Tag: kitchener

The Link Between Preeclampsia and Perinatal Mood Disorder

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Sophie Zivku
Together Waterloo Board of Directors

This May, during Preeclampsia Awareness Month, Together is drawing attention to how complications in pregnancy can increase risk of perinatal mood disorders, specifically anxiety and depression.

Preeclampsia is a rare, but serious disorder where pregnancy-induced hypertension occurs alongside other symptoms like proteinuria, changes in vision, shortness of breath, increased liver enzymes, and pulmonary, or neurological dysfunction. Preeclampsia occurs after 20 weeks gestation and can appear for up to six weeks after pregnancy. When left untreated, preeclampsia can lead to serious complications like seizure, stroke, heart disease, preterm birth, and even death. 

Some things to know about preeclampsia: 

  • Preeclampsia affects five to eight percent of pregnancies worldwide.
  • Black birthing parents in North America are 60 percent more likely to experience preeclampsia, and more severe cases of the condition, compared to white parents.
  • Recent studies have shown a correlation between preeclampsia and perinatal mood disorders. 
  • Preeclampsia is one of the top five leading causes of maternal deaths worldwide.
  • Those who experience preeclampsia have an increased risk of developing chronic hypertension and cardiovascular disease later in life.
  • More recently, studies have shown a decrease in preterm preeclampsia by taking daily Aspirin starting at 13 weeks gestation up until 37 weeks for those at risk. 
  • Birthing parents over 40 are at higher risk of developing preeclampsia.
  • Being pregnant with multiples can increase risk for preeclampsia. 

The cure? 

Delivering the baby. 

Which seems simple, but many diagnosed with the condition are nowhere near full term. Doctors are left monitoring the health of both the birthing parent and baby for weeks, even months. 

Early prevention is key. Knowing the risks of preeclampsia and reducing the symptoms often lead to more favourable outcomes. But the journey from diagnosis to birth is not an easy one. Being at risk of complications while pregnant can be psychologically draining. Your birth plan is compromised and often preterm labour occurs via induction or planned c-section. 

While some medications such as Aspirin have been shown to reduce the risk of developing preeclampsia, continued monitoring is essential. This continued body regulation increases anxiety and stress which can lead to PTSD-like symptoms, making one vulnerable to developing postpartum mood disorders. 

At 32 weeks gestation, I had sporadic hypertension, protein in my urine, my platelets were dropping and I had severe pain below my right rib. I was diagnosed with HELLP Syndrome, a variant of preeclampsia, and admitted to the hospital. HELLP Syndrome is often difficult to diagnose as it doesn’t always present in the same way as preeclampsia. 

Over the next six weeks I was in and out of the hospital. Each time I was sent home, I was terrified to not be within arms reach of an operating room. While admitted, I was closely monitored for weeks and induced at 38 weeks. I was fortunate to have a smooth labour. For many without early detection of preeclampsia, the labour experience can be full of extreme anxiety and crisis. 

After my son was born, everything went back to normal.

Except that it didn’t. 

Any pregnant person is at risk of preeclampsia for up to six weeks after delivery. And I was at an increased risk due to HELLP Syndrome. 

I counted down those 42 days like my life depended on it… which to my anxious mind, it did. 

In addition to being terrified for my life, the stresses of being a new parent, breastfeeding challenges and sleep deprivation were too much. Anxiety and depression enveloped me. Finally after six long weeks, day 42 came. Physically my risk for pregnancy-related hypertension had lapsed, but mentally my mind was still in panic mode. Anytime I felt something out of the ordinary in my body, I panicked. 

Prior to this pregnancy, I had a normal level of anxiety around sickness and death. As someone who lives with stage four endometriosis, I am no stranger to hospitals, health scares, testing or pain. I struggled with depression due to my chronic health struggles and later learned this put me at risk of developing a postpartum mood disorder. After my pregnancy with HELLPs, I had an unhealthy relationship with worry over my mortality. I no longer trusted my body and was convinced it would turn on me and leave me for dead. 

It wasn’t until nine months postpartum that I connected with a counsellor. It would be another four years before I tried to conceive again. I journalled throughout my six weeks of preeclampsia crisis. After my son was born, I didn’t write again for two years. I don’t remember a lot from those first two years of parenthood. The mother-infant bond was hanging on by a thread. I’m not sure why I didn’t journal. Perhaps I was too scared of what I would say. Perhaps I didn’t want to remember. Whatever the reason, I mourn the fact that I only have empty pages to remember those early moments with my son.  

