Baby blues or postpartum depression and anxiety? Maternal mental health under the microscope | Health

Recent research has found that perinatal mental illness affects a significant number of mothers six weeks to a year after childbirth.

In New Hampshire, roughly 25% of pregnant and postpartum women experience perinatal mental health conditions, according to Northern New England Perinatal Quality Improvement Network. Postpartum Support International places the worldwide percentage at 85%.

Increasingly, maternal care professionals are training an eye on mental health, identifying at-risk patients early and treating new mothers who are struggling.

“Most people are expecting this time to be full of sunshine,” said Dr. Sarah Slocum, a consultation- liaison psychiatrist at Exeter Hospital who works with mothers in the maternity ward. Around 80% of new moms, after any new baby, experience what’s known as the “baby blues,” according to the American Pregnancy Association, with increased tearfulness and feeling sad, anxious and unsure of what they’re doing, Slocum said.

“New mothers can feel overwhelmed, not having enough support. They may feel regret. They can put themselves into a situation where they isolate and not have visitors come over,” Slocum said. “Our goal is to help them feel less isolated.”

They’re not the only ones at risk. “If you have a new mom who is depressed, the newborn may not be getting the attention that’s needed,” she said. “Maternal mental health affects the whole family.”

Exeter Hospital’s Flamingo Project combats perinatal mental illness with a start-to-finish temperature-taking of maternal mental health. Inspired by a similar initiative at Dartmouth Hitchcock Medical Center, perinatal professionals — nurses, midwives, lactation specialists and doctors, including a psychiatrist — check in with new mothers.

Core Obstetrics & Gynecology physicians and midwives and Family Center staff monitor emotional wellbeing during pre-conception and pregnancy planning, throughout pregnancy, after the baby is born and during the first year of motherhood.

The goal is to educate women about what’s normal and what isn’t to make them feel accepted and heard, to encourage them to seek help and connect them with resources quickly.

“When flamingos have a baby, they lose their pink color. That’s like how new parents feel,” said Ashley Mitchell, a registered nurse, nurse educator and safety officer at The Family Center, who helped create The Flamingo Project. “They can feel exhausted, not like themselves.”

Flamingos regain their color when their babies become more independent, she said. For new moms, ‘Getting your pink back’ is a trend on social media.”

In the past 20 years, there’s been “an increased focus on perinatal mood disorders,” said Dr. Heidi Meinz, an obstetrician at Manchester OB-GYN Associates who delivered babies at Elliot Hospital for 23 years. “They’re more recognized and out in the open. But the true prevalence is difficult to quantify.”

Women with pre-existing mental health conditions are at greater risk for perinatal anxiety and depression, which also affects moms with no history of mental illness.

“Sometimes they’re tearful, sleeping more than expected. Sometimes they feel rage, extreme anxiety and have difficulty bonding with the baby,” said Theresa Small, a certified nurse midwife at St. Joseph Hospital in Nashua.

Across the U.S., maternal mortality is increasing, according to national research. In New Hampshire, the No. 1 and 2 causes of maternal death are substance abuse and mental health disorders that result in suicide, said Meinz. The greatest risk occurs in the first year after the baby arrives.

And dads are not immune. Roughly 1 in 10 experience paternal postnatal depression, Slocum said. Just like mothers, fathers are vulnerable during the pregnancy period.

Dr. Kelly MacMillan, an obstetrician at St. Joseph Hospital in Nashua, said women are willing to open up and talk more frankly than in the past, which is boosting identification and treatment.

Stories of past tragedies “make us more proactive to ask about it,” she said. “Our last question is always, ‘Are there thoughts of self-harm or harming someone else?’”

The Northern New England Perinatal Quality Improvement Network in Lebanon, a collaboration of maternity professionals, hospitals and care organizations, provides education and recommends screening for depression and anxiety during the first and third trimesters, at delivery and postpartum, and aids in connecting women with support groups and outpatient referrals.

