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Perinatal Mood and Anxiety Disorders, Who’s at Risk?

While pregnant and after giving birth, 10–15% of women feel seriously depressed and anxious.

Perinatal mood and anxiety disorders are often undiagnosed because of a lack of resources and education available.

For expectant and new mothers who are experiencing overwhelming depression and/or anxiety, the MemorialCare Center for Mental Health & Wellness has a Perinatal Mood & Anxiety Disorders Program.

Listen as Hopey Witherby, RN-BC, MSN/ED discusses what is a perinatal mood or anxiety disorder.

What causes it, why it is difficult to recognize or hard for women to admit to perinatal depression or anxiety, and what a woman should do if she thinks she has perinatal depression or anxiety.

Perinatal Mood and Anxiety Disorders, Who’s at Risk?
Featured Speaker:
Hopey Witherby, RN

Hopey Witherby, RN-BC, MSN/ED, clinical director, MemorialCare Center for Mental Health & Wellness, Community Hospital Long Beach. She is a member of the American Psychiatric Nurses Association.

Organization:Community Hospital Long Beach

MemorialCare Center for Mental Health & Wellness


Deborah Howell (Host): Hello, and welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Hopey Witherby, RN-BC, MSN/ED, clinical director of MemorialCare Health Center for Mental Health & Wellness Community Hospital Long Beach. She is a member of the American Psychiatric Nurses Association, and today we'll be talking about perinatal mood and anxiety disorders, who's at risk. Good morning to you, Hopey.

Hopey Witherby (Guest): Good morning.

Deborah: First of all, what is a perinatal mood or anxiety disorder?

Hopey: It used to be most commonly referred to as postpartum depression. But what we realize with this condition is that it also affects women who are pregnant, not just after delivery, and that anxiety is a prevalent symptom of perinatal mood and anxiety disorder. The name PMAD is more reflective of what occurs and when. PMAD is an order that can occur from onto the pregnancy and up to one year after delivery. It's really associated with many other types of mental illnesses such as bipolar disorder, anxiety disorders, obsessive-compulsive. You can have some of those symptoms when you're experiencing PMAD.

Deborah: Do we know at this point what causes perinatal mood and anxiety disorders?

Hopey: Hormones certainly contribute to a lot of the changes that a pregnant woman or a new mom experiences. It's natural to experience changes in mood and energy level during pregnancy. But if these feelings start to interfere with a woman's daily activities or if the symptoms persist, that's really the time to get help.

Deborah: When you say interfere with their daily activities, can you give us an example?

Hopey: If you're obsessive-compulsive and you find that you're always checking on the baby because you're fearful that harm is going to come to the baby, and you're not able to really bond with the baby and get the rest that you need because you're so obsessed with the concern over the safety of the baby, or if you're finding that you're not bonding, you don't feel that attachment that everybody always talks about—oh, the wonderful feeling the minute you give birth—that doesn't happen to everybody.

Deborah: Right.

Hopey: It certainly doesn't happen the minute you give birth to a lot of people. But those are the types of things that would be of concern to a mom. If it persists, then you really want to get professional assistance.

Deborah: Maybe that's part of the reason why it's difficult for some women to recognize or admit to perinatal depression or anxiety?

Hopey: That's part of it. I think that, really, what a lot of the issues are is that we have this vision, this myth about what we think the perfect mother should be, that the minute you give birth, you're just so joyful. You have this expectation that you're going to nap when the baby naps and your baby is always going to be clean and happy and joyful, and that's not reality. We're embarrassed to say, "I don't feel that attachment right now, and I don't feel loving. I look at my baby, and I don't have those feelings that everybody said I should have." They recognize it, but they're afraid to talk about it because they're afraid that people will think that they're a bad mother.

Deborah: Right. That's understandable. Hopey, how is this different than the baby blues that they might have?

Hopey: The baby blues is not an uncommon occurrence. It usually happens after birth because of the hormone level change, but it usually doesn't last after two to three weeks.

Deborah: I see.

Hopey: After three weeks, if you're still feeling the same fatigue and depression or anxiety and you're not sleeping well, then that's the time that you have to say it's probably more than the baby blues.

Deborah: Okay. What kind of treatment are we talking about for these women?

Hopey: There are a lot of different types of treatment. Certainly, medication is one. Depending upon if it's during pregnancy or if it's right after delivery and you're breastfeeding, you really want to talk to a psychiatrist about the pros and cons of medication. There is individual therapy, family therapy, which is very important because this illness affects the whole family.

