Perinatal Mood Disorders: Signs Symptoms, and Support Tiffany Wicks, MS, LPC, NCC © Push Online Learning

About Me B.S. from Texas A&M, M.S. in Counseling from SMU Licensed Professional Counselor Owner of Push Counseling & Coaching, PLLC Toddler Mom Doctoral Student

About Push Counseling & Coaching, PLLC In-Person Counseling at The Nest in Addison Online counseling Coaching Specializations Maternal Mental Health Trauma Birth Worker Vicarious Trauma/intentional wellness

What are Perinatal Mood Disorders? Mental illness experienced during the perinatal period that is unrelated to external mental illness Mood instability is a result of pregnancy or birth Inability to cope with environmental factors surrounding the perinatal period

Types of PMDs Perinatal Depression Perinatal Anxiety Postpartum Rage Perinatal OCD Postpartum Psychosis

Signs & Symptoms-Perinatal Depression Feelings of anger or irritability Lack of interest in the baby Appetite and sleep disturbance Crying and sadness Feelings of guilt, shame or hopelessness Loss of interest, joy or pleasure in things you used to enjoy Possible thoughts of harming the baby or yourself Information directly taken from Postpartum Support International

Signs & Symptoms- Perinatal Anxiety Constant worry Feeling that something bad is going to happen Racing thoughts Disturbances of sleep and appetite Inability to sit still Physical symptoms like dizziness, hot flashes, and nausea Information directly taken from Postpartum Support International

Signs & Symptoms-Perinatal OCD Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images related to the baby. Compulsions, where the mom may do certain things over and over again to reduce her fears and obsessions. A sense of horror about the obsessions Fear of being left alone with the infant Hypervigilance in protecting the infant Moms with postpartum OCD know that their thoughts are bizarre and are very unlikely to ever act on them. Information directly taken from Postpartum Support International

Signs & Symptoms- Postpartum Rage Instant anger over small things Not able to calm Rage in response to baby (angry the baby woke up from nap, angry the baby spit up, etc.) Unable to explain the reason for the anger

Signs & Symptoms-Postpartum PTSD Intrusive re-experiencing of a past traumatic event (which in this case may have been the childbirth itself) Flashbacks or nightmares Avoidance of stimuli associated with the event, including thoughts, feelings, people, places and details of the event Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response) Anxiety and panic attacks Feeling a sense of unreality and detachment Information directly taken from Postpartum Support International

Signs & Symptoms-Postpartum Psychosis Delusions or strange beliefs Hallucinations (seeing or hearing things that aren’t there) Feeling very irritated Hyperactivity Decreased need for or inability to sleep Paranoia and suspiciousness Rapid mood swings Difficulty communicating at times Information directly taken from Postpartum Support International

Is It a PMD or Baby Blues? How long have the symptoms lasted? It’s difficult to determine before 6 weeks but some symptoms are evident Has the patient had mental illness in the past? This is definitely a predisposition for developing a PMD How intense are the feelings? Rating the emotion 1-10 and can’t use 7 What makes it a 3 instead of a 4? When was the last time you were above a 3?

What To Do When You Suspect There’s a PMD Assess PHQ-9 Edinburgh Postnatal Depression Scale Facilitate a Conversation Express Concern Educate Make Referrals as Necessary

Opening the Conversation Ask Open-Ended Questions How are you feeling? How do you cope with that feeling? How do you take care of yourself? How are you currently receiving support? What is the way you want to be best supported? Don’t ask too many consecutive questions-validate in between Think about your scope of practice-What are you able to recommend Breastfeeding support? Sleep expert? Postpartum doula needs?

What Not to Say Have you tried…? Why do you feel like that? Oh I’ve been there before It’s not that bad That’s normal…it will pass It’s all in your head Just calm down Once you get ____ it will get better

Validating The Client Validating words hold so much power. Consider: I hear you Thank you for sharing so much with me You have been through so much and are all still going You are so brave You are so strong

Validating the Client (cont.) Do not share your stories When a client is sharing, listen for their experiences not yours Don’t relate their situation to something similar about you or someone you know-this invalidates how they feel in the moment Don’t offer stories about happy or sad endings-this sets clients up for expectation and comparison and can be damaging Do not offer solutions or ask if the client has tried ___ -this can cause the client to feel they’ve failed if what they tried hasn’t worked Instead- ask what has and has not worked…make professional recommendations; if it’s outside your scope make a referral

Active Listening Skills Summarizing/Paraphrasing A brief summary of what the person just said “You have been working hard and you have a lot of projects coming up and at the same time you have a lot of family events and school functions to attend.” Reframing Summary with an emphasis “you’d love to have more time to complete your work, but you’re concerned it will affect your family” Reflection of Feeling “You’re feeling overwhelmed as you work to juggle two important aspects of your life”

Practice Designate one listener and one talker. The Talker will role play the client scenario 1 for 10 minutes The listener will respond without sharing anything related to them. Use one of the following: Paraphrasing Reframing Reflection of feeling When ten minutes have finished, switch roles and the talker will now role play scenario 2.

Practice Scenario #1 You are a 32 year-old female who just gave birth to your second child with no complications during pregnancy or birth. You experienced baby blues with your first child, but it subsided after two week postpartum. At six weeks postpartum with your second child you are consistently tired, not feeling motivated to do anything. You have stopped hearing from friends and feel guilty for reaching out. You’ve just disclosed to your midwife that you feel ashamed for not being a good mom for your newborn and not being able to handle being a mom of two.

Practice Scenario #2 You are a 28 year old female who just gave birth to your first child. You described the birth to your midwife as traumatic, with a last minute transfer and emergency c-section. You’ve struggled with anxiety in college. At three weeks postpartum you cannot keep thoughts of the baby’s safety out of your head. Thoughts of dropping the baby, or the baby having SIDS overwhelm you 25-30 times a day. Your family has told you this is just new motherhood and will go away.

Making Referrals Know who you’re referring to-If you don’t know them personally, please look up their philosophy and practice Know what your client needs Insurance? Religious based? In-person or online? Know how to find mental health support Psychology Today Therapy Tribe

Facilitating the Transfer Validate how difficult this is Remind them of the benefits Take the pressure off the table-support will always be there Debunk the myths of therapy We don’t judge We’re not a “gotcha” business-CPS, police, etc. There isn’t a power differential We are not there to fix them-support only

Transferring Care Handing the client a card is OFTEN not enough. Is there time you can set aside to support the client while they make the first call? Does the therapist have a social media page that the client would feel more comfortable seeing to ease their anxiety? Do you know the therapist? This personal recommendation CAN be beneficial to the client Actually know the therapist enough…don’t vouch for a person you don’t know

Follow Up Follow up as you see fit Make a quick phone call- be discrete Remember: Moms often feel the pressure to keep going without help…your follow up and your education of PMD can be the change Think about your practice How will you educate your clients to prevent the crisis of PMD? How do you partner with mental health professionals for your clients to value the support?

Questions?

Tiffany Wicks, MS, LPC, NCC Push Counseling & Coaching, PLLC 214.596.8318 info@pushpostpartum.com http://facebook.com/pushpostpartum Instagram: @pushcounseling