By Melissa Whippo, LCSW – Edited By Jessica Schumer, MD
Source: UCSF Department of Pediatrics Website
In my work at the UCSF Pregnancy and Postpartum Mood Assessment Clinic, I see patients who are in all stages of their fertility, pregnancy and postpartum journey. As one of the facilitators of the postpartum support group “The Afterglow”, I hear many different versions of women struggling in the postpartum setting. It is probably the most vulnerable time in a woman’s life, and women have such diverse responses given their respective demographics and backgrounds. However, I have found that there are common themes from the beginning of a woman’s fertility journey to the postpartum period. This speaks to the universality of the transition to motherhood and also its challenges. We know that 1 in 5 women are diagnosed with mood disorders in the postpartum setting, and many struggle throughout their pregnancies as well. As obstetricians and pediatricians come into the most regular contact with postpartum women, here are 5 things to remember when screening or helping to treat women with Perinatal Mood and Anxiety Disorders:
1. The Edinburgh Postpartum Depression Scale (EPDS) is not foolproof. Many women who are experiencing symptoms of Perinatal Mood and Anxiety Disorders (PMAD) will not answer truthfully for fear of her child being removed from her care or some other stigma associated with mental health issues. If you are screening a woman who seems to have symptoms of depression, anxiety, PTSD or OCD and yet she does not score “high enough” on the EPDS, try to engage her about this. Reassure her that PMAD is extremely common, not her fault, and that women get better with treatment.
2. Calling it “postpartum depression” fails to encompass the range of mood disorders women commonly experience during pregnancy and the postpartum setting. PMAD doesn’t roll off the tongue as easily, but it is more accurate. Anxiety often accompanies depression, and is a component of PTSD. I have encountered many women who had trauma in their birth experience and afterward exhibit symptoms of PTSD. OCD can arise in women postpartum as they try to find ways to manage their feelings of being overwhelmed when attending to a baby. Attachment disorders can manifest when women struggle to bond with their new babies.
3. There is a sub-acute population of women who suffer from mood disorders and require urgent clinical attention, but they aren’t a danger to themselves or their children. This is especially tricky. How do we get these patients the help they need without sending them to the ED? Ideally, we can refer our patients to the Pregnancy and Postpartum Mood Assessment Clinic (415-353-2566). We are exploring additional treatment options for this population.
4. Many women experience a correlation between mode of delivery and mood concerns and/or disorders in the postpartum setting. There is very little clinical research available at this time on this topic, but it is prevalent nevertheless. Women also talk about connections between feeding issues and mood concerns and/or disorders in the postpartum setting. Providing lactation support as well as giving women permission to supplement or formula feed helps them feel less like they have “failed” in some way.
5. The best news (and most important to remind our patients) is that with the right treatment, women feel better. Many women believe they have to “muscle through” their difficult emotional experience and that it will resolve on its own, but this is simply not true. The right combination of treatment looks different for each individual, but perinatal mood and anxiety disorders are treatable.
About the Author: Melissa Whippo, LCSW, is honored to work with pregnant and postpartum women at UCSF. When she is not at work, she can be found practicing yoga with her 3 children. For more information about the Afterglow Postpartum Support Group, and additional resources for postpartum women, please visit: http://www.whrc.ucsf.edu/whrc/gex/afterglow.html
Image credit: Melissa Whippo
Additional Resources
The Afterglow: A postpartum support group for new mothers
In this four-week series, new moms and their babies will gather to share their experiences and support one and other in the new days of parenting.
"What to Do if You're Just Not Glowing: Emotional Aspects of Pregnancy and Postpartum."
This workshop offers an opportunity to ask questions and also addresses treatment options including support groups, relaxation classes, therapy and the pros and cons of medication. For more information, call the UCSF Great Expectations Pregnancy Program.
UCSF Great Expectations Pregnancy Program: (415) 353-2667
Visit the National Center of Excellence in Women's Health for additional information on women's health services at UCSF. Other services in Women's Mental Health are available here.
Contact Us:
Pregnancy and Postpartum
Mood Assessment Clinic
400 Parnassus Ave., Floor B1
San Francisco, CA 94143
(415) 353-2566