Postpartum Depression Support in Raleigh

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Postpartum Depression - I hear this term all the time as a perinatal health professional. In my experience, it is the most commonly discussed perinatal mood and anxiety disorder, however it is not the only one. May is Maternal Mental Health Awareness Month and whether you are expecting a baby or supporting someone who is, it’s important to fully understand all perinatal mood and anxiety disorders (PMADs). 


Approximately 15% of women experience significant depression following childbirth, while 10% of women experience depression in pregnancy. Perinatal depression is the most common complication of reproduction. Some symptoms of perinatal depression include: anger, irritability, lack of interest in the baby, appetite and sleep disturbances, crying, sadness, feelings of guilt, shame, or hopelessness; loss of interest, joy, or pleasure in things you formerly enjoyed; and possible thoughts of harming yourself or your baby. While perinatal depression can happen to anyone, research shows that the following things put you at a higher risk of developing perinatal depression: personal or family history of depression, anxiety, or postpartum depression; premenstrual dysphoric disorder (PMDD), inadequate support in caring for your baby, financial or marital stress, pregnancy, birth or breastfeeding complications; being a parent of multiples or a baby in the neonatal intensive care unit (NICU); having experienced a major recent life event: loss, house move, job loss, etc.; having a thyroid imbalance or any form of diabetes (type I, type II, or gestational); or being a parent who has gone through infertility treatments.


Approximately 6% of pregnant people and 10% of postpartum people develop anxiety. Sometimes anxiety is an isolated experience, or it is paired with depression. Symptoms include constant worry, racing thoughts, sleep or appetite disturbances, inability to sit still, feeling that something bad is going to happen, and physical symptoms such as dizziness, hot flashes, and nausea. Risk factors for perinatal anxiety include a personal or family history of anxiety, previous perinatal depression or anxiety, or being a parent with a thyroid imbalance. While perinatal anxiety is typically generalized, there are some specific forms of anxiety, such as postpartum panic disorder. This particular form of anxiety makes the parent feel very nervous with recurring panic attacks. Physical symptoms of postpartum panic disorder include chest pain, claustrophobia, dizziness, heart palpitations, shortness of breath, numbness, and tingling in the extremities.


Another form of perinatal anxiety is postpartum obsessive-compulsive disorder (OCD). This condition is the most misunderstood and misdiagnosed of the perinatal mental health disorders. You do not have to be diagnosed with OCD to experience these common symptoms. Approximately 3-5% of new parents, including non-birthing parents will experience these symptoms. This condition manifests through repetitive, intrusive, frightening images and thoughts. These thoughts and images are anxious in nature, meaning they are not delusional. They have very low risk of being acted upon, and it is likely that the parent experiencing this will take steps to avoid what they feel is potential harm to the baby. Symptoms of perinatal OCD include obsessions (persistent, repetitive, upsetting thoughts or mental images related to the baby), compulsions (where the parent might do specific things over and over again to reduce fears and obsessions), sense of horror regarding the obsessions, hypervigilance in protecting the baby, and fear of being left alone with the baby. Risk factors for perinatal OCD include a personal or family history of anxiety or OCD.


Postpartum post-traumatic stress disorder is experienced by approximately 9% of people following childbirth. This condition is normally caused by a real or perceived trauma during childbirth or the postpartum period. These traumas could include (but are not limited to): prolapsed umbilical cord, unplanned cesarean birth, vacuum-assisted or forceps-assisted vaginal birth, having your baby go to the NICU, feelings of powerlessness, poor communication or lack of support and reassurance during childbirth; or people who have experienced a severe physical complication or injury related to pregnancy or childbirth such as postpartum hemorrhage, unexpected hysterectomy, severe preeclampsia/eclampsia, perineal trauma (3rd or 4th degree tear), or cardiac disease. Symptoms include flashbacks, nightmares, intrusive re-experiencing of the traumatic event, anxiety and panic attacks, persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response), avoidance of stimuli associated with the traumatic event (including thoughts, feelings, people, places, and details of the event), or feeling a sense of unreality and detachment.


Bipolar mood disorders include Bipolar I and II. Many birthing people are diagnosed for the first time with bipolar depression or bipolar mania during pregnancy or postpartum. The low time is clinically called depression and the high time is clinically called mania or hypomania. With Bipolar II, the manic episode is less apparent as the highs and lows are not as extreme - and sometimes it is more apparent to friends and family than to the individual experiencing it. In order for symptoms to qualify as a bipolar mood disorder, they have to last longer than four days and interfere with functioning and relationships. With bipolar mood disorders, things can sometimes escalate to psychotic symptoms such as hallucinations or delusions. This is considered a mental health emergency. Sometimes bipolar disorder looks like a severe depression or anxiety. Symptoms of Bipolar I include periods of severely depressed mood and irritability transitioning to mood being much better than normal, rapid speech, little need for sleep, racing thoughts, trouble concentrating, continuous high energy, overconfidence, impulsiveness, poor judgment, distractibility, inflated sense of self-importance, grandiose thoughts, and delusions or hallucinations. Bipolar II includes periods of severe depression followed by improved mood, rapid speech, little need for sleep, racing thoughts, trouble concentrating, anxiety, irritability, continuous high energy, and overconfidence. Risk factors for perinatal bipolar mood disorder are family or personal history of bipolar mood disorder.


Last, but not least there is postpartum psychosis, which is very rare (1-2 our of every 1,000 births - or .1-.2% of births). The onset of postpartum psychosis is normally very sudden, and usually occurs within the first 2 weeks postpartum.  Symptoms include delusions, strange beliefs, hallucinations, irritability, hyperactivity, decreased need for or inability to sleep, paranoia, suspiciousness, rapid mood swings, and difficulty communicating. The most notable risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode. Research suggests there is a 5% suicide rate and a 4% infanticide rate associated with postpartum psychosis. During psychosis, the person experiences a break from reality, so immediate treatment is imperative. 


Perinatal mood and anxiety disorders are temporary and treatable with professional help. Having a doula, who is a trained professional who guides and supports families during the perinatal period can be helpful in navigating your perinatal mental health journey and getting connected to the appropriate resources.


Here are some virtual resources and resources in North Carolina for those who need support:


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