PMADS (Perinatal Mood And Anxiety Disorder)
By: Dvora Entin, LCSW
Dvora Entin, LCSW, PMH-C, has advanced training in perinatal mental health from PSI, ASRM and the MISS Foundation. With a private practice in Maternal Mental Health, Dvora consults nationally about perinatal and reproductive health challenges and directs the Safety Kid initiative for child sexual abuse in all Philadelphia Jewish Day Schools.
Q: My beautiful and healthy little boy was born about 6 weeks ago, after a long-awaited pregnancy. We experienced several pregnancy losses and some infertility treatment before we finally had our son. I really want to say, “celebrated the birth of our son.” I really want to say, “We are over the moon with joy,” and I REALLY want to tell you how happy I am to finally be a mother like I have dreamed about since I was a young girl. But I am not finding my happy. I feel so flat and disconnected, maybe even scared. I am staying home with him for a little longer, and I am terrified of being alone with him all day. I worry about all the scary things that can happen to him, and even the things I might do by accident that could cause him harm. I just don’t understand how I am feeling, and I feel like I am so ungrateful for this gift, especially after so many years of waiting. I must be a terrible mother, and I feel like such a failure. Can you help me understand what I am feeling?
A: What an overwhelming and exhausting experience it is to bring a child into this world! And for you, that experience wasn’t just nine months. For you, that experience was years of waiting and hoping and praying and treatments and medications and doctors and doctor visits. That makes me tired just listing all that went into the pregnancy and delivery. And now here you are, a few weeks postpartum, and all of that exhaustion, physical and emotional, is settling in. And let me guess—sleep is a rare and treasured commodity as well. Let’s talk about some of the normal thoughts and experiences, some that fall in the yellow zone of thinking, and some in the red zone - of heightened concern.
The first and most important, most impactful part of mental health care is sleep. A woman caring for a newborn needs to get 4 hours of sleep (minimum) a night. Ideally, that sleep is contiguous. That might mean allowing your husband to take a night feeding or sleeping in a different room for that slot of time to give yourself the space to rest and sleep. Our brain needs sleep to function successfully. Without enough sleep, our minds have a hard time staying rational and healthy. It’s important to note, that if you have the opportunity to sleep and find yourself unable to sleep because of racing thoughts or an inability to settle down, that’s a bit in the yellow zone - needing additional support.
Women can experience the normal “baby blues” that feels like a really bad case of PMS; more tearful, hormonal, or irritable. That should clear by two weeks postpartum. After 2 weeks, if symptoms persist, it’s no longer baby blues, and a woman would benefit from additional support from friends, family or a professional. A part of a spectrum of disorders called PMADs, Perinatal Mood and Anxiety Disorder, affecting at least 1 in 7 women is too often missed by medical providers and family members. We are not asking the right questions. For women, this can look like a significant case of anxiety and for others depressive symptoms that include a hopelessness, frequent crying, and even thoughts of suicide when symptoms are severe.
Those scary thoughts about the baby getting hurt or you hurting the baby are called “intrusive thoughts” and do not mean you will actually hurt your child. A recent study showed 90% of new moms experience intrusive thoughts (and at least 80% of new dads!), and it means that your mind is in a more agitated state, more aware of the responsibilities that you now hold, and the weight of that responsibility can feel heavy. Intrusive thoughts alone are not a cause for concern. However, if intrusive thoughts prevent you from walking down stairs, cutting up vegetables, changing your child’s diaper, or general functioning, then those thoughts have crossed over into the “yellow zone”, and therapeutic support would be a good idea. These scary or intrusive thoughts can cause great distress, and there is no “normal” in that.
So when is a woman’s experience in the “red zone?”
The media tends to focus on the extreme versions of postpartum struggle, with an emphasis on postpartum psychosis, a break from reality, a complete disconnection from what is real and what is not. The difference between psychosis and intrusive thoughts, is that you are fully aware that the intrusive thoughts do not reflect a reality, the thoughts make you uncomfortable, and you have no intention to harm the baby. Individuals in a state of psychosis are not aware of their distorted thinking and truly believe what their mind is telling them. This experience is deeply in the red zone, a sign of someone’s mind being in deep distress and needing immediate medical attention.
But that yellow zone is a pretty scary and uncomfortable place for a new mom to be. Your body has been through a herculean feat, everything aches, and you may feel most vulnerable to the opinions and advice of others, sad or disappointed at the way the birth turned out, or have old insecurities surface with the new child in your care. The extensive caregiving needs can be isolating and lonely and frightening.
But Momma, you are not alone! We hear your struggle, and with help, this will get better. Some women will benefit from therapy, and others may need medication to support them to a healthier and more comfortable state of mind. The first step, really the hardest step, is the asking. Reach out to a trusted friend, your husband, your mother, and share your struggle. Don’t stop asking until you find the right therapist or physician to partner with you in health.
Because being a new mom is really hard, and exhausting and overwhelming. And you are not alone, and with help, it gets better. Oh yes, and Mazal Tov!
