Building the Village: Protecting Maternal Mental Health During the Perinatal Period

IMPORTANT: This blog is not a substitute for therapy, but provides evidenced-based education for the purposes of self-help, or to compliment the therapeutic process. ​ ​This blog is non-monetized.

By: Julia D’Addurno, Registered Psychotherapist (Qualifying)

There is great emphasis put on physical healthcare for expectant mothers during the perinatal period, focused on achieving optimal health, assessing risks for the mother and the fetus, and treatment of health concerns as they emerge.

Mental and emotional wellbeing during this period of time is also essential for the overall healthy functioning of parents and their babies, however much less emphasis is placed on advocacy for perinatal mental health support, or treatment regarding birth trauma. 

Pregnancy and early parenthood can be a really exciting stage for families, but it can also be a challenging time due to the many personal and professional changes. Mental health is imperative to supporting a healthy perinatal period and transition into the maternal role. Therefore, it is important to educate families about the physiological, social and psychological changes and advocate for ways to address and protect perinatal mental health.

Many people are familiar with postpartum depression which refers to the period of time after the birth of a child, where new parents can experience depressive symptoms, also known as the “baby blues.” Many women experience the baby blues immediately after giving birth.

Now, there is a new overarching term to describe any mood or anxiety disorder that emerges during the perinatal period: Perinatal Mood and Anxiety Disorder (PMAD)

  • About 15% to 21% of pregnant women experience symptoms of PMAD, which can manifest as symptoms of depression, anxiety, obsessive compulsive disorder, post-traumatic stress disorder related to birth or infant health issues, bipolar disorders, and postpartum psychosis. 

What does it look like?

The new terminology extends beyond postpartum depression to encompass any of the difficulties surrounding birth that can be experienced by new mothers. This can occur during the preconception, prenatal, and postpartum period, and covers a wider range of symptomatology, rather than just depressive symptoms.

Common symptoms include:

  • crying more than usual,
  • increased anger and irritability,
  • withdrawing from loved ones,
  • feeling disconnected from your baby,
  • guilt about being a bad parent, and
  • loss of energy and hopelessness.

Increased stress, anxiety, and panic are also attributable to PMADs. New mothers may experience irrational thoughts and fears about their baby since early motherhood is a time of increased stress due to higher levels of cortisol (stress hormone) in the body. A new mother’s threat detection system heightens because infants are vulnerable and need protection, so mothers are primed to protect these helpless and dependent little humans. Therefore, postpartum anxiety is even more common due to this shift in the brain and the need to be on higher alert. 

In addition to all the hormonal and biological changes in pregnancy, new mothers are also struggling with the other transitions such as identity changes, physical body changes, social role shifts, and intimate relationship changes.

The added stressors of sleep deprivation and the unrealistic expectations of being a mother that are perpetuated by the media can be overwhelming and isolating. In addition to this, new parents may also experience elements of grief. With change always comes some type of loss and having a child is life changing.

​Even positive changes can bring moments of sadness. New parents may be struggling with the loss of their freedom, independence and may even feel regret, guilt and other conflicting feelings. New parents are dealing with several stressors internally and externally.

It’s important to normalize these experiences and not pathologize them.

Do you know the risks?

Because there are many known risk factors that can enhance the susceptibility of developing PMAD, it’s important to know and understand a pregnant woman’s history.

  • The prevalence of PMADs may be greater among racial and ethnic minority women and are more likely to go undetected.
  • A history of depression and anxiety or other mental illnesses,
  • Low socioeconomic status,
  • Exposure to interpersonal violence,
  • Past traumas and/or early childhood traumas,
  • Low marital satisfaction,
  • Lack of emotional and social support,Delivering a preterm baby,
  • An unwanted or mistimed pregnancy,
  • Difficulties with breastfeeding and
  • Financial strains of a new baby can also exacerbate symptoms.

Finally, many women (up to 9%) may experience postpartum PTSD from emotional, physical or psychological trauma during delivery which often goes mis or undiagnosed.  

Protection and prevention

One way to manage the difficulties of PMADs is to prevent symptoms from becoming unmanageable. Many new parents utilize a birth plan to ensure the birth of their child occurs smoothly, so they are prepared and know what to expect during the birthing process. What isn’t emphasized enough in preparing for parenthood, are postpartum plans.

A postpartum plan emphasizes prevention of PMADs by identifying supports before they are needed, identifying and managing unrealistic expectations, increasing awareness of one’s mental health and detecting signs of wellness and unwellness. 

A postpartum plan should include:

1. Knowing one’s own signs of unwellness: 

Everyone defines health and wellbeing differently. Understanding one’s own well-being and knowing when it is impaired is important for everyone, but especially new parents who are dealing with multiple stressors. Checking in with yourself and knowing the signs that your mental health is declining is important for knowing how to manage it and return to normal emotional and physiological functioning. Some signs of wellness include a balanced diet, good sleep hygiene, regular physical activity, and regular social interactions etc. An absence or reduction in any of these components could indicate the need for management and support. Having this dialogue with yourself and bringing it up to a support in your life can help address it before symptoms become severe. 

