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"But You're Supposed to Be Happy!" Perinatal Mood and Anxiety Disorders

by Marie Zahorick, MS, APRN, FNP-C, IBCLC
  • Duration: 60 Mins
  • Credits: 1 CERP, 1 R-CERP, 0.1 Midwifery CEU, 1 ACM CPD Hours, 1 ACNM
  • Handout: Yes
Abstract:

Perinatal mood and anxiety disorders (PMADs) include a spectrum of commonly-occuring mental health disorders. About 17% of postpartum mothers worldwide experience depression, with rates climbing to 60% in some low social-economic status women and adolescent mothers. However, less well-known PMADs include perinatal panic disorder, perinatal obsessive-compulsive disorder (OCD), and perinatal post-traumatic stress disorder (PTSD). These often include very distressing intrusive or bizarre thoughts, behaviors, or flashbacks. Perinatal bipolar disorder and postpartum psychosis are particularly dangerous due to severe depression, and reckless or bizarre behavior that can endanger mother and baby.

Women with bipolar disorder may have stopped medications during pregnancy and are experiencing mood instability. They may also not realize they have bipolar disorder and require careful diagnosis, since twenty-two percent of depressed women postpartum have bipolar depression. Postpartum psychosis is an emergency and occurs in 1 to 2 of every 1,000 deliveries. This requires immediate hospitalization for safety, due to a 5% suicide rate and 4% infanticide rate. The midwife is part of the safety net for postpartum mothers and is a vital first step for identifying possible PMADs and referring the mother for mental health treatment and support.

Learning Objectives:

1) List at least three categories of perinatal mood and anxiety disorders
2) Describe at least three impacts of untreated mood or anxiety disorder on mother, baby and the family
3) Describe danger signs and symptoms of severe depression, suicidality or postpartum psychosis and how to refer to emergency services for patient safety