FIVE EMPOWERING FACTS TO KNOW BEFORE ASSEMBLING YOUR BIRTH TEAM
It is definitely not the responsibility of a pregnant woman or a new mom to educate her healthcare team about Perinatal Mood and Anxiety Disorders (PMADs ). But the reality is that knowing the facts about maternal mental health empowers you and your loved ones to work with healthcare providers who can screen, diagnose and treat PMADs with deserved urgency. The recent experience of Jessica Porten, a new mom who asked for help and had the police called because her healthcare providers did not understand maternal mental health, resonates with many women across the country. Jessica’s story adds to a national narrative in which women are not being effectively screened or treated for perinatal disorders due to a lack of awareness and stigma.
Thanks to amazing organizations like Postpartum International, 2020Mom, among others, a maternal mental health revolution is in the works. The five facts below will help you and your loved ones understand maternal mental health, identify risk and protective factors, and formulate questions for your potential healthcare providers. Build your team—a team able to offer you the comprehensive and dignified care you deserve.
1. Perinatal Mood and Anxiety Disorders (PMADs)
For many women and their loved ones, the perinatal period—the time between pregnancy and the first year after birth—presents many moments of vulnerability. PMADs is a term used to describe varied disorders during the perinatal period. Although diagnosis depends on skilled professionals, it is important for you to know that PMADs are pervasive. In other words, symptoms such as sadness, anxiety, intrusive thoughts, insomnia, irritability or rage (among others) may impact different parts of your life (home, work, social) causing functional impairment. What does that mean? Basically, you can’t just “snap out of it,” or go about life the way you used to. The onset of PMADs can occur anytime from birth to the child’s first birthday and will not go away without treatment. You are your best advocate and if you are not feeling okay, even a little bit, it is important to reach out for help. Some questions that can help you start a conversation about PMADs with your healthcare providers are below:
• Will you tell me about your experience in treating PMADs?
• What resources do you have available for maternal mental health?
2. Mental Health Disorders are the MOST COMMON complication of childbirth!
(Spurlock & Burkhard, 2017).
Yes, you read that correctly, the MOST COMMON complication, but wait there is more! Both women and men are at highest risk for depression during the first year after their child’s birth (Dave, Petersen, Sherr & Nazareth, 2010). It boggles my mind how this is not common knowledge, but I think fear of stigma keeps many of us silent about our emotional struggles. Up to 20% of women experience post-partum depression (Gavin, Gaynes, Lohr, Meltzer-Brody, Gartlehner, & Swinson, 2005) and 10% of men experience paternal depression (Paulson & Bazemore, 2010). When moms are depressed, dads are at greater risk for depression (Goodman, 2004) and untreated maternal or paternal depression can have lasting impact on child development (Fisher, Brock, O’Hara, Kopelman, & Stuart, (2015).
The above facts are important because they normalize a scary, and confusing experience. Partners should accompany you to as many perinatal and postpartum visits as possible while also participating in any prescribed mental health treatment. One study found that the women whose partners attended select therapy sessions addressing baby care, housework and related tasks demonstrated a greater appreciation for partners and a significant decrease in depressive symptoms in comparison to women who attended all sessions alone ( Misri, Xanthoula, Fox, & Kostaras, 2000). PMADs are not a mom issue. The entire family needs support!
My guess is that the numbers of women and families struggling are higher than those reported above since many women are not identified through what could be simple screening procedures. Some women may be too scared to come forward and ask for help. PMADs thrive in isolation and gain momentum in shame. I hope that knowing these numbers empower you to have discussions about mental health, not only with your healthcare providers, but loved ones as well.
3. Get Screened.
The American Congress of Obstetrics and Gynecologists (ACOG) recommends that women be screened for depression and anxiety at least once during their perinatal visits. Screening tools, like simple checklists or paper-and-pencil surveys, are an effective way to have honest conversations with healthcare providers. In the same way your healthcare team checks your blood pressure during perinatal visits, they should also be screening your mental health. When assembling your healthcare team ask about mental health screening and whether or not they employ screening tools. If they do not or are not sure what you are talking about, this is a red flag. Your team should be knowledgeable of standardized screening tools and should routinely administer them.
4. Are you at RISK?
Research has identified risk factors which may leave you more vulnerable for experiencing PMADs. Risk factors will not cause PMADs, and not everyone responds to risk factors in the same way. If any risk factors apply to you, then you will benefit from extra support, and what I call a mental health plan. Name it something else, like mommy care plan, if you want, but definitely incorporate it into your birth plan if any of the experiences in the table below apply to you. The mental health plan should have names and numbers of accessible mental health professionals, psychiatry, therapy groups, online groups, and websites for resources as well as people identified as support (more about this below). You may end up not using this plan, or it may become incredibly helpful as you try to navigate your pregnancy or post-partum months. Your team should be able to provide you with linkage and resources. If you ask for linkage and resources, and they are not open to this discussion, or they are unable to help you find resources, then again, this may not be the healthcare provider for you. The below research-based table of risk factors is taken from the following source: A Report from the California Task Force on the Status of Maternal Mental Health Care, April 2017.
