Maternal Mental refers to a mother’s emotional wellness and ability to enjoy life. Traditionally, mental health education for mothers was related to Postpartum Depression exclusively. We are now aware that Depression is just one of many mood and anxiety disorders which have recently been collectively termed Perinatal Mood and Anxiety Disorders (PMAD). The World Health Organization (WHO) defines maternal mental health as “a state of well-being. In it, a mother sees her own abilities. She can handle normal stresses, work well, and can contribute to her community.

Another belief is that the Postpartum Period typically lasts 6 weeks. However, PMAD symptoms may start anytime during Pregnancy or within a year of childbirth, or pregnancy and infant loss, and it may continue for years after. Once a woman has had a baby, it takes much longer than 6 weeks for her to recover fully – physiologically and psychologically, and in reality, she will never be the same again.

As a Muslim Ummah, we should pay attention to how we treat our women and children. It is said that a woman rocks her baby in one hand and the Ummah in the other. So, if we wish for women to make a positive contribution to the upbringing of our children, we must make maternal mental health a shared priority. Before we discuss the differences between some common Perinatal Mood and Anxiety Disorders, we will discuss The Baby Blues. 

Baby Blues

Baby Blues, also called Postpartum Blues, affects up to 80% of women after giving birth. Baby Blues result from a normal hormonal dip and the stresses of being a new parent. This condition is brief. It starts 2-3 days after birth, usually when the colostrum changes to milk, and lasts around 2 weeks. During this time, a woman has mood swings. She feels overwhelmed and weepy – crying for no apparent reason. She feels tired and irritable. With support, rest, and good nutrition, Baby Blues go away on its own without any medical help. If symptoms persist after 2 weeks, professional care should be sought.

Postpartum/Perinatal Mood & Anxiety Disorders (PMAD)

These happen when Baby Blues last more than 2 weeks. For those who are a part of the support network of mothers, it is extremely important to note that Baby Blues are not the same as Perinatal or Postpartum Mood and Anxiety Disorders. PMADS get worse and starts to disrupt everyday life. If a mother is experiencing these types of symptoms, please do not invalidate a mother’s complaints or tell her that what she is experiencing is normal, be also very attentive as to how long the symptoms last. Let’s have a look at some Perinatal Mood & Anxiety Disorders in more detail.

1. Perinatal Depression

According to research done in Australia, up to 1 in 7 women experience depression in the first year after having a baby. Symptoms may look like ongoing sadness, hopelessness, emptiness, lack of interest or motivation for anything, feeling low or numb or nothing at all, continued struggle to sleep, and detachment from the baby and loved ones. Mothers may feel isolated or withdrawn from their babies, may fear being left alone with them or have thoughts of harming themselves or the baby.

2. Perinatal Anxiety (also known as Panic Disorder)

According to a study done in Australia up to 1 in 5 women experience Anxiety in the first year after giving birth. It may bring a constant or excessive state of worry or a looming danger. It can cause hyperventilation, panic attacks, feelings of terror, tension in the muscles and tightness in the chest, teeth grinding, dizziness, elevated heart rate, and a sick feeling in the stomach.

3. Perinatal OCD (Obsessive Compulsive Disorder)

Having preexisting OCD increases the risk of developing Perinatal OCD. It may look like repeatedly checking on the baby, reviewing the baby’s schedule, intense worry that the baby will fall, choke or drown, excessively sterilising and cleaning, intrusive thoughts about themselves or the baby, or obsessions about the baby’s health.

4. Postpartum Rage

It may affect any woman who has just given birth but may be more common in women with pre-existing Perinatal Depression or Bipolar disorder. Some of the most common symptoms are being extremely irritable, frustrated or “on edge”, feeling the urge to scream at others, lashing out when you normally wouldn’t, easily losing your temper, punching or throwing objects or slamming doors

5. Birth Trauma and Perinatal PTSD (Post Traumatic Stress Disorder)

According to research done in Australia, 1 in 3 women reported at least 3 trauma symptoms at 4 – 6 weeks postpartum. PTSD often results from a traumatic birth or surviving obstetric violence. Symptoms may include flashbacks and hypervigilance. They can also cause panic attacks and distressing dreams about the birth and baby. The mother may also have persistent fear, difficulty concentrating and an exaggerated startle response. They might avoid anything that could remind them of the traumatic experience, like hospitals, doctors, or even the baby.

