The Village Effect
The Essential Role of Social Support in the Prevention and Treatment of Perinatal Mood and Anxiety Disorders
A Brief History of Perinatal Psychology
In 460 BC, Hippocrates, the “Father of Medicine,” described “postpartum fever.” Later, Louis Victor Marcé, a French psychiatrist, wrote the first treatise on puerperal mental illness. Then, in the 20th century, James A Hamilton, became the “Father of Postpartum Psychiatric Illness” and co-founded The Marcé Society in 1980, which advocated for research, treatment, and social support. He shared at the 2nd Annual Postpartum Support Internal Conference in 1988 that “support groups represent the most significant and useful aspect of the renaissance in the recognition and treatment of postpartum illness.”
The Perinatal Period
The perinatal period, psychologically speaking, is considered conception through the first year after birth taking into account the vulnerability during this time of the development of perinatal mood and anxiety disorders (PMADs) due to fluctuations in hormones during pregnancy, postpartum, the onset of lactation, weaning, and the re-emergence of menstruation.
Perinatal Mood and Anxiety Disorders
PMADs are the number one complication associated with pregnancy and postpartum affecting 1 out of every 7 women. While hormones play a role, PMADs are not a strictly hormonal phenomenon. Genetics play a role as does a women’s relationship with her own mother, perfectionist tendencies, a history of trauma, and poor social support.
Unlike, PMADs, the baby blues, which impacts as many as 80% of women, is an entirely hormonal phenomenon due to the drastic drop in progesterone post-delivery and is not considered a psychological disorder. The baby blues, which can include feeling sad, crying, and exhaustion, typically peaks 3-5 days after delivery and subsides between 2 days and 2 weeks. It does not require treatment. However, if you find yourself struggling after this period, it is imperative to seek support rather than trying to “tough it out” or hope that time alone will improve things.
While many people have familiarity with postpartum depression (PPD), it is far from the only PMAD. PMADs also include postpartum anxiety (PPA), postpartum obsessive-compulsive disorder (OCD), postpartum posttraumatic stress disorder (PTSD), postpartum bipolar disorder, and postpartum psychosis.
Symptoms of PPD include low mood, loss of interest, appetite changes, sleep disturbances unrelated to the baby, feelings of worthlessness, guilt, or shame, and thoughts of suicide. PPD can also be experienced as anger, agitation, irritability, or “mom rage”. Whereas, PPA, is characterized by excessive worry that is difficult to control, feeling on edge, and trouble relaxing. PPD and PPA often co-occur. Women can also experience intrusive thoughts, urges, or impulses, that cause distress as a part of postpartum OCD. Postpartum OCD sometimes include thoughts of harming the baby, which can be especially alarming. It can be helpful to know that these thoughts, when distressing, are actually coming from a desire to protect the infant. Postpartum PTSD, can occur as a result of a traumatic delivery, due to any number of situations such as severe preeclampsia, emergency c-section, postpartum hemorrhage, unexpected NICU admission, etc. that can result in feelings of extreme helplessness and fear. Symptoms of postpartum PTSD include re-experiencing the traumatic event in the form of flashbacks and/or nightmares, avoidance of things associated with the trauma, hyperarousal, and feelings of detachment. Postpartum bipolar is characterized by extreme mood swings, including periods of depression or irritability as well as mania, symptoms of which include rapid speech, racing thoughts, excessive energy, little need for sleep, impulsivity, and an inflated sense of self-importance. Signs of postpartum psychosis include strange beliefs, odd behavior, and delusions and/or hallucinations. In the case of severe PMADs, pharmacological or even emergency intervention may be required to prevent harm to self or others, particularly if a mother believes her baby would be better off without her or is experiencing thoughts of harming the baby that do not result in feelings of distress.
The Importance of Social Support
Research shows that support groups, such as those offered at Village Birth, including postpartum circles, can play an essential role in both the prevention and treatment of PMADs. If you are at risk for the development of a PMAD, and even if you are not, signing up for a support group is a great idea! You can sign up for a support group at Village Birth here.
Individual Therapy
If you might benefit from additional one-on-one support, Dr. Lauren Cook, and myself, Dr. Carissa Gustafson, of Heartship Psychological Services, are available both in-person, at Village Birth, and online to support you during this vulnerable time of transition. You can schedule a free 20-minute consultation here.
24/7 & Emergency Resources
If you need more immediate support, the Maternal Mental Health Hotline is available 24/7 at 1-833-TLC-MAMA (1-833-852-6262). The Lifeline is also available 24/7 at 988. In the event of an emergency, including serious thoughts of acting on self-harm, call 911 or go to the nearest ER.