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The PMDA Monday Blog will discuss the many many aspects of Perinatal Mood Disorders, from what they are, to how to identify them, to how and where to get help. It is our hope that all of you find this a beneficial resource!
Read it HERE every Monday!
Written by Sarah Wizel, PMDA Advocate at Large
Antenatal depression (depression during pregnancy) is estimated to affect at least 10% of pregnant women, and receives even less attention than postpartum depression. Women can of course experience other mental health concerns during pregnancy, such as Obsessive Compulsive Disorder and Eating Disorders.
Many symptoms of depression such as fatigue, appetite changes, and difficulty sleeping can overlap with pregnancy symptoms. However, these symptoms and other signs of depression or mood disorders should not be ignored or chalked up to “hormones.”
I believe now that I experienced some antenatal depression during my first pregnancy. However, I remained functional and my doctor believed in the inaccurate and outdated notion that pregnancy protects against mood disorders (which it doesn’t). I believe these circumstances contributed to minimal attention to my mental health during pregnancy.
During my current (second) pregnancy, I have been much more attentive to changes in my mood, which have included difficulty sleeping and staying asleep for no discernable reason, widespread irritability, difficulty concentrating, and lack of interest in socializing or my regular activities. My doctor has referred me to the maternal mental health program here, and increased my medication slightly. I have also focused more on maintaining good sleep habits, keeping up with regular exercise, and avoiding negative thought patterns.
If you do think you may be having mood problems during pregnancy, talk to your health care professional and don’t hesitate to get a second opinion if required. Depending on the severity of your symptoms, treatment may include talk therapy, a support group, and/or medications.
Due to my first child’s traumatic birth 3.5 years ago, I was uneasy about the thought of going through labor again with my new baby. My husband and I decided early on to hire a doula to increase our chances of having not only a physically healthy birth, but a psychologically and emotionally healthy one as well.
A labor doula is a professional birth attendant. She is not trained in the medical management of childbirth, like a midwife or doctor, but rather focuses on physical comfort and emotional support for the mother and the partner. Using a doula can reduce the need for birth interventions, and one study showed a decreased risk of postpartum depression in women who were supported by labor doulas during birth.
I wish I had known about doulas during my first pregnancy! I was surprised at how much time my husband and I spent alone during labor in the hospital (the nurses came and checked on us occasionally). The continuous support of a doula would have been helpful for this reason, plus I knew nothing of the different positions for labor and how they affect progress. Even though I took the prenatal classes offered by the hospital, I was still quite unprepared.
I met three doulas before we decided on the one we hired. It is important to meet at least a few (some families interview more) to ensure that your personalities and birth philosophies align. The fees were definitely a consideration (they range from anywhere from free to over $1500, depending on your financial circumstances, experience of the doula, your geographic region, etc), but the most important consideration was talking to the doula we chose made me feel excited to give birth inside of anxious.
References and further reading:
Here are a few things I am doing differently this time:
Being aware of the possibility of antenatal depression (depression during pregnancy) and taking steps to prevent it is definitely making me feel more in control of the situation. It can be hard not to panic when I’m having a bad day and worry it will become many bad days, but so far my off days have been isolated incidents, although I experience them much more frequently than I did before pregnancy.
So what can you do when your health care worker downplays your symptoms, or gives you a diagnosis that you don’t believe is true? My OB/GYN minimized the symptoms of my mood disorder at my 6 week check-up, attributing my anxiety and trouble sleeping to just being a new mom, despite her being aware of my history of depression. I suspected that this wasn’t true, but unfortunately believed her despite my misgivings. This delayed my diagnosis.
In retrospect, I should have sought a second opinion immediately after this check-up with the OB instead of waiting for the next scheduled visit with a health professional (my daughter’s 2 month vaccinations). I could have talked to a counselor, another physician, or even told my OB about my disagreement with her. For my next baby, I will do better because I know better.
