According to current studies, approximately 20 percent of women with young children develop postpartum depression, which is one of the six perinatal mood and anxiety disorders (PMADs). Frankly as a clinical therapist, I think 20 percent is a bit low, considering that we are still fighting the battle of stigma associated with mental illness. Compound that with the expectation that a woman who is pregnant is expected to be “glowing” and transition effortlessly into motherhood. One doesn’t have to wonder why a woman might be reluctant to speak up if she’s feeling down.
It’s not completely clear why a woman might develop postpartum depression. However, the good news is that putting preventative measures in place can dramatically reduce the severity of depression or prevent it from occurring altogether!
It’s time pregnant women are screened for postpartum depression as consistently as they are for other potential complications in pregnancy. As a comparison, gestational diabetes occurs in anywhere from two to ten percent of pregnancies—about half the rate of postpartum depression. Yet, every pregnant woman is screened for diabetes. The bonus in postpartum depression screening—it doesn’t require a sugary syrup drink!
While significant strides have been made in the medical field to raise awareness about postpartum depression and other PMADs, the responsibility of reducing the risk for emotional health complications in pregnancy doesn’t only rest on your care provider’s shoulders. You owe it to yourself, your baby, and your family to feel as healthy as possible during this time. Speak up and advocate for yourself, momma!
Knowing your risk factors is one of the most helpful prevention steps you can take.
Many factors can contribute to a woman’s likelihood of developing postpartum depression, but here are some of the most common predicting factors:
- Personal history of depression and/or anxiety
- Family history of mental illness
- Infertility/difficulty conceiving or prior loss
- Lack of support
- High-risk/complicated pregnancy
- Perfectionism/high expectations of self
- Infant in NICU
If you have one or more of these factors, it doesn’t necessarily mean you will develop postpartum depression. However, I recommend you set up a prevention plan, just in case. Any of these actions you take during pregnancy or postpartum can positively impact the adjustment into parenthood. Each woman’s plan is personal and unique, but some basic factors that should be included for everyone are:
Practice Basic Self-Care
A lot of parents laugh when this is mentioned because newborns can be a big barrier to a mother’s sleep. Support people can be very helpful in this area. Tag-teaming with a significant other or close family member so that each person can obtain at least a four to five hour block of sleep at night can be very helpful.
Nourish your body and brain
- Preparing frozen meals before delivery can be a huge help. Freezer meals cut out a lot of the prep work for a warm meal and are quick and easy for anyone to pop in the oven or crock pot.
- Don’t forget the importance of protein to keep you fuller longer.
- Limit sugar and caffeine to help minimize energy crashes.
- Some moms find it helpful to add in an Omega-3 fatty acid supplement and/or a B-complex vitamin as well.
- Don’t forget to keep taking your prenatal vitamins, especially if you are breastfeeding.
Once medically cleared by the OB/GYN, many moms find it helpful to get outside and go for walks, start a yoga practice and/or participate in “mommy and me” groups such as Stroller Strides, FIT4MOM, etc.
Identify your support team
Make a list of who is available and for what tasks. Doing this ahead of time can be very helpful to avoid scrambling and feeling overwhelmed at the moment you need an extra set of hands. Some support people are really great at providing meals or running errands; others at coming over and helping watch the baby while you take a shower or sleep. Don’t be afraid to delegate the necessary tasks and say “yes, please,” if someone offers to help.
Reminder: Know that some things can wait! You don’t have to do it all.
Brush Up on Coping Skills
Sometimes if an intense feeling hits us, it can feel really overwhelming and our breathing changes causing a multitude of other physical symptoms that make the initial intense feeling even worse. Focused breathing can help center us and calm our mind so we can effectively process what we need to do and how to problem solve moving forward. Box breathing or belly breathing can help you center yourself in a moment, can reduce the intensity of emotions, and only takes a few minutes.
- Envision a box and breathe in when mentally tracing the top side of the box.
- Breathe out as you trace the right side.
- Breathe in as you trace the bottom side.
- Breath out again as you trace the left side.
Placing a hand on your belly and feeling your belly rise as you breathe in, and lower as you breathe out. Practice either of these breathing exercises on a regular basis, as well as when an intense emotion hits.
Mindfulness, meditation and relaxation
Regularly taking time to be present in the moment and focusing on your senses can help to ground yourself and balance your thoughts. Mindfulness, meditation and relaxation can take many formats, including guided imagery and progressive muscle relaxation. A variety of apps (Calm, Insight Timer, Breethe, Headspace, etc.) and YouTube videos exist, and can be a great place to discover tools that speak to you.
Investigate Local Resources
One of the best prevention elements before having a baby is to know your local resources and talk to your doctor about ways to get connected if symptoms arise. Many forms of treatment are available for postpartum depression, so don’t be afraid to ask about what is available. Treatment can include one or several of the following:
Workshops for Pregnant Women and Those Considering Pregnancy
Reducing Your Risk Workshop is offered at the Pine Rest Northeast, North Shore and Portage Clinics. This free two-hour workshop is great as a prevention measure to help educate yourself on your personal risk factors and develop a prevention plan for after delivery. It’s recommended you take this class during pregnancy so you have an “emotional health birth plan” before delivery.
Medication Education Group for Women Planning Pregnancy helps women and their partners weigh the pros and cons of taking psychiatric medications during pregnancy. This free class is offered several times throughout the year in Grand Rapids. Call 616.258.7509 to find out when the next class will be offered.
Many individual therapists in the area specialize in PMAD treatment. Please ask to be referred to someone with this specialty if you are experiencing PMAD symptoms or are concerned about the potential of emotional health complications in pregnancy or postpartum. Many women find it beneficial to establish with someone prior to delivery as a precaution and “safety net” in the event that issues arise.
Many Pine Rest therapists specialize in treating postpartum depression and other perinatal mood and anxiety disorders. For a current list of these providers, visit the “Find A Clinician” section.
Group therapy provides a great avenue for education, coping skills and social support as you navigate your recovery. Just hearing you are not the only one coping with the challenges of parenthood can be a huge relief and helps you mentally get through those hard days.
Anchored in Hope Postpartum Therapy Group is offered at the Pine Rest Portage Clinic several times throughout the year, this group is eight weeks in duration and structured with specific topics that target postpartum emotional health complications and ways to treat them.
Speaking to your doctor or psychiatrist about options ahead of time can be helpful to know what you can do should issues arise, especially if there are limitations or contraindications with breastfeeding or other medications you are taking.
Many support groups are designed specifically for pregnant and postpartum women. They generally welcome support people as well. Pine Rest offers postpartum adjustment groups in Grand Haven and Kalamazoo, Michigan as well as Pella, Iowa. In the Grand Rapids, Michigan area we recommend the Spectrum Health Postpartum Emotional Support group.
Do you live in another area of the country? Postpartum Support International keeps an updated list of support groups nationwide that can be searched by your specific location. They also offer online support meetings.
Resources for prevention and treatment can vary by location, but your OB/GYN or OB office social worker can be a great starting place for services in your area.
Truthfully, there is no foolproof way to know if postpartum depression or any other perinatal mood and anxiety disorder will occur. However, we do know there are risk factors and having a prevention plan in place can help to reduce your risk. You deserve to feel well as you navigate your parenting journey.
Heather Kiel, LMSW is a fully licensed clinical social worker at the Pine Rest Portage Clinic. She earned her undergraduate degree in social work from Hope College and earned her Masters in Social Work from Western Michigan University. Heather specializes in treatment of perinatal mood and anxiety disorders and is a facilitator of the Anchored in Hope Postpartum Therapy Group.