Perinatal Mood and Anxiety Disorders with Molly Nourmand, LMFT

Bonsie Skin to Skin Babywear joined in conversation with Molly Nourmand, LMFT and Founder of Life After Birth®, to discuss perinatal mood and anxiety disorders, commonly known as postpartum depression. According to Postpartum Support International, 1 in 7 moms and 1 in 10 dads suffer from perinatal mood and anxiety disorders. The more you know about the subject, the better you can prepare for it and support your loved ones.

Photo of Molly Nourmand

Here’s our interview with Molly about this important topic:

How have your own motherhood experiences shaped your career?

My experience with postpartum depression was the impetus for me creating my company Life After Birth® and specializing in working with pregnant and postpartum folks. In my training I received from Postpartum Support International, I learned that a degree of self-disclosure from the therapist helps those suffering from Perinatal Mood and Anxiety Disorders (PMADs). So in the work that I do, I combine my formal graduate training as a therapist, my specialized training with PMADs, as well as my own lived experience as a mother.

What are Perinatal Mood and Anxiety Disorders?

Although the term “postpartum depression” is most often used, since symptoms can appear any time during pregnancy and the first year after having a baby, the term perinatal is more encompassing. There are actually several forms PMADs that parents may experience, including:

• Depression During Pregnancy & Postpartum
• Anxiety During Pregnancy & Postpartum
• Pregnancy or Postpartum Obsessive Compulsive Disorder (OCD)
• Postpartum Post-Traumatic Stress Disorder (PTSD)
• Bipolar Mood Disorders
• Postpartum Psychosis

What are some major signs and symptoms?

• Sadness or depression
• More irritability or anger with those around you
• Difficulty bonding with your baby
• Feeling anxious or panicky
• Having problems with eating or sleeping
• Having upsetting thoughts that you can’t get out of your mind
• Feeling as if you are “out of control” or “going crazy”
• Feeling like you never should have become a parent
• Worry that you might hurt your baby or yourself

If you are experiencing any of these, then please contact your doctor or therapist. If you need more resources, then check out Postpartum Support International.

What resources or treatment do you recommend?

There is no need to suffer unnecessarily hoping symptoms will go away. PMADs are treatable and temporary. Here are my suggestions:

• Get connected with a therapist who specializes in PMADs to start your treatment.
• Discuss the necessity of pregnancy- and breastfeeding-safe medication (if you are feeding your baby from your body) with your doctor.
• If you do need medication, your OB-GYN may be able to prescribe it for you if it is depression or anxiety. If it is a more nuanced mental health disorder, then a psychiatrist–preferably a reproductive psychiatrist–would be better suited to diagnose and prescribe.
• Bolster your support system. Reach out to trusted friends and family, and/or if resources allow, hire someone to help take care of you, the baby, and to cook and do housekeeping.
• Find a group for new moms (such as Life After Birth®) for connection, community, and support.
• Prioritize sleep and rest.
• Go outside and get fresh air and sunlight daily, even if it’s just to get the mail.
• Keep a bottle of water near you and drink from it all day and night; refill when empty.
• Eat every few hours.
• Keep taking your prenatal vitamins.
• Go for daily walks (if your recovery allows).
• Seek out mind-body practice like yoga, meditation, and/or breathwork to help manage stress.

How can moms prepare for PMADs before having a baby?

If you have any risk factors that can contribute to a PMAD, such as depression and/or anxiety prior to or during pregnancy, sensitivity to hormonal shifts, or an IVF journey, then you may want to consider creating a postpartum mental health plan. That said, a traumatic birth, having your baby spend time in the neonatal intensive care unit (NICU), issues with breastfeeding, and lack of support can compound mental health issues. Consulting with a perinatal mental health practitioner and a lactation consultant prior to delivery may help prevent a PMAD from taking shape.

What questions do you suggest that moms ask their doctor before and after having a baby?

“Can you prescribe medication if I need it?” À la the postpartum mental health plan, mobilize your support system before the baby comes, so that it’s easily accessible if you need it when the baby arrives.

“Is this normal?” Up to 80% of women feel the baby blues after giving birth. It’s caused by the sudden change in hormones after delivery, combined with stress and lack of sleep. You might be tearful, overwhelmed, and emotionally fragile. The baby blues begin within the first couple of days after delivery, peak around one week, and resolve by the end of the second week postpartum without any intervention. While the baby blues and postpartum depression (PPD) have some overlapping symptoms, if they don’t go away after a few weeks, worsen, or the onset is after the first two weeks, then you may be suffering from a PMAD. Also, one of the key differences between baby blues and PPD is level of functioning.

What medications are safe for breastfeeding?

Although I am not an MD and this is not medical advice, from my training and experience, there are many selective serotonin reuptake inhibitors (SSRIs)–also known as antidepressants–that are safe for pregnancy and breastfeeding. Therefore, if you already take an antidepressant, make sure to consult with your prescribing provider prior to going off your medication. With anything, you need to weigh the pros and cons; however, depending on your specific mental health issues, it may be an overall safer choice to stay on your medication while you are trying to conceive, pregnant and breastfeeding.

How can PMADs affect the relationship that a mom has with her baby?

PMADs can affect bonding and they can rob the birthing person from being present and finding joy in the first days, weeks, months and even years of a baby’s life. That said, a birth person should not blame themself or create any unnecessary guilt if they are diagnosed with a PMAD. There is a confluence of genetic and environmental factors that create the perfect storm for perinatal mental health issues. PMADs are temporary and treatable, so it may not even affect the parent/child relationship at all if you can try to get ahead of these issues and bolster your support system.

How can partners and family members better support new moms?

Glad that you asked! They can educate themselves on PMADs. They can become familiar with the warning signs and risk factors for these mental health issues. They can help co-create the postpartum plan. And they can really help reinforce the support that the birthing person needs when the baby arrives.

In your experience, how does breastfeeding, cuddling, and practicing skin-to-skin contact affect both PMADs and the relationships between a mother and her baby?

Low oxytocin levels have been linked to symptoms of depression, including postpartum depression. Breastfeeding, cuddling and skin-to-skin contact boosts oxytocin release and may help decrease PMADs symptoms as well as foster a bond between the birthing person and their baby.

I hear the shame, grief and disappointment from birthing people whose baby needed to spend time in the NICU and missed the golden hour. Ina May Gaskin, the leader of the modern “natural birth” movement actually revised and updated her book to be more inclusive of all birth outcomes. She said:

The “golden hour” is a phrase that I could do without because it makes it sound as if bad things automatically happen if temporary separation places you and your baby in different places for a time. This is simply not true. Love is more powerful than missing some minutes together right after birth. Remember: Expressing love, whenever and wherever you do it, releases more oxytocin. You can always give expression to love, no matter how scared or low you may feel.”

What other advice or information do you have for new and expecting moms?

In my experience, a new mom needs just as much care as the newborn. Read that again. I am a huge proponent of the following ingredients: support/community, nourishment, rest, repeat.

Can you tell us about the services you provide and Life After Birth?

Life After Birth® provides mental health support and wellness services for expectant and new parents. We offer virtual 1:1 and couples therapy sessions, support circles led by perinatal mental health professionals, and individualized offerings such as lactation and nutrition consultation, from a collaborative team. We also provide postpartum mental health planning, birth prep, and birth story processing. Here is our website:
https://www.ourlifeafterbirth.com