A Letter to Therapists (But the General Public Should Listen in Too): Perinatal Mental Health is Everyone’s Business.
Even though only some clinicians seek out training, perinatal (the pregnancy through postpartum period)* mental health touches all of our work. Untreated perinatal mood and anxiety disorders (PMADS) negatively impact a new parent’s quality of life and increases risk for suicide. PMADS are linked to cognitive and behavioral issues in children, the same children with whom you sit eye to eye - talking, playing, and helping to process their often confusing worlds.
*At the time of this writing, there is no requirement for therapists to learn even rudimentary information about this life altering experience, a fact that a collective group is working to change in California.
PMADS intersect with eating disorders, substance abuse, grief and loss, domestic violence, and severe mental illness. Actually we’d be stretched to find a therapeutic area with which it doesn’t collide.
Perinatal mental health can be improved or hindered depending on the level of supportive relationships within couples, families, and communities. And since each of us has a different understanding of what it means to be a mother or father, perinatal mental health will be one of the biggest parts of our countertransference experience. Whether our relationship with mother or father is simple or complex, it is often rife with strong and complicated feelings, and thus therapists must be aware of their own internal and external responses.
In short, we all come from a family; therefore, this so-called niche is actually the deepest root from which all other mental health experiences will grow.
Since knowledge is power and protection, the more we collectively know the better. What follows are a few myths and truths that will improve our understanding and support of our moms and new parents as a whole..
- Myth: Postpartum depression is the only mental health issue that arises in the perinatal period.
+ Truth: Depression, anxiety, OCD, PTSD, and Psychosis are all perinatal mental health concerns.
The ‘M” in PMAD refers to mood disorders, namely unipolar and bipolar depression. 50% of women with bipolar mood disorder are first diagnosed in the postpartum period.
The ‘A’ refers to a spectrum of anxiety disorders, including generalized anxiety disorder, panic disorder, obsessive compulsive disorder, and post traumatic stress disorder.
Postpartum psychosis is very rare (1-2 in 1000) and must be treated as an emergency.
While defining these disorders is out of the scope of this article (as is naming and discussing all the many structural issues alive in the context of parenting in the USA that increase risk and reduce support) simply knowing there’s a spectrum can be a starting point for clinical considerations.
If you remember one thing only, it’s that each of these disorders is highly treatable. If you remember another, it’s that these may show up differently than in other populations you are seeing.
- Myth: Postpartum Depression is a normal part of the motherhood experience.
+ Truth: Postpartum Depression is a common (estimated at 15%) and (again) highly treatable disorder.
When talking about depression in pregnancy and postpartum, well meaning clinicians will often say that this experience is “normal,” presumably to help pregnant and postpartum people feel at ease.
Unfortunately, this can lead to parents keeping symptoms private and not getting the help they need. This is an especially problematic message in pregnancy as being depressed or anxious in this phase is predictive of being depressed postpartum so normalizing actually blocks a huge opportunity for prevention.
Overwhelm, ambivalence, fatigue, and transient crying spells are normal. About 80% of postpartum moms have the “baby blues” within the first couple weeks of having a baby, largely connected to sudden and intense hormonal changes.
A pervasive sense of sadness, guilt, irritability, and hopelessness, and even rage - which may show up anytime within the first year postpartum, and peaks around month three - may be signs of something more concerning and should be tended to with therapy and/or medication.
- Myth: You can tell by looking whether someone has postpartum depression or anxiety.
+ Truth: you can tell by screening, interviewing, and listening whether someone has a postpartum depression or anxiety.
We all know that stigma is a huge barrier to mental health treatment overall. But being depressed or anxious during pregnancy or postpartum feels especially taboo for many, thanks to messaging around how glowing, joyful, and happy moms and moms-to-be are supposed to feel.
New parents are often using energy they don’t have trying to hide their scary and painful internal experiences. Many who have a PMAD present as outwardly put together, with bright smiles, not a hair out of place.
All healthcare clinicians can overestimate their ability to informally assess how someone is doing. And since early detection of a PMAD can significantly reduce the severity and duration, we need to deliberately look for depression and anxiety symptoms.
There are accessible and reliable screening tools that can truly help pick up the hidden data. The Patient Health Questionnaire-9 (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) are two such tools, and both are free and available online.
So what do we do when we identify that a PMAD may be at play?
If you were to have one resource in your back pocket, I would highly recommend Postpartum Support International. You can learn more about all the PMADS on their website and you can find local perinatal trained providers by calling their area coordinators: https://www.postpartum.net/locations/california/.
You can also consult with practices like ours who specialize in this work to get an informed perspective on what might be happening and learn best practices to support your client. We received many self referrals from clients who sense their therapist is not truly understanding them, and while we love and adore every human who comes our way, we also see this as a missed opportunity to continue care with someone with whom they already trust. We too did not “get it” before we learned and learning can always start now.
Whether through direct service informed by additional education or by linking someone with the best resource, together we can weave a web of support for new parents to thrive.
With love and compassion,
Team SOURCE
If you are a Bay Area or California clinician looking for for a perinatal-focused practice to offer your clients, friends, and colleagues a safe landing, we have a team of trained clinicians ready to serve. If you are a clinician looking for clinical consultation so you can better support a particular or all your perinatal clients, practice owner Shana Averbach offers that service too.