Risk of any kind is scary. Our body naturally wants to fight or flee. In the case of HELLPs, neither felt like an option for me. Whether preeclampsia or another risk condition in pregnancy, the importance of peer and mental health supports for birthing parents, and partners, is critical and should include:

  • Mental health screening during (and after) pregnancy
  • Access to mental health supports during (and after) pregnancy
  • Onsite and virtual peer support to birthing parents who are admitted to hospital (antenatal or postnatal).
  • Ensuring birthing hospitals offer perinatal mental health programs and access to a perinatal psychiatrist. 
  • Monitoring long-term heart health of patients who experienced preeclampsia. 

I had mental health support in place when I was pregnant with my daughter during COVID. It was still a tough pregnancy, but I had a steady counsellor, a friend group who checked in and better support after birth. I wouldn’t say I’m on the other side of things, but I no longer feel alone with my worry. It’s now shared with a network of others who’ve had similar experiences. 

Somehow that helped me more than taking that daily white Aspirin tablet. 

The Other Half: Perinatal Mental Health Services for Dads & Partners

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By Rochelle Kaikai, MSW, RSW
www.rootedthistlecounselling.com
Serving Kitchener & Ontario

Parenthood is a transformative experience involving many twists and turns. When parents are tasked with caring for little ones, they often go through a period of turbulence as they adjust to the changes. Suddenly they must put their own needs aside and prioritize the needs of the baby. Ordinary tasks such as hygiene, eating well, doing the laundry, and getting a full night of sleep often become difficult to achieve. This may leave parents feeling disoriented and disconnected from who they once were. Feelings of disorientation are not exclusive to either moms or dads. Both parents are faced with change that may make them more vulnerable to loss of identity, stress, and even the development of a perinatal mood and anxiety disorder (PMAD). 

In the past, much of the research about perinatal mental health focused on birthing moms. We now know that dads, partners, and non-birthing parents are also at risk of developing a PMAD. Postpartum Support International states 1 in 10 dads develop postpartum depression and approximately 18% develop an anxiety disorder in the perinatal period. It is likely these numbers are even higher, as many attempt to cope in silence. This information is not widely shared or known, leaving dads and partners vulnerable to stigma and reduced access to support. 

It is important we as a collective open up the conversation about perinatal mental health to include all parents. Parents who feel supported and seen are better able to access resources in the community to assist them in navigating this vulnerable stage of life. Although the experiences of dads and moms are not the same, the common thread of disorientation in the perinatal period binds them together. Mental health services that focus on the family as a unit are critical. Adjusting to change is difficult for all parents. Each member of the family deserves space to process this change and reorient themselves. 

Rooted Thistle Counselling is committed to offering mental health services to dads, moms, and partners in all stages of parenthood. Dads and partners can access both individual and group therapy services with Rooted Thistle Counselling. We recognize the importance of feeling seen and understood and believe this important work happens through connection. Although parenthood can be disorienting at times, it presents moms and dads with a unique opportunity to expand aspects of their identity and uncover resiliency they did not know they had. If you or someone you know is looking for support, please pass along our information. Together we can keep the conversation going. 

The Connection Between Pelvic Floor Physiotherapy and Postpartum Mental Health

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Beth Halford DPT, B.Kin, FCAMPT, CAFCI
KW Pelvic Health
kwpelvichealth.com

The journey of parenthood is a beautiful and transformative experience, but it also comes with its fair share of challenges. Many parents experience physical changes and discomfort after giving birth, such as weakened pelvic floor muscles. However, what is often overlooked is the significant impact these physical changes can have on a mother’s mental health. In recent years, the field of pelvic floor physiotherapy has emerged as a promising solution for addressing both the physical and mental aspects of postpartum recovery. 

While the joy of having a new baby is undeniable, many parents experience a range of emotions during this time, including anxiety, depression, and mood swings. These mental health challenges can be attributed to a combination of hormonal changes, sleep deprivation, physical discomfort, and the challenges of adjusting to a new role as a mother.

