Let’s talk about PMADs!
What are PMADs? Perinatal Mood and Anxiety Disorders. We commonly know this as “Postpartum Depression” or “Postpartum Anxiety.” So, why the fancy term “PMADs?” Evidence shows that a lot of the cases of postpartum anxiety and depression actually begin during pregnancy. So many mothers are experiencing these issues during pregnancy that we began calling them Perinatal mood disorders (peri means surrounding and natal means birth so Perinatal literally means the time surrounding birth, pregnancy and postpartum). But, not only mothers experience PMADs. Fathers do too. Today, I’m going to focus on mothers.
As mothers, we fight sociatal norms and expectations as we try to raise our small children. Some of us get extremely overwhelmed with the duties we have to our growing family, extended family, and potentially work, church, and the list may go on. New mothers are at a high risk for PMADs in part due to the overwhelm, in part due to changing hormones, and also in part to other factors that I will discuss further. The mother in this picture looks overwhelmed. She looks sad. Shown above is only part of the picture. Here’s the rest.
This mother may very well not have any mental health concerns. A smiling mother may have postpartum depression or anxiety. It’s hard for others to be able to tell on the surface, in part because our society continues to push that if you have a new baby you need to be happy, or at least look the part. This is why I’m so passionate about this subject. We need to be talking about it. Talking about PMADs needs to be a norm. We need to fight to help mothers help themselves and know that it’s important to recognize and seek out resources and help.
I had the opportunity a year ago to guest post on Mary Morrow of ToMorrows Memories blog. Here is the text from that post (you can see the original here):
I’m grateful I have the opportunity to talk to you today about Perinatal Mood and Anxiety Disorders (PMADs). I prefer to use this term when I am speaking about Postpartum Depression (PPD) and Postpartum Anxiety because statistics say that half of postpartum depression episodes begin during pregnancy (Cynthia Good Mojab, 2016 GOLD Lactation Conference. “The Rug Pulled Out from Underneath Me: Depression During Pregnancy and After Birth.”). Not only can mothers be affected but fathers can as well. More studies are now looking at PMADs in fathers because fathers were ignored for a very long time.
Like diabetes or a broken arm, PMADs are a group of disorders caused by something in your body not working in the way it’s supposed to. It doesn’t mean something is wrong with you as a person, that you’re weak, that you are not faithful, that you’re a bad person, or that you aren’t willing your body and mind enough. Being told to “snap out of it” or “pull yourself together” will not help you overcome these issues just like someone with a broken arm can’t just pull their self together or will their arm to just be better. Your mind is extremely powerful, however, and there are a lot of different things you can do to help you overcome this.
Mary already shared some great information about symptoms of PMADs in her earlier post
. I want to focus on risks, screening, and 4 keys that I hope all moms (and dads) remember if they do have PMADs.
Some of the risk factors that I especially want to share include: parents of multiples, parents with babies with special circumstances (including a NICU stay), survivors of sexual abuse, parents who have personal or family history of depression or anxiety, mothers who experienced birth trauma, and mothers who wanted to breastfeed but had challenges or were not able to get it to work. There are certainly other risk factors but I wanted to especially point these out because as an IBCLC, I work with families with these risk factors a lot. When I’m obtaining a history, I have to ask some sensitive questions including asking if you have a history of abuse or if you have experienced depression or anxiety in the past. These directly relate to breastfeeding because they can affect your breastfeeding relationship and put you at a higher risk. This doesn’t mean you WILL experience depression or anxiety but it’s a good idea to watch yourself and have your spouse or partner also watch for red flags. It’s also extremely important if you have breastfeeding challenges to get early and continuous help.
I screen all of my clients for depression and anxiety. I encourage dads to also complete my screening tools. I do not diagnose, instead I notice red flags and refer you back to your physician or to other local resources if there are concerns. I include a handout with my screening tools with common symptoms of depression and anxiety so that you can continue observing one another. Many of the mothers I have worked with that have experienced symptoms have not recognized them in themselves for quite some time, including myself. My own journey with postpartum depression and anxiety has made this topic very important to me.
