The Struggles of Pregnancy and Postpartum: Understanding PMADs by Carrie Fogel, LCSW, PMH-C

Growing up, many of us were told we would easily become pregnant if we had sexual intercourse one time. Pregnancy would cause us to glow as we ate ice cream and pickles until a full-term pregnancy of a viable baby.

Labor might have been painted as difficult, or maybe not even described at all. We were also told that latching and breastfeeding were intrinsic and would be the sole nutritional sustenance for our babies until they were old enough to consume solids. The postpartum days would be filled with happiness and joy as we managed the household, cared for ourselves, and helped a baby thrive.

While the vision many of us have comes from an extensive history of society telling us this is the pregnancy experience, many people in this stage of life quickly realize it is not their norm. As a Perinatal Mental Health Counselor and Licensed Clinical Social Worker, the two questions I am frequently asked by clients in the pregnancy planning or perinatal period are, “Is it normal that….” or “What if….” You can fill in the blanks.

There is nothing that has not come up as a concern. “Is it normal that we keep having sex but every month I still get my period?” “Is it normal that I have always wanted to have a baby and now that I am pregnant, I hate it?” “What if labor doesn’t go as I want or if I even die?”

The lack of control, the unknown, hormonal shifts, societal pressures, exhaustion, our desires, and medical obstacles help create many anxious and intrusive thoughts.

Addressing Common Concerns During Pregnancy

So, what do we do with all these intrusive thoughts? First, let’s define a few terms. The perinatal period refers to the entire time from conception through the entire first year after delivery. Prenatal means during pregnancy, while postpartum or postnatal is defined as the first year after delivery. The baby blues occur within the first two weeks after birth and are pretty widespread because of hormonal changes and the exhaustion new parents experience.

When we hear the term, “postpartum” people tend to think of depression. Perinatal depression affects 1 in 5 women and 1 in 10 men. However, there are a variety of diagnoses that can cause distress for people in the postpartum period. More specifically, Perinatal Mood and Anxiety Disorders (PMADs) now include unipolar depression with peripartum onset, perinatal anxiety, panic disorder, obsessive-compulsive disorder, psychosis, post-traumatic stress disorder, bipolar disorder, and postpartum depression in fathers.

Intrusive thoughts are those that cause us distress and may linger persistently in our minds. “What if I drop the baby in the bathtub and she drowns?” “What if my baby isn’t sleeping the necessary hours to create optimal brain development?” These thoughts can get “stuck” for many people and often affect the interactions we have with others, our babies, and our own daily functioning.

Understanding Perinatal Mood and Anxiety Disorders

Perinatal Anxiety includes excessive worries and anxieties during the perinatal period. These thoughts are often difficult to stop. “Is it normal that I worry if I am missing a health concern with my baby so I examine him daily?” Significantly, it is almost universal for some anxious thoughts to occur in people trying to conceive, pregnant, or postpartum. When these thoughts become hard to disregard or cause distress, they often need some sort of intervention.

Perinatal OCD occurs when a pregnant person or postpartum parents have thoughts, urges, or impulses that they do not want. They usually struggle to get rid of these thoughts which causes them anxiety. People try to stop these thoughts, images, or urges or may do something to ensure they decrease.

For example, “What if I drop my baby when I walk down the stairs,” is a common anxious, intrusive, recurrent thought a new parent may experience. To avoid it, that parent may always hand the baby to someone else to walk down the stairs or may hold the baby and slide down the stairs on their bottom.

The thoughts are usually the opposite of what someone wants and parents with perinatal OCD do not actually want to hurt their baby or themselves. There are many common themes for perinatal OCD, many of which are about causing possible harm to a baby.

Importantly, these are only thoughts. While they may be scary and distressing thoughts, they do not mean there will be action toward them. People with OCD will often go to extreme lengths to ensure they do not perform the distressing thought, impulse, or urge.

Support and Strategies for Handling PMADs

Who can get a PMAD: Anyone!

