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Pregnancy and Postpartum

Pregnancy has been historically known as a period of emotional well-being, but for about 20% of women it can be just the opposite.  Studies show that depression is one of the most common complications of pregnancy and women with pre-existing mood disorders are at particular risk of relapsing during pregnancy or postpartum.  Many women are hesitant to seek help for mood disorders during pregnancy but the consequences of untreated depression are serious for mom and baby. Maternal depression can affect the child’s emotional and intellectual development.   Medications (if necessary), support, lifestyle modification and or psychotherapy are very helpful and can prevent serious life-long consequences that arise from untreated maternal depression.  

Balance Women's Health Pregnancy and Postpartum

Postpartum Depression Symptoms:

  • Feeling Sad
  • Crying a lot
  • Anxiety or nervousness
  • Trouble concentrating
  • Trouble sleeping
  • Feeling emotionally numb
  • Lack of energy
  • Not interested in things you used to enjoy
  • Not interested in your baby
  • Fear of hurting yourself or your baby
  • Feeling worthless or guilty
  • Withdrawing from people
  • Feeling Overwhelmed

The postnatal period is a time when women are vulnerable to depression and/or relapse of previous psychiatric illness. Although many women experience passing feelings of "baby blues" in the 3-14 days after giving birth, about 10 to 20 percent of women become clinically depressed during this period. A common symptom of post-partum depression is anxiety. Women may worry that they are not doing a good enough job in caring for the baby. These symptoms can worsen to the point of impairing a woman's ability to care for herself or the baby.  We can help a woman manage these symptoms. In extreme cases, a woman may lose touch with reality, for example hearing voices or believing the baby would be better off dead. This is an emergency and requires immediate treatment and possible hospitalization. 

Postpartum Obsessive Compulsive Disorder (OCD)

In contrast, to non-postpartum OCD, the postpartum variant typically comes on rapidly, sometimes within a week of giving birth. Research also indicates that postpartum OCD most often involves scary obsessions related to harm befalling the newborn infant (in contrast to obsessions having to do with contamination, paperwork mistakes, order and symmetry, and hoarding). In some instances, sufferers report obsessions having to do with accidental harm, while in others the obsessions involve unwanted thoughts or ideas of intentionally harming the newborn. Some examples of the kinds of postpartum obsessions encountered in our clinic are as follows:

  • The idea that the baby could die in her sleep (S.I.D.S).
  • The thought of dropping the baby from a high place.
  • An image of the baby dead.
  • Thoughts of the baby choking and not being able to save him.
  • Fears and obsessional thoughts of harming the baby.

Compulsive rituals among mothers with postpartum OCD often include checking on the baby, for example, during the night to make sure that the baby is still alive. New parents with OCD also report mental compulsions, such as praying over and over to prevent disastrous outcomes. Finally, many postpartum OCD sufferers engage in compulsive reassurance-seeking, including looking their symptoms up on the internet and asking others if it’s “normal” to have bad thoughts about the baby. Avoidance is also a problem and many new mothers are afraid to be left alone with their newborns for fear that they might act on their unwanted thoughts about harm.

Many women suffering from postpartum OCD worry that they might act on their harm-related thoughts, or that their thoughts mean they are unfit to be parents. “What if I drown my children like that woman on the news did?” “What kind of a parent thinks about such terrible things? Surely I am losing my mind!” What drives these fears is a lack of understanding of the differences between postpartum OCD and postpartum psychosis.

Both OCD and psychosis can involve strange, bizarre, and violent thoughts. But the similarities stop there. In postpartum OCD, the sufferer is terrified of committing harm; so much so that it scares her to even think about harming the infant. Women with postpartum OCD resist their obsessional thoughts; meaning that they try to dismiss the obsessions or neutralize them with some other thought or behavior. The thoughts seem as if they are against every moral fiber of their being. Consequently, the risk of someone with postpartum OCD acting on their violent obsessions is extremely low (one can never say with absolute certainty that the chances are 0%, but in this case it’s pretty close).

In contrast, women with postpartum psychosis tend to experience their violent thoughts much differently. The violent thoughts might be perceived as consistent with the person’s world view. Hence, such women don’t try to fight these thoughts. The thoughts are usually part of delusions; lines of thinking in which the person holds strongly to bizarre beliefs, such as the idea that someone (or the government) is after them, or that they have magical powers that other people don’t have. So, thoughts to harm the baby might be perceived as “a good idea.” Because people with psychotic disorders sometimes act in accord with their delusions, postpartum psychosis poses very serious risks and often requires hospitalization to ensure the safety of the mother than infant.

Breastfeeding is an important part of the physical and emotional health of mom and baby.  Mom’s dealing with mood disorders during and after pregnancy need special attention to manage their symptoms without preventing the bonding and attachment benefits from breastfeeding. Careful review of medications is important for the health of mom and baby.

Treatment

Balance Women's Health Pregnancy and PostpartumHelp is available for depression and anxiety during pregnancy or the postnatal period.  

  • Lifestyle modification (diet and exercise)
  • Psychotherapy and Counseling (individual and group support)
  • Building a support system and ensuring adequate rest
  • Increasing understanding and developing coping skills
  • Medication management with antidepressants, post-partum estrogen therapy when necessary