to support mothers and new families, Pollard advises patience as the parents take time to transition their lives to include a new baby. Both she and Meyer encourage family members and friends to offer help with simple tasks like cooking dinner, caring for pets, getting groceries, doing laundry, caring for other children, etc.
Ultimately, the mother needs hope.
Pollard said, “For the woman who is experiencing a perinatal mood and anxiety disorder, remind her she is not alone, she is not to blame, and with help, she will feel better! Ask what you can do to support her, and do those things. Many times family and friends offer to help but don’t necessarily do the things the mom views as helpful. Maybe she doesn’t want you to come over and hold the baby while she naps; maybe she needs a meal and would like her toilet cleaned. Ask her what she needs and do what she asks.”