Postpartum Mood & Anxiety Disorders (PMAD)

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This is the updated term for postpartum depression (PPD).  PMAD is a form of clinical depression or mental illness that can begin at any time after childbirth, from days to even years after in some cases.  PPD is not something that is anyone’s fault or that necessarily be controlled.  Between 3-24% of new mothers are afflicted, and up to 50% of male partners of women with PPD also experience PPD (Clinical Rounds, MCU Oct 2011).  Although hormone drops are often blamed, no causation has been proven.  PPD is more serious than postpartum blues; if the blues last longer than 2 weeks and aren’t resolved by rest and support then seek help.

Symptoms of PMAD include any of the following:  crying for no reason, inability to cope, feeling overwhelmed, sadness, anger, hopelessness, impaired memory or concentration, loss of interests, nightmares, bizarre / strange / intrusive thoughts, perceived or actual difficulties bonding with baby, feelings of resentment or aggression toward baby or family members, apathy toward baby, thoughts of suicide.  Call your midwife or health practitioner in case of any of these symptoms.

Risk Factors of PMAD

Note:  PMAD can hit any woman at any time postpartum – for no apparent reason.  However the following increase the risk.

  • Personal or family history of depression, related to birth or not
  • Traumatic birth
  • Pain
  • Fatigue
  • Inflammation
  • Low blood-iron levels
  • Twins or multiples
  • Being “run-down” e.g. fatigue, low blood sugar
  • Stress e.g. such as social, economic, relationship, health concerns, child-care issues
  • Lack of social support
  • Perceived or actual isolation
  • Formula feeding in place of breastfeeding
  • Cigarette smoking
  • Infant temperament
  • An affected partner

“Baby-blues” is a normal, natural emotional reaction to birth that last hours or a few days.  Symptoms are mild and transient and occur in 50-80% of new mothers around day 3, when your milk comes in.  You may experience tears, exhaustion, worry, irritability, and lack of confidence.  Mothers experiencing baby-blues need support, rest and care to prevent it from progressing to depression.  If it lasts longer then it’s prudent to follow the measures listed under “Prevention and Treatment Strategies.”

Postpartum psychosis is a rare but severe and sudden mental illness that requires immediate 911 medical attention.  Symptoms include those for PPD, plus some or all of the following:  refusal to eat, fatigue, frantic excessive energy, confusion, delusions, loss of memory, failure to recognize familiar people, visual or auditory hallucinations, irrational statements, distorted thinking, suicidal or infanticidal thoughts and behaviours.  Seek 911 medical help immediately.

Prevention and Treatment Strategies

Although there may be factors that can’t be controlled, the best defence against PMAD is a well supported, healthy mother.  There seem to be higher rates of PMAD in Western cultures, likely due to stress and isolation.  In almost every other culture, new mothers are surrounded by women and family to take care of them.  All they’re expected to do is rest, recover, breastfeed and bond with baby for the first 40 days.  In North America most new mothers are expected to take care of themselves, their baby, and the household; and of course entertain a steady stream of visitors who want to check out the baby.

  • Prevention starts during pregnancy
    • Learn as much as possible about birth, breastfeeding and life after baby
    • Arrange postpartum support to allow for rest and bonding i.e. circle of friends or family, postpartum doula, community resources
    • Learn to say no
    • Plan to do nothing for 8 weeks; have freezer full of healthy tasty prepped food, kitchen stoked with non-perishables, household items stocked, major home chores done, hire house-keeper, dog-walker etc, get groceries delivered
  • Early intervention leads to shorted duration
  • Limit visitors and length of visits!!! Have a visitor rule: everyone has to bring a healthy meal – fresh or frozen – and do a chore from a “to-do” list on your fridge.  Set a time limit.
  • Take one day at a time
  • Ask for help
  • Manage pain, even if that means taking pain meds while breastfeeding
  • Have and use a simple schedule, allowing for the unpredictability of newborns
  • Take it slow; re-enter world gently if hibernating with new baby (40 days highly recommended)
  • Adequate sleep; sleep when the baby sleeps
  • Breastfeed
    • Hormones of breastfeeding, prolactin and oxytocin, help reduce PPD
    • Several studies find breastfeeding mothers actually get more sleep on average than formula feeders
    • Benefits of breastfeeding for both mother and baby far outweigh any risk of anti-depressant drugs effecting baby
  • Do something that brings joy daily
  • Find a way to have a little time alone daily, including time to relax (meditation, rest, praying, reading – whatever’s rejuvenating)
  • Self-care e.g. shower, get dressed, eat, get out for walk
  • Healthy foods (see Postpartum Nutrition handout)
  • Ingesting placenta e.g. dry and encapsulate
  • Craniosacral therapy, especially in case of lost consciousness during birth process
  • Community support programs such as Y’s Moms and LaLecheLeague groups
  • Mental health professional, ideally one who specializes in postpartum mental health
  • For mild PMAD, take supplements of a fish oil high in EPA and St John’s Wort; can be taken with antidepressant medication; safe with breastfeeding
  • Psychiatric care may be required including antidepressant drugs, many are safe for breastfeeding
  • Many antipsychotic drugs are not recommended with breastfeeding, but there may be alternative schedules available for some women (e.g., taking high dose at night and then not using breastmilk until 8-12 hours later – do this only upon advise from psychiatrist, who will help determine safe dosages and timing on a case-by case basis)

Support Measures to Consider

  • Support with housework, meals, daily tasks from one with whom mother feels comfortable
  • Postpartum doula
  • Call midwife or health practitioner with any concerns or questions regarding blues or depression
  • Families Matter Postpartum Support 1-888-545-5177
  • Sask Health Link 811
  • Online support at Mothering Magazine’s Forum: mothering.com/community

What Partner Can Do

Be there. Be present and involved.  While PMAD affects the mother directly, it’s a family issue.  Partners can’t “fix” this, but can be supportive.

