Issues with Conceiving
Perinatal mental health refers to a woman’s mental health while trying to conceive, during pregnancy and postpartum. Most of the focus is on anxiety, depression, and post-traumatic stress disorder. Research suggests that 7-15% of women suffer with antepartum (during pregnancy and before childbirth) depression (also called maternal depression, prenatal depression) and about 10% experience postpartum depression. Research report that about 15% of pregnancy people meet diagnostic criteria for anxiety disorders. Functional impairment can adversely affect the pregnant person and their pregnancy.
Caring for your mental health is just as important as your physical health. This is especially true if you have anxiety and depression before trying to conceive, as well as during pregnancy and postpartum.
Perinatal depression is depression (a mood disorder) that occurs during and after pregnancy. It includes prenatal depression and postpartum depression. Symptoms can range from mild to severe and include extreme sadness, anxiety, and fatigue that interferes with the ability to perform daily tasks and caring for themselves and others. It is treatable.
Research indicates that perinatal depression is caused by a combination of genetics and environmental factors including stress from work demands or past traumas, physical and emotional demands of raising children and caring for a new baby, and hormone changes during and after pregnancy.
Prenatal depression is a mood disorder that affect at least one in ten women during pregnancy. Signs include depressed mood, loss of interest in work things that make life worth living, feeling hopeless, guilty, or worthless, anxiety, and fatigue that makes it difficult to perform daily activities including caring for yourself (prenatal care) including getting enough rest and unhealthy eating. It can also affect caring for other family members including other children. Untreated depression has been shown to affect the growth of the fetus, and cause early labor, small babies, and health complications for the baby after birth. Untreated prenatal depression also raises the risk of postpartum depression. If you suffer with symptoms of depression for at least two weeks, it is important to seek treatment.
The “baby blues”
About 2-3 days after childbirth, some women can begin to feel depressed, anxious, angry, and distressed, cry easily, have difficulty sleeping, eating, and making choices and worry whether they can handle being a parent or even how to handle the baby. This is called the “baby blues”. These feelings tend to improve within a few days or up to two weeks.
Depression after childbirth is called postpartum depression. It is a real and serious condition that can affect any person who becomes pregnant. It can interfere with mother/child bonding and in severe cases can be life-threatening. Symptoms include intense sadness, anxiety or despair that interferes with their daily lives, including taking care of their newborn. Postpartum depression typically begins around 1-3 weeks after childbirth. However, Studies report that postpartum depression can occur up to a year after birth.
Research reports that postpartum depression is associated with a host of factors including:
- changing hormone levels that change dramatically within hour after childbirth
- a history of depression before, during and after pregnancy
- emotional adjustments such as doubt about pregnancy, caring for the baby, having a new baby, feelings of sadness, fear, grief, or guilt over having a sick baby, fatigue, and lack of support.
Trying to conceive
Many women describe it as an emotional rollercoaster.
- Stress, uncertainty, and anxiety dominate the period during which one is trying to conceive. Stress is not benign. High levels of stress can alter your cycle contributing to irregular periods. Certain mental health conditions like anxiety, depression and eating disorders can impact your cycle. Irregular periods can make it difficult to time ovulation and affect sexual intercourse. Full circle high levels of stress can negatively impact your mental health. Symptoms may extend to self-blaming, and frustration.
- Infertility-related distress. Infertility is defined as a failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. While the studies show that male and female factors causing infertility are equal, women generally bear the brunt of the burden. Infertility distress affects 30% – 40% of women attending fertility clinics. They experience clinically significant depression and anxiety, shame, self-blame, grief, loss, anger, sadness and lack of femininity, threats to self-esteem, identity and purpose, social stigma, and deterioration of the couple’s relationship. They can become preoccupied and emotionally invested in the day-to-day occurrences of their menstrual or treatment cycle, leading to high anxiety and mood fluctuational worry about not being taken seriously and perceive there is a lack of compassion and understanding about the emotional impact of infertility. Other common worries are what life would be like if they are unable to conceive and explaining themselves to others.
What are the treatment options?
Treatment is vital for the health of the mother and the baby. With appropriate care symptoms improve and most mothers feel better.
Treatments for perinatal mental health may include medication and talk therapy such as:
- Cognitive behavior therapy
- Acceptance and commitment therapy
- Dialectical behavior therapy
- Interpersonal therapy
- Mindfulness – based approaches, and more.
Studies suggest that CBT, DBT and mindfulness-based approaches are most helpful to address anxiety as well as emotional regulation, finding balance between accepting and letting go, grounding, and breathing.
Perinatal mental health is essential and treatments work. Dr. Paul Poulakos is a board-certified psychiatrist in Greenwich Village who treats a range of mental health concerns including perinatal mental health. He is kind and compassionate and will help you deal with the challenges you face before, during and after pregnancy. Contact him to discovery how he can help you navigate life’s challenges today.
At a Glance
Dr. Paul Poulakos
- Attending Psychiatrist at Mount Sinai Beth Israel Medical Center
- Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai
- Past Clinical Assistant Professor of NYU Langone Medical Center
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