To best prepare for postpartum, it’s essential for new and expecting mothers to fully know and understand their individual risk factors for developing perinatal mood disorders.
When I started working with prenatal and postpartum women, I quickly realized many of them were perplexed about why they had developed depression, anxiety, PTSD, and other mental health challenges before or after having their babies.
It became clear that women weren’t informed of all of the risk factors contributing to them feeling this way or about PMADs (perinatal mood and anxiety disorders) in the first place.
Now, you may be nodding your head or saying, “of course she wouldn’t know; there are so many things women aren’t made aware of about pregnancy, birth, postpartum, or parenting.” But, a mother’s mental and emotional wellness is vital to the well-being of herself and the babies, children, and our society.
It would seem an absolute necessity to educate women on what psychological risk factors they may bring to their prenatal and postpartum experiences. Then, they can better prepare, gather supports and build on their protective factors to help them navigate this time from the most resourced place possible.
Perinatal mood disorders in pandemic times
Before the pandemic, reported cases of Postpartum Depression and Anxiety and other mental health issues related to the perinatal time hovered around 10-20% (reported) for women, making this the most common complication of childbirth. However, we know that those numbers have climbed since the start of the COVID-19 health crisis.
Although it remains unclear how much those numbers have risen, one thing is obvious, perinatal women and women who are parenting young children are struggling now more than ever before.
Before I continue, I feel compelled to name the elephant in the room; modern motherhood is a set-up for mental and emotional struggling and suffering.
When society de-prioritizes its mothers’ needs through unsupportive cultural norms and policies, mental and emotional challenges like anxiety and depression flourish.
Robyn Alagona
Factors that may increase the chance of developing PMADs in new or expecting mothers
1. Family history
One of the most significant determining factors is a personal or familial history of depression, anxiety, or another mental health challenge. Women with a personal history of mood disorders will be 30% more likely to develop postpartum depression or another perinatal mental health issue.
According to statistics from Jenna Carberg on postpartumdepression.org, women who have had postpartum depression in the past are 10-50% more likely to experience it again.
2. A lack of support
Another very influential factor in a perinatal woman’s mental, emotional, and psychological state is her support from her partner and her care team. Some stress and strain are expected in couples after the seismic changes of becoming new parents and welcoming a new baby into their relationship.
However, how couples navigate those stressors is significant in determining how the adjustment will go as they move through the postpartum period. Many factors contribute to couples feeling stressed including:
- Birth experience
- Healing from birth
- Sleep deprivation
- Caring for baby
- Parenting perspectives
- Navigating expectations
- Division of labor
- Boundaries with extended family
- Going back to work, etc.
With personal self-care and resources low and vulnerabilities high, conflict can become primary, especially for couples who didn’t have good communication skills before their baby. Stress can escalate quickly, and without a course correction, this can significantly increase the chance of developing depression and anxiety.
3. Inadequate postpartum planning
The quantity and quality of support a woman receives throughout her perinatal experience, as well, will play a significant role in her mental and emotional state.
In the last couple of decades, it has become commonplace for pregnant women to have educated themselves regarding the kind of labors and births they want.
Many will now provide a detailed birth plan to a doctor or midwife. Although this doesn’t always determine the outcome of labor and delivery, among many other things, it gets a woman thinking through what she needs and wants for herself and her baby and what will feel most supportive.
Unfortunately, postpartum planning has not yet become customary.
Many women are surprised at both the amount of support they need in postpartum time and the kinds of supports they need to bolster them in the steep learning curve of new motherhood. A postpartum planning workbook may help.
Postpartum moms need help in every area of life; social support (friends, mom’s groups), emotional support, breastfeeding support, healing from birth, baby care, essential needs support (help with food, time for personal hygiene), help with older children, etc.
Few women find that they have sufficient support during this time, leaving them feeling depleted, overwhelmed, exhausted, anxious, and depressed.
A list of risk factors for perinatal mood issues:
Unfortunately, a thorough look at every single risk factor is more of a book-length piece than an article. However, I find that women get a lot out of just reading or hearing the list and preparing someone for postpartum. It can also validate and legitimize a woman’s experience by seeing her circumstances printed out on paper.
- Personal/familial mental health issues
- Partner relationship issues
- Insufficient support
- Insufficient social support
- Unplanned pregnancy
- Pregnancy loss
- Infertility
- Birth trauma
- Birth injury
- NICU stay
- Breastfeeding/feeding issues
- Challenging baby
- Financial stress
- Change in identity
- Body image
- Change in a friend group
- Perfectionism
- COVID-19
If you see your experience reflected in the list, you are not alone; most folks see many of their experiences reflected here.
How to prevent perinatal mood disorders
What then are the protective factors associated with preventing perinatal mood and anxiety disorders? Although there is no one thing that anyone can do to avoid this, being aware, educated, and prepared can go a very long way.
Now that you know the risk factors, you can start to plan for what you think might be your vulnerabilities and begin to rally the troops. Begin accessing resources and putting into motion what you will need to navigate this time.
Ideas for increasing protective factors:
- Have conversations with your partner about what you need, individually and together, to have a supportive experience
- Hire a supportive birth team
- Create a birth plan that embodies your voice
- Create a postpartum plan (including a postpartum self-care plan)
- Find a maternal mental health therapist
- Find a support group for moms
- Find an Internationally Board-Certified Lactation Consultant
- Find a breastfeeding support group
- Hire a doula/postpartum doula
- Find other perinatal care providers including pelvic floor PT, chiropractic, acupuncture, craniosacral therapist, massage therapist
- Rally mom-friends
- Have a friend organize a meal train
- Ask for help
- Receive help
Where to turn to for help with PMADs
If you’re struggling with PMADs and would like more support or information, the below resources are available to you for free:
- A Free Mental Health Checklist for New Moms
- Postpartum Support International Helpline
- Find local PMADs resources in your area
