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Most of us have heard of postpartum (after delivery) depression, but mood disorders can occur at any phase of a pregnancy. Perinatal refers to the time both before and after the baby’s birth. This kind of depression is different from the more common weepy exhaustion that many new mothers feel the first few days after giving birth, when their hormones are shifting rapidly, and their sleep is interrupted by caring for the baby. 

Feeling extremely sad, depressed, hopeless, or anxious can prevent a mother from being able to care for her baby and herself. There are two questionnaires, the Beck’s Depression Inventory, and Edinburgh Postnatal Depression Scale which can be self-administered in order to evaluate levels of depression and/or anxiety a mother, or mother-to-be, might be experiencing. Intervention and treatment can not only bring relief to the mother but also helps prevent more long-term disruptions in the mother child bond. 

This is much more common than most people realize, in fact 1 in 7 women experience perinatal depression thus making it the #1 complication of pregnancy. 

All pregnant and postpartum women should be screened

The American College of Obstetricians and Gynecologists recommends that obstetrician–gynecologists, midwives, NPs, PAs, other obstetric care providers screen pregnant moms at least once during the perinatal period for depression and anxiety symptoms using the type of tools I linked to above. Providers should then be able to offer appropriate therapy, or offer referrals to other resources. 

Untreated perinatal depression in a mother is potentially harmful for children as their social and psychological development is linked to the emotional health of their caregivers. When a mother is so depressed and/or anxious that she can’t care for herself or her child it can lead to these effects as children get older:

  • Developmental and cognitive delays
  • Behavioral issues
  • Increased school absence
  • More frequent emergency department visits

Mother’s Risk Factors for Perinatal Depression

These are some of the risk factors that occur in a woman’s life before or during her pregnancy that make her more susceptible to perinatal depression:

  •  Maternal anxiety
  •  Life stress
  •  History of depression
  •  Lack of social support
  •  Unintended pregnancy
  •  Medicaid insurance
  •  Domestic violence
  •  Lower income
  •  Lower education
  •  Smoking
  •  Single status
  •  Poor relationship quality
  •     Poor sleep quality

Risk factors for Postpartum Depression:

  • Depression during pregnancy– Depression, the most common mood disorder in the population, is almost twice as frequent in women as in men, with its initial onset peaking during the average ages of reproduction.
  • A pre-pregnancy history of depression, mood disorders, or suicidal thoughts.
  • Anxiety during pregnancy– extreme anxiety and anxiety with insomnia can indicate a mood disorder such as bipolar disorder. Mania symptoms include inflated self-esteem or grandiosity, having energy after very little sleep, or engaging in risky behavior.  
  • Experiencing stressful life events during pregnancy or the early postpartum period
  • Traumatic birth experience
  • Preterm birth/infant admission to neonatal intensive care
  • Low levels of social support
  • Breastfeeding problems

Sleep is Essential

After first identifying that a mom has postpartum depression, and then developing a plan with a licensed health care provider, one of the most effective treatments is to help a mother get enough sleep. This helps increase energy, perspective, and clears the brain fog so that she can deal with caring for herself and her baby. It’s also important to identify other supportive people to help care for the baby. 

Postpartum Psychosis 

Much less common, but no less real, is postpartum psychosis. It effects about one or two women out of every thousand who give birth. These mothers are often suffering from paranoia, delusions, hallucinations, and severe insomnia, and can become a danger to themselves and their babies.  

California researchers are convinced that suicides by new mothers could be largely prevented if our health care system did a better job of screening, diagnosing, and treating this illness. Also needed are psychiatric wards that are set up so new mothers can recover while staying connected to and caring for their babies in a safe environment.

In the United Kingdom, there are 21 of these mother-baby psychiatric units. In France, there are 15. The US only has three–in North Carolina, New York, and California. In fact, the only one in California is located in the hospital in which I work.

Inpatient Perinatal Psychiatry Programs in the US:

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