2. Attunement of self-care: 

Part of knowing the signs of wellness and unwellness is also knowing what is needed to address such concerns. Attunement to self-care needs is so important as a new parent. You can’t take care of someone else if you are not caring for yourself first. New mothers tend to put their own needs behind their family so ensuring there is time set aside for self-care is essential. Practicing healthy lifestyle habits and setting boundaries can help reduce stress and increase energy.

3. Identifying the different types of supports in your life: 

​New parents need different kinds of support to meet their various needs when navigating the challenges of parenthood.

  • Emotional supports are those who will meet the emotional needs and provide validation when having those bad days or feeling like a bad parent. Regardless of how complex or uncomplicated a woman’s pregnancy and childbirth was, it is important to be able to talk about feelings, concerns and fears. One way to find these supports is to pay attention to how these people respond when you seek emotional support. Do they dismiss and minimize any other feelings besides love and joy for your new child? Those people in your life may not be able to hold space for your emotional struggles but they can help you in other ways, and you can seek emotional support from a mental health professional like a therapist. 
  • Practical supports can help around the house with chores, help with cooking and cleaning, and groceries. These are the people who can help manage the various duties so that the new parents do not become overwhelmed and fall behind on their other responsibilities. 
  • Social supports are other parents, baby and mom groups that can help new parents navigate all the changes and normalize their experience. They can also be a source of community and belonging for the new parents and a place to learn and gain insight from others’ experiences. Social supports are associated with increased parental self-efficacy which decreases depressive and anxiety symptoms.
  • Professional information supports these supports include doctors, nurses, midwives, OBGYNs etc. These supports provide valid and accessible information when you need it, which can ease the stress of all the new encounters and questions new parents have about their child’s health and safety. 

It’s important when thinking about these supports in your life that you are able to advocate for yourself and ask these people for what you need. Learning to be vulnerable and asking for help is difficult. Acknowledging and accepting that you can’t do it all and need these various supports can relinquish any guilt you may be feeling about not being able to do it all (you don’t have to)!

4. Recognizing interpretations of motherhood and identifying unrealistic expectations: 

Many people have an inaccurate perception of what it means to have a new baby due to social media. Popular media and even friends and family tend to focus only on the joy, happiness and fulfilment of being a new parent, and may not talk about the stress and challenges that are involved, especially not those challenges that induce guilt and shame.  The problem with this is that this perception that you are doing something wrong or feeling something wrong can further increase guilt, isolation and suffering.

​If we can recognize that motherhood involves a wide range of emotions and experiences, and it’s okay to feel anything other than joy, we can support new moms through the difficult times. 

Untreated and under-recognized PMADs are a public health concern that can negatively impact families; it’s important to recognize it and know how to prevent it.

Persistent symptoms can result in inconsistent parenting and poor parent-child attunement, which can have negative effects on children’s social and emotional development, and impact the mother-child relationship. This may result in children who are less securely attached, which can lead to long-term behavioural issues among children, impact their relationships, and perpetuate the cycle of developmental and intergenerational trauma, which further increases risk of PMADs for the next generation.
 
As the old saying goes… “It takes a village to raise a child.”

Not only is it important to be able to detect the symptoms of PMADs, but we need to also encourage new parents, grandparents, aunts, uncles, and friends of new mothers to help build the village of support that new parents need, and in turn, support the development of healthier children, families and communities. 

Resources

  • Everyone on the DALD team offers free telephone consultations, to determine if we are a good fit for you. Check out the team bios and get the help you need today. ​
  • Check out our Resources page, including local community resources in Peel Region. 

More parenting articles from us:


​If you prefer talking to a human to help find the right therapist for you,
Call 905-584-8963,
or email admin@digalittledeeper.ca

You can expect a reply within 24-48 hours, Mon-Fri, during regular business hours.


References

Byrnes, L. (2018). Perinatal Mood and Anxiety Disorders. The Journal for Nurse Practitioners, 14(7), 507–513. doi:10.1016/j.nurpra.2018.03.010.

Douglas, J., Nagasawa, S. (Host). (2021, June 24). Perinatal Mood and Anxiety Disorders (No.7) [Audio Podcast episode]. In On Psych: Presented by the Ontario Psychological Association.

Long, M. M., Cramer, R. J., Jenkins, J., Bennington, L., & Paulson, J. F. (2018). A systematic review of interventions for healthcare professionals to improve screening and referral for perinatal mood and anxiety disorders. Archives of Women’s Mental Health. doi:10.1007/s00737-018-0876-4.

Share the Post:
Picture of Julia D'Addurno, H.BA, MACP

Julia D'Addurno, H.BA, MACP

Registered Psychotherapist (qualifying) Julia is a Registered Psychotherapist (qualifying) with Dig A Little Deeper and also completed her graduate training with us.  Julia completed a double major undergraduate degree in Psychology and Creative Writing, before enrolling in her Masters program to become a Psychotherapist, and enjoys using her creative skills to bring mental health awareness & healing to her readers.

Leave a Comment

Keep reading