What do we do if we have distressing thoughts, impulses, or urges:

Ask for non-judgemental help. Seek support from your network. Tell your support system what you are experiencing.
Seek medical advice. Talk with your OBGYN or internist. Consider a psychiatrist specializing in perinatal care.
Find therapeutic assistance. Many therapists have received their PMH-C and specialize in perinatal care. The PMH-C is a Perinatal Mental Health Certification and ensures therapists have been specifically trained.
Join a support group. There are several online or in-person support groups. Support groups help build your network, let you know you are not alone, provide psychoeducation, and help address symptoms.
Postpartum Support International (PSI) has a peer mentor program and will arrange for you to have a peer to speak with on an ongoing basis. This peer has recovered from a PMAD and received volunteer training to provide the best non-professional support.
Find times to sleep. Take shifts with a partner, hire a baby nurse, look into postpartum doulas, and gather family or friends. A lack of sleep is a major contributor to PMAD symptoms.
Develop healthy habits. Once you are medically cleared, try to get some movement and exercise. Remember, all movement can be helpful. A walk around the block in fresh air counts!
Eat! Many new parents forget to eat or drink water.
Throw out your harsh judgments. Again, as many as 1 in 5 women and 1 in 10 men experience a PMAD. Likely, these numbers are even higher and underreported.
Consider a doula or postpartum doula for assistance. Doulas are not only for delivery and sleep assistance. They can offer many forms of practical support.
Try mindfulness exercises.
Go to the emergency room if needed.

Remember, while it is very common to have some intrusive thoughts, if they are causing distress it is important to seek therapeutic help. Depressive symptoms that last longer than two weeks should also indicate a need for mental health assistance. Any time symptoms feel like too much or as though they are interfering with your functioning, seek help.

At the Lukin Center, we understand how overwhelming these feelings can be, especially during the perinatal period. Our compassionate therapists are specifically trained to help you recognize and alter distressing thought patterns and behaviors effectively.

Contact the Lukin Center today to connect with a therapist who specializes in PMADs. Our therapist will make sure you receive the non-judgmental support needed to face this critical stage successfully. Additionally, Lukin Center assists in treating a wide range of men’s and women’s issues, aiming to bring parents peace of mind and mental stability while raising a child. Reach out to us for further help.The Lukin Center is ready to provide non-judgemental therapeutic support with specifically trained therapists who can help you during this life stage.

Carrie Fogel, LCSW, PMH-C | Lukin Center

Carrie Fogel, LCSW, PMH-C is a psychotherapist at Lukin Center for Psychotherapy, specializing in treating anxiety, depression, relationship/ family conflicts, life transition, and perinatal/postpartum mood and anxiety disorders. As a therapist, Carrie tailors her approach to each client based on their individual needs and uses the therapeutic alliance to develop a trusting and effective relationship in a supportive environment. She treats each client with a non-judgmental approach that allows them to examine their thoughts, behaviors and feelings. She uses an integrative approach including cognitive behavioral therapy (CBT) and psychodynamic modalities to assist clients in developing positive coping skills, rational thinking and effective communication styles to have clients reach their goals, gain insight and make desired changes. Throughout her career, Carrie has facilitated individual and group therapy in a variety of outpatient settings, including in the public school environment. She has provided effective treatment to those with an assortment of life stressors including anxiety, depression, relationship struggles, family conflict, parenting challenges, women’s issues, behavioral disorders, substance abuse, developmental disabilities, and ADHD. This extensive experience provides a unique foundation for assisting clients to reach their mental health goals. Additionally, Carrie is trained in perinatal mental health, including fertility issues, perinatal and postpartum mood and anxiety disorders, and transitioning to parenting. To that end, Carrie completed an extensive PSI Perinatal Mood and Anxiety Disorder Training to more effectively help clients with these concerns. Carrie earned her Bachelor of Arts in Psychology from the University of Michigan and her master’s degree from Columbia University School of Social Work with a concentration in clinical social work.