Physical changes, particularly those related to the pelvic floor, can have a profound impact on a birthing person’s mental health postpartum. The pelvic floor muscles play a crucial role in supporting the organs within the pelvis and maintaining urinary and bowel control. During pregnancy and childbirth, these muscles undergo significant stress and can become weakened or damaged. Common pelvic floor issues include urinary incontinence, pelvic pain, and sexual dysfunction. These physical challenges can lead to feelings of embarrassment, frustration, and a loss of confidence, exacerbating the risk of developing postpartum mental health issues.

Pelvic floor physiotherapy is a specialized form of physical therapy that focuses on assessing and treating the pelvic floor muscles. Trained physiotherapists use a variety of techniques, including exercises, manual therapy, biofeedback, and education, to address pelvic floor dysfunction and promote optimal recovery. While the primary goal of pelvic floor physiotherapy is to restore pelvic floor function, it can have a significant positive impact on postpartum mental health as well. Here’s how:

Restoring Physical Function:

  • By addressing pelvic floor issues such as incontinence, pain, and sexual dysfunction, pelvic floor physiotherapy helps birthing people regain control over their bodies. This restoration of physical function can improve self-esteem, body image, and overall confidence, positively influencing mental well-being.

Empowering Self-Care:

  • Pelvic floor physiotherapy educates parents about their bodies and provides them with the tools and knowledge to manage their pelvic health independently. Empowering parents to take an active role in their recovery can boost their sense of agency and control, reducing anxiety and promoting mental resilience.

Pain Management:

  • Postpartum pelvic pain is not uncommon and can significantly impact a birthing person’s quality of life. Pelvic floor physiotherapy techniques, such as manual therapy and relaxation exercises, can help alleviate pain and discomfort. By reducing physical pain, parents can experience improved emotional well-being and a decreased risk of developing postpartum depression or anxiety.

Stress Reduction:

  • Engaging in pelvic floor exercises and relaxation techniques can help reduce stress levels and promote a sense of calm. By incorporating mindfulness and breathing exercises into pelvic floor physiotherapy sessions, parents can learn valuable stress management strategies that can benefit their mental health beyond the clinic.

The journey of postpartum recovery involves both physical and mental healing. Recognizing the interconnectedness of these aspects is crucial for holistic well-being. Pelvic floor physiotherapy plays a vital role in addressing physical challenges and improving postpartum mental health.  If you have any questions, please don’t hesitate to reach out: [email protected]

The Birth of a Mother: Matrescence as a Lens to Support Perinatal Mental Health & Wellbeing

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Rachel Brnjas
Tapestry Counselling & Consulting
Tapestrycc.com

When I thought about the “resume” I brought into mothering: many years working at summer camps, nannying, being the eldest child and cousin on both sides of my family, supporting families in the community… I believed I was “qualified” for the job. I’d heard some friends who had experienced birth trauma, challenges with breastfeeding… but I’m sure I could overcome these things, right? I imagined I could resume my life, continuing to do the things I loved, only with a baby tied around me. Having a baby wouldn’t need to change me. 

When I brought my first child home from the hospital after a whirlwind birthing experience (two weeks early, the day after I started maternity leave and only spending 6 hrs in the hospital), I couldn’t stop playing the birth over and over in my head. Every time I closed my eyes, I felt like I heard my baby crying only to discover him quietly sleeping next to me. I could hardly sit, my breasts were dripping and tender, my eyes wouldn’t stop crying. I was completely disoriented.

When will I feel like myself again? Perhaps at 6 weeks? Or maybe after the fourth trimester?

I clung to these markers of time with the hope that they would bring the clarity and reorientation that I so desperately needed. But when these times came, I didn’t feel the relief I’d been hoping for. The voices of anxiety and shame felt loud and so, in a moment of desperation, I sought therapy. And while having a soft place to land felt helpful, it didn’t help me make sense of WHY I was feeling the way I was or how I might find myself again. 

It was later, much later, after having my second child and once again navigating another disorienting postpartum experience that I started to find resources and language to understand what I was experiencing. I discovered the work of Postpartum Support International (PSI) and I started seeing a postpartum therapist. And slowly, I started to a find a way back to myself. 

Part of feeling reoriented was a passion that arose within me to make sure we have more perinatal mental health resources in our community; the kind of resources that I needed but struggled to find. Even though I’d been working as a social worker with parents in the perinatal period, I was missing some education and specialized training to really come alongside parents. So, I leaned in and did my Maternal Mental Health certificate through PSI and in June of 2021 launched Tapestry Counselling & Consulting. 

