This Isn’t What I Imagined: Perinatal Mood and Anxiety Disorders

In 2019, the CDC published a study showing the prevalence of depression and anxiety disorders in postpartum women. What it illustrates is that about 10% of women experience postpartum mood and anxiety disorder (PMADs). But being someone who serves women in this deeply tender and intimate time after birth, I know the true numbers are much higher. Something more like 20% to 30%.

When speaking about number like this, I have to sit back and let the information arrive in my body. I have to sit with how it feels, knowing that within these numbers are so many stories and lives impacted by mental health crises. In the U.S., 20% of women are not asked about any depression symptoms. And probably many more are not asked about anxiety, obsessive thinking, intrusive thoughts, mood swings, rage, and the host of other symptoms. This is a real epidemic. It is so common, societally we often slip onto passivity and numbness around it. But we must fight against that, because the postpartum women in our lives deserve to live unburdened by mood disorders. They need inclusive, trauma-informed care and solutions. And the first step to honoring that need is education.

What are PMADs and how do they show up?

Perinatal mood and anxiety disorders is the broad name we give for mental health issues that arise during the childbearing year. It includes mood disorders that crop up during pregnancy, too, but mostly focuses in on the time after birth. Depression and anxiety are the most common, followed by postpartum obsessive-compulsive disorder, bipolar disorder 1 and 2, and postpartum psychosis. This is not a complete list.

There are many factors that influence postpartum mental health. Risk factors for PMADs include:

• Systemic racism

• Poverty

• Sleep deprivation

• Lack of nutrition and hydration

• Hormonal shifts after birth

• Hormone sensitivities

• Thyroid disorders

• Birth trauma

• Stressful pregnancy

• Fussy baby

• PTSD

• Social isolation or unsupportive partner/family

And many more. Sometimes, there are little to no risk factors.

They can look different depending on each person and family, but generally signs to look out for are:

• Feeling down, hopeless, and dull most days

• Flat affect in voice paired with a lack of interest in things that normally bring joy

• Crying for what feels like an abnormal amount of time for you (weepiness in the first 2 weeks is very healthy and normal, so keep that in mind!)

• Intense rage and agitation that comes on quickly

• Having racing, anxious thoughts that keep you from being able to rest or sleep

• Panic that cannot be calmed by deep breathing and cold water

• Severe mood swings, oscillating between feeling depressed and having an almost superhuman amount of energy, not needing to sleep, and thoughts grandeur

• Thoughts of harming oneself, one’s family, or the baby

• Seeing or hearing things that are not there, and not being able to recognize that they aren’t real

It’s important to remember that even though PMADs are painful to deal with, they are a common part of the postpartum experience, to varying degrees. I’m not saying that to downplay their severity, but to remind people that they are not alone. There is nothing wrong with a mother who is depressed or experiencing rage. We must look at PMADs as we look at any physical ailment: an illness that needs to be treated, at both the root level and symptomatic level, and with a lot of well-informed support and care. Experiencing a PMAD does not make someone less whole, a bad parent, or “crazy”. People are people first; they have depression or anxiety, they aren’t their depression and anxiety. The added isolation and pressure of being a new parent creates tinder for a wildfire of mood disorders.

PMADs also inform us about the health of a mother, and truly the health of a society or culture. Past traumatic events will often create ripples in the postpartum time, so any shifts in the mood can be a guide to supporting a person with the deeper things that lie within. The systemic issues of racism, classism, homophobia, transphobia, sexism, and ableism, along with the immense amount of guilt and shame that gets heaped onto new parents, create the perfect storm for mental ailments. When supporting someone with PMADs, it is important to listen deeply and intuitively to what is coming up, as that can help guide to the root of the issue.

So, what can we do?

