By Adrienne Griffen, Executive Director of the Maternal Mental Health Leadership Alliance
Having a new baby…often the happiest time in a woman’s life.
Not always.
In normal times, 1 in 5 women will experience anxiety or depression either during pregnancy or the first year of baby’s life. In fact, mental health issues like postpartum depression are the MOST COMMON complication of pregnancy and childbirth, turning joy into sadness, loneliness, confusion, regret, and guilt.
In addition, we are not in normal times. We are in a pandemic, and stress and anxiety have reached unprecedented rates:
- According to the Kaiser Family Foundation, almost 50 percent of Americans report their mental health has been negatively impacted due to worry and stress about the virus.
- Experts predict that the general stress of the pandemic, coupled with the economic crisis, will lead to new mental health issues and substance use crises.
- Postpartum Support International – the world’s leading organization in providing support to childbearing women experiencing mental health issues – quadrupled the number of online support groups from February to April to accommodate the increased need for services.
The pandemic has opened a pandora’s box of worry for new mothers and mothers-to-be, who ask: What is the impact of coronavirus on me, my unborn baby, or my newborn? Who can accompany me to the hospital for labor and delivery? How will I care for my baby if I have COVID-19? How does COVD-19 impact breastfeeding?
To all the new mothers and mothers-to-be who are struggling, please know that you are not alone, that you are not to blame, and that with help, you will be well. Help is available from Postpartum Support International (www.postpartum.net, 1-800-944-4773, text 503-894-9453). Specially trained staff and volunteers can provide support and information about local resources.
I’m pregnant and I have lots of questions about COVID-19. Where can I find good information?
Many organizations have created coronavirus “hubs” on their websites with information related to COVID-19 and pregnancy. Here are a few good places to start:
- CENTERS FOR DISEASE CONTROL. The CDC website is accurate, up-to-date, and easy to understand and navigate. Important pages include:
- NATIONAL INSTITUTES FOR HEALTH. The NIH has published Coronavirus Disease 19 Treatment Guidelines to inform clinicians how to care for patients with COVID-19. The Guidelines contain Special Consideration In Pregnancy and Post-Delivery. Because clinical information about the optimal management of COVID-19 is evolving quickly, the Guidelines will be updated frequently as published data and other authoritative information becomes available.
- MATERNAL MENTAL HEALTH LEADERSHIP ALLIANCE. MMHLA’s website includes information about research and ongoing studies looking at the impact of COVID-19 during pregnancy and postpartum, along with resources for both women experiencing PMADs and the healthcare providers supporting them.
I’m feeling really overwhelmed and anxious. Maybe the pandemic is contributing to these feelings…but maybe it’s something else.
Maternal mental health conditions – often referred to under the umbrella term “postpartum depression” - can occur any time during pregnancy or the first year after pregnancy and can include anxiety, depression, panic attacks, obsessive-compulsive disorder, post-traumatic stress disorder. Maternal mental health conditions are bio-psycho-social illnesses, meaning that the root of the illness is often multi-factorial. It is crucial that a new mother (or a pregnant woman) experiencing these illnesses understand that they are not her fault.
Symptoms of maternal mental health conditions include those commonly associated with depression (feeling sad, hopeless, alone) and anxiety (feeling overwhelmed, worried, fearful). Many women have scary intrusive thoughts of hurting themselves or their babies. Please note that having thoughts does NOT mean that you are going to act on them.
In addition, women experiencing maternal mental health issues often say things like:
- I’m exhausted, but can’t sleep, even when my baby sleeps.
- I feel like I am drowning.
- I am overwhelmed with rage (often focused on partner).
- I feel like the worst mother in the world.
- My family would be better off without me.
- I feel guilty for having these feelings.
Some of the well-known risk factors for maternal mental health challenges include personal or family history of anxiety or depression; sensitivity to hormone changes; lack of social support, especially from a partner; traumatic birth; and major life stressors such as the pandemic, financial stress, or death/illness of a loved one. Certain groups of women are at increased risk of experiencing mental health issues during the childbearing years, including:
- women who have had previous experience with a maternal mental health condition;
- women who live in poverty;
- women of color; and
- women who have a baby in the neonatal intensive care unit
How does someone recover from a maternal mental health condition?
Fortunately, maternal mental health conditions are often temporary and treatable. The path to wellness can include a combination of self-care, social support, therapy, and medication.
1. Self-care. New mothers need to recover from the physical and emotional challenges of pregnancy and childbirth. Being a new mother, caring for a newborn, and maintaining home and family is challenging, especially if the mom feels anxious or depressed. Moms as much as possible should focus on:
- Sleep. Getting 4-5 hours of uninterrupted sleep is the most effective, least expensive thing a new mother can do to start feeling better. Passing off just one night-time feeding can help a new mom get this long-ish stretch of sleep. Note: sleeping too much may be a sign of more serious depression or anxiety.
- Nutrition. New moms can try to eat every time baby eats. Water and a high-protein snack (yogurt, cheese stick, nuts) are good mini-meals. Try stocking a feeding station for mom and baby.
- Exercise. Gentle exercise – such as taking a walk outside – can have terrific benefits. The combined effect of change of scenery, fresh air, vitamin D from the sun, and endorphins released in the body can have a positive impact on mood.
- Time off. No other job is as demanding, requiring being on duty 24 hours/day, 7 days/week. New moms need time off to recharge and rejuvenate, especially if feeling overwhelmed. The challenge is to identify and meet those needs, whether it’s taking a shower, reading the newspaper, or “zooming” with an old friend.
2. Social support. New moms often feel the need to connect with other new mothers, especially if experiencing anxiety or depression. Being at home with a newborn or toddler can be socially isolating, compounding feelings of sadness. Fortunately, technology has allowed many peer support groups to move to online formats, providing safe spaces for non-judgmental listening, support, and encouragement from others experiencing similar issues. Leaders of these support groups are caring, empathic, and have survived these illnesses.
3. Talk therapy/counseling. New moms may need to address topics such as their role as a mother, changes in relationships, and communications with a partner. Talking with an objective third party – a social worker, psychologist, or professional counselor – can help put things in perspective. The pandemic has loosened up restrictions on teletherapy, and many therapists and counselors have embraced online appointments.
4. Medication. Sometimes medication is needed to lessen anxiety or depression. Several medications commonly used to treat anxiety or depression are widely considered safe to use during pregnancy or while breastfeeding. These medications can be prescribed by primary care physicians, obstetrician/gynecologists, or psychiatrists.
For information and connections to resources, contact Postpartum Support International (www.postpartum.net, 1-800-944-9773 (phone), text 503-894-9453).
What can I do to help a new mom or mom-to-be who might be struggling?
How can you help someone struggling with a maternal mental health challenge? Here are a few ideas:
- ASK a new mom how she is doing. Really listen and ask about HER – not about the baby.
- NORMALIZE her experience. Let her know that she is not alone, that lots of women have a tough time in the transition to motherhood, and that help is available.
- HELP by offering to take the baby so she can take a nap or take a shower or take a break. Do a chore: cook dinner, fold the laundry, do the dishes, walk the dog.
- CONNECT her with help. Tell her about Postpartum Support International, an organization with volunteers in all 50 states who provide support and resources. (www.postpartum.net, 1-800-944-4773, text 503-894-9453).
You are not alone. You are not to blame. With help, you will be well.
