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Perinatal Mood and Anxiety Disorders (PMADs)

The often surprising realities of new motherhood.

Everywhere we look we can find images of perfectly glowing, immaculately groomed women with their babies peacefully sleeping in their arms. That idyllic representation of motherhood, while extremely prevalent, is far from the reality that most new mothers actually experience when an addition to the household finally arrives.

In fact, if depression or anxiety is going to surface over the course of a woman's life, it most often occurs at this time. Estimates are that up to 20 percent of women, and perhaps even more, suffer from Perinatal Mood and Anxiety Disorders (PMADs), which can occur anytime during pregnancy and/or the postpartum period. Many women struggle with significant emotional challenges during their pregnancies, months before their babies arrive, and often have unspoken fears of what will happen after the baby is born.

Perinatal Mood Disorders - Chrysalis Counseling Center

New mothers are frequently excessively sleep deprived, overwhelmed by all of the change taking place, and may even be frustrated by trying to balance the endless needs of a new baby with other preexisting obligations. Having a baby is a major life transition and requires a lot of flexibility and significant adjustments, and this remains true whether it is your first baby, or if you are adding additional children to your family. For the new mother it can often feel as if nothing is being accomplished all day long. Another pile of laundry, stack of dirty dishes, or diaper change just lines up to take the place of what you just took care of. There is no end in sight. And there are no breaks; you are on duty, quite literally, around the clock.

Even though it may not feel like it at this moment, you are likely doing many more things right than you feel you are doing, or that are going, wrong. Give yourself a moment to pause, and acknowledge all that you are doing for your family. Reflect on the knowledge that you are not alone in this tumultuous journey into motherhood. And know, while not often openly discussed, there are plenty of others out there that can relate to what you are experiencing, and can empathize with your concerns and struggles.

Is it the "baby blues," or could it be something more than that?

It is common for around 80 percent of new mothers to experience a phenomenon commonly referred to as the "baby blues," which is considered to be a normal part of postpartum adjustment, and requires no medical or psychological intervention. These "blues" often include frequent, prolonged bouts of crying, irritability, anxiety, difficulties with sleep, rapid mood changes, and a sense of being overwhelmed. The "baby blues" usually occur within the first three days after a woman gives birth, and with proper rest, nutrition, and support, they typically go away on their own in less than two weeks. However, for about 20 percent of new mothers, these feelings do not resolve on their own, and last for longer than two weeks. If your symptoms continue on like this, it is likely that you are experiencing Postpartum Depression or another Postpartum Mood or Anxiety Disorder (PMAD). Seeking support as soon as possible is extremely important in order to make a quicker recovery.

Postpartum Depression is the most common complication following childbirth, and is characterized by frequent crying, mood swings, anxiety, anger or irritability, difficulty concentrating, sleep problems, extreme fatigue, appetite changes, scary thoughts, feelings of being overwhelmed, inadequacy, hopelessness, and/or despair. These feelings are present for a large portion of each day, and interfere with a mother's ability to function in daily activities or in relationships with others as she typically would. In addition, feelings of anger, shame, and guilt are often present, and frequently keep new mothers from speaking up about what they are going through. These symptoms can appear anytime during the first year after the birth of your baby. If you have a personal history with Depression or other Mood Disorders, a family history of Postpartum Depression, or have been experiencing a lot of recent stressors in your life, you are at higher risk of developing a Postpartum Mood Disorder.

Perinatal Mood Disorders - Chrysalis Counseling Center

Perhaps what you are feeling is different from being depressed, but you don't feel like yourself anymore.

Both pregnant and postpartum women can experience symptoms and feelings that cannot be classified as Depression. These include Anxiety Disorders, Obsessive-Compulsive Disorder (OCD), which often involves intrusive thoughts about some type of harm coming to the baby, and Posttraumatic Stress Disorder (PSTD). The latter may be seen if a mother experienced a challenging or frightening birth experience. It's important to note, however, that the statistics we have on rates of occurrence of these various conditions are probably lower than truly experienced in the general population, because common, but unnecessary, guilt and shame keep many women from telling anyone how they are really feeling.

Are you occupied by thoughts of a difficult or frightening labor?

Postpartum Posttraumatic Stress Disorder (PTSD) following childbirth is more common than most people realize. It can be triggered by real or perceived traumatic events during delivery or shortly afterwards, and estimates are that it effects up to 6 percent of new mothers. The traumatic experience often leaves a woman feeling that either her life or the life of her baby was at risk, and can have a huge impact on how she feels emotionally in the weeks or months after the birth, and how she relates to her family and others.

Symptoms of Postpartum PTSD might include intrusive thoughts, images, or dreams about the events during labor, such as medical procedures, pain, and expectations of harm or even death happening to either herself or the baby. It may cause her to want to avoid places or things associated with the negative experience. She might have persistent increased physical hyperarousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response), anxiety and panic attacks, and feelings of detachment from herself or others. It can also leave the one experiencing it feeling hopeless and in despair.

Women who have experienced a previous trauma, such as sexual assault, or any other trauma that compromised their safety, are also at a higher risk for experiencing Postpartum PTSD. If a woman plans to get pregnant again, it is important to spend time processing what happened in the last labor before the birth of the next child.

Are you experiencing emotional struggles during your pregnancy?

