Baby Blues

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Although it is not technically a PMAD, the baby blues, which impacts 60-80% of new mothers is a common phenomena and something that is important to know about. Unlike PMADs, it is an entirely hormonal phenomena that results from the sudden, drastic drop in estrogen and progesterone. The baby blues is experienced in the immediate aftermath or first two weeks of giving birth. Many people experience it as an emotional rawness characterized by feeling stressed, sad, anxious, lonely, tired, and tearful. After the first two weeks, the baby blues resolves on its own. 

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Postpartum Depression (PPD)

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If low mood persists after 2 weeks, it is indicative of PPD, which impacts approx. 20% of new moms. If you are experiencing symptoms of depression such as feelings of sadness, guilt or worthlessness, irritability, anger, agitation, or suicidal thoughts, you may have PDD, which occurs in about 20% of women. Risk factors for PPD include a history of trauma, prior experiences of depression or anxiety, a family history of mental health issues, having a “difficult” baby or baby with special needs (premature birth, medical complications, illness), other stressors, such as financial or employment issues, isolation, and lack of social support. Perfectionism and high expectations are also risk factors. It is worth noting that PPD can begin prior to the postpartum period with 26.5% of women diagnosed with PPD having it prior to pregnancy, 33.4% developing depression during pregnancy, and 40.1% in the postpartum year. 

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Postpartum Anxiety 

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Unlike postpartum depression, many people are unaware of postpartum anxiety, which affects approx. 15% of new moms. Symptoms includes excessive worry that is difficult to control, restlessness, irritability, or agitation, sleep disturbances, and physical symptoms (e.g., muscle tension, racing heart, shortness of breath, GI distress).

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Panic Attacks

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Panic attacks, affect approx. 10% of new mothers. Panic attacks which are characterized by intense fear or discomfort that typically peaks within 10 minutes, can occur postpartum. Symptoms of panic attacks include shortness of breath, increased heart rate, chest pains, dizziness, hot or cold flashes, numbness or tingling, restlessness, agitation, irritability, fears of going crazy or losing control, etc. 

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Postpartum OCD

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Postpartum OCD also occurs in approx. 10% of new mothers. Symptoms includes obsessions, which are recurrent and persistent thoughts, urges or images that are intrusive and cause distress. Individuals typically seek to ignore, suppress or neutralize obsessions by engaging in a compulsion, which is a repetitive behavior intended to reduce anxiety. Obsession can include thoughts of harm coming to the baby, either deliberately or accidentally, which can lead to intense distress as well as feelings of guilt and shame. In the case of Postpartum OCD mothers are often alarmed or even horrified by these thoughts and take steps to prevent harm, unlike the kind of thoughts of harm that can occur in postpartum psychosis in which someone may intend to cause harm. In fact, it is the protective part of the brain at play in postpartum OCD that results in these types of thoughts. 

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Birth Trauma & PTSD

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Childbirth can be an extremely traumatic, sometimes life threatening experience. Every year an estimated 1,200 women in the US suffer complication during pregnancy and childbirth that prove fatal and another 60,000 suffer near-fatal complication. Tragically, the CDC estimates that 80% of these deaths could have been prevented with better access to care, more timey diagnosis, and medical intervention. It is especially bad for women of color with black mothers being more than 4x likely to die. Black mothers are also more likely to experience long-lasting mental health consequences after childbirth and less likely to receive treatment. The U.S. CDC suggests that 60% or more of maternal deaths could be prevented by addressing racial and socioeconomic disparities. 

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As many as 45% of women say their births were traumatic with about 5% going on to develop PTSD. Symptoms include intrusive symptoms (e.g., flashbacks, nightmares, memories, physical reactions), avoidant symptoms (e.g., social withdrawal, denial, apathy, emotional numbing), negative changes in thoughts and mood (e.g., guilt, depression, irritability, hopelessness, feelings of self-blame), and arousal symptoms (e.g., sleep disturbance, poor concentration, agitation, aggression, hypervigilance).

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It is not just childbirth that can be traumatic, but also the aftermath, particularly in the event of complications that may require a NICU stay, which happens to 10-15% of newborns. NICU parents often experience high rates of depression, anxiety, and PTSD. Additionally, mental health does not necessarily improve after the NICU stay with parents being left to care for fragile infants without the support they had in the hospital. 

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Postpartum Bipolar Disorder (PPBD)

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Postpartum bipolar disorder is distinguished from PPD in that it includes a hypomanic or manic episode, which may include feelings of euphoria or agitation, decreased need for sleep, racing thoughts, increased productivity, speech, and energy. Hypomania lasts for up to 4 days and often improves functioning whereas in a full-blown manic episode functioning is impaired due to severity of symptoms and lasts at least 7 days and/or requires hospitalization. Like PPD, PPBD puts women at risk for suicide. Women who stop mood stabilizers due to pregnancy have a 2x greater likelihood of reoccurrence postpartum.

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Postpartum Psychosis (PPP)

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Postpartum psychosis is a very rare (it occurs in 1-2 in 1,000 women), but very serious condition in which mothers have delusions and hallucinations sometimes putting their infants at risk. The onset is usually sudden and typically occurs within the first 2-4 weeks postpartum. Risk factors include a personal or family history of bipolar disorder or psychosis as well as sleep deprivation. Symptoms include hallucinations (e.g., seeing, smelling, tasting, or hearing things that are not present) and delusions (e.g., false beliefs), disorganized thoughts and speech (e.g., difficulty making sense of thoughts and communicating clearly), and odd, bizarre, or inappropriate behavior (e.g., talking to oneself without awareness). Whereas in postpartum OCD parent recognize that their thoughts are unhealthy and often experience distress as a result of their intrusive, unwanted thoughts, in PPP mothers may not have this awareness or alarm. Additionally, whereas in postpartum OCD mothers take steps to protect or safeguard their infants, in PPP women might act on them. Of those with PPP, 5% die by suicide and 4.5% commit infanticide. For this reason, PPP is a medical emergency. If you are experiencing symptoms or have a partner or loved one who is experience symptoms, please call 911 or go to the nearest ER. 

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Breastfeeding & D-MER

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Breastfeeding is a complex issue in that it can be a protective factor from PMADs with women who are exclusively breastfeeding being less likely to be depressed. However, it can also be a stressor for women. When women find themselves struggling to breastfeed, for whatever reason (trouble latching, pain, low supply), choosing to discontinue can be followed by feelings of guilt and shame. Conversely, women may find that they want to continue to breastfeed, but are lacking the support needed to do so. PMADs can also interfere with breastfeeding. For example, there is a phenomenon known as D-MER or dysphoric milk ejection reflex, which impacts up to 9% of women, that results in an intense wave of negative emotions just before milk is released, which can make breastfeeding an emotionally difficult process.

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