I immediately loved holding space for parents navigating the transition into parenthood: supporting them with managing the voices of anxiety, of depression, of guilt, of rage…

But it still felt like something was missing from this work. Why were an increasing number of parents feeling so disoriented? And why did I also sense the tremendous potential within this disorientation for healing and growth? How could these things both be true? 

This is when I discovered the concept matrescence. We didn’t just birth our child(ren); as parents, we undergo our own birthing experience. 

Matrescence sounds like adolescence for a reason. It’s a time of developmental shifts and changing hormones, relationships, bodies, identities… kind of like when we went through adolescence. In our cultural context where the parenting pressures are unrealistic at best and oppressive in their most extreme, it’s easy to feel like there’s something wrong with us when we struggle through this transition into parenthood.

Having a framework like matrescence reminds us we are changing and while change is uncomfortable, it doesn’t mean we aren’t a great or capable parent. It means we ALL need support, community, and particular tools and resources to reorient ourselves. And while all parents navigate matrescence, it will look unique for each of us. 

A matrescence-informed lens matters deeply to our conversations about perinatal mental health because it gives us the big picture to better understand why a parent might be feeling disoriented. It is a paradigm that makes space for duality: BOTH & AND. 

Parenthood is beautiful and hard.

Parenthood is monotonous and can provide deep meaning.

Parenthood is exhausting and can feel so energizing and inspiring.

Parenthood is thankless and deeply rewarding.

Research is showing that conversations about matrescence lower rates of postpartum anxiety and depression. 

I recently completely a 6 month matrescence apprenticeship program called “The Village” with a group of practitioners from around the world who are fiercely committed to maternal wellbeing. I’ve been weaving matrescence education and tools into my individual clinical work, my Wholehearted Mothering group (https://tapestrycc.com/wholehearted-mothering) and groups I run in the community. Parents have expressed excitement and deep validation by learning about this concept. It’s helped to “connect the dots” to better understand why they are feeling the way they are.

I wish I had known about matresence years ago. I believe this framework, used in conjunction with other therapeutic tools (especially ones that include our bodies) can help us to better support the wellness -and even the flourishing- of parents in our community.

Chapter 4

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By Sophie

As someone who lives with stage four bilateral endometriosis, I am no stranger to anxiety and depression. My journey to motherhood was fraught with surgery, clinical appointments, loss, risk in pregnancy, a slow postpartum recovery, and breastfeeding challenges. All these experiences, on top of my daily struggle with chronic pain led to an even more stressed mental state.

After the births of my son (now 7) and daughter (now 1), I struggled to cope. Even though I had access to a trusted counselor, loving partner, supportive family, and friends, I struggled. Still today, the demands of my disease and the NEED to care for my own body, are often at war with the needs of my children. I am learning that you can have all the support in the world, and still struggle with your mental health.

I often think: “If only I try harder, do more, I can push past the way I am feeling”. The truth is, we need to feel these feelings, with the right supports in place. We need to hold them close, not push them away. In fact, we may never push past the way we are feeling. Mental health isn’t about getting over something, it’s about learning to live safely with the what ifs, the down days and the panic.

The challenges around motherhood are deeply systemic, starting at the beginning, with how those of us with reproductive-related disease are treated in the health system, how postpartum bodies are NOT supported and how women are often expected to put aside their needs for EVERYONE else.

My story comes from a place of privilege. I am a cis-gender white woman surrounded by friends and family who support me. Imagine the postpartum experience of those who aren’t in the same position. I’m not yet out of the darkness. Some days are tough, and I want to be someplace else. I often wonder if I made the right choice having children. Is it supposed to be this hard? Or is it just hard for me? While I may not love being a mom every day, I do love my kids, and that is what matters most.

Chapter 3

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by Anneke VB

I have four kids. During all pregnancies and postpartum I was flagged as showing signs of depression. I wasn’t surprised; depression is something I had been familiar with. It was just always there, especially during the first 10 years that I was in Canada. As an immigrant, I had a hard time fitting in, and unsure how to access the resources I needed. I didn’t have a community, and though my husband is my best friend: he really was all I had.

