Friday, September 11, 2015

Sandra Wood, APRN, CNM, is a certified nurse midwife at The University of Vermont Medical Center and clinical instructor at the University of Vermont College of Medicine.

There is a prevailing myth and cultural expectation that pregnant women go through pregnancy simply “glowing”. Following the birth, after some initial fatigue and adjustment, most women expect to adapt easily to the arrival of their baby. We envision the photo of the smiling mother and content baby. Having a baby is supposed to be one of the happiest times in your life.
However, some women find that they are struggling with emotions that they did not expect!   They feel badly about themselves if they are not “glowing” in pregnancy or are experiencing distressing emotions after the birth and find it hard to talk about. New mothers and soon-to-be-mothers may feel confused and alone.
Let’s put an end to that with some facts about “postpartum depression” – starting with the term itself.
Myth #1: “Postpartum depression” occurs within the first few months.
The terms “postpartum” and “depression” may confuse women who are struggling emotionally. It may not feel like depression and it may not be postpartum. Emotions can range from the sadness of depression to irritability to outright panic. The time frame can be from the first positive pregnancy test to the baby’s first birthday. The term “Postpartum depression” is inadequate. What we are talking about is “perinatal mood and anxiety disorders.” This describes emotional distress/ complications that may occur at any or all stages, including pregnancy, birth, and the postpartum period up to a year. It is not just “postpartum.”
Myth #2: Mothers with perinatal mood and anxiety disorders are sad and weepy.
Pregnancy, birth, and parenthood come with enormous physical, emotional, and relationship changes. As with any major life change, there is a range of pregnancy and postpartum emotions. All women experience some changes in mood and behavior in the transition to motherhood. It is a matter of how much the changes are affecting your life and functioning. Distress or complications captures the sense that something is not right.
Women may experience:
  • Being worried all a time
  • Being scared/panic attacks
  • Difficulty concentrating
  • Crying
  • Feeling alone
  • Feeling ashamed
  • Feeling guilty (this has a lot to do with a woman feeling that her symptoms are evidence of her worth as a mother)
  • Feelings as if you have lost yourself
  • Feeling numb, lack of feelings for the baby, not looking forward to the future
  • Having intrusive scary thoughts
  • Headaches, backaches, stomach aches, nausea – even the feeling like you are having a heart attack
  • Irritability
  • Low energy and feeling worn out, or alternatively being full of nervous energy
  • Loss of interest in sex
  • Overeating/no appetite
  • Trouble coping
  • Trouble sleeping or excessive sleep
Myth #3: Perinatal mood and anxiety disorders are rare.
Mood and anxiety disorders are one of the leading complications of being pregnant. Up to one in five women will experience perinatal emotional complications. This is more than gestational diabetes or preeclampsia, conditions for which we regularly screen.
Myth #4: Women with perinatal mood and anxiety disorders want to hurt their children.
Many women who are experiencing emotional distress or complications protest: “Oh no, I don’t have postpartum! I don’t want to hurt my baby or anything”  Perinatal mood complications are linked in the public mind to the media reports of postpartum psychosis. Postpartum psychosis is a rare, but serious symptom of a mood disorder that can indeed endanger the mother’s or the infant’s life.
Women and their families should know the symptoms of postpartum psychosis and report those symptoms to their health care provider. It can develop within the first weeks after birth and is considered a psychiatric emergency. Postpartum Psychosis is temporary but requires treatment and responds quickly to treatment.  Symptoms include:
  • Delusions, or strange beliefs
  • Decreased need or inability to sleep
  • Difficulty communicating at times
  • Feeling irritated
  • Hyperactivity
  • Paranoia and suspiciousness
  • Rapid mood swings
  • Seeing or hearing things that others do not
Unfortunately, this rare postpartum emotional complication has been sensationalized in the media. This poses a danger as women are afraid to admit that they are experiencing emotional distress and will not report symptoms because they fear that their baby will be taken from them.
Myth #5: Perinatal mood and anxiety disorders will go away on their own.
Women should be proactive in tackling perinatal mood and anxiety disorders. The first step is to understand what they are. Next, make a plan to promote nutrition, sleep, time for yourself, and social support (both personal and professional) during and after your pregnancy. If you or your family and friends start to notice symptoms, talk to your health care providers. That includes your nurse- midwife, obstetrician, and your primary care doctor. Ask for help and keep asking.
If your provider determines that you do have a perinatal mood or anxiety disorder, there are treatments available including therapeutic approaches and medications. It’s important to note that medications are available that are safe to use during pregnancy and breastfeeding.
My final thought to women reading this blog: if you are worried about how you are feeling or you are experiencing any of these symptoms: You are not alone. You are not to blame. With help you will be well. Transition to parenthood is difficult. Talk to your health care provider: there are effective treatments. Every baby deserves a healthy mom.
Online resources:
Must-read book:
  • “Life Will Never Be The Same: Real Moms Postpartum Survival Guide”
Sandra Wood, APRN, CNM, is a certified nurse midwife from at Champlain OB/GYN and The University of Vermont Medical Center as well as a clinical instructor at the University of Vermont College of Medicine.


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