Perinatal Mood & Anxiety Disorders (PMADs) and Their Impacts on Perinatal Mental Health

Author – Karin Thoms (She/Her) is a passionate advocate for perinatal mental health and peer support. As the Peer Support Program Manager for Perinatal Wellbeing Ontario and a volunteer with organizations like Postpartum Support International, Karin strives to create a supportive community where parents can heal and thrive together.

 


 

CAMH (2024) states that “perinatal mood and anxiety disorders arise during pregnancy or in the first year postpartum. They affect between 10 and 20 percent of pregnant women and new mothers, and the non-child-bearing parent can experience problems as well.”

This statement resonates with me completely. I am not an expert or a researcher, but I am an individual who has experienced different variations of Perinatal Mood and Anxiety Disorders (PMADs). For clarity, the perinatal period includes when trying to conceive, at conception, and up to and including 24 months postpartum. 

Because of my experiences with PMADs, I am now a trained Peer Support Worker, and I will eventually become a Counsellor/Social Service Worker for individuals in the perinatal community when I have completed my education through Durham College.

I can only share my own experience (as a privileged, cis-gendered, heterosexual, white woman) and share what I have learned through my training with Canadian Perinatal Mental Health Trainings (CPMHT) on perinatal mental health. I believe that by sharing our lived experiences, we can help others who may not know how to help themselves and help others feel less alone in their experience. 

 

My Experience

I struggle to fully remember how I felt after having my first baby due to it being six years ago, and having some mental and emotional dissociation from the experience. It was a tough time for me and my new family mentally, emotionally, physically, and spiritually. 

What I do remember is feeling alone in my thoughts and feelings, feeling like no one would understand, and if they knew what I was thinking, they would be afraid for me and my baby. Not only did I think that others wouldn’t understand, but I also didn’t even understand what I was experiencing. It wasn’t until I finally connected with a Therapist at about six months postpartum that they explained I was experiencing postpartum depression and anxiety. 

I remember fearing for my baby’s safety and well-being constantly; I had intrusive thoughts about him being taken from me or being hurt. I tried my best to make everything “perfect,” but when it wasn’t perfect, I felt discontented, angry and unproductive, which were all things I rarely felt as a high-achieving, self-described perfectionist. I also remember thinking multiple times that I was an unfit mother and that my son and husband deserved better. I imagined running away, or worse, and believed they would be better off without me.

Another feeling I had that I didn’t understand until much later was grief. I grieved the life I had before the baby —when life was “simpler,” and I could be an independent version of myself. These feelings of grief and loss of the life I once had only added to the guilt I experienced. I wanted this baby, and now I was unhappy. What kind of mother was I?

When my son was about one year old, I got pregnant again; all the while, I was still experiencing symptoms of depression and anxiety. This pregnancy ended in a “missed miscarriage” when I was around 12 weeks pregnant. You can read more about my pregnancy loss experience in my blog post titled, On The Other Side of Miscarriage. What I know now but didn’t understand then is that aside from the grief I was experiencing, I was still managing PMADs and all the thoughts, feelings and emotions that come with them. Thank goodness for Therapy.

I got pregnant again about a year after my pregnancy loss, and my last experience with PMADs lasted from the moment of known conception until my daughter was about 6 months old. During my pregnancy, I felt constant fear and worry. Much of it was warranted, as I had lost the pregnancy before; however, it was unmanageable, as I couldn’t sleep and would Google literally every new symptom, tinge of pain and different feeling I experienced. Every milestone throughout my pregnancy was a relief, and although the stress lessened as each month passed, the fear lingered. I never wanted to experience the pain of loss again.

Once my daughter arrived, the anxiety and panic attacks I experienced were surprising. With it being my second child, I thought I would feel more confident and prepared than I did with my first. Instead, I still strived for perfection, felt like I was failing as a wife and mother of two, and sometimes felt incapable of my responsibilities. I felt that I couldn’t complain because I  wanted our second baby and endured a loss to get her. I should be grateful for every moment! I know now that I can feel grateful, AND it can be difficult. The two can coincide.

In both postpartum experiences, I had an immense fear that someone would take my baby from me. So much so that I insisted on an alarm system in our home. Not to say that it is nonsensical to have a security system, but it was my severe anxiety that made me do anything to feel safe. This and other worries caused me to have difficulty falling asleep and kept me glued to the baby monitor, with my anxiety telling me that I needed to be on edge and alert to my baby’s needs at all times – even when, in reality, they were perfectly safe. I literally slept on the edge of my bed so that I could spring to action as soon as I heard my baby cry. 

