Perinatal Mental Health
Beyond Universal Screenings
WRITTEN BY: Farrah Deselle, MSN, RN, CLC, CBE (BFW)
Perinatal Education Coordinator
The Mom’s Place at Catholic Medical Center
The United States Preventative Task Force recently published recommendations for universal screening for depression of pregnant and postpartum women. All of the responses I have read agree that this will identify more women who need access to mental health care, will likely help decrease the stigma associated with perinatal mental health diagnosis and will give more women the opportunity to express their mental health concerns during this period.
There are so many factors impacting perinatal mental health and illness. (Perinatal refers to the period of time from conception to a year or so after birth) Universal screening is one way to begin to identify it, but let’s have a bigger, more complex conversation; one that involves both the normal feelings of loss that come with the transformation to parenthood, and that involves the cultural forces that are likely involved in the experience of perinatal mental health and illness. It is not likely that you will hear that parenting comes with a sense of loss and grief, but the truth is that it does, and if you experience it, you are not alone and you are not doing anything wrong. Any time that our life changes, grief occurs, even if our job changes or we move. Grief is part of the process. Sometimes it is mild and passes quickly and easily. Sometimes it is intense and we require more support to get through it.
Mental health is complex, dynamic, and variable from one person to another or even within one person throughout their life. Perinatal mental health is no different. The experience is likely one of the most complex and rich during this time period in a human’s life. And it is not exclusive to biological parenting. In fact, there is currently a study out of Purdue University exploring depression in parents who have adopted children. And men can experience postpartum depression as well. So the experience of a shift in state of mental health during the period following the arrival of a child is as much a cultural and societal experience as it is biological.
Some reports indicate that one in eight women will experience perinatal depression, anxiety or a related mood disorder. But I often wonder, of those, how many experience a search for their new self as mother, a potentially rich period of personal growth and development, that our culture does not recognize and that they are unable to name for themselves. And then because it is not normalized and appropriately supported, ultimately become depressed or anxious.
When I meet with families either prenatally or postpartum, I often remind them that just as their baby is a “newborn” baby, so too are they “newborn” parents. And as newborn parents they must be cared for, gentle on themselves and invite others around them to support them. In our culture this takes a conscious and valiant effort as it is not built in. When a mother or father is born, they no longer exist in the state they were before the child arrived. They are forever changed, forever responsible for this new human being. Whether or not they are biological parents, the act of participating in raising a child changes EVERYTHING. How can this most significant of life’s changes not come with intense and varied feelings, ambivalence, insecurity, sometimes sadness and longing for the life one once had. In our culture of high demands and expectations, of returning to work after 6 weeks or sooner for many, of perfectionism, one-up ism, do it just right or else you might screw your kid up messaging, how can parents not have some feelings of anxiousness every day? To cope, there are things you can do.
If you are preparing to be a parent, come up with a plan to help support your own mental health during this intense transition in your life. The following suggestions are credited to the Birthing From Within ™ Childbirth Preparation model –
- Identify five or six people or places of support – someone you can call at 2am when the baby has been crying for an hour and you are at your wits end, someone you trust who you can call for baby advice, someone who can hold baby while you sleep, someone who can bring you a meal… you get the idea.
- With your partner or someone else that will be involved in the care of your infant, think about the things that could be challenging and identify three or four solutions for each one. You may not use any of the solutions, but at least you will have begun the conversation so that when you are sleep deprived and shocked at how much work it is to take care of an 8lb creature, you are not starting at square one. (Some suggestions – sleep, infant feeding, alone time with partner, new intense emotions etc.)
- Consider three or four things in your life now that you value, that will very likely change or cease to exist for a while when baby arrives. If you have a partner, sit down and do this together. You each make a list and then make one for the two of you (things you do together that you value). Now pick one thing each and one thing on your together list. It may be something as simple as going grocery shopping alone, or perhaps you like to sky dive and you won’t be able to do that for a few months… whatever it is, write it down, discuss it and come up with a plan to do it again at some point that first year (or six months or whatever you decide makes sense for you). Set a date on your calendar.
If you are already parenting and are worried about postpartum depression or anxiety, your adjustment to parenthood or you are just very surprised at the intensity of the experience and the feelings you are having – below are some resources you might find helpful. Most importantly, talk about what you are experiencing, and remember you are a newborn mom or dad. Be gentle with yourself and allow yourself to grieve the life you used to have. It doesn’t mean you don’t love your baby, it just means that you miss that life and that’s ok. Or it might be that you are grieving what you thought parenting would be, or birth or breastfeeding. And it is just not what you thought. When you have a different experience than you expected, there is an experience of grief too. You might cry, be sad, not be sure about anything, or feel anxious at times. Have a good cry. Give yourself permission to feel what you are feeling. It’s ok to talk to a counselor or therapist. You don’t have to have any diagnosis to get help. And if you are diagnosed, it does not mean you are a bad mom or that you failed. Your experience is a melting pot of all of the forces that are at play in your parenting journey, not any one thing that you did or that someone else did or didn’t do.
Postpartum Support International – www.postpartum.net
Postpartum Progress – postpartumprogress.org
Pam England’s Blog posts – Birthpeeps.blogspot.com (Some great articles on viewing birth through ancient wisdom)
If you are experiencing thoughts of harming yourself or your child or feel that you are not safe, go to your nearest Emergency Room for care.
If you believe you are experiencing any type of perinatal mental illness, do not wait to get help. Speak up. You are not alone, you will get better, and help if available. Call your OB, midwife or Primary care provider.
At The Mom’s Place, our classes are developed using the Birthing From Within ™ model (BFW) preparing parents in the body, mind and heart for the full range of childbirth. Our childbirth educators are nurses who work at The Mom’s Place and in our Special Care Nursery and have received training as BFW mentors. If you want to learn more about our offerings or schedule a welcome visit, call (603) 626-2626 or check out our website www.catholicmedicalcenter.org/moms-place.
Farrah Deselle is a Certified Birthing From Within ™ mentor and coordinator of Childbirth and Parenting Preparation, Education and Support Programs at The Mom’s Place at CMC. She teaches many of the classes and works at The Mom’s Place as a lactation consultant. She has a Master’s of Science in Nursing: Health Systems Leadership. For more questions email Farrah at: [email protected]