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Dr. Mayo – Moms & Mental Health

Mental health should be a priority for moms.

 

by Dr Nicolle Mayo - January 24, 2018

Mental health should be a priority for moms. Unfortunately, a lot of time and sacrifice goes into taking care of kiddos, leaving mom fatigued and stressed to the max. Not only that, but a mom’s body chemistry literally changes, from the time she conceives to after birth, which can wreak havoc on her mental health. This time period is often when we see the rise in certain mental health disorders.

There are so many postpartum disorders that can occur after childbirth (though sometimes these begin during pregnancy, or even prior to that). Some of the most common disorders are postpartum depression, anxiety, and bipolar disorder, along with postpartum PTSD (post traumatic stress disorder), OCD (obsessive compulsive disorder), and the most rare, psychosis. Identifying and understanding these disorder symptoms are important for implementing earlier interventions. So, let’s talk about each one.

Postpartum depression (PPD) symptoms look a lot like major depressive disorder, though many of the symptoms focus on mom’s feelings of disconnect from her baby. Symptoms last two or more weeks, and can show up hours, days, weeks, or even months after giving birth. A mom with PPD usually has significant difficulty getting any sleep (she cannot go back to sleep after the baby wakes and feeds), or she sleeps the day away. Interests wane, and mom lacks the desire to bond with the baby; apathy is common. Guilt, hopelessness, worthlessness, feelings of regret towards being a mom, or even resentment towards the baby or spouse take over. Energy takes a downward spiral, and motivation to do anything declines significantly. Sometimes it takes everything for mom to just get out of bed in the morning. Concentration, focus, and remembering take a permanent hiatus. Mom feels like she can’t do or finish anything. To remember what she had for breakfast that morning seems like a chore (if she even ate breakfast). Appetite is either in full swing, where mom binge eats and adds significant weight gain, or she loses her appetite altogether, followed by rapid and drastic weight loss. She feels either extremely sluggish, with slow body movements, or constant restlessness; she can’t sit still. Sometimes, a mom might even have suicidal thoughts, wishing she wasn’t alive, having preoccupied thoughts of death, or worse, planning ways she could end her life. This last symptom is usually much less common, but still a possibility.

Postpartum anxiety (PPA) includes constant worry over how the baby is doing, whether he/she will get sick (a health focus is mostly common), whether he/ she is still breathing (will usually check on baby several times at night, even with no crying), or whether she is even capable of being a good mother to keep her baby healthy, happy, and safe. This responsibility seems so overwhelming it consumes the mom. Muscle tension takes a toll on her body. Nauseousness, headaches, hot flashes, and stomach pangs, are the rules rather than the exception. Racing thoughts consume mom’s mind as she thinks about all of the negative things that could happen to her child. She can’t stop these thoughts; they haunt her. Increased irritability towards the baby, spouse, or other loved ones is acted out on a regular basis. Mom often feels like she is out of control. Similar to depression, there is a sudden loss of energy, yet a lot of restlessness. Mom feels like she can’t stop doing things because she will continue ruminating (reflecting on negative thoughts). Moving and doing are mom’s ways of avoiding thinking and worry short-term. She can’t sleep. Mom can go through these symptoms for weeks, and even months.

Postpartum bipolar disorder (PPB) includes episodes of depression, noted above, and at least one week of mania symptoms. Depression and mania alternate inconsistently. One of the main symptoms of mania is either extreme euphoria (feeling really good), or extreme irritability and rage. Anger can easily overcome mom, sometimes it appears as if for no reason at all. Mom gets distracted easily, not able to finish a project. She forgets things often, feeling like her mind is running faster than she can keep up. Sometimes this results in excessive writing, also called hypergraphia, so that mom can get all of her great ideas out. Moms will often write their ideas and feelings on anything they can get their hands on, just so they don’t lose the thought (kleenex boxes, sanitary napkins, etc.) In this mode, mom mixes up the day, time, and events; everything seems like such a blur. Moms act impulsively, making emotional decisions, rather than thought out. As such, frequent and excessive shopping can be a regular part of mom’s day. There are so many great things to buy for her, for the kids, and deals that can’t be passed up. It is not unlikely that hundreds or even thousands of dollars are spent in one shopping trip or spree. Moms might also feel a greater sense of importance, like she is uncommonly unique. They might feels as though they are the best mom out there, and wonder why others don’t follow in her footsteps. Mom’s activity level grows leaps and bounds, so much that she does not need to sleep for days at a time. As a result, she might spend her normal sleeping hours cleaning or re-organizing, or starting new projects. Productivity is the name of the game, though projects tend to go unfinished. Her speech also follows suite, sounding pressured much of the time. It can be difficult to understand what a mother says because she talks so fast. Sometimes, feelings of paranoia or even psychosis can accompany other symptoms of mania. Moms can feel like everyone and everything is against them. This can perpetuate feeling alone, rejected, and isolated.