Two years after first arriving in Canada, I got pregnant. It was planned, but I couldn’t have been less prepared emotionally. I was 26 and I hadn’t given parenting much thought, but I winged it. Child is 14 now, still alive and without major trauma, child says. In the following years, I just went from pregnancy to postpartum, always was screened and found to be scoring slightly too high on the (flawed) Edinburgh scale. A doctor would mention something about looking after myself, and that was it. I didn’t give it much thought, as I plodded along.

It wasn’t until my last one when things started to feel off for me. One of my earliest memories of postpartum with my 4th is what I now refer to as headlice day. It was the first day of winter break, and I had found headlice in all the kids’ hair, my husband’s and my own. It’s a rite of passage for most family with young kids, but it couldn’t have come at a worse day for my family.

With my husband having to work overtime, I spent the whole day doing headlice treatments, the nasty chemical kind. I was exhausted, which is to be expected 3 weeks postpartum from a c-section, and baby had to spend a lot of time unhappy in their crib. It was (and still is) the longest day of my life.
Once it was time for me to give myself treatment, I had given up. While the kids maybe had a few headlice here and there, my hair was literally full of them. I saw no other way out then cutting all my hair off, and giving myself a treatment, while husband put the kids to bed, way after their bedtime. There are benefits to wearing a head scarf and rarely having visitors. Nobody asked me a question.

While headlice day was an exhausting day for good reason, I never really recovered mentally. I was already not doing great after baby was born, but now I literally felt myself spiraling. I didn’t enjoy life and didn’t enjoy being me. My doctor got me on a waiting list for counselling, as we didn’t have insurance and due to our financial situation, we didn’t have many other options. I didn’t want medication, as I thought it too complicated, and I had no energy to research the options to make a well-informed decision.

Early March I had to drive my child to a birthday party, and while navigating traffic with 4 kids, I thought how much easier it would be if I just had an accident. I can’t say it was a scary thought, as it wasn’t. It felt like an option that I felt rather intrigued by.

After that day, slowly things got better. I started to realize that I had options and that felt very liberating. With the warmer weather I was able to get out more, which was only getting easier with baby getting older. Counselling had started and while I never thought it particularly helpful, it gave me the opportunity to reflect on my life and who I was beyond being a parent.

By summer, things had much improved, though it wasn’t really until I started working a part time job 10 months postpartum, that things really started to change. Work brought (and brings) me so much joy and I love what I am doing. An important part of my work now is to share my experiences as an immigrant parent with perinatal depression, but also to create services that support parents who are situations like I was. I did it (mostly) alone, but parents shouldn’t have to. There are so many resources out there now. Please, ask for help. It is the most courageous thing you can do for yourself.

Chapter 2

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by Catherine M

My journey with Perinatal Mental Health includes a pre-existing mental health condition diagnosed in childhood (OCD) that had been managed for decades before I got pregnant. I wasn’t educated on how pregnancy and postpartum could affect my experience of OCD. Nor was I educated to know that in becoming a parent I would experience increasing and challenging sensory overstimulation. It would leave me feeling like my skin was aching daily, and my ears would ring and throb to the point of making sleep difficult. With my first pregnancy and birth, I was fortunate at the time to live in Toronto and receive care after my first was born. When I gave birth to my second in Waterloo Region, I realized how few supports were available once outside an urban community.

I once made a list of all the people I thought could raise my first child for me, because the weight of the responsibility sent me spiraling into a cyclone of intrusive thoughts, every hour of every day. I was certain I had made a horrible mistake and that I wasn’t supposed to be raising him. Instead of sleeping, I listed all the people that I could ask to take him for me. And that if I was lucky, it would be someone in my family so I would still get to be a part of his life, see him grow up. I was heartbroken and lost, more than I had ever been in my life or in my experience of my disorder up until then.

I still struggle. I will always struggle. I know this. That doesn’t mean I’m a mess every day, but some days I definitely can be. I have never loved anything more in my life than my children. And though that is a gift I get to live every day, it can also turn to fear and terror very quickly.

I am a white, female passing, womyn who lives within a circle of privilege – including a strong community and support system around me. Imagine those who aren’t the same position.

Chapter 1

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by Lisette W

Postpartum hit me like a brick. On the outside I was happy, keeping it together. Inside I felt like I was drowning. So much doubt. So much self-loathing.

