Having a baby is a milestone occasion in many women’s lives. It is a time of profound role transition and development of reordering of priorities. For many women, motherhood brings joy, a sense of wonder, and tremendous fulfillment. And, for at least 20% of all child-bearing women, motherhood can bring about significant perinatal mood/anxiety concerns.
What is a perinatal mood/anxiety disorder (PMAD)?
I would like to first underscore that in no way do I recommend labeling a woman as “disordered.” As a strengths-based therapist, I believe that empowering clients to work through challenges is essential to good therapy. However, for the purposes of educating clinicians/therapists on this intricate and specialized field, it is necessary to identify what is meant by a PMAD. Furthermore, this particular subspecialty of women’s reproductive mental health is highly “medicalized” in terminology, given the delicate hormonal physical influences on mood health. Therefore, at times, it is virtually impossible to address such a topic without using medicalized terminology. That being said, interventions for perinatal women require a strengths-based perspective, including generating supports for the client and helping her to grow in her confidence as a mother.
Specifically, a PMAD is a cluster of symptoms which can include anxiety and depression from the time of conception on through the first year postpartum (including during pregnancy). If you, as a clinician/therapist, are working with a female client who is exhibiting signs of depression, anxiety and/or mood challenges around the reproductive life event of pregnancy/childbirth, it is important for you to receive consultation on how to work with your perinatal client and/or refer her to a perinatal specialist. Please humor me as I describe that which is a medical reality: PMADs can be an intricate combination of symptoms, which when misdiagnosed, or improperly treated, can deter the client’s resolution of symptoms, and in some cases, cause harm. As a strengths-based therapist, I believe that empowering the female client to obtain support is vital to her recovery.
Where do you find a perinatal specialist?
Postpartum Support International (PSI) (www.postpartum.net) is the largest non-profit organization in the world dedicated to supporting perinatal women and their families. This website provides a list of volunteer co-coordinators that disseminate resources for many countries, each state in the U.S. (and in some cases, regions within states). Volunteers can inform you of providers in your client’s area, including perinatal psychotherapists, psychiatrists who specialize in women’s reproductive mental health (and can prescribe for pregnant/lactating women), lactation consultants, support groups, doulas (hired caregivers for baby/mother), and more. In addition, the website publishes recent articles in the field and hosts an online support group and chat forum for moms and dads. Downloadable fact-sheets are available in many languages. And a Spanish Warmline is also running and highlighted.
What causes PMADs?
As mentioned, at least 20% of all child-bearing women develop PMADs. These symptoms arise during the hormonal events of pregnancy and childbirth and affect the serotonin levels of the client, which in turn, impacts mood stability. A woman can develop at PMAD due to a variety of reasons, including but not limited to the following: prior personal or family history of depression/anxiety/mood disorder, sleep deprivation, traumatic birth experience, prior losses (perinatal or otherwise), and a host of situational stressors impacting mood. Postpartum Support International (PSI) posts the latest medical research developments in the perinatal field.
PMADs are not “baby blues.”
Baby blues occur in at least 80% of all childbearing women, where mild challenges of overwhelm, tearfulness, and generalized worry are present but resolve after a few weeks postpartum. Baby blues is not a disorder. It is generally considered a part of “normal” postpartum adjustment. If symptoms intensify or worsen beyond those first few weeks of “baby blues,” it is important for the woman to be assessed by a trained perinatal specialist for a potential emerging PMAD.
The good news.
PMADS are very treatable and temporary, as long as the client receives help. It is important for the client to receive help as soon as possible because her symptoms can elongate and intensify the longer she waits for treatment. Intervention typically includes a combination of psychotherapy with a specialist, possible medication evaluation if indicated, support group or other community supports referrals, and self-care strategies. Some self-care strategies can also include holistic/alternative interventions, including Omega-3 supplementation, exercise, light therapy, yoga, and stress reduction exercises.
If you suspect your client has a PMAD, go online to Postpartum Support International (www.postpartum.net), and look up the local volunteer co-coordinator that covers your client’s geographical area. She can then guide you to the nearest team of perinatal specialist(s) to help your client resolve her symptoms and move forward to a place of embracing and enjoying motherhood.
© Copyright 2010 by Andrea Schneider, LCSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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