Perinatal Mood and Anxiety Disorders (PMADs)

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Perinatal Mood and Anxiety Disorders
(PMADs)
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Outline

• PMADs Overview
• Risk Factors
• Types
• Impact
• Building Counseling Skills to Support Families
• Considerations
• Conversation tips
• Sharing Resources Information
• Support for moms emotional health

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Objectives

• Staff will identify 3 types of PMADs and their
  symptoms.
• Staff will identify 2 ways in which PMADs impact
  pregnancy, birth outcomes, and the postpartum
  period.
• Staff will describe 2 strategies to integrate the
  subject of maternal mental health into their work
  with women.
• Staff will list 2 resources to support WIC
  participants who have or are at risk for
  perinatal mental health concerns.

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PMAD Overview

• Why do we say Perinatal Mood Disorders and not
  just Postpartum Depression?
• Can occur during pregnancy
• Can occur after pregnancy loss
• Can occur up to one year postpartum
• Why do we say Mood Anxiety Disorders and not
  just Depression?
• Anxiety is a common characteristic
• Sometimes women are more anxious than depressed
• Depression is a separate illness

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• What is the difference between PMADs and Baby
  Blues?
• Baby Blues are short term. Many new moms feel
  weepy and anxious during the first few weeks
  after giving birth.
• Baby Blues goes away with rest, support and
  time.
• The symptoms of Baby Blues rarely get in the
  way of daily life or need intervention from a
  medical provider

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Risk Factors for PMADs

• Previous perinatal mood disorder
• History of mood disorders
• Sensitivity to hormonal changes
• Poverty
• Low social support
• Under age 18

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Risk Factor Check List From Oregon Prenatal and
Newborn Handbook

• Check the statements that are true for you
• Its hard for me to ask for help.
• Ive had trouble with hormones and moods,
  especially before my period.
• I was depressed or anxious after my last baby or
  during my pregnancy.
• Ive been depressed or anxious in the past.
• My mother, sister, or aunt was depressed after
  her baby was born.
• Sometimes I dont need to sleep, have lots of
  ideas and its hard to slow down.
• My family is far away and I dont have many
  friends nearby.
• I dont have the money, food or housing I need.
• If you checked three or more boxes, you are more
  likely to have depression or anxiety after your
  baby is born (postpartum depression).

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Multiple causes influence each other
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Types of PMADs

• Prenatal depression or anxiety
• Postpartum depression (PPD)
• Postpartum anxiety or panic disorder
• Postpartum obsessive-compulsive disorder (OCD)
• Postpartum Psychosis

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Prenatal Depression or Anxiety
Prenatal Depression I am going to act as
though everything is fine but I am terrified of
what lies ahead.
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Postpartum Depression (PPD)
Incidence Overall 13.6 Teen Moms 26 Moms of
Multiples 25 Adoptive Moms 8
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Postpartum Anxiety or Panic Disorder
I finally told my husband that he and my
daughter would be better off without methat I
was not a good mother or wife. I felt like
things were never going to get betterthat I
would never feel happy again.
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Postpartum Obsessive-Compulsive Disorder
PMADs can be present in any family. Existing
mental health issues can be intensified with
pregnancy and delivery.
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Postpartum Psychosis
Depression doesnt turn into psychosis.
Psychosis is a real break from reality and
becomes a medical emergency Incidence of
Postpartum Psychosis 0.1 to 0.2
My children weren't righteous. They stumbled
because I was evil. The way I was raising them
they could never be saved. They were doomed to
perish in the fires of hell.
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Impact of Untreated Perinatal Mood Disorders
In Oregon, one in four new moms reports feeling
depressed or anxious during or after pregnancy
(PRAMS study)
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Pregnancy Complications

• Inadequate Prenatal Care
• Poor Nutrition
• Fears of Childbirth
• Risk of Substance Abuse

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Birth Complications

• Premature Labor
• Low Birth Weight
• Maternal Hypertension
• Increased Rates of Miscarriage

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Postpartum Impacts

• Impaired mother-infant bonding, moms avoid
  connecting
• Anxious mothering, moms can be over-sensitive and
  over-reactive
• Negative maternal identity and low self esteem,
  moms can be highly self critical
• Isolation from social support
• Increased family conflicts

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Effects on Toddlers and Older Children

• Symptoms mimic moms depressed behavior
• Higher risk for mood disorders
• Poor peer relationships
• Poor self-control
• Neurological delays
• Attention problems

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Building Counseling Skills to Support Families

• How can we help women when they dont know whats
  wrong?
• How do we reassure women when they are afraid to
  disclose that they need help?
• How can we reduce shame and normalize the new
  mothers need for support?

