A Maternal Mental Health Moment

by Sara E. Crow, MEd, LCMHC, NCC

Hi everyone! I’m Sara Crow and I am a therapist with Three Oaks Behavioral Health & Wellness. One of my specialty areas of focus is maternal mental health which includes pregnancy and postpartum support. I’m going to share a bit of information about mental health related challenges that can happen sometimes after birth and even during pregnancy. These are just snippets to give you a taste of what this time can be like, so please reach out for more information. Let’s get started!

It’s safe to say that everyone goes through an adjustment process during this time- that’s to be expected. Things that normally feel easy may not, you may question things you never have before, or feel like you aren’t sure what’s happening. You may have expectations that aren’t met, assumptions that don’t happen, and the shift of entering parenthood. That’s ok! And very normal. I mean, you just had a baby! Also, babies aren’t born with instruction manuals, so you may feel a bit in the dark on what to do. I’m going to explain more about Perinatal Mood and Anxiety Disorders to give you an idea of what to look for in case you want additional support. These disorders are the number one complication of pregnancy & aren’t much talked about.

Overall, you’re looking for signs of things that get in the way of daily functioning. In the first two weeks after birth, 60-80% of new mothers experience what are called “Baby Blues.” This is due to hormone changes and acute sleep deprivation, and usually lasts up to 2 weeks. It is unique in that it’s not related to any other mental health condition. During this time, reach out to your OB for support if anything medical comes up or feels weird. Also, reach out to your counselor for support if you have one established.

If symptoms continue after two weeks, we look for other signs like depression, panic, bipolar, anxiety, obsessive compulsive behaviors, trauma, and psychosis. The term “postpartum” can actually refer to all of these, and has different abbreviations (PPD for depression, for example). Also, symptoms can begin during pregnancy and not just after having your baby. Here are some signs/red flags to look for:

Depression (PPD): having more bad days than good, not wanting to do anything, change in appetite and sleep, not processing information well, wondering about not wanting to live like this, feeling worthless or guilty, loss of joy, thoughts of suicide, lack of energy. These signs may look like not connecting to your baby, feeling overwhelmed, not coping well, not caring for yourself, isolation, irritability, and physical symptoms like body aches & pain.

Anxiety (PPA): excessive worry, repeating thoughts, irritability, feeling restless, edginess, trouble concentrating, trouble sleeping, and physical symptoms like muscle tension, heart palpitations, racing heart beat, shortness of breath, and tummy troubles.

Panic: intense fear or discomfort, feeling like you can’t breathe, chest pain, tingling, numbness, restlessness, irritability, fear that you are “going crazy,” excessive worry, and fear that you are losing control or dying

Obsessive Compulsive Disorder (OCD): recurrent and persistent thoughts, urges & impulses that are not wanted and cause distress, so you try to neutralize them with an action or other thought. They might be scary thoughts and usually involve harm coming to the baby or “what if” thinking. You are horrified by these thoughts, feel guilty for having them, and take action to make sure nothing bad happens, or to keep the thoughts from coming back. Symptoms may be related to fears of purposeful harm, contamination, accidental harm, arranging/ordering, religious, and checking. Thoughts DO NOT equal action. You recognize that these thoughts are not healthy, are extreme, and you are worried about having them.

Psychosis: compared to OCD above, psychosis feels different because you don’t recognize that the thoughts are dangerous or unhealthy, so you have little to no anxiety about them & do not feel the need for these thoughts to stop. You are out of touch with reality and find these thoughts safe and protective. You may have beliefs about the baby that aren’t true, but you think they are reasonable and feel tempted to act on them.

Post-Traumatic Stress Disorder (PTSD): a trauma response in the body to a sense of overwhelming and intense fear. Can include feeling abandoned and stripped of dignity, lacking emotional support, feeling like others don’t care, poor communication, feeling invisible, feeling powerless and betrayed, feeling unprotected, wondering if the process is worth it, or feeling violated. You may want to avoid people or places, have distressing memories or nightmares, feel like you are reliving what happened, physical discomfort, negative moods or thoughts, changes in sleep and concentration, and constantly being on the lookout for danger.

Bipolar: an overall unstable mood, changing between depression and mania (euphoria, little sleep, racing thoughts, high productivity, increased energy, and pressured speech). These changes and symptoms are noticeable by others.

If you’re having trouble and you need help, you have options & resources for support. If you are in an emergency situation and there is a risk of harm to yourself, another adult, or your baby, or you are having hallucinations & unclear thoughts/speech, contact emergency resources right away. If you or someone who loves you is concerned, you may be in a state of postpartum psychosis, reach out to emergency resources immediately.

While you are pregnant, you can set yourself up to feel more supported and to hopefully avoid mental health challenges after birth. Think of things you would normally do to feel stable, healthy, and happy & keep these things going: a regular routine, sleep schedule, healthy eating, exercise, social outlets, family get-togethers, etc. Preparing for this now will allow you to focus on the new person arriving in your home who needs your 24/7 attention. Ask questions. Ask for help. Think of things you might need ahead of time that could help in the future when you may be stressed (for example, schedule supports to bring food, clean your home, do laundry, run errands, hold the baby so you can sleep, etc). People LOVE to help when you have a new baby, so don’t be shy. Advocate for what you need. Also, get counseling support to help you prepare for becoming a parent and going through the birth process. Counselors are here to give a safe space to explore all feelings and concerns. You are not weird for having them, so please do not hesitate to reach out.

Also, prepare to meet someone new that you may have not thought about since before the birth of your baby: YOU! It is normal to wonder how you now fit into this little person’s world, what your identity is as a mother, as an individual, and how you and your partner relate. Be kind to your new “you” as you figure things out. You’re in brand new territory. Your body may look and feel different and you may be healing from physical pain. That’s ok. It may help to find someone who you can talk to, one-on-one for support, who focuses on you so that you don’t feel forgotten. That can be anyone you find supportive. Sometimes a counselor, who can also help you process what has happened and focus on YOU for self-care during this time, which is super helpful & necessary.

Your partner and those around you will be changing and adjusting too, so be kind to each other and offer grace where you can, trusting that everyone is doing their best. Communicate about what you are thinking and feeling.

Pregnancy and postpartum time can bring a mix of feelings and questions. Welcome them. Be kind to yourself during this huge transition in your life. Remember yourself and your own self-care: taking care of YOU is not selfish. It is one of the best ways to care for your baby. Ask for help and remember there is no one “right way” to do this parenting thing. We are in it together.

Here are some helpful resources to use that may fit your needs. Use what fits you best!

● OBGYN
● Psychiatrist/Medication Provider (focused in maternal mental health specifically)
● Counselor
● Doula
● Pediatrician
● Lactation Specialist
● Postpartum Support International (PSI)
○ Website: www.postpartum.net
● 4th Trimester Project
○ Website: www.newmomhealth.com