About Lesson
Intro and objectives
Introduction
This course is specifically aimed at pregnant and postpartum mothers. It is designed to support women who are navigating the complex and often challenging mental health landscape that can accompany pregnancy and the postpartum period. The course targets mothers who might be experiencing anxiety, OCD, birth trauma, or other mental
health concerns related to their maternal journey.
Given my specialization and the course content, it is also likely suitable for mothers who are interested in proactive mental health strategies, mindfulness practices, and those seeking to understand and manage the psychological transitions associated with pregnancy and motherhood. Additionally, the course could be beneficial for mothers
seeking community and support, as it likely offers a space for shared experiences and learning in a safe and understanding environment.
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Defining Perinatal Mood Anxiety Disorder (PMAD)
a. Perinatal - conception through the first year postpartum
b. Mood - Depression, Bipolar Disorder, psychosis
c. Anxiety - Generalized, Panic, OCD, PTSD, and Social
d. Disorder - when symptoms impact day to day life for longer than 2 weeks (good general rule of thumb)
e. These disorders can affect people at any time but there is an increased
risk during the perinatal period and symptoms often have a unique
presentation
Who is Affected
Who is affected
a. 1 in 7 new moms
b. 1 in 10 new dads
c. limited data on same sex couples, adoptive parents and surrogates but
we know they experience PMADs at a higher rate than is diagnosed
d. PMADs do not discriminate (universal), they can impact anyone and
money/socioeconimic status are not protective factors
Risk Factors
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Why Is It Important? Risk of Untreated PMADs
Risk factors
a. Biological
i. personal history or family history of PMADs
ii. personal or family history of depression, anxiety, OCD, eating
disorder, bipolar disorder
iii. fertility treatments
iv. thyroid changes
v. severe premenstrual syndrome
vi. lack of sleep
b. Environmental/Social
i. life changes such as new home, new job, change in work status
ii. loss of a loved one
iii. isolation or lack of social support
iv. history of trauma
v. domestic violence
vi. systemic racism
vii. substance use
viii. financial stress
ix. barriers to communication
c. Psychological
i. perfectionist tendencies
ii. difficulty with transitions
iii. unrealistic expectations
iv. relationship issues
v. low self esteem
vi. anxious or highly sensitive personality
vii. feeding baby
6. Why is it important? Risk of untreated PMADs
a. According to ACOG Consensus Bundle on Maternal Mental Health from
2017
i. Relationship problems
ii. poor adherence to medical care
iii. exacerbation of medical conditions
iv. intimate partner violence, separation, divorce
v. loss of interpersonal and financial resources
vi. child neglect/abuse
vii. developmental delays, behavioral problems
viii. infanticide, homicide, suicide
7. what is the difference between pregnancy symptoms,
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What is the Difference Between Baby Blues and PMADs?
What is the difference between pregnancy symptoms, baby blues and PMADs)
a. Common symptoms across most PMADs
i. feeling sad, hopeless, overwhelmed
ii. feeling anxious, panicky
iii. regret having the baby
iv. trouble sleeping even when the baby sleeps
v. thinking her family would be better off without her
vi. fear of leaving the house or being alone
vii. isolation from family and friends
viii. unexplained anger or irritability
ix. fearful that she might harm herself or the baby
x. trouble coping with daily activities of living
xi. difficulty concentrating or making simple decisions
xii. feeling “out of control”
xiii. feeling guilty
xiv. relentless worry
xv. significant self doubt
b. Physical symptoms that might be present:
i. nausea
ii. dizziness or lightheadedness
iii. racing heart
iv. persistant headaches
v. chest pain
vi. shortness of breath
vii. numbness of hands or feet
c. Words you might hear them say:
i. This is supposed to be the happiest time of my life… why am I so
sad?
ii. Everything would be better if I got a good night’s sleep
iii. I feel like the worst mother in the world
iv. I’m having thoughts that are scaring me
v. Why am I such a failure?
vi. I worry all of the time
vii. Why can’t I snap out of it?
viii. I want to run away
d. Table? Pregnancy vs Depression
i. Pregnancy
● mood - easily tearful, emotional
● self esteem stable
● sleep - disrupted by bladder or heartburn, but able to fall
back to sleep
● no suicidal ideation/intent
● Energy - tired, but restores with rest
● Appetite - might increase
ii. Depression
● mood - gloomy, irritable, agitation, rage
● self - esteem - lowered, guilt
● sleep - difficulty falling and staying asleep
● suicidal thoughts, plans or intentions
● energy - rest does not restore
● appetite dysregulated
iii. Baby Blues
● Affects 60-80% of new moms universally
● peaks around day 3, resolves around day 14 postpartum
without treatment other than social support
● tearfulness, exhaustion
● generally happy, self esteem remains stable
● able to care for self and baby as would be expected
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PPD
Anxiety – General
Perinatal Psychosis – a TRUE MEDICAL EMERGENCY
Perinatal Psychosis - A TRUE MEDICAL EMERGENCY
a. 1-2 out of every 1,000 deliveries (or 0.1% of births)
b. Of those with PPP, there is a 5% infanticide rate or suicide rate
c. Risk factors:
i. first baby
ii. discontinuation of mood stabilizers
iii. obstetric complications
iv. perinatal or neonatal loss
v. previous bipolar episodes, psychosis or postpartum psychosis
vi. family history of bipolar disorder or postpartum psychosis
vii. sleep deprivation
d. Symptoms - usually within first 2 -4 weeks postpartum, rapid onest not
necessarily consistently present (can cycle through psychosis and
normalcy)
i. Hallucinations
ii. Ego-syntonic intrusive thoughts
iii. Thoughts of harming self or baby with plan and/or intention
iv. poor concentration, disorientation
v. agitated, hyperactive, aloof, lack of self care
vi. mood is elated, and less often depressed
vii. speech is rambling
viii. disorganized thought, flight of ideas
e. Treatment
i. Postpartum psychosis is temporary and treatable with professional
help BUT it is a TRUE EMERGENCY
ii. Inpatient hospitalization
iii. Medication
iv. Social and psychological support once discharged to home
Conclusion