Because I have also suffered with PMADs, I want to share with you 4 things that I feel are very important to remember if you have depression or anxiety.
1. This is not your fault, and you are not alone.
You did not do anything to make this happen. You are an awesome mother (or father). You are an amazing and special person. Many of the best of us have experienced these issues. Here are some statistics about generalized anxiety and depression (link to: https://www.adaa.org/about-adaa/press-room/facts-statistics
). 20-26% of women and 8-12% of men will experience depression at some point in their lifetime (link to: http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_depression
). There is a stigma around mood disorders and there shouldn’t be. You are not alone. Please share your story! You have no idea who else is suffering in silence that your story may help.
2. There are many treatments that are safe for breastfeeding mothers! There are treatments that range from supplements, therapy, lifestyle changes (including exercise and yoga), to medications. There are natural remedies and there are pharmaceuticals. Even many pharmaceuticals are safe for breastfeeding mothers. If you have questions about the safety ratings of a medication please don’t hesitate to call myself, the Oklahoma Breastfeeding Line, or Infant Risk (please see the resources at the end for contact information). We are all happy to share the data and safety ratings of medications.
3. A healthy mother and father are extremely important to the family. If you have ever had a flat tire in your car, you know that it’s hard to drive. The flat tire slows down the rest of the wheels, your ride is super bumpy, and it can be dangerous. If mom (and/or dad) are not healthy mentally it can be much the same. You are important! Your mental health can also throw off the balance in your home. There have been studies that mothers with untreated mood disorders can impact the brain and emotional development of their child.
4. YOU are worth it.
You are worth spending the time and money to get help. If money is an issue, often there are free and low cost resources. You just have to ask. One of the hardest parts of PMADs is often an overwhelming feeling that you aren’t worth it. I’m here to tell you that you are. You are a very important person, even if you don’t feel that way. You are worth getting help. This is a problem worth getting help for.
More breastfeeding resources are available at: nurturingbonds.wordpress.com/breastfeeding-resources
Oklahoma Breastfeeding Line: 1-877-271-MILK (6455). 24/7 number. If you have an urgent question select to talk to an IBCLC on call.
Infant Risk Center Hotline: Monday – Friday, 8am – 5pm CT (806) 352-2519. www.infantrisk.com
. Also available is the Mommy Med app (it’s about $3-you can even scan a medication at the pharmacy or store to check the safety during pregnancy and breastfeeding).
: Kathleen Kendall-Tackett is an IBCLC and PhD who studies PMADs. She has a lot of articles on her website and references to many books she has written or co-authored.
Depression in New Mothers: Causes, Consequences and Treatment Alternatives, 3rd Edition by Kathleen Kendall-Tackett.
The Hidden Feelings of Motherhood: Coping with Mothering Stress, Depression, and Burnout by Kathleen Kendall-Tackett.
This Isn’t What I Expected: Overcoming Postpartum Depression by Karen R. Kleiman and Valerie Davis Raskin.
Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth by Walker Karraa.
Beyond the Blues: Understanding and Treating Prenatal and Postpartum Depression and Anxiety by Shoshana S. Bennett and Pec Indman.
Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family by Diane Wiessinger, Diana West, Linda J. Smith, and Teresa Pitman.
Nighttime Parenting: How to Get Your Baby and Child to Sleep by Dr. William Sears.
Traumatic Childbirth by Cheryl Tatano Beck, Jeanne Watson Driscoll, and Sue Watson.
When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women by Penny Simkin and Phillis Klaus.
Rebounding from Childbirth: Toward Emotional Recovery by Lynn Madsen.
It’s OK Not to be OK…Right Now: How to Live Through a Traumatic Experience by Dr. Mark Lerner.