Perinatal mood disorders

Mamas on Bedrest: Your Mental Health Matters

July 6th, 2015

Hello Mamas,

Calling your attention to an amazing organization that is doing exceptional work globally for mamas, The Maternal Health TaskForce (MHTF). A project of the Women and Health Initiative at the Harvard T.H.Chan School of Public Health, MHTF is working towards:

  • Making the most up to date evidence-based information is available to practitioners, provider, researchers and anyone with a vested interest in helping and supporting women during childbearing
  • Provide opportunities for the global maternal health community to come together to discuss and create unified policies on women’s health issues globally
  • Provide resources and support for research in Maternal/Infant/Child Health
  • Train the next generation of Global Women’s Health Practitioners and researchers.

I receive the MHTF e-newsletter and the last newsletter was all about Maternal Mental Health. Maternal Mental Health is an often overlooked (ignored!!) part of women’s health. Current research estimates are that 10-15% of women in upper income countries (like the US, Canada, Australia and the UK for example) experience perinatal mental health disorders. In lower and middle income countries (Africa and parts of Asia), the current estimate is closer to 33% and many researchers feel that this number is low because until now mental health in childbearing women in these countries hasn’t been addressed. However, the impact of adverse maternal mental health has had significant impact on maternal health, infant and child health and the maternal child bond, so researchers and clinicians both are very keen to study the various mental health disorders common in childbearing women-mainly depression and anxiety.

Over the last month, MHTF had a blog carnival addressing mental health issues in childbearing women in their Mental Health: The Missing piece in Maternal Health series. It’s a really interesting series of blog posts and reflect how pervasive mental health disorders are in childbearing women, and how overlooked the signs and symptoms have been until very recently. The blogs also address how the stigma of mental health is so strong in all countries regardless of economic status, and this stigma is keeping many women from receiving much needed care. The articles do a wonderful job of highlighting the issues surrounding the stigma of mental illness, how women are not being heard in terms of the emotional toll of adverse birth outcomes and barriers to care. I highly recommend taking a look.

For those of you not really interested in global women’s health and need assistance closer to home, (i.e. for yourself!!) I am happy to announce that our Third Thursday Teleseminars are going video! It has long been a dream of mine to be able to bring Mamas on Bedrest together to be able to talk and share ! I have been researching platforms on which to do this for years and until recently, the platforms were just too grainy (i.e the images were really not that good), Platforms were only able to accommodate up to 10 participants or platforms that could accommodate more than 10 participants had hefty user fees or required expensive software. Now there is Zoom web conferencing and it’s amazing! I attended a web conference using it last week and I could clearly hear and see all of the other participants! So we are giving Zoom a test drive for our Third Thursday Teleseminar, July 16, 2015. Login details will be shared in our upcoming newsletter and will be available on our website. So if you have concerns about anxiety, depression or other feelings you may be having during your bedrest journey, this is the perfect time and place to bring your concerns.

In the meantime, share pressing questions or concerns in the comments section below or send an e-mail to Info@mamasonbedrest.com for a 24hr response.

Mamas on Bedrest: How pregnancy triggers physiologic and emotional responses in women

May 9th, 2014

Hey Mamas!

PregnantwomanonballI’m bringing you Part II of Kathy Morelli’s series on physical and hormonal influences on women’s mental health. In Part II she focuses on the changes that occur during pregnancy. Kathy breaks down the emotional responses to pregnancy this way:

Emotional. What if the pregnancy was unplanned? What if this pregnancy follows a stillbirth or miscarriage? What if her primary relationship with the baby’s father is not going well? There is also job stress, financial factors and a whole host of other life stressors that combined can make the news of a pregnancy hard to take and All of these emotional considerations require attention and adjustment. We clinicians and birth workers must be aware of these potential life stressors and be sure that we are as vigilant in addressing these emotional needs of the women that we serve as we are addressing their physical needs.

Physiologic/Hormonal. By the first six weeks of pregnancy, estrogen levels rise to three times more than during the menstrual cycle! Progesterone levels also rise quickly and Progesterone is also implicated in depressive moods. As the pregnancy progresses through the second and third trimester, along with elevated estrogen and progesterone levels, the hormones cortisol, prolactin and oxytocin rise. Cortisol is a strong player in the HPA feedback loop. High levels of cortisol are also associated with depression. And prolactin is also associated with anxiety, anger and irritability. Oxytocin is known as the bonding and happiness hormone. Natural oxytocin causes nutrition absorption, uterine contractions, pair-bonding, mother-infant bonding, pain amnesia, calmness and feelings of belonging and happiness. Now add in bed rest! Mamas on Bedrest are at increased risk of developing perinatal mood disorders because in addition to the normal hormonal fluctuations of pregnancy, the stress of being on bed rest and the unsurety of the pregnancy stimulate the “fight or flight” response, releasing additional cortisol and neurotransmitters that will affect Mamas’ mood.

