Perinatal
The term perinatal refers to the period between the start of pregnancy up to the baby’s first year of life. This is a time where there are significant changes in every area of an individual’s life.
For some, the perinatal period can bring about distressing feelings, such as anxiety, depression, fear, guilt and shame, grief and loss, and uncertainty. Although many parents will experience a rollercoaster of emotions during the perinatal period, some individuals will be greatly impacted by significant mental health symptoms. Perinatal mood and anxiety disorders (PMADs) are considered one of the most commonly associated complications of pregnancy and childbirth.
Approximately 15-20% of women and 10% of men will experience significant perinatal mental health symptoms.
Perinatal Mood & Anxiety Disorders (PMADs)
Many people use the term “postpartum depression” to describe mental health concerns during the perinatal period, however there are other presentations to be aware of:
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Feelings of anger or irritability
Lack of interest in the baby
Appetite and sleep disturbance
Crying and sadness
Feelings of guilt, shame, or hopelessness
Loss of interest, joy, or pleasure in things you used to enjoy
Possible thoughts of harming the baby or yourself
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Constant worry
Feeling that something bad is going to happen
Racing thoughts
Disturbances of sleep and appetite
Inability to sit still
Physical symptoms like dizziness, hot flashes, and nausea
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Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images related to the baby. These thoughts are very upsetting and not something the individual has ever experienced before.
Compulsions, where the individual may do certain things repeatedly to reduce her fears and obsessions. This may include things like needing to clean constantly, check things many times, count or reorder things.
A sense of horror about the obsessions
Fear of being left alone with the infant
Hyper-vigilance in protecting the infant
Individuals with postpartum OCD know that their thoughts are bizarre and are very unlikely to ever act on them.
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Intrusive re-experiencing of a past traumatic event (which in this case may have been the childbirth itself)
Flashbacks or nightmares
Avoidance of stimuli associated with the event, including thoughts, feelings, people, places, and details of the event
Persistent increased arousal (irritability, difficulty sleeping, hyper-vigilance, exaggerated startle response)
Anxiety and panic attacks
Feeling a sense of unreality and detachment
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Bipolar I Mood Disorder
• Periods of severely depressed mood and irritability
• Mood much better than normal
• Rapid speech
• Little need for sleep
• Racing thoughts, trouble concentrating
• Continuous high energy
• Overconfidence
• Delusions (often grandiose, but including paranoid)
• Impulsiveness, poor judgment, distractibility
• Grandiose thoughts, inflated sense of self-importance
• In the most severe cases, delusions, and hallucinations
Bipolar II Mood Disorder• Periods of severe depression
• Periods when mood much better than normal
• Rapid speech
• Little need for sleep
• Racing thoughts, trouble concentrating
• Anxiety
• Irritability
• Continuous high energy
• Overconfidence
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Delusions or strange beliefs
Hallucinations (seeing or hearing things that aren’t there)
Feeling very irritated
Hyperactivity
Decreased need for or inability to sleep
Paranoia and suspiciousness
Rapid mood swings
Difficulty communicating at times
What causes perinatal mental health disorders?
There is no single factor that contributes to an individual developing a perinatal mood or anxiety disorder, and it is most definitely not something that is at the fault of the individual. Women, and men, undergo significant hormone changes during the perinatal period, which can contribute to fluctuations in mental health. In addition to the physical and lifestyle changes that occur, below are some risk factors for perinatal mood and anxiety disorders:
Inadequate partner/social support
Lack of adequate sleep
Interpersonal violence
Financial stress/poverty
Childcare stress
Recent loss and/or move
Barriers to care
Institutional racism
Complications during pregnancy, birth, and/or breastfeeding
Health issues with baby and/or parents
Temperament of baby
Returning to work
Unresolved grief
Family and/or personal history of PMADs, or other mental health concerns
History of sexual abuse
How are Perinatal Mood and Anxiety Disorders diagnosed?
Again, many individuals will experience mild to moderate fluctuations in their mood during the perinatal period due to the transition into parenthood, this does not mean they would necessarily meet criteria for being diagnosed with a PMAD.
For a formal diagnosis of a perinatal mood or anxiety disorder to be made, the symptoms will have become severe enough that it consumes of the individuals time and energy and begins to interfere with important activities that the person values. The diagnosis must be given by a qualified professional such as your family doctor, a psychologist, psychiatrist, or Nurse Practitioner.
Please note that a formal diagnosis is not required to begin therapy and recovery.
How is it treated?
Perinatal Mood and Anxiety Disorders are treated using evidence-based models such as Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT). CBT has various models that are specific to certain disorders such as Exposure and Response Prevention (ERP) therapy for OCD. Treatment may be completed through individual therapy, group therapy, peer support, or a combination of each. Lotus now offers Mindful Mamas Support group for new and soon to be moms.
Some individuals may benefit from medications to support their mental health symptoms. There are many medications for depression and anxiety that are safe to take while pregnant and breastfeeding. It is important to speak to a medical professional who understands mental health and the perinatal period to discuss a medication and dosage that is right for you.