A screening tool, the Edinburgh Postnatal Depression Scale, uses a questionnaire to identify women at risk for postpartum depression. A score of 10 or higher suggests possible depression. A score of 13 or more indicates an 80% likelihood. Moms seem more willing to check boxes than to volunteer personal admissions such as “I don’t feel like myself,” MacMillan said.

Today’s pre-pregnancy OB-GYN visits review the risks of medications. Psychiatric prescriptions are screened for whether they’re safe and necessary. The focus is on stabilizing maternal mental health, said Small at St. Joseph Hospital. “We keep them on the medications they need with close observation and follow up.”

According to The Flamingo Project: The “baby blues” affect new moms, usually within two or three days of giving birth, bringing feelings such as worry, unhappiness, fatigue, tearfulness, restlessness, anxiety and poor concentration. When the symptoms last more than two weeks, moms are advised to seek help.

Full-blown postpartum depression affects 13% of new mothers, Slocum said, and is functionally disabling, bringing a tide of sadness, anger, irritability, guilt, changes in eating and sleeping, trouble concentrating and hopelessness. It can bring a lack of interest in your baby, or thoughts of harming yourself or the baby.

Postpartum anxiety afflicts roughly 10% to 20% of women before and after birth, according to behavioral health research. It can manifest as extreme fears over the baby’s health and safety.

Some women experience panic attacks with chest pain, dizziness, shortness of breath, numbness and tingling, and feelings of losing control.

Slocum said a mother with paralyzing anxiety might feel “I can’t go down the stairs with my baby. What if I drop them?” Or, “I can’t pare vegetables because what if the knife slips with my baby nearby?” She might stop cooking or won’t carry the baby downstairs, the psychiatrist said. But “She’s terrified of saying that” because child welfare authorities or someone else “might think she’s an unfit mom.”

Postpartum obsessive-compulsive disorder brings intrusive, repetitive thoughts or mental images, and the subsequent need to avoid things or do certain things over and over again.

Postpartum PTSD, which can occur after a scary or traumatic birth, brings disturbing flashbacks or a need to avoid things related to the birth event.

Bipolar depression during pregnancy or after birth can appear as severe depression, mood swings, impulsiveness, rapid speech, little need for sleep, delusions, high energy and grandiose thoughts, according to The Flamingo Project.

In perinatal psychosis, a rare but dangerous condition, it may become impossible to sleep. Patients see images or hear voices that others cannot. They believe things that aren’t true, distrust those around them, and may experience spells of confusion, mania, depression or memory loss.

Perinatal mental health conditions are temporary and are treatable with professional help, Slocum said.

The best medicine at homeSelf-care helps to tip the scale toward positive mental health postpartum.

The Flamingo Project offers the following strategies for ‘getting your pink back.’

Share nighttime duties with your partner, nap while the baby sleeps, limit screen time before bed and establish a calming bedtime routine.

Aim for 10 to 15 minutes of daily exercise to start. Pick physic.al activities you enjoy, such as yoga, dance or walking.

Eat balanced meals and stay hydrated with a water bottle you carry with you.

Do things that make you happy, such as reading, crafts, gardening or taking photos. Take a few moments each day to meditate or breathe deeply. Look into guided sessions offered by online apps.

Reach out to friends. Join a new parent support group.

The Flamingo Project recommends positive self-talk, including affirmations such as: “I face difficult situations with courage.” “I am surrounded by people who love and support me.” “I will take this one minute at a time.” “I’m doing the best I can. That’s all my baby needs.” “Today, I will see the best in my baby, and the best in myself.”

Reneee Maloney, a nurse and director of maternal child health at Catholic Medical Center, said women are screened for postpartum depression at the beginning of prenatal care, a couple of times before birth, and before and after delivery. A team of maternal health nurse practitioners makes follow-up calls to mothers at home.

“The support networks have been changing,” said Maloney, who’s been at CMC for 18 years. “The change is screening more often, with more follow up.”

“Knowing that help is out there is really important,” said Slocum at Exeter Hospital.