My first’s birth was traumatic, followed by a NICU stay where we fell through the cracks of support and had to find our way ourselves. Add the struggle to breastfeed and I was gone.

I was diagnosed with postpartum depression and anxiety. I was screaming at a three week old. I would snap with sudden rage at a little baby who thought I was her whole world. I didn’t want to be her mom. I wanted to run away. There must be someone out there who can love and care for her more than me. Better than me.

This side of parenthood isn’t talked about. The ugly side where you’re at the door with your keys wondering where you could go that isn’t here. The feelings of utter failure because you’re incapable of nursing – the thing everyone notes as natural and easy. Being surrounded by people but not knowing how to ask for help that’s helpful. Surrounded by people but grasping for sanity.

Thankfully I was able to start seeing a therapist who specialized in perinatal mood and anxiety disorders and got onto medication. I am a much better mom for my kids when I take care of my needs first.

Roundtable with Minister Carolyn Bennett

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Last week we had the great pleasure and privilege to meet with Minister Carolyn Bennett and MP Tim Louis to discuss the crisis and inequity of funding and support for Perinatal Mental Health. Grassroots non-profits like Together are often not considered for funding at the Federal level and conversations like this one, matter IMMENSELY.

We spoke candidly about how grassroots organizations like Together are key to understanding the needs of the communities in which we work. Furthermore, we addressed how peer support work is a must have (not a nice to have) to ensure support for racialized parents, newcomer parents, parents with disabilities, and 2SLGBTQIA+ families. These parent groups need more dedicated supports as they are at higher risk of Perinatal Mood and Anxiety Disorders just for being who they are.

While creating national standards and educating health professionals to better understand perinatal mental illness are good building blocks, peer support is the foundation for those blocks.

We will continue advocate for the support of unseen parental experiences and to push forward to ensure that peer support work is seen as key to Perinatal Mental Health. If you’d like to support the work of Together, consider supporting our upcoming Climb.

Our colleagues Olivia Scobie, Christine Cunningham, Fadhilah Balogun, and Sophie Zivku were rallying alongside us in this important conversation. Together, we will increase support systems, educate health care providers, and build a village so that no parent is left behind.

Photos by Only1AndyWright Photography

Postpartum Psychosis

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Postpartum Psychosis is a medical emergency. Please go to nearest Hospital Emergency Room. 
Here 24/7: Call anytime at 1 844 437 3247 (HERE247)
or TTY: 1-877-688-5501

1-2 in every 1000 deliveries but the risk for parents with bi-polar is 25-50%.

“The symptoms of Postpartum Psychosis may appear very similar to those of other psychotic disorders but they are usually unexpected and develop very rapidly, within hours. They most often appear within 72 hours to four weeks after the baby is born. The episode lasts at least a day and may last up to one month with eventual return to the woman’s previous level of functioning. Immediate treatment is required for the safety of the woman and her baby.” – BC Women’s Hospital and Health Centre

Symptoms may include:
Mania

Feeling “high”, “up”, elated, over-excited, or “on top of the world”

Increased energy, activity, or productivity

Racing thoughts, being more talkative, a “busy” brain, increased creativity, or pressured speech

Needing less or no sleep or not wanting sleep

Feeling restless, agitated, or unable to keep still

Losing inhibitions, spending a lot of money, or being much more sexually or socially forward

Extreme irritability, impatience, or anger

Very increased interest in your surroundings

Easily distracted, starting many things but not necessarily finishing them

Depression

Feeling low, flat, tearful, emotional, or crying easily

Anxiety, feeling tense, nervousness

Feeling withdrawn and not wanting to talk to or be near others

Tired, heavy, or without energy

Having a harder time taking care of yourself or your baby

Psychosis

Severe confusion or delirium

Seeing, hearing, or feeling things that aren’t there – hallucinations

Thoughts or beliefs that aren’t within reality or that people around you think are strange and out-of-character – delusions

Feeling suspicious or afraid of people or events, paranoia

Acting like you aren’t yourself

Feeling detached from reality, unreal, or like you’re in a dream

Additional Resources
Resources During Recovery
PSI Provider Directory

PSI Postpartum Psychosis For Moms Support Group

Support for Families
PSI Support for Families Touched by Postpartum Psychosis