Postpartum obsessive-compulsive disorder (PPOCD) can include obsessions, compulsions, or both. Similar to general anxiety, moms have intruding thoughts about harm coming to their baby that either they, or someone else might inflict. These haunting thoughts occur 24/7; many moms report that they can’t turn off these thoughts. Watching violent or graphic movies, the news, or other intensified TV can also make these obsessions worse. Worrying about dropping the baby down the stairs, drowning their baby in the bathtub, falling off of the deck, or someone grabbing the baby from the backseat of the car while it is stopped at a red light can be terrifying to a mom. Germs that infest the local mail, or passers-by coming in contact with their baby might keep mom at home to preserve baby’s safety. Moms tend to know and understand that their thoughts are distorted. Nevertheless, they can’t shake them. To reduce their obsessions, moms might act on compulsions, or irresistible urges, to prevent any harm coming to their baby (which, by the way, 99% of mothers never act out on their obsessions; they just maintain the fear that they will). Compulsions make take the form of checking (looking on the baby to make sure he or she is still alive during nap or night time sleep), cleaning (washing hands several times under scolding hot water until they are cracked and bleeding to prevent germ transfer), counting (counting the number of times a baby is pat on the back to burp them), etc. Compulsions reduce obsessive fears and anxiety short-term, until the next obsession enters her mind. The cycle continues.

Postpartum PTSD is based on a real or perceived threat (trauma). Trauma is, in and of itself, subjective. In other words, what one person perceives as traumatic, another person might not. Trauma tends to occur during the child birthing process. Whether a mom experiences a prolapsed cord, an unplanned C-section, use of forceps to retrieve the baby, feels as though her medical team is unsupportive, feels powerless, experiences poor communication or severe physical complication or injury, many scenarios can run the gamut of trauma. Within a month or more, moms start to re-experience this trauma through uncontrollable and intrusive flashbacks or nightmares. As a result, moms usually try to avoid any thoughts, feelings, people or situations that trigger flashbacks. Because these triggers cause a lot of anxiety or even panic attacks when mom leaves the home, moms might even develop agoraphobia, or the fear of places or situations that might cause panic, helplessness or embarrassment. Resultantly, she might never leave the house. Moms frequently feel detached from themselves or even reality, like they are living in a daze. They constantly feel irritable, and startle easily. Moms will report having a hard time just functioning in general. They feel so disconnected from other people; irritability becomes their baseline. They appear cold sometimes, aloof. They have a hard time trusting others.

Psychosis, as mentioned earlier, is usually pretty rare. Though if it occurs, usually the time frame is within the first two weeks after birth. Women 35 years or older have an increased risk for developing after childbirth. Moms experience delusions, or strange beliefs, that they are unique or a special entity on the earth to complete a mission. Moms also tend to feel very connected to the natural world, as though the news, magazines or any one they meet on the street has a message directed at them. Auditory and visual hallucinations (hearing or seeing things that aren’t there) can overcome mom’s reality. She feels paranoid, or suspicious of others’ motives, thus increasing her irritability and mood swings. Moms tend to sleep less because they don’t feel as though they need the sleep. Communicating with others is difficult because of mom’s irrational statements, confusion, incoherence, and memory loss. Sometimes in their frenzy, moms can act in ways that post significant dangers to themselves or others. If you are familiar with the Andrea Yates case in the early 2000s, this gives a flavor to experienced psychosis dangers. Thankfully, only 1 to 2 out of 1,000 deliveries results in psychosis, but it is still important to be aware of for moms.

For each and any of these disorders, it is so important for a mother to receive support. If it is in the form of calling 911 because she is in danger of hurting herself, others, or experiencing psychosis, we need to verify the safety of the mom and others. Otherwise, a careful listening ear along with genuine validation and understanding without adding unsolicited advice or judgment is crucial. Sharing parts of our own story can add validation, as long as we are not overpowering the conversation. The story should be coming from the mom so she can process what she is going through. Talking out loud to someone who can relate, who asks questions out of curiosity and care, can be relieving. Providing support in a helpful way, physically, verbally, in whatever ways the mom requests can help her feel as though she isn’t alone. Taking this all in one moment at a time reminds the mom that she is okay in this very moment and time. Inquiring about current habits of coping and self-care also increases the mom’s awareness of what she needs to do to better to take care of herself. And if nothing else, there are several online supports that provide helpful information to supporting a mom in her post partum period, like this one: http://www.postpartum.net/get-help/help-for-moms/. Help a mom who needs support to get in touch with others who can help.

Credits:

Idea/Concept: Dr Nicolle Mayo

Videography: Tim Crane

Video Editing: Tim Crane

Writing: Dr Nicolle Mayo

 

Produced by Vogt Media

Funded by UPMC Susquehanna, First Citizens Community Bank

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