Tag: perinatal mental health

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. 

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

Birth Trauma and the Pelvic Floor

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Nadia Qahwash
Pelvic Health Physiotherapist
Encompass Health & Wellness
https://www.encompasshealth.ca/

As a Pelvic Health physiotherapist, I have had the pleasure of meeting many wonderful birthing parents who have had the courage to share their birthing stories with me. These stories vary from positive experiences to extremely distressing, negative stories that have left these parents feeling alien to themselves, their bodies and their minds.

The postpartum stage in a birthing parent’s life can be both a mental and physical struggle that makes it difficult for one to function in their daily social life and relationships. They are dealing with hormonal changes, caring for a tiny human that relies heavily on them, and mentally trying to process the traumatic experience that labour and delivery can sometimes create.

Through my experience as a pelvic health physiotherapist, the best way to approach these stories is with a listening ear, empathy and stepping back to look at the person as whole, and what they may need. Trying to understand their traumatic birthing experience is the first step in a pelvic physiotherapy assessment. What is important to highlight here, is that some of the physical symptoms these patients present with in my office, can often be linked to the trauma they have gone through. Although you can gather some information from an internal vaginal exam during an assessment, it is not always the best route to take with patients who have experienced birth trauma or any other trauma for that matter. I rarely will do an internal assessment on an individual who is clearly still processing their emotions about the trauma they have endured. The whole premise of the assessment in these particular cases would be to calm the central nervous system using various breath work techniques that reduce tension in the muscles and develop a trust between you and the patient. At some point an internal examination may be completed only when the patient feels ready and with their consent. During the internal examination, I am making note of any tension or trigger points internally. I am also checking the strength and endurance of the muscle, and how these muscles respond to touch.

In most cases, birthing parents require additional help from other health care professionals, such as a licensed counselor. This may help sort out some of the lasting effects of the trauma they have experienced and help these patients move forward in the healthiest way possible. I often will refer my patients to a trauma counselor and work alongside them in order to provide the best patient centered care.

Every birth trauma story is very different and perceived differently by the individual. It is important to listen carefully to the story, the language used to describe their birth story and their current mental state in order to help accordingly.

If you are someone who has continued to struggle to mentally process your traumatic experience during birth, remember that you are not alone and that there is help out there!

Support Makes a Difference: Doula Care and Perinatal Mental Health

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Kirsten Carney, Grace Van Bruwaene, and Geraldine Tait
https://www.circledoulacare.ca/

It feels pretty straightforward to say that having support makes a difference to how we feel about ourselves and how we navigate life events. Describing what this support looks like and how it can affect our experiences can feel a bit stickier. To examine the qualities of effective support and illustrate its impact, we drew from our own experiences in birth and postpartum life. All three of us described our second (and third) births as more positive than our first births. We understood that our own increased knowledge and personal growth were factors in this improvement. At the same time, we identified the presence of dedicated support people as being instrumental to the change in experience.

Our first babies entered the world in ways that left us struggling to cope. Some of the words that came to mind when describing this time were “overwhelming”, “scary”, and “dehumanizing”. Doctors rushed through procedures with barely an explanation. This left an information gap that undermined our attempts to grasp what was happening to our bodies and our babies. We felt ashamed of our apparent inability to do such natural things as birthing and feeding our babies. We felt scared of the unknown and dismissed as autonomous humans. From this level of vulnerability, we struggled to speak up for ourselves. Coming up with options seemed daunting, and we felt trapped in the healthcare system funnel. It was easy to catastrophize these challenging feelings as well. We felt like we failed right out of the gate, and we feared subjecting our babies to more failures. Surrounded by these whirlwinds of emotion and activity, we were thrown into the position of being fully responsible for our babies once home. These experiences all fell under one common theme: feeling de-centred in our own perinatal journeys.

For all of us, our first children sparked a journey of learning, but it was one born out of fear, stress, and rage. We didn’t just dip our toes into the pool of knowledge, we dove in obsessively. Let down by care providers, we felt forced to learn and do everything ourselves. The pressure was immense; we couldn’t trust anyone else to take care of us and our families. Because of all our research and reflection, though, when it came to having second babies, we made different choices and preparations. Some of us changed care providers and two of us chose to hire a doula.

“Hopeful”, “in control”, “empowered”: these were the words we chose to describe our second journeys through pregnancy, birth, and postpartum life. We had a better idea of what to expect from the healthcare system, ourselves, and our babies. We also had an understanding that these were challenging, layered, and personal experiences. With this lens, we didn’t feel like failures, but rather, like people trying their best at a new thing. In addition to these internal shifts, we also had effective external support. Our doulas were there for us and our families. They always checked in with us to see how we felt about what was happening, and the conversations grew from there. They accepted our lived experience as valid, and offered us a safe space in which to share our big scary feelings. Being heard and accepted in this way was affirming, and gave us confidence to keep talking and asking questions. When faced with a decision, our doulas provided us with information and helped us come up with a range of options. They facilitated informed decision-making, which empowered us in our relationships with primary healthcare providers. As Kirsten said, “I felt like I had more of a right to talk about what I wanted and needed. I didn’t care if they liked me or if I was being the perfect patient; I was going to have the experience I wanted.” With this support, we were able to reframe the whole situation, keeping ourselves firmly grounded in the centre. The healthcare system was one part of the story: we now could listen to their options and seek their advice, and we could also access further resources, make informed decisions, and discuss our feelings with our partners and support people. Moving from a place of hearing “no, but” to a place of saying “yes, and” took us from fear to empowerment.

Recent research on doulas and continuous support indicates many benefits, including shorter labours, reduced interventions, and lower postpartum depression. (https://evidencebasedbirth.com/the-evidence-for-doulas/) Evidence also suggests that doula support during labour can lower rates of indicated and non-indicated cesarean delivery, reducing medical costs and risks to the birthing person. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538578/) At the same time, there is a significant unmet demand for doulas. The main barrier to access, not surprisingly, is the out-of-pocket expense. Additional barriers include but are not limited to: geographical distance from professional support people, lack of understanding of doula support from partners or family members, and lack of culturally or linguistically aligned support. (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003766.pub6/full) It’s important to recognize that many of these barriers have been created as a direct result of the colonization of birthwork and subsequent doula training industrial complex—from which we ourselves benefit. We feel strongly that doulas, birthworkers, and support people must operate with transparency, accountability, and sustainability with the goal of resisting white supremacy culture. We must incorporate community care/mutual aid, intersectionality, and anti-racism into our practices, and we must aim to provide inclusive and accessible services. We must also recognize that this is an ongoing process of unlearning and relearning, and it is our hope that this work extends to all birthworkers who benefit from systems founded in and catering to white, heteronormative privilege.

Between our lived experiences and the research, we strongly believe that doula support that upholds self-determination is vital to perinatal mental wellness. Effective doulas practice with the awareness that one-size-fits-all often ends up being one-size-fits-none. Consequently, they must continually centre the feelings and experiences of the people and families they are supporting. Not only is a supported experience less likely to lead to birth and postpartum trauma, doulas can also help families properly identify the challenges they are facing, become aware of their options, and put together a plan that works best for them. This process allows for more of their clients’ needs to be met, leading to improved mental and physical outcomes and a better experience overall.

Circle Doula Care logo. Circle with "Circle" written inside. Doula Care Supporting You Completely written underneath