  • Call midwife or health practitioner right away with any concerns
  • Don’t wait for mother to reach out – find help for her
  • Remind partner that she’s loved and partner is there for her
  • This is no one’s fault – remain non-judgemental
  • If she cries just hug and hold – allow the tears
  • Remind mother to get fresh air or do something for herself daily.  Make it happen.
  • Do something as a family – take a walk, cuddle by the fire
  • Self-care as this is a difficult time for partners too.  New parenthood is an adjustment for both parents even without challenges such as PMAD.  Eat well, rest when possible, and get fresh air.
  • Remember anything that takes care of mother (food, chores etc) is also taking care of baby
  • If partner can’t be there and take care of food / home then arrange for people who can
  • Listen attentively – partner may be the only person she opens up to
  • Remind her that she’s not alone, this will get better and you’ll all get through together
  • Ask “what can I do” or “what do you need” rather than “do you need anything”
  • Point out triumphs such as growing a healthy baby, meeting with a counsellor
  • Guard the door – only supportive helpful visitors are allowed and only if mom truly has energy
  • Be open with those closest family / friends about what’s happening
  • Observe, as health practitioner will ask about patterns and behaviours
  • Be wary of partners mental health; up to 50% of male partners of women with PPD also experience PPD (Clinical Rounds, MCU Oct 2011)

For mild issues some women find just getting out for fresh air daily, or having a bath, time with girlfriends, a nap, or whatever their thing is, helps.

Local Resources

  • Healthline Phone (part of public health care) as they have the training to screen and refer now and alert crisis if needed (811 is the new number)
  • Smiling Mask www.thesmilingmask.com and/or book by Carla O’Reilly & Tania Bird (this is a brilliant resource started by 3 local Regina women who suffered from PPD)
  • Edinborough screening tool – self assessment.  This is now part of the EPDS Screening, available at http://skprevention.ca/?s=EPDS .  There’s some other good info on that page too.  Take this to a qualified care provider if you score in a range that needs to be addressed.  Do this test at regular intervals.
  • Marlene Harper (Private therapist) 306-584-2731, Regina (note i don’t know her personally but she comes recommended by other mamas)
  • Online Therapy – cognitive behavior treatment program for maternal depression (Pilot program; may or may not continue long term)
    • Includes 7 interactive evidence based modules
      Therapist-assisted via email and telephone
      Provided at no cost
      Inclusion criteria:  SK resident, > 18 years, minor-major depressive symptoms, have a child <1 year
      For more information or to refer:
      –Website: www.onlinetherapyuser.ca
      –Email: Nicole Pugh: pugh…@uregina.ca
      –Phone: (306) 585-5369; (306) 337-3331

Holistic helpers who may be able to offer help, and could certainly compliment any medical care.
Dr. Vanessa DiCicco, ND – http://wellfamily.ca/meet-nds/vanessa-dicicco/
Cheryl Lloyd, hypnotherapist www.tranquiljourneys.ca

Psych Unit at RGH
Visitors are welcome!

 

References

Calgary Health Region. (2007). From Here Through Maternity. Calgary: Alberta Health Services.

Corwin, E., Murray-Kolb, L., & Beard, J. (2003). Low Hemoglobin Level Is a Risk Factor for Postpartum Depression. The Journal of Nutrition , 133, 4139-42.

Kendall-Tacket, K. P. (2005). The Hidden Feelings of Motherhood (2nd ed.). Amarillo, TX: Pharmasoft Publishing, L.P.

Kendall-Tackett, K. (2010, Aug). Nighttime Breastfeeding and Maternal Mental Health. Retrieved Sep 2011, from Science & Sensibility: http://www.scienceandsensibility.org/?p=1398

La Leche League Canada Health Professional Seminar, Calgary AB.  Preserving the Simplicity of Breastfeeding in a Complex World: a Paradigm for Depression, Stress and Postpartum Healing. 1 day seminar; Dr. Kathleen Kendall-Tackett.  2008.

Lim, R. (2001). After the Baby’s Birth – A Complete Guide for Postpartum Women (Revised). Toronto: Celestial Arts.

Sarah Breese McCoy,  J. Martin Beal, Stacia Miller-Shipman, Mark Payton, Gary Watson. (2006). Risk Factors for Postpartum Depression: A Retrospective Investigation at 4-Weeks Postnatal and a Review of the Literature. Journal of the American Osteopathic Association , 106 (4), 193-198.

The Mother Reach coalition . (n.d.). Postpartum Mood Disorder . Retrieved Sep 2011, from Mother Reach: http://www.helpformom.ca/

Varney, H., Kriebs, J. M., Gegor, C. L. (2004). Varney’s Midwifery, 4th Ed. Toronto: Jones and Bartlett Publishers.