The issue may also be the proposed treatment plan, rather than the diagnosis. Some health care workers are reluctant to prescribe medication for pregnant or breastfeeding women, even though the benefit outweighs the risks in many cases. Conversely, your practitioner may hand you a prescription with no other avenues for support, such as counselling, which would also be a concern.
Sometimes women worry about offending their primary care practitioner by seeking a second opinion, from another doctor, or another health care professional altogether. Remember that you are the boss of your own health, you know yourself better than anyone else does, and an inaccurate diagnosis or substandard care plan will negatively affect both you and your family. You are entitled to a second opinion, and it may be life-changing.
Most recent or soon-to-be mothers are familiar with birth plans: a document that specifies preferences for how the birth will go, if pain relief will be offered, who will be present, etc. Equally important is a postpartum plan that covers the weeks after the baby is born.
In many cultures, a postpartum plan would be completely unneeded: women are automatically cared for according to cultural traditions. In Western society though, women are expected to cope on their own fairly early on. A plan helps spell out details rather than assuming your partner and family will know what you want, and can decrease your stress in the early weeks.
Some of the things you may wish to plan ahead for are how visitors will be handled (when can they come, and for how long), who will take care of household chores while the mom is recovering from the birth, and how any older children will be cared for. Picture your ideal postpartum period just like you would picture your ideal birth, and be clear about your expectations and desires. Assumptions will not translate into reality!
Postpartum Progress - This is an excellent blog written by a woman who has overcome severe postpartum depression, with many guest posts from other women. It features personal stories as well as helpful information and tips on handling and recovering from all kinds of perinatal mood disorders.
Postpartum Support International - This organization has a helpful website, with lots of information for women and their families. Most importantly, they also havea a helpline! Call 800.944.4PPD (4773) to speak to a trained volunteer about your perinatal mood disorder.
Perinatal Mood Disorders Awareness Ltd - Of course I need to highlight our own website! PMDA has worked hard to develop a website with many resources. Besides information, you can also find more personalized support through our organization. See here for a list of volunteers who can provide peer support, or message us to be added to our private facebook support group.http://www.ppda.ca
Everyone’s recovery from a perinatal mood disorder is a little bit different. Some people recover more quickly than others. Some people have relapses, while others never experience this.
Recovery would be described as the symptoms of the mood disorder either being eliminated, or reduced to a very manageable level. During my recovery, I noticed the following specific changes in my mood and outlook (in addition to better sleep, improved coping skills, etc).
Ah, January. The Christmas season is wrapping up, leaving us with freezing weather and little sunlight. It is no coincidence that the founder of PMDA chose January to be postpartum depression awareness month!
I personally found the January after my daughter was born to be extremely hard. My mood was at all-time low since her birth and I finally decided to start medication and counselling. After that, it was all uphill!
What can be done to make getting through this month easier? I suggest getting outside the house as much as possible. It can be hard, but getting to a gym or even walking around the mall may help your mood. Get what sunshine you can - open the curtains, and go outside as long as weather will permit you to do so. Today in Saskatoon that’s only about 3 minutes!
Remember that Spring will come soon, and focus on enjoying this month as much as possible. Plan some activities that you will enjoy, and get lots of rest. Eating healthily is important too - winter squash, sweet potatoes, and cabbage are all in season and are nutritional powerhouses.
Gradually, people are gaining awareness of postpartum anxiety as a distinct condition from postpartum depression. However, many people are still unaware that there are actually different kinds of anxiety disorders. Today I want to mention social anxiety specifically.
Social anxiety is different than shyness or introversion (needing alone time to recharge). Rather, affected people experience symptoms of anxiety such racing heartbeat, nausea, and psychological distress (ex. intense fear of embarassment or judgment) specific to social circumstances. This differs from generalized anxiety disorder, where symptoms occur in many different circumstances.
While postpartum anxiety disorders in general are gaining more recognition, women with social anxiety may have their diagnosis missed because they function well in many other parts of their life. I was not able to find statistics on the prevalence of social anxiety postpartum. Further research in this area in regards to risk factors, prevalence, and treatment options is needed.
References and further reading:http://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/basics/definition/con-20032524