As I mentioned, one resource that helped me with my symptoms of postpartum depression and anxiety and with my pregnancy loss was talking to a Therapist, specifically a practitioner who was trained in Perinatal Mental Health. Therapy helped me understand that the feelings I was experiencing were normal and treatable. It wasn’t something I would endure for the rest of my life, and it was something I could work through and talk about openly, without judgment.

Another tool that helped me immensely with my second bout of postpartum depression and anxiety was Peer Support. The beauty of peer support is that the peers you talk to have gone through the same or similar experiences and struggles. They understand what you are experiencing and listen without judgment and without inducing shame. They make you feel validated and less alone in your experience because they have been or are there, too. 

 

Others Experiences

Because I have a hard time remembering these painful experiences, I asked my Instagram followers the following question, “I would love to get some first-hand perspectives from those who have experienced or are currently living through Perinatal Depression, Anxiety, OCD, PTSD, Bipolar Disorder, and/or Psychosis. What symptoms, thoughts, feelings or behaviours did you experience, and were you surprised by them?” I received some amazing responses that I related to immensely and helped me recall some memories. If you can’t relate to my experience, maybe you can relate to some of the following responses:

“I had persistent thoughts about never being good enough, fear of judgment, intrusive thoughts about me accidentally neglecting or harming my babies, guilt, shame, dizziness and panic attacks. I was foggy and irritable and felt so unworthy of motherhood and life in general. I was most surprised by the insomnia, scattered thinking and challenges with communication. I’d have thoughts in my head but couldn’t put sentences together enough to say them out loud for a long time. It also felt surreal, like my thoughts were disconnected from my actions like I was watching myself from the outside. This evolved into self-sabotage and disconnecting from people, including my kids. At one point, my symptoms seemed to mimic bipolar, ADHD and BPD (Borderline Personality Disorder). I typically come across as calm. I feel all my feelings inside. PMAD had my emotions scattered all over the place, snappy, defensive, angry, sad, etc., even for the littlest things.”

 

“[What I remember most about my pregnancy] is the intrusive thoughts and the overwhelming feeling of “if I do that, I will hurt my baby” being the only thing that ever stopped me. The intrusion thoughts were the kind that were impossible to ignore. I had no idea the depression could show up before you hit postpartum!”

 

“[I had] SEVERE anxiety and intrusive thoughts, obsessions about someone coming to harm the baby or take the baby. [I received] poor support from a psychiatrist – told ‘It’s just regular depression with a baby.’”

 

“I had Postpartum Anxiety (PPA) but only heard of Postpartum Depression (PPD), so I actually dismissed my symptoms. I also really thought that people with PPD couldn’t form a connection with their baby, and I was so focused on the baby, but I had no patience for the two older boys. I would just do the bare minimum and tell them to go play together somewhere else. I had a lot of anger and rage, which again confused me. I was very low, had depression as well, but the anxiety was so much higher that I felt depressed and extremely sad but like I was constantly vibrating, I just couldn’t settle physically and emotionally. I also had symptoms of OCD [Obsessive Compulsive Disorder]. I developed a fear of leaving the house with the 3 kids and forgetting something and so my compulsion became to check the diaper bag constantly to make sure I had everything. I would wake up in the middle of the night to check it, even if the baby was sleeping. And if I had an appointment the next day I’d be packing the bag the morning before and checking it constantly all day and night and up until leaving for the appointment. I was incredibly sad and weepy (depression symptoms). I would just cry all the time. At doctor’s appointments, at the lactation clinic, at home. I was sobbing in the shower once and my husband could hear me from the living room downstairs and came up and asked what was wrong and I couldn’t explain it. I was just sobbing uncontrollably… I had thoughts that my family would be better off without me and that anyone could be my baby’s mom because I couldn’t nurse him. I genuinely believed that in the moment. And that lead to me not trusting my parenting for the first time since having kids. And then when I finally started medication, there was so much grief at looking back and seeing how rough that was.”

If you would like to share your story, please reach out to me on Instagram at @karin.mental.health.advocate. I would be honoured to hear from you.

 

An Accessible Resource

Perinatal Wellbeing Ontario (PWO) is a non-profit in Ontario that provides virtual support and information to individuals and families in the perinatal period. PWO has one of the most relatable definitions of the different PMAD diagnoses that I have seen. The perinatal disorders they focus on are Depression and Anxiety, Obsessive-Compulsive Disorder (OCD) and Bipolar Disorder, and Postpartum Psychosis and Post-Traumatic Stress Disorder (PTSD). 

