Happy Maternal Mental Health Awareness Month!

As a mental health counselor who specializes in perinatal mental health, I believe in the importance of using the awesome CRM platform to bring useful information about maternal mental health to increase awareness amongst local moms. So, buckle up because here we go!

What is maternal mental health, anyway?

Maternal/perinatal are used interchangeably. The World Health Organization (WHO) defines maternal mental health as “a state of well-being in which a mother realizes her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her community.” I will more often use the term perinatal, which encompasses the time during pregnancy and a year or two postpartum. This definition includes a broad range of things – normative adjustment concerns, perinatal mood and anxiety disorders, fertility difficulties, pregnancy loss, birth trauma. All of these are closely linked and can have a significant impact on a mother’s experience with pregnancy, postpartum adjustment and parenthood.

I won’t bore you with stats, but trust me when I say it’s highly likely that you or someone you love has experienced struggles with mental/emotional health related to one of those listed above.

When people hear about maternal mental health, their thoughts commonly go to postpartum depression. While depression is one condition that mothers can face postpartum, there are so many lesser-known aspects of maternal mental health that are often overlooked, which can increase feelings of loneliness and isolation, and reduce help-seeking in the individuals who are being impacted. Let’s look at building some awareness around some of these other aspects of maternal mental health that are commonly misunderstood!

maternal mental healthMyth: I must not have postpartum depression because I’m not feeling sad

There are a few frequently reported but underrecognized symptoms of PMAD including increased anxiety, irritability, anger, strong overwhelm or sensory overload. Irritability is often directed at partners, other children, or pets. It may not even be on a person’s radar that they are dealing with a mood or anxiety disorder because what they’re experiencing may be so different from the perceived idea about what depression or anxiety even looks like. On the topic of anxiety, postpartum Anxiety (PPA) is a thing! A pretty BIG thing, actually. Have you found yourself excessively worrying about the health and safety of your baby, your partner, or yourself? Are you noticing a strong urge to check often that your baby is breathing? Have you been unable to sleep when your baby is sleeping because you can’t turn off your mind? If worried thoughts feel excessive or difficult to turn off, it may be an indication that you’re struggling with PPA.

Fact: Extra anxiety and intrusive thoughts are common for ALL parents in the postpartum time

This will blow your mind (it blew mine when I first found out!!) – did you know that after giving birth, our brains are wired to look for danger in the environment to keep our offspring safe? This results in things like us being more sensitive to sound (do you hear every single noise your baby makes??), feeling more anxious, and having increased intrusive thoughts/imagery in order to alert us to potential dangers in the environment. Chances are good you’ve had intrusive thoughts before – have you ever been driving and had a thought like, “I wonder what would happen if I drove off of this bridge right now?” If yes, you’re like most people. Intrusive thoughts in the perinatal time are commonly centered around the health and well being of the baby, partners, or self. These can be quite violent or graphic in nature, which is why Karen Kleiman of the Postpartum Stress Center has coined the term “scary thoughts,” as many women will respond to these thoughts with fear and distress and won’t share with others that they are having them, even though in the vast majority of people these thoughts are JUST thoughts, and don’t mean that someone is dangerous, doesn’t love their child, or that they’re a bad mom. Research estimates that up to 90% of parents experience these types of thoughts, although the reality is that it’s probably much closer to 100%!

Myth: Taking medication, seeking therapy, or using other informal supports are a sign of weakness

There is so much misinformation surrounding help-seeking behavior, in general. If a person can get through all of the misinformation presented to pregnant and lactating women about the safety of medication while pregnant or lactating, then there is the huge internal battle of believing that you are in some way defective or inadequate because you “have to” or “can’t do it” without medication or therapy.

Here are things I know to be true:

  • There are many medications that are commonly known to be compatible with pregnancy and lactation.
  • The health of the baby is not the only consideration that has to be made when you are both experiencing a perinatal mood or anxiety disorder and making a decision about seeking support through medication and/or therapy.
  • Seeking support from others is one of the most difficult things a person can do, and is therefore incredibly brave.
  • You are not the only person in your life who is experiencing difficulties. If we regularly allowed a little more openness and vulnerability, we would all be better for it.
  • It is likely that you can “push through it” on your own. But why? There is no need to allow yourself to suffer when it doesn’t have to feel so bad.

Myth: Breast is best

I know this one is controversial and I may take some heat for my view on this. That’s okay. It’s important to recognize that if you’re looking exclusively at what is the best nutrition for baby, then research says breastmilk. HOWEVER, this is not the only factor that has to be taken into consideration. Just like when making a decision about the use of medication, there are TWO HUMANS whose needs must be considered. Mothers and babies are a unit, and what is best for baby may be causing harm to mom. And in that situation, the harm to mom’s mental and emotional well-being will absolutely negatively impact the baby if it’s not addressed. Breastfeeding can be both a protective factor and a risk factor for the development of PMADs, depending on the situation and level of support.

Myth: A physically healthy mom and baby is the only outcome that matters in birth

Birth doesn’t have to be, but it can be an extremely emotional and transformational event. There are many birthing women that come out of the experience of birth with disappointment, grief or trauma that may be the result of unmet expectations, unexpected medical interventions, disrespectful treatment by professionals or medical emergencies . Often, these experiences can be minimized, bringing shame or guilt at the feelings they have toward their birth. It is common for the mom or the people around her to say some flavor of, “yes, the birth was really hard but we are healthy so that’s all that matters and I/you should just be thankful for that.”

It’s so important in these situations to acknowledge the complete picture. The use of the word “and” can be a helpful way to do this. “The birth was really hard, I have a lot to process so it may take some time to feel okay about it. AND I am thankful that we are healthy.” Perspective taking is important, AND so is acknowledging the trauma or difficult emotions in order to process and move through it. Trying to suppress or minimize these feelings can lead to mood changes, increase anxiety, and/or make subsequent pregnancies and births much more difficult.

The more you know!

Hopefully this information enhances your understanding and brings more awareness about the wide range of experiences that fall under the umbrella of maternal mental health. It’s so important to remember that if you’re concerned about the way that you’re feeling – it’s okay and important to reach out for help and support. You do not have to suffer through it.

I’m including some information about resources that are available to learn more and/or to get support! Please let me know if I missed any of your favorites and join me on Cedar Rapids Moms Instagram on May 4 for World Maternal Mental Health Day!

Postpartum Support International Iowa Chapter

No Foot Too Small

Postpartum Support International
Find virtual support groups and links to additional local resources! PSI also has a Psychiatric consultation line for physicians to consult about patient care and medication during pregnancy and lactation.

The Postpartum Stress Center

International OCD Foundation

2020 Mom

Dr. Kathleen Kendall-Tackett

Good Moms Have Scary Thoughts: Karen Kleiman

What About Us?: Karen Kleiman

The Calm Pregnancy Workbook: Dr. Kat Kaeni

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