It was once thought that maternal depression only occurred in the postpartum period, after the birth of the baby, and so for many years treatment focused almost exclusively on Postpartum Mood Disorders. We now know that many women experience emotional difficulties during pregnancy as well. Contrary to popular belief, pregnancy is not protective; that is, it does not insulate a woman from getting depressed or anxious. Approximately 15 percent of pregnant women experience Depression during pregnancy, and many also suffer from excessive worry and rumination (repetitive, often distressing thoughts), feel stressed and overwhelmed, and have significant changes in appetite, sleep, and concentration.

With help from trained professionals, PMADs are very treatable.

If you are pregnant and dealing with worry, sadness, hopelessness, or any of the other symptoms mentioned above, you should know that these are common experiences for expectant mothers, and that these things are all very treatable. Many women experience Perinatal Mood and Anxiety Disorders during or after one or more of their pregnancies. PMADs are in no way your fault. You are not to blame, and with help, you can feel better.

Perinatal Mood Disorders - Chrysalis Counseling Center

However, it is important that you recognize these symptoms and seek help. Research shows that PMADs can have a major impact on the relationship between you and your baby, who is finely attuned to your emotions. Seeking treatment before the baby arrives can reduce the chances of developing Postpartum Depression, or can lessen the length and severity of symptoms if they occur.

Women can, and do, respond well to treatment protocol. Help is available; you do not need to continue to feel this way. But it is extremely important to attend to these conditions as soon as possible, because without proper intervention, the symptoms may become chronic. Twenty five percent of mothers with untreated Postpartum Depression remain depressed after one year.

If left unaddressed, there is an increased risk for the woman to not only develop chronic Depression or relapse, but an increased risk of a woman's child(ren) developing emotional or behavioral disturbances themselves, and there is a negative impact on the marriage and on all family relationships. It is important to seek treatment for your own sake, but also for the wellbeing of your entire family.

You may still have some hesitation about reaching out in order to get the help you need.

You may already feel like you don't have enough hours in the day to take care of your baby and your family, let alone yourself. Even though you are extremely busy, overwhelmed, and tired right now, it's very important that you make time for yourself and your own wellness, so you can be in a good place emotionally to care for your baby and other family members. Specialized therapy for Perinatal Mood and Anxiety Disorders will offer you the support you need to get through this major life transition in a healthy and productive way.

The treatment of PMADs is a specialty, so make sure you get in touch with a therapist who is well trained in and experienced with this particular branch of psychology. A qualified therapist should be able to help you craft an individualized, practical, holistic plan for wellness that includes sleep, nutrition, and emotional, psychological, and physical support, so you can feel like yourself again. New mothers are often concerned about taking medications. There are natural treatments for PMADs that are often quite effective, so medication may or may not be a necessary component of treatment. It depends on the individual woman and what she needs at the current time.

You might acknowledge that getting help is important, but are already concerned about the financial strain that having a baby has put on your family.

Making therapy a priority is very important. When you're in a good place mentally, emotionally, and physically, everyone in the family benefits, and long-term personal, relational, career, and financial goals are more attainable. Numerous studies support the importance of taking care of yourself and getting proper help during this critical life transition. Addressing these issues now will improve your ability to perform in your role as mother and partner more productively, positively, and effectively in the future, as well as in the present moment.

How support people, such as spouses or partners, and important others, can help a woman recovering from PMADs.

  • Let her know that this will not last forever. She will get better.
  • Remind her, and yourself, that the Postpartum Mood and/or Anxiety Disorder is not her fault, and she did not cause this condition.
  • Help provide healthy, nourishing meals.
  • Assist with household chores and baby care. Hire help if necessary and financially feasible.
  • Consider hiring a postpartum doula.
  • Take shifts with feeding the baby, if the baby can take a bottle, and allow the new mother to sleep, take a walk, or do something relaxing for herself that does not involve the baby.
  • Give her ample self-care time to read, write, meditate, exercise, do yoga, get a massage, or engage in other rejuvenating, health-promoting activities.
  • Remind her that you love her and that you will not leave her because she is going through a hard time right now. Women with PMADs often feel extreme levels of guilt and shame, and are terrified of being judged or abandoned.
  • Encourage her to enter treatment immediately. Recovery from PMADs will be resolved more quickly the sooner treatment is initiated. Make certain she seeks professional help from a qualified therapist who is specifically trained in working with PMADs.
  • Remind her that recovery is a journey; she will have good days and challenging days as she heals. But ultimately, she will experience more stable moods, and in many cases, will start to feel better that ever before.
  • Do not put a time limit on recovery. For each woman, the length of time for full remission from PMADs varies. The sooner the treatment is initiated, the sooner she will recover.

If you are experiencing any of the above symptoms after the birth of your baby, or if you are concerned about the way you are feeling, please seek the advice of your healthcare provider and reach out for help as soon as possible. You are not alone. You can recover. And the sooner you reach out for help, the sooner that recovery will begin.

Perinatal Mood Disorders - Chrysalis Counseling Center
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Chrysalis Counseling Services PLLC | Juliana K. Tyler, MA, LMHC | Licensed Mental Health Counselor
Certified HypnoBirthing® Childbirth Educator and Fertility Educator
PO Box 1604, Mukilteo, WA 98275 | 206.604.0996 | juliana@chrysalis-counseling.com