The Most Common Perinatal Problem? Depression and Anxiety. But There Is Hope

Rachel Noble, MS, LPC, is a mental health provider. She serves as Director of Theapeutic Programs and Women’s Behavioral Health Services at Inova Health System.

In honor of Mother’s Day, and in recognition that May is also Mental Health Awareness Month, here is some helpful information about perinatal mood and anxiety disorders (PMADs): what they are, why they happen, and how you can get help.

Few things in life are as joyful, and as challenging, as motherhood. Even so, most moms have moments when the reality of being a mom seems far different than the ideal they had imagined. Social media, and different types of content on it for example, can feed the idea that everyone else has motherhood all figured out, fostering feelings of shame and isolation.  

That was certainly the case for one local mom, who was thrilled to welcome her fourth child to the family recently. Once the baby arrived, however, she struggled with feelings of hopelessness and disconnection that made bonding difficult. Her older children, who were delighted with their new sibling, worried about their mother. They tried everything they could think of to “cheer her up,” which just made her feel like she was letting everyone down.

The perinatal period, which includes both pregnancy and postpartum, can be especially difficult. Hormones, exhaustion, isolation, and the physical recovery from childbirth can combine to cause distress. For women who have a history of depression or anxiety – or who have family members who have struggled with them – the perinatal period can trigger symptoms.

“The most important thing I want all new moms to know is that you are not alone, and there is no need to suffer in silence,” said Rachel Noble, MS, LPC, Director of Women’s Behavioral Health Services and Therapeutic Programs at Inova. “Many women experiencing PMADs feel ashamed, but I’m here to say that it’s not your fault, and you are not alone. There are effective treatments and lots of support available. There is hope.”

What Are PMADs?

PMADs are very common. In fact, mental health struggles are the most common complaint during pregnancy. One in five women will develop PMADs. Among women living at or near the poverty line, that percentage is much higher: as much as 50 percent by some estimates.[i] PMADs run along a continuum and can include:

  • A short-term dip in mood, often called “baby blues”
  • Postpartum depression
  • Postpartum anxiety
  • Post traumatic stress disorder, caused by a traumatic birth experience
  • Obsessive-compulsive disorder
  • Postpartum psychosis

Why Do PMADs Happen So Often?

Many factors can lead to PMADs. For example, many women in the Washington, DC region are high achievers, used to pushing themselves to get things done. “Women who are driven and achievement oriented may already have a high level of anxiety. On top of that, they may have a vision of what motherhood ‘should’ look and feel like, and if their experience doesn’t match that vision, they may feel shame,” Noble said. That shame can lead to isolation and intrusive anxious thoughts.

The other side of the coin, according to Noble, is depression. “Anxiety and depression are related. Anxiety drives a heightened sense of fear, which becomes intrusive. When it’s too intrusive, people can start to shut down, sliding into hopelessness.” The stakes are high: sadly, 20 percent of postpartum deaths are due to suicide.

An existing mood disorder, or even a family history of a mood disorder, puts a woman at higher risk of developing PMADs. “All stressors are amplified during this time, and hormone surges can trigger any type of mood instability that you might have and make it worse,” Noble said.

Post-Traumatic Stress Plays a Role

Another underrecognized perinatal mental health challenge is post traumatic stress disorder. As many as 40 percent of women describe their birth experience as “traumatic” psychologically.[ii] “Psychological trauma is rooted in a loss of control or a feeling of powerlessness. Too often, clinicians may focus on trauma in narrow physical terms, minimizing women’s experience and thus increasing isolation, shaming, shutdown, and silent suffering,” Noble said.

There Is Hope

Although the challenges can seem insurmountable, PMADs are all treatable. Inova Women’s Behavioral Health Services, a new, integrated program offered between Inova Women’s Services and Inova Behavioral Health Services, has psychiatrists who have specialized in reproductive psychiatry. They are well-versed in safely prescribing medication during pregnancy and breastfeeding. The growing program also has therapists who specialize in working with pregnant women and new moms. “We know what their specific struggles are and how to support them,” Noble said.

A variety of perinatal-focused support groups in the community also serve as helpful resources. Appointments within Inova are currently offered via telehealth, making it easier than ever for women to access care. Inova’s Women’s Behavioral Health program helps moms by screening them for PMADs, assessing the level of help they require, and referring them to providers so that they can get the care they need. The program is small, but growing. So, if referrals are required outside of Inova, they can help connect you. Inova Women’s Behavioral Health Services is dedicated to helping women across the region – including the mom at the beginning of this article – feel better and get back to their lives and families.

“If you’re suffering, please reach out,” Noble said. “It can be hard to believe that things will get better, but they will.”

If you are dealing with feelings of depression, anxiety or chronic stress, a mental health professional can help you to develop the tools to help yourself.

To learn more about Inova Behavioral Health Services, call 571-623-3500.

[i] Luca D, Garlow N, Staatz C, Margiotta C, Zivin K. “Societal Costs of Untreated Perinatal Mood and Anxiety Disorders in the United States.” Mathematica Policy Research: Issue Brief. April 2019.

[ii] Ibid.

Leave a Comment