The pressure on a soon-to-be mom or the mother of a newborn is something I cannot begin to fathom, and the weight on the shoulders of a woman simultaneously struggling with mental health issues is that much greater.

Imagine everyone you know and love expecting you to be all smiles and joy, telling you that this should be the happiest time of your life … but you’re feeling anxious, alone, exhausted and unable to cope, inching ever closer to your breaking point, and you feel you can’t even express it to your loved ones for fear of judgment.

As many as 1 in 5 women will experience some type of perinatal mood and anxiety disorder (PMAD), yet a local expert says about 70 percent of them will not receive adequate treatment.

“That's a lot of women who might be falling through the cracks and then going on to continue to have mental health problems,” Melissa Hoffman said.

Hoffman is a nurse at Lawrence Memorial Hospital and founder of Build Your Village of Douglas County, a support and awareness group focusing on perinatal mental health. She is pursuing a doctorate in nursing practice with a psychiatric and mental health focus at the University of Kansas.

She draws from her own experience to help others. Fourteen years ago when her first son was born, resources on the subject were not readily available.

“I was a labor and delivery nurse and I still didn't have a full understanding of what was going on with me,” she said. “So after I recovered from my own experience, I really wanted to help other women by educating them and by providing a resource here in town that was accessible to everybody.”

by Mackenzie Clark

Basics of the disorders

Many women — approximately 80 percent — will experience baby blues, which Hoffman described as “almost the normal expectation of what I call the emotional roller coaster that many women will ride after giving birth.” That includes mood swings all over the map, sleep deprivation and adapting to the new role of being a parent.

Jeff Burkhead/Contributed Photo

Melissa Hoffman

However, Hoffman said that parents will generally “see the light at the end of the tunnel” in the second week postpartum. When those blues continue into the third week and beyond, it might be time to seek some extra help — or even sooner than that, if the woman feels she needs it.

"If what they're experiencing is interfering with their ability to function in their day, to take care of their baby or if they just don't feel like themselves, then it's a good reason to talk to somebody and evaluate whether there is need for something else,” she said.

Hoffman said depression and anxiety are the most prevalent PMADs, but there are others, such as obsessive compulsive disorder, post-traumatic stress disorder, panic disorder, bipolar depression and postpartum psychosis. The term “perinatal” encompasses mood disorders from pregnancy through the first year after a child’s birth.

Hoffman said the disorders can happen with a woman’s first child or subsequent births. Some risk factors include a prior history of mental illness for the woman or for someone in her family history and poor social support or dissatisfaction with a partner. Also, she said PMADs are more likely to occur in women of color and women of lower socio-economic status, such as those who qualify for Medicaid.

Some signs women can watch for in themselves, and loved ones can try to spot, include appetite changes; sleeping too much or too little; racing thoughts; excessive worry; lots of sadness; feeling overwhelmed; thoughts of hurting herself; irritability or rage; and scary or intrusive thoughts — a vision of something bad happening, which some have described as an image popping into her minds, Hoffman said.

These disorders aren’t exclusive to women — roughly 10 percent of men experience paternal postpartum depression, and the likelihood of that increases when the mother is suffering, Hoffman said.

What to do

Perhaps most important for concerned family members to know is what not to do: "Don't tell her to just snap out of it,” Hoffman said. “... You can't just tell a sick person, 'Will yourself out of it.'”

Showing support of new parents — asking how they’re doing and not solely fawning over their baby — can be helpful. Gather good resources and start the conversation.

“Show them that they're not alone, that this happens to upward of 20 percent of new moms, and that they're not to blame,” Hoffman said. “This has nothing to do with the kind of mother that she is or her abilities, or how much she loves her baby, and then that with help, she will be well, she will feel like herself again."

Many women won’t speak up about how they’re feeling for many reasons, including that they fear their babies will be taken away. That’s why so many go untreated, which can cause the illness to become chronic and make it last far beyond the first year postpartum.

Postpartum psychosis is different: the mother experiences a break from reality, departing completely from her normal self. Onset is generally sudden, usually within the first two weeks postpartum, and symptoms can include delusions, hallucinations and paranoia. It is much more rare — just .1 to .2 percent of births — but very severe, and immediate treatment is essential.

Treatment and resources

Hoffman said there are three main options for treatment: medication, talk therapy and social support.

Going to a doctor is important because they can rule out certain conditions, such as postpartum thyroiditis, diabetes and some endocrine dysfunction that can have a direct effect on mood. If it’s the right option for the patient, they can prescribe medication.

Social support is crucial. I noted that in this digital era, a mother may have 1,000 friends on Facebook, but not one of them can coddle her screaming infant. Hoffman agreed.

“It's so true that we just need to think about what that's like day to day for people who don't have that social support around them,” she said, such as single moms or those with unsupportive partners. She also said many women who come to her group have moved to town recently and haven’t made friends yet.

Build Your Village meets from 10 to 11:30 a.m. each Thursday in the auditorium of Lawrence Memorial Hospital. Babies are welcome. The group can be found on Facebook and at buildyourvillagekansas.com. For more information on the group or any related local resources, call Hoffman at 785-550-6795.

Hoffman also suggests Postpartum Support International’s website, postpartum.net. It offers phone and online support groups for those who can’t make the weekly meetings.

Doctors can help keep watch, too — part of Hoffman’s work includes serving as president of Postpartum Support International of Kansas. She’s educating providers around the state about the issues and screenings. She said pediatricians can help where women’s OB-GYN visits leave off, with screenings at babies’ frequent first-year checkups.

• • •

Though this column has focused on moms of infants, I want to emphasize a point from a panel I attended recently on women’s mental health: No one mothers Mommy.

Women seem to have been socialized for generations to handle all of life’s challenges, from the small daily complications of life to massive obstacles like trauma and childbirth, all with a smile on their faces and a graceful ease. It’s neither necessary nor realistic, and we need to take a giant step away from that expectation.

Happy Mother’s Day to moms new and seasoned alike. I hope moms reading this right now can make it a priority not only to take care of themselves with the same tireless fervor they give their families but also to ask for help and be taken care of.

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