You may have seen the term “Perinatal Mood and Anxiety Disorders (PMAD)” bandied about on the internet; you may have even encountered it here at EmmaWell. This term can come across as clinical, unapproachable, or even scary. We are going to unpack the meaning of “perinatal mood and anxiety disorders” to make sure you understand what they are, how to recognize if you have one, and how to get help so you can feel better. You shouldn’t need a dictionary or a medical degree to know the signs of a serious mental health condition that often accompanies the rollercoaster of early motherhood.
What’s in a Name?
First off, what does “perinatal” mean? Perinatal refers to the entire span of a pregnancy and the first year after childbirth. Some other common terms are “prenatal” and “antepartum”, which indicate pregnancy or the period before birth, and “postpartum,” which denotes the year-long period following birth, ranging from the first six weeks up to a year. Whereas the medical community once attributed most emotional issues surrounding childbirth to “Postpartum Depression (PPD)”, it has now embraced “Perinatal Mood and Anxiety Disorders (PMADs)” as the catch-all term for the spectrum of mood changes that may occur during or after pregnancy.
This shift in nomenclature illustrates that many women first start to experience symptoms during pregnancy and that these symptoms cover a vast range of experiences that cannot be classified under one overarching condition. In addition to postpartum depression, there are a number of overlapping illnesses that comprise mood and anxiety disorders. These include anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar disorders, and psychosis.
What Are the Signs?
Having some difficulty adjusting to parenthood in the first few months is considered normal. About 60-80% of new mothers suffer from the “Baby Blues,” which is a mild, momentary case of depression characterized by sudden mood swings, inexplicable crying, irritability, impatience, exhaustion, loneliness, sensitivity, and vulnerability. If these symptoms interfere with a mom’s typical coping abilities, functioning, or parenting, or last beyond the first 2-3 weeks postpartum, a more serious PMAD might be to blame. It is estimated that up to 20% of mothers who suffer from “Baby Blues” eventually develop symptoms of a PMAD beyond two weeks postpartum.
Even though pregnancy is often portrayed as a period of great joy and excitement, in many cases this is not the reality. As women mentally prepare for permanent life changes and increasing responsibilities that come with a baby, some develop intense fears and anxieties related to pregnancy or childbirth. According to research in Obstetrics & Gynecology, one in five pregnant women develop a moderate fear of childbirth, and 6-13% of pregnant women experience severe, crippling fear of childbirth. Women who have wrestled with long-term infertility are particularly vulnerable for developing these feelings. Often, mood or anxiety issues that crop up during pregnancy persist and even worsen after childbirth.
Below is a summary of signs that characterize the most common perinatal mood and anxiety disorders. Keep in mind that these are not one-size-fits-all illnesses, and many women do not experience all or even most of their symptoms. Mood disorders can often be comorbid, meaning someone might have overlapping symptoms. What rings true for all women who suffer from PMADs is that their symptoms do not come and go, like a bad day that is passed over and forgotten. These symptoms last for longer than two weeks and make functioning normally, as well as enjoying everyday life, incredibly difficult.
Loss of interest or pleasure
Robotic about daily tasks
Lack of energy
Lack of bonding with your baby
High levels of resentment and rage
Low levels of patience and hope
Pervasive changes in appetite or sleep
Difficulty with concentrating on tasks and connecting with others
Feeling guilt or shame that you are failing and your baby deserves better
Thoughts about harming your baby or somehow ending your misery
Uncontrollable sense of anxiousness
Excessive and oppressive worries
Doom and gloom mentality
Extreme fears about your baby and other children
Inability to shut brain off
Disturbances in appetite or sleep
Feeling loss of control
Dizziness, heart palpitations, shortness of breath, nausea, numbness, tense muscles
Perinatal Obsessive-Compulsive Disorder:
Hypervigilance in protecting your baby
Fear of being left alone with your baby
Intrusive thoughts or upsetting obsessions regarding your baby
Compulsive behaviors to try to reduce fears
Perinatal Bipolar Disorders:
Fluctuation between extremely low (depression) and high (mania) moods
Low periods can mimic severe depression or anxiety
High periods can make you feel wired, chatty, creative, and unable to sleep
Hallucinations (seeing things that are not real)
Delusions (hearing things that are not real)
Delusions or strange beliefs
Feeling disoriented or confused
Decreased need or ability to sleep
For more in-depth information on each PMAD, visit Postpartum Support International.
Why Does This Happen?
