Perinatal Mood Disorders | Real Life Midwife

First up, let me say that we need to talk about this. There’s a lot of talk already about postnatal depression, but I really think we need to talk about what it is, and I’d even like to change the term – to perinatal mood disorders. Why? Because I think it’s MUCH more common that the statistics say, and I think a lot of anxiety and other mood disorders go under the radar. ALSO I think as a society we need to know that these things often start in pregnancy, maybe mildly, but just bubbling under the surface. You might be worried about a particular blood test, or have heard a friend’s recent bad birthing experience, or panicking about your chances of a particular complication, or stressing about how you are going to afford the time off work. Then something happens (birth, stopping work, feeling overwhelmed in pregnancy?) and boom – it explodes into a bigger deal.

My problem with the term postnatal depression is that people then limit it to after they’ve had the baby, when really it can happen at any time. I have also found that doctors and midwives frequently use the term postnatal depression inappropriately, such as referring to cases of anxiety and so on, and I feel that anxiety and depression are distinctly different and should be recognised as such. Therefore, the term perinatal mood disorder is all encompassing (covers all manners of mood changes in pregnancy, birth and the postnatal period), and probably comes with less stigma than any term using the word depression.

If you don’t want to read the wall of text that’s coming, here’s a quick recap of the reported official stats on anxiety and depression in pregnancy and postpartum. Note that I said reported – as I am certain many mums (and dads!) don’t report their symptoms because they a) don’t recognise them as fitting these disorders or b) they are too scared/anxious/embarrassed…and therefore the actual rates of perinatal anxiety and depression are probably way higher.

Are these numbers really confronting for you? That almost 1 in 4 mums-to-be report anxiety in pregnancy (and studies have shown that anxiety escalates/increases over time in pregnancy, peaking in the third trimester - leaving mums ripe for a postnatal anxiety/depression diagnosis). That over 1 in 10 mums experience depression in pregnancy? That it's not all about glowing in pregnancy or warm, snuggly newborns after birth?!

If you are thinking, why should you care about perinatal mood disorder? Well, if you’re a mum, or a mum-to-be, you will feel like absolute shit, emotionally (excuse my French, but need to emphasise it). If you’re a partner, or a health professional, it’s because mums will feel like absolute shit, if they have it. And unfortunately, there are studies showing that there can be an effect on the baby/child when their parents are not well. A really big concern is the effect on parent-infant attachment (i.e. bonding), but also a baby’s cognitive, behaviour, social and motor development[1]. So not only does a mum feel absolutely terrible at this time, but her baby is at risk. And we have all heard the awful news stories of when a parent’s mental health suffers to the point that they and/or their children are at risk of danger. This is the rare, but extreme reason to care about perinatal mood disorders.

Right, so we are getting really heavy in this article. To lighten it up a bit, let’s talk about that old saying of “prevention is better than cure”. Yes – what do we know about what helps to reduce the chance of developing perinatal mood disorder?

In a systematic review (a study that summarises the results of available healthcare studies and provides the highest level of evidence on the effectiveness of healthcare interventions) on interventions designed to prevent postnatal depression, the only one that showed a clear preventative effect was intensive support from a health professional in the postpartum period[2]. Here’s the problem: this (generally) doesn’t happen in Australia (and I’m not aware of anywhere that offers this as part of standard maternity care). In Australia, most women birth in the public system, usually by a team of health care professionals but without continuity of carer. Mums are discharged home within a few days of birth, they might get one or two home visits by a midwife and then a maternal and child health nurse (MCHN) will visit around 1-2 weeks after birth (and then it’s up to mum to visit her MCHN after that). No continuity, definitely not intensive, and debatable as to whether this can be called ‘support’! In the private sector (care by obstetrician), mums get continuity of carer in pregnancy, generally their hospital stay is a few days longer after birth, but the trade-off is there is no midwife home visiting service (although some private hospitals/obstetricians are beginning to offer this). Then the standard MCHN consults apply. Still no intensive support after birth! So how can you take advantage of the fact that intensive support from a health professional in the postpartum period is proven to prevent postnatal depression? Engage in a private midwife or doula, or even a student midwife, to provide this. It is worth noting that doulas and students are not registered qualified health professionals, but a good one is still worth her salt at this time. If you run into troubles, they can help recognise this (particularly if they can work with you during pregnancy) and will know how to get you good help. Whilst there are other preventative strategies, the research tends to show that they work for some women sometimes, and other women not at all – making it really hard to tailor to each individual mum based on her, where she lives, and her access to services and so on.

Another way to go about preventing perinatal mood disorders in a way is to reduce your risk factors, where you can. So, what is the biggest risk factor for developing anxiety/depression in pregnancy (bearing in mind that this is a precursor to the conditions being present in the postpartum period)?

Lack of support[3]. Not previous mental illness, not stress, not money, not relationship worries, not smoking (although these can be linked to perinatal mood disorders as well), but just a lack of support.