6. Perinatal Bipolar Disorder

Bipolar Disorder may be a pre-existing condition but it may be that it presents during the perinatal period for the first time. It is often identified by a fluctuation of highs (mania) and lows (depression). The mood shifts between clear signs of depression: devastation, numbness, and sadness. Then, it shifts to hypomania: beyond normal high moods, rapid speech, and overconfidence.

7. Perinatal Psychosis

Compared to other PMADS, Perinatal Psychosis is very rare, affecting 2 in 1000 birthing women. It occurs suddenly within the first 2 weeks postpartum. It is characterised by delusions and hallucinations. They can be auditory or visual. It also includes paranoia, high irritation, loss of inhibitions, decreased need for sleep, making lots of unrealistic plans, excessive happiness and dangerous behaviour.

Risk factors for Perinatal Mood & Anxiety Disorders

Some causes may be due to biological reasons like thyroid imbalance, diabetes and other hormonal imbalances, a family or personal history of depression or other mental disorders, difficult childhood experiences, trauma or abuse, severe PMS, miscarriage or infant loss, a traumatic pregnancy or birth, a baby in the Neonatal ICU, an unplanned pregnancy, poor quality of marriage, high levels of stress, domestic violence, and low self-esteem, life changes such as isolation, illness, job loss or moving to a new city. Outside pressure, media, or having an “A type” personality may also cause some mothers to feel excessively pressured to fulfil others’ expectations of the “perfect mother” or “perfect wife”.

Factors that exacerbate PMADS

These include lack of sleep, pain, lack of education and support from husband, family and friends, financial stress or poverty, nutritional deficiencies especially postpartum depletion of iron, omega 3, vitamin B12, and vitamin D. Also, relationship and childcare stress, pregnancy, birth and breastfeeding complications, the baby’s temperament, and returning to work.

Screening

Perinatal Mood & Anxiety Disorders can be managed and treated with proper screening and referral. The American Congress of Obstetricians and Gynecologists (ACOG) 2015 Committee Opinion recommends

women be screened at least once during the perinatal period for PMADS. The American Academy of Pediatrics, based on a 2010 clinical report, encourages pediatric practices to screen mothers for PMADS, use community resources for the treatment and referral of the depressed mother, and provide support to the mother-child relationship. 

Prevention and Treatment

Studies have shown that women who were supported by a doula during birth, showed lower incidences of depression, and anxiety in the postpartum period, and increased confidence and better family bonding.

Research done around postpartum care in some cultures shows that perinatal mood and anxiety disorders are almost non-existent when there is proper postpartum support and rest. Women who don’t have family support may consider hiring professional support from a Postpartum Care Provider or Doula.

Treatment options may include medication to help balance brain chemicals, hospitalisation (for the more severe PMADS), and Psychotherapy, such as Cognitive Behavioural (CBT) and Interpersonal Psychotherapy (IPT). Other options are talk therapy through Peer Support (eg support groups) or Counselling. Treatment may be further supported by implementing healthy habits (the SNOWBALL acronym); taking care to get sufficient Sleep (contrary to popular belief, most women postpartum need a solid 8 – 12 hours of sleep per 24-hour period), proper Nutrition, Omega 3’s, Walking (exercise helps your brain release feel good and sedative hormones)), taking Baby breaks, spending time in Adult company, Liquids (maintaining good hydration), Laughter (reduces stress hormones).

If you think you may be suffering from a Perinatal Mood and Anxiety Disorder, know that you are not alone and it isn’t your fault. If you would like help with screening and referrals, please reach out to us.

References

COPE Fact Sheets for families

ICEA position paper – perinatal mood and anxiety disorders

https://matrescence.africa/motherhood-and-mental-health

Postpartum Care manual – Jaqui Bloemraad de Boer

https://www.joyful-beginnings.com/perinatal-mood-disorders

https://my.clevelandclinic.org/health/diseases/24768-postpartum-rage

https://www.whattoexpect.com/first-year/postpartum-health-and-care/perinatal-mood-and-anxiety-disorders

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