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Depression

How to Talk to a Mom (About Postpartum Depression or Anxiety)

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How to Talk to a Mom (About Postpartum Depression or Anxiety)

In April of 2018 the Association of Certified Nurse Midwives held a symposium at George Washington University Hospital. The event drew a diverse group of professionals, from Certified Nurse Midwives who work labor and delivery, or even in private practice at birth centers or attending homebirths, MD’s, physical therapists, mental health professionals, and a handful of non-medical professionals, including doulas from Doulas of Capitol Hill and our sister agency, Doulas of Prince George’s County.

Of the many topics and guest speakers at the symposium, Dr. Pooja Lakshmin came to speak from her expertise in perinatal mood and anxiety disorders (PMAD’S). Dr. Lakshmin is a board certified psychiatrist specializing in women's mental health and reproductive psychiatry.

Today on the blog we share this list of questions Dr. Lakshmin included in her talk because we feel that one of the most challenging barriers a new mom can have toward getting mental health attention is that those people nearest to her don’t know what to say or how to talk about it. Breaking the stigma around mental health can start by asking any one of these questions.

How to talk to a mom 1.jpg

For more resources and tips on supporting someone you think may be experiencing a perinatal mood or anxiety disorder, please check out Doulas of Capitol Hill Resource Guide.

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PMAD's and the Role of the Doula

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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 women

    Symptoms generally emerge in the first 2-3 weeks postpartum and are thought to have a hormonal link

    Symptoms include: Delusions and hallucinations, Can include violent commands, Hyperactivity and decreased need for sleep, Mood swings, Paranoia

    Risk 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


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

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

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Resources For Postpartum Depression, Anxiety, and PMAD's

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Resources For Postpartum Depression, Anxiety, and PMAD's

Perinatal Mood and Anxiety Disorders are the most common pregnancy complication..jpg

According to the research, between 15 and 20% of new moms will experience some sort of perinatal mood and anxiety disorder (PMADs) after giving birth.  PMADs are the most common pregnancy complication. Having a baby can be very isolating and suffering from a mental health problem on top of that can cause even more problems. PMADs might affect a woman’s ability to care for herself and her children.  These illnesses are common and treatable.

Signs and Symptoms

Healthy New Moms.org

Crisis/ Suicide Hotline

Suicide accounts for 5.3% of perinatal deaths, or approximately 1 out of every 19 deaths in pregnant or postpartum women during that time period.
Suicide Prevention Lifeline

Crisis Text Line

Screening Tools

Mental Health America.net Online screening for depression, anxiety, psychosis, and other mental health disorders

Maternal Mental Health Now- Self-screen toolkit

Edinburgh Scale for Postnatal Depression Easy to use screening tool for postpartum depression used by doctors, nurses, and health professionals


How to Set Up a Postpartum Depression / Anxiety Plan

How to talk to a Mom, by Pooja Lakshmin, MD at the American College of Nurse Midwives DC Affiliate Conference on Women's Health and Wellness in April 2018, Doulas of Capitol Hill blog (coming soon!)

Mother Mag blog post How to Prepare for Postpartum Depression

National Institute of Health Mom’s Mental Health Matters (website down)

Postpartum Support Virginia PDF The Postpartum Plan


Postpartum Mood and Anxiety Disorders; Healing Outcomes, by Laura Macone, MSW, LCSW, Doulas of Capitol Hill Client Portal, resource accessible for Doulas of Capitol Hill families (requires password).

PMAD and the Role of the Doula, by Dr. Emma Basch PsyD,  Doulas of Capitol Hill blog (coming soon!)

Talking with Women about Postpartum Depression and Anxiety,  by Laura Macone, MSW, LCSW, Doulas of Capitol Hill Client Portal, resource accessible for Doulas of Capitol Hill families (requires password)


Local Resources

Healthy New Moms- Maryland’s Maternal Mental Health Campaign

Postpartum Support DC

Postpartum Support Maryland

Postpartum Support Virginia


Local Mental Health Professionals

Catalyst Counseling, Laura Macone LCSW, Alexandria, VA

Center for Maternal Wellness NW DC

DC/MD/ VA Guide find a specialist in perinatal mental health

Dr. Emma Basch, PsyD NW DC

George Washington University Five Trimester’s Clinic- low fee medication evaluation and management

Mary’s Center- lower fee therapy and medication

The Spring Project low fee psychotherapy

Washington Anxiety Center SE DC


Local Support Groups

Dr. Emma Basch PsyD NW DC

P.A.C.E Moms groups many small groups throughout the DMV

Postpartum Support Virginia Fairfax and Alexandria

Emily Griffin LCSW NW DC

Online Resources

Center for Disease Control

Climb Out of Darkness  The world’s largest event raising awareness of maternal mental illnesses like postpartum depression, postpartum anxiety and OCD, postpartum post-traumatic stress, postpartum psychosis, perinatal bipolar mood disorders, and pregnancy depression and anxiety.

National Institute of Mental Health

Postpartum Depression.org Tips for partners, Take a quiz

Postpartum Progress The world’s most widely-read blog dedicated to maternal mental illness.

Postpartum Support International

TED Talk on one woman’s experience and her TED Talk to bring awareness and reduce the stigma of postpartum depression

Medication During Pregnancy and Breastfeeding/ Chestfeeding

LactMed online catalog of medicine and it’s safety rating for breastfeeding/ chestfeeding parents

Reducing stress and anxiety while breastfeeding, by Kim Hawkins Birth Doula, Postpartum Doula, Certified Lactation Counselor, Doulas of Capitol Hill blog
SSRI’s, Pregnancy, and Motherhood, by Katie B, Doulas of Capitol Hill blog


For Partners

The Postpartum Husband: Practical Solutions for Living with Postpartum Depression

Postpartum for Fathers from Postpartum Support International

Postpartum Men for fathers who have postpartum depression



Trainings for Doulas/ Birth Attendants

Mary’s Center DC based trainings

Maternal Mental Health Now “Community Provider Toolkit” pdf download

Maternal Mental Health Now “Online Training”

Postpartum Support International webinars for families and community

Postpartum Support International Perinatal Mental Health Alliance for Women of Color created to fill a gap in support services for professionals and communities of color around perinatal mood and anxiety disorders

Seleni Includes a free 30 minute training and course bundles


Supplementary Methods

Acupuncture Lavender Retreat SE DC

Fertile Living Alexandria, VA

EFT tapping/ Hypnosis

Flower essence (Bach Rescue Remedy ™) study on use of flower essence to assist in depression treatment

Yoga- published study on the use of yoga for treatment of depression


Research

Sleep and Perinatal Mood Disorders: A critical review

Recent Advances in Understanding Maternal Perinatal Mood Disorders

Racial and Ethnic Disparities in Postpartum Depression treatment for Low-income Women of Color




Information on this web site is for educational purposes only. It may provide some self-help relief. However, it should not substitute for a comprehensive evaluation by a licensed mental health professional.




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