World Maternal Mental Health Awareness Day, May 3
RCC Nursing faculty Kimberly Polley, BSN, RNC-OB, PMH-C, recognizes the importance of Maternal Mental Health Awareness and wrote a paper, “Perinatal Mood and Anxiety Disorders: SWRMC Brings Awareness and Support to Maternal Mental Health” published in Sentara’s monthly newsletter. Read the paper below or download at Perinatal Mood and Anxiety Disorders
Perinatal Mood and Anxiety Disorders:
SWRMC Brings Awareness and Support to Maternal Mental Health
Kimberly Polley BSN, RNC-OB, PMH-C
Sentara Williamsburg Regional Medical Center
May 3rd 2023 is recognized around the world as Maternal Mental Health Day. It is a day meant to bring global awareness to the mental health concerns of women and their families. The hope is that increasing global awareness will decrease negative stigma surrounding maternal mental illness, improve quality of care for women experiencing perinatal mood and anxiety disorders (PMADs), and prevent tragic, long-term consequences to mothers and their families (Postpartum Support International, 2023). This article aims to do the same. Information within this article will help Sentara employees understand the difference between baby blues and PMADs, identify risk factors for developing PMADS, recognize consequences of PMADS, and highlight Sentara Williamsburg Regional Medical Center’s (SWRMC’s) role in improving health outcomes for our mothers and their families.
The perinatal period, defined in relation to maternal mental health, is the period during pregnancy and continues through the first year following birth (Maternal Mental Health Alliance, 2023). Most people associate the perinatal period as a time of joy and happiness. This may be true for many women and men but for others this major, life-changing event can be stressful. This, combined with the many physical and emotional changes that occur during and after pregnancy, can put women and men at risk for perinatal mood and anxiety disorders (Alba, 2021).
Baby blues, experienced by as many as 80% of women following the birth of a child, is not considered a mood disorder. It is commonly referred to as “normal adjustment” in relation to the substantial physiologic/hormonal changes that occur after delivery (Postpartum Support Virginia, 2023). Symptoms can begin 2-3 days after birth, peak around 5 days, and last up to 2 weeks. These symptoms include feeling overwhelmed, sad, anxious, exhausted, irritable, and often crying for no clear reason. These symptoms may come and go, but do not last longer than 2 weeks. They require support and reassurance from healthcare providers, family, and friends, but do not require medical treatment (Beck, 2006).
In contrast, perinatal mood and anxiety disorders cause intense feelings of sadness, anxiety, hopelessness, guilt, shame, or despair that prevent or limit people from accomplishing simple daily life tasks. This group of mood disorders includes: perinatal depression, perinatal anxiety, perinatal panic disorder, perinatal obsessive compulsive disorder, postpartum post-traumatic stress disorder, bipolar disorders, and perinatal postpartum psychosis. Women experiencing PMADs may feel insecure, overwhelmed, and like things are not going to get better. Mothers may have trouble sleeping, regret having a baby, lack interest in their baby, or have trouble bonding with the baby. They may feel out of control, have fears of harming themselves or the baby, or think their family would be better off without them. They can also experience physical symptoms such as nausea, dizziness, lightheadedness, racing heart, shortness of breath, chest pain, or numbness in hands and feet. Someone experiencing a PMAD may state, “I feel like I’m the worst mother in the world” or “I’m having thoughts that are scaring me.” Symptoms can occur any time during pregnancy or up to one year after childbirth. They last >2 weeks and will not resolve without professional treatment (Postpartum Support Virginia, 2023).
It is important to note that perinatal postpartum psychosis is a medical emergency. It is the most severe mood disorder, occurring in 1-2 out of every 1000 births. The onset is sudden, typically occurring within the first two weeks following birth, but can occur anytime within the first year (Postpartum Support International, 2023). Symptoms may include extreme sleep deprivation, irritation, hallucinations, memory loss, confusion, or mania. People suffering from perinatal postpartum psychosis may believe things that are not true, distrust those around them or have persistent thoughts of harming themselves or others (Postpartum Support Virginia, 2023). According to Michele Davidson, a postpartum psychosis expert and board member of Postpartum Support International, “Among mothers suffering from postpartum psychosis, about 5% will attempt suicide and 4% will commit infanticide” (Chuck & McShane, 2023). Someone exhibiting signs of perinatal postpartum psychosis is in need of immediate medical intervention.
Worldwide, it is estimated that PMADs affect 1 out of 5 women. It is also suggested that a large number of women, 7 out of 10, hide or downplay their symptoms due to societal stigma surrounding a mental health diagnoses (Postpartum Support International, 2023). Many women feel that expressing negative emotions related to pregnancy or being a new mother is unacceptable in society and even frowned upon among family and friends (Wolfburg, 2019). This stigma perpetuates mothers to suffer in fear and silence, leaving PMAD symptoms untreated. In-turn, these women often experience relationship issues with their partners and hindered maternal-child interactions/bonding, both contributing to “serious, long-term health, developmental, and behavioral consequences for the child” (Associates of Women’s Health, Obstetric and Neonatal Nurses, 2022, p.36).
