Tips for your perinatal mental health.
Guest blog with Joni Lybbert, PNMHNP
(PNMHNP = Psychiatric mental health nurse practitioner)
In case you don’t know what a PMHNP is, we are RNs who then go on to become nurse practitioners specializing in psychiatry. We are able to diagnose conditions, prescribe medications, and provide therapy. Supporting women in their mental health feels like a calling to me and I love witnessing women grow and helping them along their journey to becoming the person they always could be.
Here are some important topics that I discuss with pregnant and postpartum mothers.
1. Experiencing a perinatal mood and anxiety disorder is THE MOST common complication of pregnancy.
Did you know that 20-25% of women experience a perinatal mood and anxiety disorder (PMAD)? This includes postpartum depression, postpartum anxiety, postpartum OCD, panic disorder, postpartum PTSD, and postpartum psychosis. Chances are you or someone you know has experienced a PMAD.
Some common symptoms of a PMAD are:
-feelings of anger, rage, or irritability
-having scary or unwanted thoughts
-lack of interest in the baby or difficulty bonding with baby
-loss of interest, joy, or pleasure in things you used to enjoy
-feelings of guilt, shame, or hopelessness
-disturbances of sleep and appetite
-crying and sadness
-constant worry or racing thoughts
-physical symptoms like dizziness, hot flashes, nausea, upper back pain, headaches, stomachaches
-possible thoughts of harming yourself
-possible thoughts of harming baby
Perinatal mood and anxiety disorders are common, but they are not normal. If you’re experiencing some of these symptoms, reach out for help (I’ll tell you how to find it).
2. You will have thoughts that scare you.
Have you ever been driving down the road and suddenly have the urge to hit one of those orange cones and send it flying?
The thought to hit the cone is an intrusive thought. We all have them. When you are pregnant or postpartum, these thoughts are often about the baby’s safety and they can be much more distressing.
For example, one study1 showed that between 81.4-90% of parents worry about suffocation and sudden infant death syndrome, 83.7-92% worry about an accident happening, 53.5-59% worry about contamination, and 32.6-46% worry about causing intentional harm to the baby.
These thoughts can become more problematic when you deem them significant and start changing your behaviors so much that it affects your function. Like if you aren’t sleeping at night because you are staring at the baby breathing for hours. Maybe if you won’t let anyone hold the baby which means you are getting zero breaks. Or if you are afraid of driving your baby around, and you no longer feel like you can go anywhere.
When these thoughts become more common and start impacting how you live your life, you may be experiencing postpartum anxiety or postpartum OCD.
Many people are afraid they may actually harm their baby. This is very unlikely. The exception is with someone who is experiencing postpartum psychosis (which can be learned more about here).
3. You still have needs.
Having a baby is all-consuming. You must remember that you were a human being with needs before you had a child, and you are still a human being. Those needs didn’t go anywhere.
Think of a pie chart…. What were the portions of your identity before motherhood?
Maybe you were a yogi, a pickleballer, or a movie enthusiast. Maybe you were a partner, a friend, a daughter, a working professional, or a volunteer.
Oftentimes, after baby comes, the majority of the pie chart is filled with motherhood with perhaps a small slice for the partner or a friend. This is unsustainable and you will likely begin to feel drained if you do not intentionally carve out time for yourself.
What are things you enjoyed before motherhood? Or if you are currently pregnant with your first, recognize what brings you joy now before baby comes. Maybe it’s time with friends, being outside, baking, cooking, going for a walk, playing a sport, engaging in a creative expression, playing a game, listening to a podcast, etc.
Try making a list of things you enjoy and spend time doing something for you daily. Does daily feel impossible? Maybe start with weekly. It can be as short as 15 minutes for yourself!
4. No one needs you to be the perfect mother. Instead, aim for good enough.
Perfection is unattainable… You will not/cannot be a perfect mother. If somehow it was possible, you would be setting your child up to fail in the world outside of your home. Dr. Donald Winnicott, a British pediatrician and psychoanalyst, first coined the term “good enough mother” in 1953. He realized that children benefit from minor “failures.” Children do better when their mothers do not meet every single one of their needs.
This article2 states it perfectly: “Children need to learn, in small ways every day, that the world doesn’t revolve around them, that their every request won’t be honored, and that their behavior impacts other people. They need to learn – through experience – that life can be hard, that they will feel let down and disappointed, that they won’t always get their way, and despite all of that (or perhaps because of it) they will still be ok.
If our children never have these experiences, and if their every need is met every time, they will have no ability to manage the challenges that will inevitably arise. They won’t learn that it’s ok to feel bored or annoyed or sad or disappointed. They won’t learn, time and again, that life can be painful and frustrating, but they’ll get through it.”
Try to stop striving for perfection, just be good enough.
5. There are people here to help.
If you are feeling like you are struggling, whether it is a diagnosable PMAD or not, you are not alone, and there is tons of help.
First, find a way to get sleep. Sleep is foundational to mental health. This may mean asking for help from your partner, your family, your partner’s family, your friends, or hiring a postpartum doula if that is an option for you. It may mean moving the bassinet a few feet away from your bed so you don’t hear baby every time he/she moves. It may mean sleeping in a different room. It will look different for each family, so find what works for you. Bottomline: You have to sleep well to feel well.
Second, read through SUNSHINE. SUNSHINE is an acronym that hits on eight different ideas for wellness during pregnancy and postpartum. It was created by the Utah Department of Health and Postpartum Support International Utah.
Third, consider finding a perinatal therapist. Postpartum Support International is an organization dedicated to helping women during the perinatal period. If you are in Utah, the best place to start is at MMHRN where there are oodles of providers listed who specialize in the perinatal period.
You can also check out my podcast, The Sad Moms Club, where I interview local therapists in Utah (among other providers who support women in the perinatal period), so you can be more informed about local resources.
If you are not in Utah, look at the national PSI directory or call/text the PSI help line where you will be connected to a volunteer in your area who will help you find local resources.
Fourth, find a support group. Local support groups (online and in-person) can be found on the Utah website listed above. If virtual is more your jam, you can look at the ka-jillion support groups PSI offers. There is literally one for everyone.
Fifth, consider starting medication. Medication can put the floor back beneath your feet. If you are hesitant to start medication while pregnant or breastfeeding, listen to this podcast episode. You can start by talking to your OB/GYN or midwife or you can reach out to a specialized maternal mental health provider. Most of the time, no referral is required.
If you’re not feeling well, I promise things will get better. It might not feel like it right now, but you will find your new normal.
If you’re worried about the potential for a PMAD, prepare now using this postpartum planning worksheet and listen to The Sad Moms Club podcast to be more prepared.
We’re here to help. Please, let us know how we can.
I hope you find this information helpful, because it’s so important & many of us wish we would have had it sooner. Save for later, send to loved ones, use the resources provided.
Cheers: to our beautiful, complex brains that change with us as life unfolds.
Sam (& Joni)
(References from Joni’s Blog Post:)
1. Collardeau, F., Corbyn, B., Abramowitz, J., Janssen, P. A., Woody, S., & Fairbrother, N. (2019).
Maternal unwanted and intrusive thoughts of infant-related harm, obsessive-compulsive
disorder and depression in the perinatal period: Study protocol. BMC Psychiatry, 19(1), 94.
https://doi.org/10.1186/s12888-019-2067-x
2. Naumburg, S. (2018, March 14). The gift of the good enough mother. Seleni.
https://www.seleni.org/advice-support/2018/3/14/the-gift-of-the-good-enough-mother