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Counseling Goals

• Utilize participant centered skills to create a
  safe, comfortable environment for conversation
• Integrate subject naturally
• Reduce fear of disclosure
• Encourage small action steps
• Support mother-baby
• bonding

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Counseling Considerations

• Primary focus on baby might miss moms distress
• If mom is depressed or anxious, usual suggestions
  for new moms might not work well
• Watch for signs that she is trying too hard to be
  agreeable or is overwhelmed
• Break down suggestions into
  small, achievable
  steps

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Picking Up On Cues

• Depression
• Withdrawn
• Distant
• Flatness of facial expression
• and voice
• Anxiety
• Repetitive fears and questions
• Over-protective
• Too well put-together

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Motherhood Myths

• Social myths about joyous and selfless motherhood
  make depressed and anxious moms feel worse.
• Moms feel guilty and embarrassed about the
  feelings and thoughts that arise with maternal
  depression and anxiety.
• Most depressed moms dont recognize that what
  they are feeling is depression they feel they
  are failing.
• Counselors are challenged to
  reduce shame and normalize
  new
  mothers need for support

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Conversation tips about motherhood myths

• Becoming a parent can be a tough transition. We
  talk to all our families about emotions and
  mental health. How you have been feeling?
• Lots of women tell us that being a new mom is
  harder than they expected. How has it been for
  you?
• You are not to blame for your feelings this is
  a normal part of becoming a mother for many
  women.

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Social Relationships

• Depressed and anxious moms are usually
  embarrassed and afraid of judgment.
• A depressed or anxious mom might appear to be
  okay, but is truly feeling insecure and upset.
  She is working very hard to look good.
• She needs reassurance that it is healthy to talk
  about difficulties and reach out for help.

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Conversation tips aboutsocial relationships

• What are your questions about emotions and
  mental health?
• It looks like youre taking good care of your
  baby. Motherhood can be hard work. How are you
  finding time to take care of yourself too?
• Thank you for telling me how youre doing. It is
  really healthy to speak up.
  Have you told anyone else
  how you are
  feeling?

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Attachment and Bonding

• Bonding difficulties
• Moms might appear distant, over-anxious,
  controlling,
• Moms might express negative perceptions of baby
• Little physical contact or tentative/insecure
  contact
• Mom might perceive herself negatively
• Its important to objectively assess mom and baby
  interactions
• Mom might just be tired!

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Conversation tips about attachment and bonding

• Oh, look how that baby looks at you when s/he
  hears your voice.
• How are you feeling when you're with your baby?
  
• What questions do you have about ways to connect
  or play with your baby?

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Importance of Self-Care Strategies

• Moms need both support and self-care
• Self-care is essential to health and recovery
• How do we help a depressed parent feel empowered
  to initiate change?
• What are some supportive ways we can help a mom
  put herself on her list of priorities?

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Examples of Self-Care Strategies

• supportive relationships
• peer support
• healthy nutrition
• physical activity
• sleep/rest
• taking breaks
• positive coping strategies
• stress-reduction techniques
• reaching out for help (practical and supportive)

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Conversation tips aboutsmall steps toward
healthy goals

• Remember that you will feel better, one step at
  a time. It helps to start with small steps, and
  build from there.
• Yes, they say what you need to do but they might
  forget how hard it can be to get going. Some moms
  find it helpful to start small. For example, if
  you wanted to exercise more, you can just step
  outside for a few minutes each day, then you can
  add a little walk, then build up from there

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Helping Mom Reach Out

• Listen without judgment
• Encourage or help her talk to her healthcare and
  mental health provider
• She can reach out to resources for any question
  related to support/stress during or after
  pregnancy. No diagnosis is needed to seek help
• Help her find Oregon support at
  www.postpartum.net/get-help
• Encourage or help her call the Support Warmline
• Offer referral to a public health nurse

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Sharing Resources Information

• What is your role in sharing resources?
• Practicing PCE skills
• Use Active Listening Skills
• Normalize the subject
• Find out what she already knows
• Avoid judgment
• Offer menu of options for follow up
• Share resources and offer referrals

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Oregon Resources

• Postpartum Support International, Oregon
• 1-800-944-4PPD (800-944-4773)
• English Spanish
• Telephone Help Line for support resources
• Connects with support volunteers
• www.postpartum.net
• Oregon Health Authority Website
• www.healthoregon.org/perinatalmentalhealth
• 211

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Parent Education Materials

• OHA Website www.healthoregon.org/perinatalmentalhe
  alth
• Parent Brochure from OHA
• HRSA brochure in English and Spanish
• (Health Resources and Services Administration)
• http//mchb.hrsa.gov/pregnancyandbeyond/depression
  /morethanblues.htm

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Online Resources for Families

• www.postpartumprogress.com
• www.ppdsupportpage.com
• www.mededppd.org/mothers
• www.postpartumdads.org
• www.postpartum.net

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Emergency Resources

• In an emergency, call 911 or go to your nearest
  emergency room
• Local or Regional Mental Health Crisis Hotlines
• National Suicide Hotline
• 1-800-273-TALK (800-273-8255)

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Food for Thought

• If you were a depressed or anxious mom, what
  would you want the WIC staff to say? How should
  they say it? What would you want them to ask?
• What resources in our community might be the most
  helpful to WIC moms with perinatal depression and
  anxiety?
• What other questions do you have about PMADs?
  Your state nutrition consultant can be a
  resource.

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This presentation is based on work done by

• Perinatal Mood Disorders TrainerWendy N. Davis,
  PhDPostpartum Support International, Executive
  Directorwdavis_at_postpartum.net 503-246-0941