Fathers are also at risk for developing depression during the perinatal period. It is estimated that 1 out of 10 dads will develop paternal depression. The number one, contributing factor to paternal depression is the presence of PMADs in mothers (Postpartum Support International, 2023). Fathers suffering from depression often report feeling overwhelmed, underprepared, neglected by their partner, and feelings of resentment towards their infant (Alba, 2021). It is important to recognize that fathers are an integral part of the family unit. Their mental health also affects the well-being and development of the child.
The are many known risk factors for PMADs. Etiologic risk factors include family history of depressive disorders, hormonal fluctuations in the perinatal period, prior history of anxiety, depression, or OCD, thyroid imbalance, diabetes, and endocrine disorders. Other risk factors include financial stress or poverty, history of abuse, unintended or adolescent pregnancy, and lack of support from family and friends (Postpartum Support International, 2023).
The good news is, through patient education and validated, reliable screening tools, early identification and treatment of PMADS is possible. PMADs are temporary and treatable. Treatment options for PMADs may include counseling, medication, support from others, exercise, adequate sleep, healthy diet, bright light therapy, yoga, relaxation techniques, or any combination of these therapies (Postpartum Support Virginia, 2023).
So what is SWRMC doing to help new mothers in our community? Sentara is following recommendations from the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) for early screening and treatment of PMADS. Women are screened by their obstetrician prenatally and prior to discharge using the Edinburgh Perinatal Depression Scale (EPDS). The EPDS is a 10 question, self-reported screening tool and receives one of the highest ratings for reliability according to Cronbach’s alpha (Alba, 2021). Interventions are based on patient scores. A patient scoring in the moderate to immediate risk range may have discharge held by their obstetrician. They may also receive an inpatient psychiatric consultation to assess their immediate safety and devise a follow-up plan of care. These patients will also receive a post-discharge phone call, within 72 hours of discharge, to assess how the patient is coping and confirm they have made an appointment for follow-up care.
Following discharge, screenings may be performed by pediatricians at well-baby visits. These screenings help identify women that may begin suffering from PMADs during the 4th trimester. The fourth trimester is defined as, “the time between birth and 12 weeks postpartum” (Goldfarb, 2021). The American Academy of Pediatrics (AAP) recommends screenings take place at “one, two, four, and six months postpartum” (Alba, 2021).
Family Maternity Center (FMC) nursing staff does a wonderful job educating all new mothers, partners and families about PMAD risk factors, symptoms, and treatment options. They are aware that a mother’s lack of knowledge about perinatal mood and anxiety disorders will limit her ability to recognize symptoms and seek treatment. Through patient education, FMC nurses are addressing the stigma surrounding maternal mental health and informing women they are not alone, it is not their fault, and that they can get better!
In January of 2023, SWRMC launched a social support group for new moms suffering from PMADs. Facilitated by two FMC nurses, both certified in perinatal mental health, this peer support group can offer moms experiencing PMADs a way to connect with other new moms that may be experiencing the same thing. It offers nonjudgmental listening, support and encouragement. This is another great example of how SWRMC is improving health every day.
PMADs are the #1 complication for women in pregnancy and postpartum. Worldwide, as many as 1 in 5 women experience some type of PMAD (Postpartum Support International, 2023). If left untreated, PMADs can having devastating and long-term consequences for mothers and children. Raising awareness and changing attitudes towards maternal mental health can prevent tragedies and improve health outcomes. I am asking all SWRMC employees to help drive social change surrounding maternal mental health. Spread the word about maternal mental health and PMADS. Do not assume all new mothers are happy. Ask them how they are really feeling, physically and emotionally, and listen without judgement. Most importantly, help them reach out to others for support and treatment.
Alba, Barbara Marie PhD, RN, NEA-BC. CE: Postpartum Depression: A Nurse’s Guide. AJN, American Journal of Nursing 121(7): p 32-43, July 2021. | DOI: 10.1097/01.NAJ.0000756516.95992.8e
Associates of Women’s Health, Obstetrics, and Neonatal Nurses. (2022, July). Position statement: Perinatal mood and anxiety disorders. Journal of Obstetrics, Gynecologic, & Neonatal Nursing, 51(4), e1-e4. doi: https://doi.org/10.1016/j.jogn.2022.03.007
Beck, C. T. (2006). Postpartum Depression. AJN, American Journal of Nursing, 106 (5), 40-50.
Chuck, E. & McShane, J. (2023, January 30). What is postpartum psychosis? Rare condition is in the spotlight after the killing of 3 children in Massachusetts. NBC News. https://www.nbcnews.com/news/us-news/postpartum-psychosis-rare-condition-spotlight-killing-three-children-m-rcna68165
Goldfarb, Ilona T. (2021, April 6th). The fourth trimester: What you should know. Women’s Health. Retrieved from https://www.health.harvard.edu/blog/the-fourth-trimester-what-you-should-know-2019071617314
Maternal Mental Health Alliance (2023). Perinatal mental health. Retrieved from https://maternalmentalhealthalliance.org
Postpartum Support International (2023). World maternal mental health day. Retrieved from https://wmmhday.postpartum.net/
Postpartum Support Virginia (2023). About PMADs. Retrieved from https://postpartumva.org/types-of-perinatal-mood-and-anxiety-disorders/
Wolfburg, Adam. (2019, February 22). Are we massively underestimating how many women have postpartum depression? Center for Health and Journalism. https://centerforhealthjournalism.org/2019/02/21/are-we-hugely-underestimating-how-many-women-have-postpartum-depression