What Expectant Parents Should Know About Perinatal Mood and Anxiety Disorders

By Nancy Cherry
April 30, 2018

As a nurse-midwife and family nurse practitioner, I’d seen it all when it comes to pregnancy and maternal health. Even more so with my personal journey. I’m a tough, warrior goddess of birth. Or so I thought until I was faced with a perinatal mood disorder. With Perinatal Mood Disorders Awareness Month upon us, I felt compelled to share my story, should it inspire hope or educate all the incredible mamas-to-be out there.

I have three beautiful, healthy children. During my first two pregnancies, I experienced similar physical side effects including excessive morning sickness and an “irritable uterus” (imagine having contractions every couple of minutes!), which resulted in modified bed rest in the third trimester.

Fast forward to the third trimester of my last pregnancy when I started to experience what felt like psychotic episodes. A week after the school shootings at Umpqua Community College rattled me, I watched a disturbing episode of a primetime show before going to bed. I woke up in the middle of the night gasping for air—I was having a vivid nightmare and was terrified.

Having had a history of panic attacks in college, I quickly recognized what was going on, but none of the self-relaxation tricks I learned back then were working. What was happening to me? My mind was racing so fast with bizarre and frightening thoughts, and I was rocking back and forth on the floor.

I decided to call my OB the next day when the panic attacks and intrusive thoughts continued every few minutes. She immediately called in a medication for me to pick up that night. I started the medication but realized it would take six to eight weeks to take full effect. This triggered suicidal thoughts since I was convinced there was no way I could survive that long without relief. I couldn’t eat or sleep, and by the next day, I’d lost five pounds.

I called my OB back, and she had me come in for monitoring. The hospital staff was confused by my situation. As a clinician, I knew exactly what conversations were going on at the nurses’ station, which only worsened my anxiety. I was worried that they’d admit me to a psychiatric ward.

My doctor came by, checked my labs and ordered an anti-anxiety medication that helped me get some sleep. A social worker visited with me to make sure I was safe. I went home that night with the name of a therapist and an outpatient perinatal mood disorder program in hand. Still, I was a mess and rather confused. I became a shell of my normal self and was stuck in my own mind. I was scared to be left alone with my kids. Whatever was going on, I knew had to get better before the baby was born. I was determined.

With my medical knowledge and resources, I was able to start seeing a therapist and psychiatrist who both specialize in perinatal mood disorders. I got weekly massages, started using a daily meditation app, took magnesium supplements, and underwent eye movement desensitization and reprocessing (EMDR).1

When I asked my doctor what was going on with me, I was surprised by his response: I had postpartum depression that started during pregnancy rather than after birth. He went on to explain that perinatal mood and anxiety disorders (PMAD) is the more appropriate term that encompasses depression, anxiety, panic, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) that occurs in up to 1 in 5 women during pregnancy or in the postpartum period.2

Slowly, I began to heal, but I employed a host of medical, behavioral and complementary therapies to get there. By the time our third baby was born, I was about 90% better. Now, two and a half years later, I still use some of these coping tools to help manage the stress of a full-time job and raising three small children.

I realize I was lucky as a “medical insider” to find the right resources and treatment. Most women in this situation may not know how or where to find the help they need. In fact, the first therapist I saw didn’t recognize what was happening to me and wasn’t helpful at all. It was only after I found a psychiatrist who sub-specialized in perinatal mood disorders that I was on the right treatment path.

Not all psychiatrists fully understand the distinctions between “normal” panic and what I was experiencing, nor do they know how to treat it properly. My doctor was able to explain to me that the physiological and hormonal changes of pregnancy coupled with my predisposition to anxiety had culminated in acute panic and triggered an obsessive-compulsive episode.

If I was that unprepared for the reality of a perinatal mood disorder, I can only imagine how those without clinical backgrounds might handle this. We need to talk more about perinatal mood and anxiety disorders—beyond just during the awareness month. These disorders are real and don’t make you less of a woman or a bad mom. It may feel shameful to talk about, but it is critical that we destigmatize this common illness and empower women to get the care they need.

If you or a loved one might be showing signs of a perinatal mood disorder, please call your care provider or Postpartum Support International at 1.800.944.4773.

Source

  1. “The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences,” NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951033/, Winter 2014
  2. “How to Help Women With Perinatal Mood and Anxiety Disorders,” Psychology Today, https://www.psychologytoday.com/us/blog/women-s-mental-health-matters/201509/how-help-women-perinatal-mood-and-anxiety-disorders, Sep 2015
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Nancy Cherry

Nancy Cherry

Nancy Cherry, FNP-BC, is a Family Nurse Practitioner and Certified Nurse-Midwife who attended Emory University for her training. She joined Grand Rounds after eight years of delivering primary care to patients of all ages. She is passionate about women's health, preventative medicine, and population health. In her role as Clinical Operations Manager, Nancy leads a team of contract physicians, care coordinators and physician services liaisons to support Grand Rounds’ Expert Opinions offering.