Perinatal mood and anxiety disorders (PMADs) are a set of mental health disorders specific to women in their childbearing years that occur during pregnancy or in the year following giving birth. Though commonly referred to as “postpartum depression,” PMADs include both depression and anxiety disorders and are strongly related to poor maternal and infant health outcomes, calling for consistent screening, education, and treatment.1
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What Are Perinatal Mood & Anxiety Disorders (PMADs)?
Perinatal mood & anxiety disorders (PMADs) are a group of disorders with symptoms that affect women during pregnancy and after childbirth. They occur in about 15-20% of the population, and rates of PMADs in mothers who experience stillbirth or infant loss are higher.4 Concern exists that these numbers are higher still in vulnerable populations.2
Baby Blues vs. PMADs
While “baby blues” is a common occurrence in women who have recently given birth, and it’s normal for women to feel highly emotional or experience postpartum anger, PMAD’s endure longer than two weeks and cause impaired daily functioning.3
6 Types of Perinatal Mood & Anxiety Disorders (PMADS)
Types of PMADs include postpartum depression, postpartum anxiety, postpartum OCD, postpartum psychosis, bipolar mood disorder, and postpartum PTSD.5
Here are the six types of PMADs:
1. Postpartum Depression
Postpartum depression can occur during or after pregnancy and is characterized by persistent low mood, grief, or sadness, and can often be accompanied by postpartum rage. Depression while pregnant may manifest as a lack of joy about becoming a mom or a sense of dread about motherhood, whereas peripartum depression is often characterized by intense grief of how one’s life is different after giving birth.
2. Postpartum Anxiety
Postpartum anxiety can occur during or following birth and is characterized by excessive worry and rumination about the birth process (if one is experiencing anxiety while pregnant) or the baby’s health and well-being after giving birth.
3. Postpartum OCD
Postpartum OCD consists of intrusive or obsessive thoughts, compulsions, or images related to the harm or injury of a child. This can cause great discomfort and shame for the person experiencing it.
4. Postpartum Psychosis
Postpartum psychosis, in which a mother has delusions, hallucinations, or extreme thoughts or beliefs about her baby, will normally occur within the first two weeks after birth and can present similarly to postpartum OCD, but with far more severe symptoms. This disorder should be taken extremely seriously.
5. Bipolar Mood Disorders
Bipolar disorders are characterized by a vacillation between highs and lows with symptoms resembling extreme anxiety one minute and depression the next. Bipolar I has a greater degree of mania (high or anxious mood), whereas bipolar II is characterized by longer periods of hypomania (low mood).
6. Postpartum PTSD
Postpartum post-traumatic stress disorder (PTSD) can occur in mothers who did not experience a birth trauma, but is far more common in women who suffered the traumatic birth of a child or who are dealing with perinatal loss, including miscarriage or stillbirth. PTSD can occur anytime one experiences the fear that one’s life (or the life of their baby) is in jeopardy.
What Causes PMADs?
A complex series of physical and environmental changes can cause PMADs. During and after pregnancy, a rapid shift in sex and stress hormones can affect someone’s mental health. Additionally, the changes to sleep, relationships, work, and financial status can trigger increased stress, which may result in developing a PMAD.9
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9 Ways to Cope With PMADs
If you’re concerned that you may be suffering from a PMAD, it’s always advisable to reach out to your doctor or midwife so they can help you explore next steps regarding therapy options, support groups, or anxiety medication during pregnancy. A qualified medical professional can also help as it relates to coping with stress during pregnancy and establish a plan for support after giving birth.
Here are nine ways to cope with PMADs:
1. Create an After-birth Plan
Before you even conceive, put a plan in place that details who will help you, who can offer you direct and honest feedback, and what your boundaries are for visiting, meal training, etc. during pregnancy and after birth. Many women put a lot of time and energy into a birth plan, but after-care is just as important if not even more so.
2. Have a Mental Health Consultation Before You Need it
One of the greatest risk factors for developing a PMAD is any kind of preexisting mental health concern. Women who have experienced depression or anxiety prior to pregnancy are more likely to experience a PMAD.6 Prior to conceiving, consult your care provider, like your doctor, therapist, or midwife, about risk factors and discuss options for identifying and treating any potential maternal mental health issues.
3. Exercise & Focus On Nutrition
Focusing on eating well and exercise can help regulate your hormones and neurotransmitters, especially with the other changes in the body. Exploring these coping skills can help boost your energy and happiness, and help regulate your sleep.
4. Befriend Self-Compassion
Data shows that embracing mindfulness-based self-compassion is a coping strategy that attenuates the risk of postpartum depression or other PMADs.7 Because becoming a parent is one of the biggest stressors, embracing an attitude of compassion and grace toward oneself is helpful. Through this, you’ll find yourself more able to forgive yourself for mom guilt and other negative feelings related to motherhood.
5. Accept & Offer Peer Support
Accessing support from peers during pregnancy and in the postpartum period has been shown to alleviate symptoms related to postpartum anxiety.8 Peer support can both provide education within communities and give women a safe place to discuss fears and challenges related to birth and caregiving.
6. Designate a Partner or Trusted Friend to Give You Honest Feedback
Because the time period after giving birth can be blurry at best, many women struggle to see their own emotional struggles. During early pregnancy, request that a very honest (or even blunt) person in your life give you feedback if they see that you seem distressed or are “not acting like yourself.” These crucial observations can be critical to timely intervention.
7. Employ Relaxation Techniques Early & Often
Due to the emotional and physical toll pregnancy and birth can take on the mind and body, it’s important to find daily ways to engage in relaxation. Whether it’s meditation, yoga, cuddling with a pet, journaling, or drinking a cup of tea.
8. Do a Daily Self Check-In
PMADs can spin out of control quickly, so make time to check in with yourself at least once a day. Ask yourself the simple question, “What do I need right now?” If your answers are out of character, negative, or frightening, be honest with yourself and share these observations with someone close to you or a medical provider.
9. As Much as Possible, Prioritize Sleep Hygiene
Though sleep can be extremely difficult with a newborn, mental health disorders are exacerbated by lack of sleep. As much as possible, sleep when there are windows of time when you can safely do so, such as when help is available or when your newborn is sleeping.
Treatment of PMADs
Because PMADs are a relatively new area of focus in mental health, access to appropriately trained providers may be limited, but it’s rapidly expanding. Ask your physician, midwife, or child’s pediatrician about PMADs. They can connect you with a therapist and/or psychiatrist who is trained in perinatal mental health and able to discuss best therapy options and medications, including which antidepressants are safe during pregnancy.
Common therapies for treatment of PMADs include cognitive behavioral therapy (CBT) and mindfulness-based therapies such as those that employ self-compassion.
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Final Thoughts On PMADs
PMADs are serious and can be extremely frightening for a new mother and their family. Fortunately, there are methods of treatment and modes of support for both mother and newborn. When recognized and caught early, PMADs are highly treatable mental health disorders that shouldn’t hold you back from having a healthy and connected relationship with your baby.
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Perinatal Mood & Anxiety Disorders (PMADs) Infographics
