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Ask the Doula Featured Article: A complete spectrum of perinatal mood disorders can occur during pregnancy and up to one year postpartum. These mood disorders like any other illness can occur no matter how old you are, what race you are or how much money you have. We have all seen Brooke Shields bear her soul, Maria Osmond follow suit, and the sad tribulations of Brittney Spears. The stigma associated with perinatal mood disorders needs to be erased to allow us, as a community, to support mothers through this immense transition in life. The following courageous and generous women shared their stories to help me to introduce you to some of the mood disorders. Sarah Fields of Hobart, Indiana asked her neighbor to leave her house convinced she was trying to kidnap her children and make them part of a cult. Sarah accused her husband of having affairs with all of her friends. Sarah called the police, insisting she was guilty of murdering her grandmother who was alive. Sarah wandered the highway in sub-freezing temperatures with no coat, seeking rescue from a cult. Sarah was hospitalized with Postpartum Psychosis. Postpartum psychosis occurs in 1/2000 births with an onset that usually begins within days of the birth. This disorder has a 5 % suicide rate and a 4% infanticide rate. Risk factors include a personal or family history of psychosis, bipolar disorder or schizophrenia. Symptoms include visual or auditory hallucinations and/ or delusional thinking. Andrea Arleth-Bewley of Berlin, NJ experienced a short stint with Postpartum Depression (PPD) after the birth of her twins. Andrea had delivered the first twin vaginally, but the second twin came via cesarean. With a challenging cesarean recovery, a series of social and medical stressors, less than a month later, Andrea was experiencing classic signs and symptoms of PPD. Andrea contacted her OB for help and immediately received a supportive prescription of Zoloft. She returned to work within 5 weeks and after 10 weeks was able to stop Zoloft with no remission. Holly Flemming of Quincy, MA had a family and personal history with PPD. Immediately following birth, Holly could not sleep, eat or make the simplest decisions. Holly was afraid to be alone, filled with anxiety, thoughts of suicide and thoughts of hurting her own child. Holly, like many women, was too ashamed to reach out to the medical community, so she remained isolated for six months. Fortunately, Holly found it safe to open up to her best friend, who had the insight to direct Holly to a therapist. Holly was admitted to a psychiatric hospital for three weeks. With the continued support of her friend and husband, she weathered the long road to recovery. Brenna Pearce of South Seaville, NJ had dreamed of being a mother her entire life. With the birth of her son, she was filled with Anxiety. After bringing her son home, Brenna had a fear of being left alone and making simple decisions was a challenge. She cried a great deal, had no appetite, and encountered relentless insomnia as the anxiety continued. When Brenna's mother in law came to take her son so she could rest, she secretly wished that her mother in law would take him forever as she saw that as her only way out of her state of misery. After several days of unremitting insomnia, Brenna's mother took her to the OB who prescribed Zoloft for depression, Xanax for anxiety and Ambien for sleep. Brenna felt that knowing that there was a light at the end of the tunnel and living each day in 10 minute segments helped as well. Within 6 months, Brenna began to feel like herself again. Depression and anxiety occurs in 15-20% of mothers. PPD is the most commonly reported postpartum mood disorder. The onset is usually gradual but can be rapid and begin anytime within the first year postpartum. Some risk factors include a personal or family history of depression or anxiety, abrupt weaning, social isolation and lack of support, mood changes with birth control pills, and thyroid dysfunction. See side bar for a listing of symptoms. Krystina Poor of Orlando, FL suffered from Postpartum Obsessive Compulsive Disorder (OCD) after the birth of her third child. Krystina had a strong family history of OCD. Krystina's OCD was triggered by a television crime show that instigated her battle with horrific mental images and thoughts of harming her own children. Images of stabbing them, pushing them down the stairs, or drowning them, would torment her daily. To distract herself from the images and thoughts, Krystina kept herself surrounded by supportive friends and family. She took advantage of their support to rest and had her husband hide all the knives in the house. Krystina found spiritual support through her faith. A prescription of Zoloft and avoiding triggers has helped Krystina tremendously. Obsessive Compulsive Disorder (OCD) occurs in 3-5% of new mothers. The main risk factor is a family history of OCD. Symptoms specific to OCD include intrusive, repetitive, and persistent thoughts or mental pictures often about hurting or killing the baby resulting in a tremendous sense of horror and disgust. These thoughts may be accompanied by behaviors to reduce the anxiety (hiding knives), and counting, checking, cleaning or other repetitive behaviors are used to help reduce anxiety. Adrienne Oleck of Maryland suffered from Post Traumatic Stress Disorder (PTSD) after the traumatic birth of her daughter. Adrienne nearly died in the process of enduring two postpartum hemorrhages and two surgeries in the first 4 weeks of her daughter's birth. With cognitive talk therapy, medication and EMDR therapy, Adrienne began her long and arduous healing process, which she believes includes the entire family, not just the new mother. Info on EMDR therapy can be found at www.emdr.com. PTSD presents with recurrent nightmares, extreme anxiety, and the reliving of past traumatic events such as sexual, physical and emotional abuse as well as a traumatic birth experience. Self Help Tips It is imperative to get an adequate amount of rest, as sleep deprivation seems to play an integral role in the development of postpartum depression. Exercise by taking the baby for a stroll. Ensure ample nutrition including 3 meals per day and increase your water intake. Be sure to carve out "me" time to recharge. Open up and talk to your partner, family and friends about how you may be feeling. If you feel you need outside support, seek out support groups online or offline, request help with childcare, cleaning, cooking, household chores and errands from family, friends or look into postpartum doula care. Although it is hard to do for most women, please know that it is ok to feel overwhelmed and to ask for help. You don't have to be alone, and you don't have to be super mom. Avoid being alone for extended periods of time. To help with the mental disorganization and difficulty making decisions, set simple goals for yourself and applaud your small accomplishments. Consider journaling to write down your emotions. If you have tried everything and you still don't feel quite right, reach out to your OB or Midwife, who may make the referral to a mental health provider who specializes in perinatal mood disorders. Successful Treatment Options Alexis Menken, NJ Coordinator/presidential Advisory Council Member for Postpartum Support International, has a psychology practice in northern NJ with 95% of the emphasis on reproductive mental health. Dr. Menken believes that the best approach for treating a mood disorder is psychotherapy with medication, but she also believes that different people response to different types of therapy. Most women she works with stabilize within 3 months. When asked what she thinks these mothers need most, she replied SUPPORT. Pampered Pregger and Beyond, a member of Postpartum Support International offers support, through Buoy for Perinatal Blues Blog, Peer E-mail support, and online & offline support groups. |
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Tiffani
Lawton, RN, Antepartum & Postpartum Doula writes for The
Parent Station. 