This almost shocked me in a way, because I thought “what if the whole of Australia knew that they only had to drop off a meal to a new mum, or check in via text to see how she’s going, or meet her for coffee, or hold the baby while she sleeps, or bring in her mail, or fold the washing”…or endless other things to reduce her mental load, and therefore her risk of psychological distress. Ask her what worries her during pregnancy. Ask her if her midwife/OB is listening to her, hearing her concerns. Talk to her partner about providing support to her. Ask what you can do to help! Creating a mama’s village for her (rather than making her do all the work to create her village) will no doubt go a long way to reducing her biggest risk factor – lack of support. Side note – if you are a partner or family member, READ THIS to understand what I mean about the mental load.

 

So that in mind, what IS perinatal mood disorder? How can you spot it, if you're a mama, partner, family member, health professional? This is important, because if I can illustrate with my own example after birth, I had many health professionals use the term 'postnatal depression' with me, but I felt anything but depressed. I felt wired, panicked and on edge the whole time, but not depressed. In retrospect I also developed some obsessive compulsive tendencies. With the help of hindsight, this is why I think perinatal mood disorder is a better suiting term to use (it's more generalised).

Well, instead of listing a whole heap of text, here's an infographic that contains common words and themes, and if you recognise these in yourself or someone you know, you need to follow the steps below to get help!

So what's next - you're recognising these symptoms or feelings in yourself or someone else. And I want to highlight here, please do not excuse these feelings as being an essential byproduct of pregnancy, birth and/or new baby. Yes, they might be explained by the circumstances, but that doesn't mean you have to keep feeling this way, and definitely doesn't mean there aren't things we can do to help you feel better.

The first step is to find help right now. Don't put it off, you'll feel better for even making a plan. There are a number of different mental health hotlines, which I am going to list below. The best one is PANDA because it's specific to perinatal mood disorders, however it's not a 24hr hotline. If it's after hours or you can't bear to ring one of these hotlines, call a friend or family member to make the call for you. The second thing is to make a GP appointment, to discuss your mental health. If things are still quite mild, your GP might be able to manage things. However, they might also do a mental health care plan, the Edinburgh Postnatal Depression Scale (an assessment of your perinatal mental health, which you can do yourself here, if you'd rather try it yourself first) and refer you to a mental health clinician. Here, I really recommend trying to find one that specialises in perinatal mental health. If this is all a bit too hard or daunting, or you need more support, you can check PANDA's website for a mental health checklist here (for pregnancy, postpartum, dads, non-birth parents etc).

Ok - now the phone contacts (or click the logo to go to the organisation's website):

PANDA logo.JPG
beyondblue logo.JPG
lifeline logo.JPG
mensline logo.JPG

As a side note, PANDA is the only one that's not a 24 hr hotline here. Goodness knows why - well, funding is why - but it's such an important support option. And of course 2am is when things are often going wrong! But if you are ever looking for a reason to lobby governments, here is one (make PANDA 24hrs!). And if you ever need a cause to donate to, help the funding on its way and donate to PANDA.

I'm not going to go into treatment - because there are many options and treatment should be individualised, but also because hopefully you are getting help with a great health professional who can guide you through the effective options.

I will add, from my own personal experience, that I was completely taken aback by my postnatal anxiety, in a way. The midwife in me had assumed the depression was more common/likely - so I was unprepared for my symptoms. And after a turbulent pregnancy, I excused the symptoms for way too long, and thought that it was a normal response to the trauma I'd been through. Once I had my rational mind back, I was able to see things more clearly and seek help for my feelings. And at the time, I felt like a shit mum. Of course - I was feeling terrible, but I wasn't a shit mum - everything I was doing, I was doing for the benefit of my baby! But getting help made me an even better mum, and best of all, I am totally loving the experience now! PS you can read more about my story here!

I hope this has been a helpful read. Please share the love by sending this post to a supermum or supermum-to-be, or a new parent,who might benefit from this article. And I would love to hear your thoughts and experiences in the comments below!

Want more? Click here to read some real mums' stories - such as my personal story and Jess' story - and how they felt emotionally during pregnancy and postpartum
 

Click here to read my blog post about the skill of hearing versus listening

[1] Kingston, D.; Tough, S.; & Whitfield, H. (2012). Prenatal and Postpartum Maternal Psychological Distress and Infant Development: A Systematic Review. Child Psychiatry and Human Development 43(5): 683 – 714

[2] Dennis, C-L (2005). Psychosocial and psychological interventions for prevention of postnatal depression: systematic review. BMJ 331(15)

[3] Biaggi, A.; Conroy, S.; Pawlby, S.; Pariante,C.M. (2015). Identifying the women at risk of antenatal anxiety and depression:A systematic review. Journal of Affective Disorders 191: 62 - 77

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