PMAD's and the Role of the Doula

Doulas of Capitol Hill was founded on three guiding principles: Support the Family, Build the Community. Grow the Profession. Today on the blog we are sharing this resource from Dr. Emma Basch PsyD, a psychologist in Washington, DC, who specializes in women’s mental health with a focus on perinatal and reproductive concerns.

Dr. Basch was a recent guest speaker to one of our team meetings and she shared her expertise with our birth and postpartum doulas, as well as our lactation consultants, to help our professionals continuing education and growth. She provides this useful guide for doulas to support clients and their families.

Recently the American College of Obstetrics and Gynecology (ACOG) updated their recommendations that women see their health care provider sooner than 6 weeks to screen for physical and mental health complications. Having a doula during pregnancy and in the first year after birth is an additional layer of support to see you through this transitional time between leaving the hospital and seeing your health care provider.

Dr. Basch acknowledges that “reaching out to a therapist can feel like a daunting task.” She recognizes the valuable role that doulas can play in screening for PMAD’s, as we often spend many hours with a client over weeks or months, whereas a doctor or nurse may only spend a few minutes.

PMAD’s are common and also treatable. You are not alone.

PMAD’S and the Role of the Doula

by Dr. Emma Basch PsyD

• PMAD is an umbrella term that refers to the spectrum of emotional challenges that may arise during the perinatal period (from pregnancy through one year postpartum).

• There are seven different perinatal mood and anxiety disorders including Perinatal Anxiety, Perinatal Depression, Perinatal Panic Disorder, Perinatal Obsessive-Compulsive Disorder, Postpartum Posttraumatic Stress Disorder, Perinatal Bipolar Disorder, and Postpartum Psychosis.

• PMADs are the most common complication of pregnancy with 15-20% of people who have given birth reporting symptoms. While PMADS are most common in people who are pregnant or who have given birth, partners and adoptive parents can also develop symptoms of a PMAD.

• Risk Factors: A personal or family history of depression or anxiety or other mental health concerns, Medical problems including diabetes, thyroid disorders, or PMDD, Difficult pregnancy, birth complications, Financial stress, Lack of social support, History of Pregnancy Loss, Infertility

• Typical Symptoms of PPA/PPD: Irritability, Difficulty sleeping, Lack of interest in pregnancy or baby, Sadness, tearfulness, Shame and guilt, Feeling hopeless, Worry or feeling like something bad is going to happen, Racing thoughts, Restlessness, “Scary” or upsetting thoughts which may include thoughts of hurting yourself or your baby

• VERY Common: Ego dystonic scary, bizarre or violent thoughts, Thoughts are terrifying to sufferer, Person does everything possible to resist the thought or neutralize it, VERY low risk of hurting baby

• Psychosis/Emergency: Ego Syntonic scary, bizarre or violent thoughts, Thoughts are ego syntonic and connected to delusions. There is a risk of hurting baby or self

• PP Bipolar/Psychosis:A rare illness that occurs in about 1% of womenSymptoms generally emerge in the first 2-3 weeks postpartum and are thought to have a hormonal linkSymptoms include: Delusions and hallucinations, Can include violent commands, Hyperactivity and decreased need for sleep, Mood swings, ParanoiaRisk Factors: Personal or family history of bipolar disorder or psychosis, 5% Suicide Rate and 4% Infanticide Rate so should always be treated as emergency

Role of a Doula

• ASSESSMENT (PREGNANCY AND POSTPARTUM)

  • Pregnancy- what to ask

    • Ask about mental health history

    • History of pregnancy- infertility, losses?

    • Prior births- listen for trauma

    • Worries/mood (frequency, intensity, duration, distress)

    • Sleep

    • support system

    • Postpartum

      • Sleep (#1) question- if birthing person is not sleeping, not tired, racing thoughts, this is an emergency

      • May look “well” but not be coping well

      • Watching baby breath

      • Feeling disconnected from baby

      • Not caring for self

      • Tearful and overwhelmed

      • Feeding challenges

      • Edinburgh Postnatal Depression Scale (EDPS)- you can administer and score

      • Birth trauma

      • BRIEF INTERVENTION

        • Education

        • Normalizing

        • Help clients to plan for support- put support in place before giving birth

          • PP Plan

            • Who will I call

            • What will I do

            • How will I take care of myself?

            • Groups to join

            • Engage with partners/family

            • Postpartum doulas prioritize sleep- 5-hour magic #

            • Make sure client is showering, getting out of house, talking to others adults

Dr. Basch has advanced training in the treatment of postpartum depression and other perinatal mood and anxiety disorders (PMADS), infertility, perinatal loss, and birth trauma