Mental health disorders are more common throughout pregnancy and the postpartum period than you might think. About 8-10% of pregnant women experience generalized anxiety disorder, and roughly 10-15% of postpartum women suffer from postpartum depression, across every age, income level, and ethnic background. According to CDC research, women in their childbearing years experience anxiety and depression at roughly two times the rate of men. There is reason to believe that the incidences of mental health complications during this phase of life are even higher than reported, as many symptoms go unrecognized and underreported. What causes pregnant and postpartum mothers to suffer psychologically - often in silence?
The emotional, hormonal, and physical shifts that take place throughout pregnancy and after childbirth can often increase stress in a way that triggers major mood shifts. Women who are highly sensitive to hormonal fluctuations around their menstrual cycles may be more predisposed to developing a PMAD. Thanks to a growing belly, relentless fatigue, and dietary and drinking restrictions, pregnant women often slow down their fitness and social rituals, which can lead to feelings of elevated stress and social isolation.
Childbirth alone can be a very stressful event full of unknowns, and the aftermath can be challenging if breastfeeding struggles and sleep deprivation enter the picture. When a mother or baby requires repeated hospitalizations or medical interventions, feelings of stress can skyrocket. Women who have experienced a difficult or unplanned pregnancy, a birth trauma, or treatment for their baby in the ICU after birth are particularly predisposed to postpartum emotional struggles.
For women who have a history of mental health issues, pregnancy can be a high-risk time because they might need to temporarily halt their medication or find that the hormonal changes that take place throughout pregnancy and after childbirth exacerbate their symptoms. A personal or family history of mental illness, a history of alcohol or drug abuse, and ongoing stressful life events are all risk factors for a PMAD.
One in seven women is affected by a perinatal mood or anxiety disorder at some point; but in low socio-economic communities, this figure rises to one in four women. Financial insecurity and domestic violence are major factors for mood and anxiety issues both before and after the arrival of a baby. Lack of social supports, including poor access to healthcare and workplace discrimination, also put women at a heightened risk for developing a PMAD.
Ultimately, mood and anxiety disorders during pregnancy or after birth do not happen because of something a mother does or doesn’t do - they are valid medical conditions that result from changes in physiology, environment, and expectations.
What Can Help?
Mothers suffering from a PMAD should know that they are not “crazy,” that they have not become a changed person forever, and that they will not be judged for seeking out help. As temporary illnesses tied to momentous life changes, PMADs are treatable with a combination of self-care, social support, talk therapy, and in moderate to severe cases, medication.
Moms are notorious for trying to take on too many responsibilities without asking for help and then end up feeling undervalued and overwhelmed. Your partner, family, and friends should be leaned on for support during this time, and you should be open about your struggles. Ward off social isolation - particularly in our current climate - by connecting with an old friend and sharing the good, the bad, and the ugly. You can also learn from others’ experiences and suggestions by joining a virtual community of moms in the same stage of motherhood, such as EmmaWell’s Circles, or finding a support group in person.
In the throes of emotional upheaval, it may be difficult to remember what used to make you tick. Get back in touch with your former self by readopting a favorite hobby, spending one-on-one time with your partner, and finding an exercise regimen that works for your lifestyle. Yoga and meditation are particularly beneficial for alleviating symptoms of PMADs. Though newborn sleep patterns are unpredictable, try to rest and recharge as much as possible, even if that means handing off one of your baby’s feedings to someone else. Sleep is akin to medicine for both mental and physical wellness.
In addition to increasing self-care and support, many women rely on the benefits of talk therapy with mental health providers. EmmaWell’s telehealth providers, who are nationally-recognized for their expertise in PMADs, are available morning through evening for video-based therapy sessions from the comfort of your home. After an initial screening, a maternal mental health therapist works with you to come up with a treatment plan. Discussing your feelings, challenges, and concerns with a professional can dramatically improve your coping mechanisms throughout the tumultuous period of bringing a baby into the world. Your provider can help you channel your racing thoughts or adverse feelings in a productive way and make changes that alleviate your symptoms.
Though many manifestations of PMADs can be treated with a combination of lifestyle changes and therapy, some of the more severe symptoms - especially when dealing with Bipolar Disorder or Psychosis - might require urgent medical attention. Likewise, some mothers might need the help of medication, along with other forms of treatment, to come out on the other side of a PMAD. Now that you are familiar with the most common symptoms, causes, and treatment options of PMADs, you should make sure that one never goes untreated. Ignoring a perinatal mood and anxiety disorder could place your entire family under undue stress and deprive you of the joy of becoming a mother - an indescribable joy that every mother deserves to experience!
“You are not alone. You are not to blame. With help, you will be well.”
- Postpartum Support International
Additional Mental Health Resources:
With Warmth and Wellness,
Your EmmaWell Team