When she was pregnant, Jen had researched PEPS and signed up. When Jen finally had her baby, however, she called PEPS to cancel.
While postpartum mood and anxiety disorder are very common, affecting 1 in 5 new moms, many women without a mental health history are completely unprepared for this postpartum complication. Jen said there were signs leading up to what happened postpartum, but that she didn’t see them at the time. After all, she was a new mom, and was focusing on the basics: coping with sleepless nights, a newborn who wanted to breastfeed around the clock, and the other demands of newborn care.
Professionals working in perinatal mental health always tell women that sleep and support are crucial in helping prevent mood and anxiety symptoms in the postpartum period. Fortunately, Seattle has a lot of support groups to help new moms adjust to the transition to motherhood.
Given all of the changes that come with having a baby; lack of sleep, difficulty finding time to eat, feeling exhausted and overwhelmed, many women commonly don’t recognize underlying mood and anxiety symptoms that if identified, can be treated. Unfortunately, lack of knowledge, the pressure be perfect, and lack of providers often make it even more difficult for women to access care.
There was a day when Jen could not get up. She knew she could not care for her son. She called a friend out of state, confessed that she couldn’t get out of bed and care for her son. The friend asked if she could call 911 and get Jen some immediate help.
The next couple of weeks passed for Jen and she relates that she doesn’t have a clear recollection of all that happened. It was in the ambulance to Swedish Ballard Behavioral Health Unit that Jen now realized that her perceptions of the world around her were altered. She was experiencing psychosis.
She was able to see a psychiatrist, who recognizing the severity of her symptoms was able to get her admitted for inpatient care. It turned out that Jen was suffering from an acute psychotic episode.
The pressure to breastfeed
Jen ended up being hospitalized at Ballard for about 10 days. The doctors she saw there prescribed a variety of medications to treat her symptoms. Since she was inpatient her son was not with her most of the time and she was unable to breastfeed her son on a regular basis.
In retrospect, Jen was able to identify multiple factors that may have contributed to her symptoms. While breastfeeding has many advantages and can frequently help with bonding, the relentless pressure to breastfeed even when it is challenging, and frequently at the expense of sleep and self-care can also contribute to the development of or exacerbation of perinatal mood and anxiety disorders.
When she was back at home, her son did not want to breastfeed, working with lactation specialists at Swedish. “He cried profusely when I tried to breastfeed him and would not latch, but he accepted his bottle without hesitation. This was both somewhat of a relief and also very difficult for me. On the one hand, I no longer had to fear the endless feedings coupled with sleep deprivation, but on the other hand, I wanted that connection with him, and had been told so many times by lactation specialists and others that breast is best, though I later came to believe fed is best.”
Jen says that it is really easy to be judgmental of how a mom is feeding her baby, but “people often make assumptions and don’t know the experiences of others.”
Finding support
Following her admission at Ballard, Jen was referred to the Center for Perinatal Bonding and Support at Swedish, which offers individual and group therapy as part of a PHP (Partial Hospitalization Program). She received one-on-one support for a couple days until 2 other moms enrolled to the PHP, which is group based. More moms joined the following week and there were enough moms to form a group.
Moms who complete the PHP at the Center participate in a variety of group therapies, including cognitive therapy and dialectical therapy for mood and anxiety symptoms, and practice mindfulness, coping, and bonding skills before graduating from the program. They attend the program with their babies. At the tail end of her time in the program she mentioned PEPS and asked her group if they thought she should give a try, thinking that maybe she wasn’t ready. The group, who had gotten to know her through the course of the program, encouraged her to get more support through PEPS.
“Though I had made great progress, I was actually still struggling when I entered PEPS,” Jen says. At that point, Jen decided to participate in both daytime and evening groups. Although it was difficult, Jen says that she appreciated her PEPS experience.
Breaking silences
In light of her postpartum experience and struggles, Jen feels a responsibility to tell her story. She says lots of women don’t know about the range of postpartum mood and anxiety disorders and they don’t get support. “I feel there should be more dialogue and resources concerning perinatal conditions and experiences, both from experts in the field and from those who have personally experienced this as well as those who are close to those who have experienced a perinatal condition. While many women know of perinatal/postpartum depression, there is less knowledge regarding perinatal anxiety, OCD, and psychosis,” she says.
“I was ashamed for having all of the experiences and feelings I was having. I struggled with perfectionism and did not want to make any mistakes,” she says.
Of the range of postpartum mood and anxiety disorders, postpartum psychosis affects approximately 1% of women postpartum, and is a serious mental health complication of pregnancy. “It took me longer to come to grips with the psychosis diagnosis because it felt like a scarier diagnosis than perinatal depression and anxiety. I experienced shame and felt alone and did not yet understand perinatal psychosis,” Jen says.
It’s important to note that postpartum OCD, which is frequently marked by intrusive or scary thoughts about bad things happening to the baby and are very distressing to the women who have them, are not psychosis. In either case, however, evaluation and treatment are important.
Overall, 15-21% of women experience a mood disorder or anxiety during pregnancy or postpartum, which makes these conditions the #1 complication of pregnancy, exceeding preterm birth, gestational diabetes and maternal hypertension. Because these conditions frequently start during pregnancy and include not only mood, but also anxiety symptoms, they are now called perinatal mood and anxiety symptoms (PMADs) to accurately represent the timing and range. It is not uncommon for mothers to have more than one condition, such as perinatal depression and anxiety.
Having overcome postpartum psychosis, Jen’s hope is that if we can openly talk about difficult conditions in pregnancy and postpartum that this will decrease the shame associated with these conditions and allow more women to get help. She emphasizes it would be better to talk about this as a “condition” or “complication” associated with pregnancy and postpartum, rather than being called a mental illness. “I am actually not fond of the term “mental illness” and think “mental condition” makes more sense.” Frequently these symptoms are a temporary complication of pregnancy and early motherhood and not chronic.
She also emphasizes how important it is for women to talk about the range of their experience. “Perinatal mood and anxiety disorders are not talked about, or they are deemphasized with words like rare. But these illnesses are not uncommon and they deserve a platform.” Jen says that a lot of good can come from “being honest and breaking silences.”
Her frustration and her passion for change is inspiring.
Next steps
Jen later learned that the friend she had called for support had also experienced a perinatal mood and anxiety disorder. Unfortunately, she had suffered through that time on her own, with no treatment or support.
Jen says she knows that by breaking silences, she can help other new moms. Her group at Swedish continues to meet to support each other. Because her PEPS group recently ended, she has volunteered to host the first post-PEPS meet up.
Jen is a pseudonym used to protect the parent’s identity.
PEPS is so grateful to be able to share this story from Jen and to encourage all parents to seek support. Perinatal mood and anxiety disorders are some of the most common complications of pregnancy and respond well to a wide range of treatments.
PEPS would like to thank the staff at the Center for Perinatal Bonding and Support for their help providing context and expertise for this story.
RESOURCES
Swedish Center for Perinatal Bonding and Support
Perinatal Support Washington , including warm line at 1-888-404-7763 and local support group listings