During an uninterrupted birth, there is a surge of oxytocin, beta-endorphin, adrenaline, noradrenaline and prolactin. These hormones all combine to orchestrate the event of birth and positive emotional outcome. Oxytocin for uterine contractions, calmness, love.  Beta-endorphins for a protective emotional high during a peak physical activity.  Adrenaline rush for energy and the final push of the fetal ejection reflex.  And high prolactin levels to consolidate breast milk production and breastfeeding. However, if there is medical intervention of any sort during labor and delivery; an epidural, episiotiomy, forceps/vacuum extraction or cesarean section, this natural hormonal protection and mood enhancement is disrupted and often lost resulting in birth trauma, post tramautic stress disorder and post partum depression. The extent of the trauma is different for every woman and typically correlates to the level of intervention. Researchers are just beginning to understand the delicate interaction between hormones, labor and deliver and a women’s mental health, and as more research is done, we will have better understanding of this complex interaction and how best to care for women during pregnancy labor and delivery to protect their mental and as much as possible, minimize negative emotional effects.

In Part III, Kathy looks at hormones and post partum! 

 

Mamas on Bedrest: Your irritability isn’t all in your head!

May 5th, 2014

Hi Mamas!

Kathy Morelli, LPC, Director of BirthTouch (R) LLC

Kathy Morelli, LPC, Director of BirthTouch (R) LLC

The next three blog posts feature a series on perinatal mental health by my friend and colleague Kathy Morelli. Kathy is a Licensed Professional Counselor (LPC) in Wayne, NJ and the Director of BirthTouch® LLC. As an LPC, she provides Holistic Counseling in Wayne, New Jersey with a focus on Maternal Mental Health, Family Systems and trauma from sexual abuse and medical intervention. Kathy is also an author and very engaging speaker on perinatal mood disorders and mental health. When I saw her series on the effects of hormonal changes on a woman’s mood, I knew I wanted to share this important information with Mamas on Bedrest. Almost daily I hear women say, “I feel so sad/angry/lonely/irritable…yet I know that I shouldn’t complain.”  It’s not complaining to express how you are feeling and according to Kathy’s articles, there are some real physical and hormonal reasons for how you feel.

The first part of the series is called, Pre-Pregnancy: How Women’s Brain Biology, Hormones and Mood Relate.  In this first installment, Kathy gives an excellent-albeit a bit technical-explanation of why women seem to have such wide ranging mood fluctuations. Beginning at birth we are all “pre-wired” with our temperaments based on our innate physiology as well as genetic influences. Then based on our external environments and life experiences, our innate temperaments are either augmented or tempered, but remain underneath it all in the “pre-wired” state.

ks15511wNext women begin menstruating and the complex neural feedback systems kick into high gear in response. The Hypothalamus-Pituitary-Adrenal Cortex  Loop (HPA-C) links the brain with the adrenal glands. It puts out cortisol and adrenaline in response to stress, and sometimes that stress is simply the menstrual cycle. The Ovarian-Hypothalamic-Pitutary Axis (O-HPA) is a feedback loop system between the ovaries. Located in the midbrain, the HPA is in part responsible for regulating menstrual function. The HPA puts out cortisol and serotonin, the “feel good” chemicals while the ovaries put out estrogen and progesterone. The big crux of this feedback system is that the precursor to serotonin is estrogen! So when women begin menstruating and having the various fluctuations in their estrogen and progesterone levels, the messages being sent back to the brain-the variations in estrogen levels-will cause fluctuations in the serotonin levels put out by the HPA and thus impact women’s moods.

There is an important take home message that runs through all three posts. Kathy gives the indepth, bio-physiologic reasons for women’s mental health fluctuations so that women can be aware of when their hormones are up and down and take care of themselves accordingly. Self Care is key to good mental health and with this information, I believe women have some powerful information to use to take care of their mental/emotional health.

In the second part of this series, Kathy looks at the hormonal influences during pregnancy and childbirth!