RISK FACTORS FOR PRENATAL DEPRESSION
Lack of social support/isolation (family and friends to share experiences with; practical support with life’s challenges)
Prior birth loss
Low socioeconomic status
History of domestic violence (either as victim or perpetrator)
Younger age (e.g., teen pregnancy)
Older age (e.g., over age 40)
History of premenstrual syndrome (PMS)
Body dissatisfaction in third trimester
Untreated thyroid disorders
Single relationship status and/or
poor relationship quality
Poor health status and chronic conditions prior to pregnancy, particularly for women of color
RISK FACTORS FOR POSTPARTUM DEPRESSION
The same factors that place a woman at higher risk for prenatal depression also place her at risk for postpartum depression, as do these additional factors specific to the postpartum period or identified in research specific to the postpartum period:
Depression or anxiety during pregnancy
Stressful life events
Perfectionism/fear of making a mistake
Traumatic birth experience
Preterm birth/infant admission to neonatal intensive care unit (NICU)
Infants with colic/significant fuss patterns and sleep deprivation
Living in a city/increased isolation
5. Protection through Connection
So much can be said about the benefits of social support! Here are a few studies that highlight the importance of having a village of connection, particularly during the perinatal period. Women report fewer symptoms of post-partum depression when they perceive that they have access to support (Haga et al., 2012). One study found that women who received high quality support (defined by authors as support from baby’s father, healthcare providers and satisfaction with received support) experienced less postpartum depression. Particularly of interest is that social support buffered against risk for depression when women experienced several stressful life experiences such as someone close dying, moving or immigration issues (Collins, Dunkel-Schetter, Marci & Scrimshaw, 1993). We are meant to raise children in community, but modern culture has modified the term of mothering to mean one person as opposed to a village of caretakers.
A support network does require some proactive work, but the benefits of creating this network of help can have long lasting benefits for your entire family. Again, as part of your birth plan, which now we know should include a mental health plan, specific people/groups should be identified as support sources. It sounds like a lot of work, but so many women prepare for birth by learning everything they can about pregnancy and baby care without paying much attention to their own needs. Yes, let’s get very specific and break it down, because you will benefit from help.
Emotional Support – Safe and trustworthy people who you can share your real self with. People you can cry or be a mess in front of and talk about whatever you want, e.g., partners, family members, friends, therapists, mommy support groups, midwives, doulas, caretakers, etc.
Informational Support – People who can give you advice or guidance on mommy- or baby- related issues, such as how to change diapers, when to swaddle, how to work a breast pump, where to buy formula, etc. Obtain informational support from partners, family members, friends, midwives, doulas, lactation consultants, mommy and me classes, etc.
Instrumental Support – People who can offer you assistance with tasks such as partners, family members, or doula who can take care of baby early on post-partum, or cook meals for you, help you shower, provide babysitting, etc.
Again, it is definitely not the responsibility of a pregnant woman or a new mom to educate her healthcare team. But, the above information will help you assemble a team that can appropriately address your mental health needs. Until the system changes, you and your loved ones are your best advocates. Get your mental health needs met, Mama!
A Report from the California Task Force on the Status of Maternal Mental Health Care (April 2017). Retrieved from, https://www.2020mom.org/ca-task-force-recommendations
Collins, N.L., Dunkel-Schetter, C., Marci, L., & Scrimshaw, S.C.M. (1993). Social support in pregnancy: psychosocial correlates of birth outcomes. Journal of Personality and Social Psychology, 65(6), 1243-1258.
Dave, S., Petersen, I., Sherr, L., & Nazareth, I. (2010). Incidence of maternal and paternal depression in primary care. A cohort study using a primary care database. Archives of Pediatric Adolescence Medicine, 164 (11), 1038-1044.
Fisher, S.D., Brock, R.L., O’Hara, M.W., Kopelman, R., & Stuart, S. (2015). Couple and family psychology: Research and practice. Couple and Family Psychology: Research and Practice, Vol. 4, No. 2, 61–73.
Gavin N.I., Gaynes, B.N., Lohr, K.N., Meltzer-Brody, S., Gartlehner, G., Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics Gynecology, 106(5, Pt 1), 1071-1083.
Goodman, J. H. (2004). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Journal of Advanced Nursing, 45(1), 26-35.
Haga, S.M., Ulleberg, P., Slinning, K., Kraft, P., Thorbjørn S.B., & Staff, A. (2012). A longitudinal study of postpartum depressive symptoms: Multilevel growth curve analyses of emotion regulation strategies, breastfeeding self-efficacy, and social support. Archives of Women’s Mental Health, 15, 175–184.
Misri, S., Xanthoula, K., Fox, D., & Kostaras, D. (2000). The impact of partner support in the treatment of postpartum depression. Canada Journal of Psychiatry, 45, 554-55.
Paulson, J.F., & Bazemore, S.D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression. A meta-analysis. Journal of the American Medical Association, 303(19), 1961-1969.
Spurlock, B., & Burkhard, J. (2017). Delivering moms from the most common childbirth complications: Depression and anxiety. California Health Care Foundation Blog. Retrieved from, https://www.chcf.org/blog/delivering-moms-from-the-most-common-childbirth-complications-depression-and-anxiety/#.WoSZYoTPrck.