Even with all of that mentioned above, PMADs are 100% something one can recover from. Even in our society, support is there. The first step is reaching out. Getting help as soon as something seems off is crucial to getting the right support or treatment. The right treatment can be more rest, medication, therapy, or a combination of many supportive modalities. The first people you might reach to could be:

• Your midwife, OB, or primary care doctor

• Your child’s pediatrician

• A counselor or therapist, preferably one who specialized in perinatal mental health

• A perinatal psychiatrist

For emotional support, there is:

• Peer support, i.e., a warmline, new parents support group, or postpartum circle

• A postpartum doula

• Church, mosque, or other spiritual centers or groups

• Loving and trustworthy friends and family

For general wellbeing, there are:

• Acupuncturists and TCM practitioners

• Massage therapists

• Herbalists

• Nutritionists

• Somatic experiencing counselors

There are lots of things that are beneficial to do at home, too, in addition to outside help:

• Eating whole foods with lots of healthy fats and proteins

• Supplementing with fish oil, prenatal vitamins, and probiotics

• Daily walks and exercise

• Cathartic self expression through dance, sweating, singing, and shaking

• Time spent in nature, or at least around plants and trees

• A journaling practice

• Art and music

• Positive, loving touch with a trusted person, or self massage

• Herbs that help the body handle stress, such as rhodiola, ashwaghanda, shatavari, reishi, and tulsi. Always consult your provider before starting any herbs, especially if treating with medications

If there is an immediate threat to parent or child safety, or any symptoms of psychosis, it is important to seek emergency help immediately and call in your circle of support. The national crisis line is 1-800-273-8255.

After seeking help, the second step is taking a big deep breath. Reaching out for help is brave and not always easy. Give yourself a little hug or gentle massage, and remind yourself that you are whole, you will get better, and that you are perfect for your baby as you are. Have your partner or whomever you live with help remind you of your strengths as a parent, and leave reminders for you around the home.

The bottom line

I hear many parents who experience PMADs say that they feel guilt that they aren’t happy. That they aren’t glowing. That they don’t love every moment of caring for their baby. I acknowledge this and hold them in this. And if I feel its appropriate to say, remind them of the unhealthy image that gets put into many new parents minds; the image that this is supposed to be the happiest time in ones life, and that any bump in the road means something about your ability to parent.

When things don’t look as they had expected or hoped, that must be held as something very fragile and sacred. We put a lot in our expectations of what becoming a parent is, and the pain that comes with letting go of those expectations is huge. So instead of letting go right away, I help parents find ways to cradle and nurture what they feel they have lost, to honor it, until it is ready to be integrated. No bad parents, no wrong ways, no shame or guilt- just human beings working with big change in body, mind, and heart.

If you or a loved one is experiencing a mental health crisis, you are not alone. Even if it feels like you are alone and an echo chamber of those thoughts is created, it simply is not true. Even being barefoot outdoors or being in a forest proves that otherwise.

Every new parent deserves to be held in a gentle yet fierce love, honoring where they have been, where they are, and where they are going. They deserve true understanding and deep listening. They deserve all the love and celebration, even when things do not look or feel as planned.

Local resources

If you’re here in Whatcom county, here is a list of resources for perinatal mental health:

• Perinatal Support Washington: Warm line, provider directory, and other free resources, https://perinatalsupport.org/

• PAL for Moms: Perinatal psychiatry line, https://www.mcmh.uw.edu/ppcl

• Laurie Arndorfer, MD: Perinatal psychiatrist, https://seattlentc.com/our-team/laurie-arndorfer-md/

• The Village Circle support group: https://www.villagecirclebellingham.com/#:~:text=The%20Village%20Circle%20is%20made,trauma%2Dresponsive%20support%20group%20model.

• Mobile Mama Therapy: mental health counselors specializing in perinatal mental health, https://mobilemama.com/

• Whatcom County Suicide Prevention Hotline: (800)584-3578

• Maternity Support Services (MSS): (360)255-7855

• SeaMar WIC office: (360)788-7149

• Rebecca Schayes, ARNP: Trauma-informed well-women’s care, https://bnfm.com/about-us/

• Brigid Collins Family Support Center: Parental resilience classes, https://www.brigidcollins.org/parenting-education-whatcom

• I offer perinatal peer counseling and postpartum doula services. Please reach out to get connected with support, or for a more complete list of local resources.