Most of us refer to it as the “baby blues,” but for some new mothers, it’s a phenomenon that lasts longer and cuts far deeper than they could ever have imagined. Whilst the miracle of bringing a new life into the world is a magical event, there is a lingering melancholy built into our biology that casts a shadow over the psyche of a new mother, and sometimes even a father. For some, it may pass sooner than for others, but if one thing’s for certain it’s that PMAD doesn’t get spoken about nearly enough, and this prevents many new parents from reaching out and getting the support they need.
What is PMAD and what causes it?
Perinatal or postpartum mood and anxiety disorder (PMAD) refers to the distressing feelings that occur both during pregnancy (perinatal) and throughout the first year following the pregnancy (postpartum). Distressing feelings may include sadness, irritation, depression, anxiety, and frequent feelings of exhaustion. These symptoms can range significantly in severity from one individual to the next, presenting as mild, moderate, or severe.
What happens when a PMAD is not treated?
Often, new parents are told that the “baby blues” are normal and that it will pass soon enough. However, studies have found that untreated anxiety and mood disorders during pregnancy can have detrimental effects on the health of both the mother and her unborn child (Diego et al., 2006; Misri & Kendrick, 2007). Research has shown that pregnant mothers experiencing anxiety and other forms of psychological distress tend to have elevated cortisol levels, which is associated with lower foetal weight. The effects can also be felt later in the child’s life, with prenatal maternal anxiety being a predictive factor in levels of hyperactivity, irritability, and excessive crying during the later years of childhood.
For parents suffering from perinatal or postpartum depression, they may come to feel frightened and isolated, and may struggle to carry out normal functions of everyday life. They may lose interest in activities they once enjoyed, or struggle to sleep or eat properly. Low self-esteem and unexplained feelings of guilt may also creep in, which may perpetuate the depressive mood of the mother/father. In severe cases, PMAD sufferers may even experience nausea, dizziness, and trembling. On the extreme end of the spectrum, there have been incidences of postpartum psychosis, which affects just 1 in 1000 women globally, and is characterised by delusions and hallucinations.
The symptoms that have been highlighted here do not only affect the person who is experiencing them, but also puts strain on the person’s relationship with their significant other and the health of their new-born. A partner or spouse may come to feel estranged or alienated from the person experiencing PMAD, and the infant may become neglected or withheld from receiving the necessary care and attention. The need for support and treatment of PMAD is therefore undeniable.
Managing and treating PMAD
If you or someone you know has a loved-one suffering from a PMAD, there are several ways in which you can help them to cope and even improve their situation. Whether you are their partner, spouse, friend, family member, or colleague, your support can make a significant difference in how they deal with this challenging period in their lives. Make them feel loved, heard, and seen, by validating their experiences and reminding them how valuable they are both to you and to their baby. Remind them that what they are feeling is not their fault. If they show noticeable improvements after visits to their doctor or psychologist, encourage future visits or motivate them to go more regularly. This will allow them to unpack these thoughts and feelings in a medically sound and judgement-free environment. Doctors and psychiatrists will also be able to prescribe medication that can help restore chemical imbalances that are causing the feelings of depression and anxiety.
A significant part of becoming a parent is that the person is suddenly expected to take on a whole new role, which understandably feels strange and unfamiliar. This can cause them to become so focused on mastering their new responsibilities that they may end up feeling distant or estranged from the person they once were. To help someone with a PMAD re-establish their sense of self, we can talk to them about their interests and hobbies and the things that they love. We can play them an old playlist they used to listen to in their younger years, have them watch their favourite film, cook their favourite meal for them or ask them to tell us a fond memory from their childhood. These forms of self-expression and re-discovery can be both grounding and enjoyable. As Gabor Maté puts it, “the loss of self is the essence of trauma.” If we can help the ones we love to remain in touch with their most authentic self, we can give them a better chance at overcoming the adversities that life throws their way.
Another way in which you can offer support during this challenging time in your loved-one’s life is to nurture their relationship with their baby. This can be done by facilitating bath-time, or bed-time routines, or encouraging them to attend weaning classes or parenting workshops. When the person becomes empowered in their new role and gains confidence in their ability to be a parent, the feelings of inadequacy, shame, and guilt often associated with PMAD may start to fade away. Learning how to play and laugh with the infant can also be extremely powerful in helping overcome debilitating feelings of fear and stress.
The benefits of multi-disciplinary assistance
When it comes to seeking professional help for PMAD, it may be hugely beneficial for the PMAD sufferer to receive support from a specialist who has extensive knowledge of and a holistic approach towards PMAD. It is a disorder which affects all areas of the person’s life, including the physical, psychological, social, and occupational, meaning that the condition cannot only be addressed from one angle. If a PMAD specialist cannot be found, assistance from a multi-disciplinary team can be equally beneficial (i.e., a midwife, nurse, doctor, psychologist, psychiatrist, social worker, and occupational therapist).
Reflections
PMAD is a reality that many parents have to face, but with the proper support from loved ones and medical experts, it can be overcome without any lasting effects on the mother, father, or child. By creating awareness and opening up conversations about PMAD, parents and families will become better informed on the topic and will be able to help themselves and others obtain the right intervention and assistance.
