More Than The Baby Blues?

In Pregnancy/Postpartum by Melinda FontaineLeave a Comment

By Melinda Fontaine

 

The majority of women experience some emotional fluctuations known as the Baby Blues in the first three weeks after they give birth, and it is natural. A smaller, but still significant percentage of women will experience Perinatal Mood and/or Anxiety Disorders (PMADs) before or after giving birth. There is a pressure for moms to feel a certain way, and that leaves the potential for shame when the reality of how a mom feels veers from the path that society expects. Typically in the US, four months after birth, maternity leave ends, and Mom goes back to work. She should be physically, emotionally, and spiritually all recovered from giving birth and adjusting to parenthood and ready to continue life as she was before she was a mom, right? Ummm…no…

 

Recently, I had the pleasure of speaking with expert Robyn Alagona Cutler, LMFT about Perinatal Mood and Anxiety Disorders. She and I would both like it if PMADs were better understood so that they would not provoke a negative connotation, people would recognize them without judgement, and women would get the help they need. Here are the cliffnotes of our conversation.

 

How do you tell the difference between Baby Blues and peripartum mood disorders?

 

Baby Blues can last for the first two to three weeks after birth. Peripartum mood disorders last much longer and can start much later, up to one plus years after giving birth. We should also note that we are using the term Peripartum instead of Postpartum. Peripartum simply means before, during, or after giving birth. This emphasizes that peripartum mood disorders can occur at any time, including during pregnancy.

 

Who is likely to have a Peripartum Mood or Anxiety Disorder?

 

15-20% of mothers will develop Perinatal Mood or Anxiety Disorders. There is rarely ever only one cause of a perinatal mood disorder. More likely, it’s the perfect storm of a number of things at once.

 

Risk factors include:

 

  • Family history of mental health issue
  • Individual history of mental health issue
  • Lack of support by partner, family, friends, community
  • Marital stress
  • Financial stress
  • Loss in life, such as moving, changing jobs, or loss of a loved one
  • Hormonal imbalances
  • Issues with infertility
  • Loss of pregnancy
  • Breastfeeding challenges
  • Difficult pregnancy
  • Difficult birth
  • Baby health issues or a stay in the NICU

 

How does one identify a Peripartum Mood or Anxiety Disorder in themselves or a loved one?

 

Providers often screen for mood disorders with the Edinburgh Postnatal Depression Scale, but doctors, midwives, and other care providers are not often in contact with women after their six-week follow up visit, so it is important to know the signs and symptoms. Diagnosis is not made based on one symptom, but instead a cluster of the following would be present:

 

  • Feeling sad and depressed
  • Disturbed sleep – when you have the opportunity to sleep, can you?  
  • Not finding joy in the same things that have always brought you joy
  • Anxiety or panic
  • Lack of bonding with baby
  • Irritability or anger
  • Changes in eating habits
  • Racing or upsetting thoughts
  • Feeling out of control
  • Feeling like you should not have become a mother
  • Worried that you might hurt your baby or yourself

 

What can be done for Peripartum Mood and Anxiety Disorders?

 

Women who have a history of mental health issues would benefit from getting support early, before or during pregnancy and continuing into the postpartum period as needed. If you think you or a loved one may be living with a peripartum mood disorder, reach out as soon as possible. Reach out to your physician, friends, a therapist, etc. It can be difficult to find the help you need, so use your support system. Research shows that psychotherapy in combination with  medication have been proven effective at treating peripartum mood disorders. It will get better. Postpartum Support International has a great list of resources.

 

If you want to help a loved one who is struggling, show your support, assist her to find a professional who can help, and make sure she is getting her basic needs met. Is she eating well, drinking enough water, and getting an opportunity to sleep?

 

In addition, we can do our part to change the cultural expectations for moms.  Showing moms that it’s alright to be a parent differently from your neighbor and we are all OK. Parenting is challenging; not every moment is Instagramable. Let’s show our moms support instead of assigning a stigma.

 

The Mind-Body connection is so strong that mental or emotional issues are often tied with physical discomfort. Emotional struggles can lead to physical pains and vice versa. I often see both in my patients, and my patients feel better when they are addressing both kinds of pain with physical therapy and psychotherapy. See the blog on Meditation for Pelvic Pain Relief and our Pregnancy and Postpartum Physical Therapy webpage.

 

 

Robyn Alagona Cutler is a licensed Marriage and Family Therapist specializing in Maternal and Parental Mental Health with an emphasis on Perinatal Mood and Anxiety Disorders. She has been working with moms and families for 20 years. Currently you can find her in private practice in Oakland working with moms, dads and parent-couples and facilitating Postpartum Therapy Groups for Moms (http://www.alagonamft.com/groups). Additionally, Robyn is also the Bay Area Coordinator for Postpartum Support International. For more information visit her at www.alagonamft.com.

FAQ

What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.

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