Increasing Awareness for the Perinatal Experience
Written by Karla Boertzel LAC, May 2024
Overview of Population:
The perinatal population includes any expecting parent or current parent from conception through the first year after giving birth. The parent can be of any culture or sexuality. This population also includes non-birthing parents such as adoptive parents. While becoming a parent can be a time of great joy, it can also be a time of enormous change and challenges. A surge in hormones (estrogen, progesterone, oxytocin, prolactin), lack of sleep, and biological factors position the perinatal population at greater risk of developing a PMAD (perinatal mood and anxiety disorder), including generalized anxiety disorder, panic disorder, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder with peripartum onset, and/or psychosis. Contributing social factors are trauma, lack of adequate social support, discrimination, social environment, and a prior mental health history. Unrealistic societal expectations have the potential to make mental health challenges worse for these clients, such as: getting pregnant is easy, that there will be an instant bond between parent and child, and that becoming a parent is instinctual, among many others. Taken together, these biological, mental/emotional, and societal factors have the potential to negatively affect outcomes for the parent, their partner, and even the child.
The need to prevent and detect PMADs in this population is great. In one study 49.9% of women with antenatal depression and 30% of women with postpartum depression were identified, yet just 8.6% and 6.3% received proper treatment respectively (Cox et al, 2016). Untreated PMADs increases costs of medical care, the likelihood of child abuse, discontinuation of breastfeeding, substance use, infanticide/suicide, inadequate parent-child bonding, as well as developmental consequences for the child. Lack of consistent, and reliable information and screening protocols have made it particularly difficult for this population to get access to the mental health resources they need during this time. Additional barriers include clinician’s perception that tools may be time consuming or expensive, lack of awareness for validated screening tools, lack of reimbursement for screening from insurance companies, feeling medically liable if someone screens positive, and uncertainty about treatment.
One of the most prevalent maternal mental health disorders is postpartum depression (PPD), affecting approximately 1 in 7 women and 1 in 10 men. PPD is characterized by persistent feelings of sadness, hopelessness, and worthlessness that interfere with daily functioning. It can also manifest as anxiety, irritability, changes in appetite or sleep patterns, and difficulty bonding with the baby. For men, symptoms may include increased hostility, isolation, or unhealthy coping such as substance use.
Another significant concern is postpartum anxiety, which affects around 10% of mothers. Unlike PPD, postpartum anxiety may not always present with feelings of sadness but instead with excessive worry, restlessness, and intrusive thoughts about harm coming to the baby. This constant state of apprehension can be debilitating and exhausting for mothers, impacting their ability to care for themselves and their infants.
Bright Spots:
Fortunately, there is hope and support available for expecting/new parents struggling with their mental health. Increased awareness and destigmatization of PMADs have led to improved screening practices, better access to mental health services, and greater community support. When individuals are screened early, the prevalence of specific PMADs is reduced as well as the duration of symptoms. From therapy and support groups to medication and lifestyle interventions, there are various treatment options tailored to meet the unique needs of each individual. Additionally, fostering a culture of empathy, understanding, and support within families, communities, and healthcare systems is crucial. Encouraging open conversations about the challenges of parenthood, validating parents’ experiences, and offering practical assistance can go a long way in reducing feelings of isolation and shame.
