What to Do if Sadness, Extreme Worry or Difficulty Functioning Appear During Pregnancy or After

What to Do if Sadness, Extreme Worry or Difficulty Functioning Appear During Pregnancy or After

Pregnancy and the birth of a child are often seen as occasions for joy, but the physical challenges of hormone imbalances and sleep disruptions can turn these times into emotionally painful and difficult transitions. While perinatal mood disorder, previously known as postpartum depression, is common, fortunately it is very treatable. In her DocTalk below, OB/GYN MaryEllen Maccio, MD, gives practical insights into this condition, what to watch for and how to get help if you or someone you care about may be experiencing it.

0:17 | What is perinatal mood disorder?
Perinatal mood disorder is the condition of excessive worry or low mood experienced during pregnancy, or after delivery. The old term “postpartum depression,” is no longer used because it leaves out many of the people who would benefit from identification of these mood problems during pregnancy. We’ve realized that since people will have mood issues or mood imbalances earlier in pregnancy, as well as the during postpartum period, this gives us more opportunity for intervention.

1:06 | What is the difference between baby blues and perinatal mood disorder?
Both baby blues and perinatal mood disorder are very common.

  • Baby blues is a more specific condition. It occurs after delivery, commonly develops around one to three days after birth, and symptoms are intermittent. This means a person may have low mood or excessive worry, but not all day long. There may be times where they feel better during the day, and the symptoms often get better without any treatment by about two weeks postpartum.
  • Perinatal mood disorder can occur during pregnancy or after birth, and symptoms are more persistent. A person may experience low mood or anxiety every day, which begins to interfere with things like function, difficulty enjoying their life or going about their day-to-day work. Perinatal mood disorder generally benefits from treatment.

2:19 | What are the symptoms of perinatal mood disorder?
A low mood or excessive worry that prevents a person from enjoying or functioning in their day-to-day life is the main thing to watch for with perinatal mood disorder. Specific symptoms can include crying, irritability, insomnia, or a person becoming very withdrawn and not engaging in their usual enjoyable activities.

2:49 | What causes perinatal mood disorder?
There’s no single cause for perinatal mood disorder, but we know that the hormonal shifts during pregnancy and after the birth are a main factor. During and after pregnancy, there are also sleep changes that contribute to perinatal mood disorder.

3:11 | How common is perinatal mood disorder for first time and future pregnancies?
Perinatal mood disorder is the most common complication of pregnancy. It affects one in every seven pregnant people, and it can occur in any pregnancy, so if a person does not experience it in a first pregnancy, it can still occur in a second pregnancy. About 15% of people who are pregnant will experience perinatal mood disorder.

3:40 | Are there risk factors that might make someone more likely to have perinatal mood disorder?
If a person has had a mood disorder in the past, it increases the likelihood that they will have some mood problems during their pregnancy. Other factors that can influence the risk are social stressors, not having family or friend support during a pregnancy and during the postpartum period, and financial stressors.

4:13 | As a loved one of someone who has recently given birth, what signs should someone watch out for?
One of the most important signs to watch out for is sadness or worry that takes up most of your loved one’s day, especially if it makes it difficult for them to function. If the person has difficulty accepting a break, taking a nap when offered, or doing something for themselves when offered, that can be a sign. Lastly, difficulty with self-care or difficulty just taking care of themselves.

4:52 | If someone suspects that their loved one has perinatal mood disorder, what should they do?
This is important because there’s a lot of social pressure to see pregnancy, and having a new baby in the home, as a universally happy time, but it’s generally much more complicated than that. If you suspect your loved one is struggling, encourage them to talk to you, listen to their concerns, express your support, and acknowledge that it’s common to have complicated feelings, and to experience low mood or excessive worry. Encourage them to talk to their OB provider, whether that’s their OB doctor or midwife. And finally, consider going online to look at some of the resources that talk about perinatal mood disorder. Perinatal Support International, and our local chapter Perinatal Support Washington, are excellent online resources.

5:53 | What are the treatment options, and are there ways to prevent perinatal mood disorder?
Luckily, perinatal mood disorder responds really well to treatment. When it comes to ways to prevent it, it’s important to make sure that pregnant individuals know that problems with mood are very common during and after pregnancy. Working on adequate sleep, learning to nap, and getting regular exercise, are things that can prevent difficulties with mood imbalance during and after pregnancy. If a person begins to struggle more with significant perinatal mood disorder, treatment options include talk therapy, which is very effective, and support groups are also very helpful. Medication can be used during and after pregnancy, and while breastfeeding. Medications for perinatal mood disorder are safe and effective.

6:53 | What might happen if perinatal mood disorder is left untreated?
If left untreated, perinatal mood disorder results in an increase in premature birth and low birth weight infants. There’s also an increased risk that the child may experience mood imbalance later in life. For the patient, there may be difficulties with confidence in parenting after the birth. It’s important to know that if a person is on medication for mood before getting pregnant, continuing that medication during pregnancy is very beneficial. If a person stops medication that was previously treating mood disorder, there’s a 50% chance that the mood disorder will return during pregnancy. Most medications are safe during pregnancy, so we encourage patients to continue their mood medications.

7:53 | Is it possible for the partner of a pregnant or postpartum person to have perinatal mood disorder?
Yes, partners can experience perinatal mood disorder symptoms, and there are great resources for partners, like Perinatal Support Washington, mentioned earlier. There are also parenting support groups for the partner, including Parent Trust, which has some partner support and education, and Families of Color Seattle is an excellent support group.

8:26 | How is Valley addressing perinatal mood disorder for patients?
At Valley, we recognize that untreated perinatal mood disorder has a significant negative impact on individuals, families, and our whole community. We’re working to educate patients and providers about how common perinatal mood disorder is, and that there are excellent treatment options. Treatment options include support groups, counseling, and medicines which are very safe and effective for treatment of perinatal mood disorder. We’re also increasing screening, so that during pregnancy and after birth, patients are given a mood questionnaire to identify if they have symptoms of perinatal mood disorder.

9:14 | If a person has concerns about their mood during or after pregnancy, what should they do?
The most important first step is to talk about it. Talking with your family, with your friends, and with your OB provider, is the best first step to getting treatment for a perinatal mood disorder.

Learn more at valleymed.org/valleybaby

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