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

2. 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

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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?

13. 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

14. 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?

15. 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

16. 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

17. 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

18. 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”

19. 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.

20. 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.

21. 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 times a day. Your family has told you this is just new motherhood and will go away.

22. 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

23. 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

24. 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

25. 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?

26. Questions?

27. Tiffany Wicks, MS, LPC, NCC
Push Counseling & Coaching, PLLC