Deborah: Right, absolutely.

Hopey: It's not just the mom or the mom-to-be that's experiencing this. It's also stressful on the partner and stressful on the baby and the fetus. That's one of the things that have to be considered. Therapy is very helpful. Light therapy is very helpful. You have an occupational therapy that would help with the time management and just being able to plan ahead, make sure you get the rest you need. So the support systems are important, and it helps in identifying that.

Deborah: Absolutely. This leads me to my next question. Are there certain risk factors that increase the likelihood of developing a perinatal mood and anxiety disorder?

Hopey: Yes, there are. Generally, if you've experienced some sort of depression before in your lifetime or, certainly, stress in relationships—financial stresses all play a part in that—and not having the support system. Because if you look at other countries, most countries, when a mother gives birth, the neighbors, the village takes care of the baby for six weeks so the mother can just rest.

Deborah: Right.

Hopey: This is one of those countries that we expect them to get up and just do everything.

Deborah: Right.

Hopey: So being able to have a support system where it -- and just because you have a mother or a mother-in-law does not mean that they're supportive.

Deborah: That's right, absolutely.

Hopey: Or even a husband. It really is somebody that you can call up and say, "Can you help me out for a couple of hours? I need to just take a break."

Deborah: Right.

Hopey: Of course, there's also increased risk if they have substance abuse, if they've had sleep disturbances, if they have eating disorders, history of any sort of physical abuse, domestic violence. All of that are contributing factors.

Deborah: Okay, all right. What should a woman do if she thinks she has perinatal depression or anxiety?

Hopey: I think the first thing is to recognize that there is help out there. Whether you talk to your primary care physician and tell him that you're not feeling the way you think you should and ask for a referral to a psychiatrist, or recognize that there are support groups out there. At Community Hospital Long Beach, we have a comprehensive program. We have an outpatient clinic where the moms can be seen by a psychiatrist and either referred to therapy—thus continue with the psychiatrist—or we have a partial hospitalization program, which is the day program. We also have an inpatient program where the moms can be with the babies for up to 10 hours a day, and then the moms stay in the hospital.

Deborah: That's great.

Hopey: We have extended visiting hours, and we incorporate the full family into the treatment.

Deborah: That just sounds so healthy and so wonderful and exactly what a woman who has just given birth really needs.

Hopey: We are still in the learning phase so we do take the cues from our moms as to what their needs are. This is a relatively new program, and we're one of the few in the nation that has both an inpatient and an outpatient program. But we really designed it to meet the needs of the individual mom and her family.

Deborah: It just sounds like we've come a long way. I think women are a little bit more now used to the fact -- see, there are so many TV shows, and they've shown this syndrome where the mom cannot bond with their babies. It's not quite so out there. I'm understanding 10 to 15 percent of women feel seriously depressed and anxious following birth?

Hopey: Actually, some of the numbers go up as high as 20 percent.

Deborah: Okay.

Hopey: I think one of the things that's very important, we do hear in the news about all these women who have what they call postpartum psychosis and all of these very stressful and concerning things are happening. That is a very small percentage of people who have perinatal mood and anxiety disorder. Of the 10 to 15 percent, less than 5 percent experience postpartum psychosis.

Deborah: Okay.

Hopey: But the other thing to recognize—and I think that this is what's concerning to moms—is that if you have ruminating thoughts about the baby being harmed, that is not unusual for PMAD, especially if you feel concerned about it. That is the time you do want to get help, but that does not mean that you are going to harm your baby. It is really just a symptom.

Deborah: Okay. And there is help. You can get help. You're not alone. That's the real important thing to remember.

Hopey: You're not alone, and you're not crazy. And with the right help, you will get better. That's what's really important. The earlier you get the treatment, the better for you and the baby, because not being treated does have high risks to not only the mom but to the baby and to the development of that fetus and, later on, into the childhood. The sooner you get the help you need and the sooner that you get treatment, the better off that it will be for the entire family.

Deborah: Absolutely terrific advice. It's been really, really wonderful to have you on the show. Very illuminating. I'm sure there are some women out there who are hearing this message and feeling great hope. Thank you so much, Hopey Witherby, for taking the time to talk to us today about perinatal mood and anxiety disorders. Thanks so much for coming on the show today.

Hopey: Thank you.

Deborah: I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. By the way, the MemorialCare Center for Mental Health & Wellness has a perinatal mood and anxiety disorder program if you would like to check it out. Have a fantastic day.