To summarize, PWO (2024) describes PMADs as including:

  • constant worry or racing thoughts;
  • crying and sadness;
  • disturbances to sleep and appetite;
  • thoughts of harming yourself or your baby;
  • feelings of irritability, anger and rage;
  • lack of interest in the baby or older children;
  • loss of interest in things that previously brought you joy;
  • feelings of excessive guilt or shame;
  • physical symptoms such as dizziness, nausea or hot flashes; and
  • panic or anxiety attacks.

Check out PWO’s informational documents on each of the PMADs listed above, including helpful coping strategies to try out:

Postpartum Depression and Anxiety

Perinatal OCD and Bipolar Disorder

Postpartum Psychosis and Post-Traumatic Stress Disorder

Coping Skills and Strategies for PMAD Symptoms

 

Coping Skills and Strategies to Manage PMAD Symptoms, from PWO (2024)

     Grounding Skills:

  • 54321 (See a description of the 54321 Grounding Technique from Calm.com);
  • Describe an object;
  • Spend time in nature;
  • Journaling;
  • Yoga;
  • Petting an animal;
  • Hugging meditation (See a description of hugging meditation from Lionsroar.com);
  • Eat something mindfully, noticing all the texture and flavour;
  • Deep breathing, box breathing (View how to box breath from Sunnybrook);
  • Listen to music; and
  • Mindfulness: simply observe the present moment without judgment.

     Ideas for activating the Vagus Nerve/Closing the stress response cycle:

  • Gargle;
  • Hum or sing;
  • Have a good cry;
  • Splash cold water on your face or take a cold shower;
  • Rub an ice cube on your face or neck;
  • Jump on the spot – get your heart rate up;
  • Shake out your hands and feet;
  • Orgasm;
  • Deep breathing;
  • Connect with a friend or loved one;
  • Creative Expression;
  • Laugh;
  • Touch (if you’re feeling touched out, then don’t try this one);
  • Yoga;
  • Foot massage/massage your clavicle, neck and ear lobe;
  • Sun exposure; and
  • Hard exercise such as a HIIT workout.

     Coping Skills for depression and/or dissociation:

  • Try to reconnect to your body, i.e. progressive muscle relaxation;
  • Have someone talk to you about anything to bring you back to the present moment;
  • Distraction (making sure to come back to your emotions later when you feel more able to);
  • Drink a glass of water or eat some food mindfully;
  • Take a shower and really notice how the water feels on your body;
  • Engage in pleasurable activities, i.e. read a favourite book, talk to a friend, eat a favourite food, listen to your favourite music, watch a comedy;
  • Connect with a friend or loved one;
  • Connect with nature;
  • Move your body in a way that feels good/realistic for you; and
  • Connect to your spirituality or spiritual practices.

     Coping Skills for nightmares/flashbacks/Panic Attacks:

  • Acknowledge that you are having a nightmare, flashback or panic attack;
  • Take deep breaths and ground yourself by putting your feet on the floor, feeling your back on your chair or noticing what is around you (54321);
  • Try not to analyze the nightmare or flashback; continue to focus on the present moment and what is around you, and tell yourself you are not in danger currently;
  • Engage in self-soothing afterwards; and 
  • Connect with a friend or loved one.

     Other Ideas:

  • Scaling your symptoms (1/10 is not activated – 10/10 is a panic attack) and choosing coping skills for each level (5/10 – Focus on my breathing and engage in healthy distraction);
  • Step away/take a break;
  • Come back to the Self and give yourself permission to prioritize your needs and self-care;
  • Talk to your support person; and
  • Consider individual therapy.

Remember the essentials: food, water, sleep, and connection. Taking care of the essentials will help to reduce your overall symptoms, open your window of tolerance, and improve your capacity for coping in moments of distress.

 

Seek Support

In addition to these coping skills and strategies, I always recommend reaching out to a Counsellor, Psychotherapist, Peer Supporter or Mental Health Support virtually or near you. Cambrian Counselling & Wellness has wonderful Clinicians’ who are experienced with PMADs and other mental health challenges. PsychologyToday.com also has a long list of mental health care providers and can be sorted by expertise, such as Perinatal Mood and Anxiety Disorders. Also, many peer support groups are popping up online and in person across Ontario and Canada. Try one out and meet individuals who will understand what you are going through.

If you have any questions about PMADs, miscarriage, mental health in the perinatal period, or just want to chat, please feel free to reach out to me at karin.thoms@dcmail.ca or on Instagram @karin.mental.health.advocate.

 

 

References

Perinatal Mood and Anxiety Disorders | CAMH. https://camh.ca/en/professionals/treating-conditions-and-disorders/perinatal-mood-and-anxiety-disorders

PMAD Information | Perinatal Wellbeing. https://www.perinatalwellbeing.ca/pmad-information

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