Beyond the Blues: Perinatal Mental Health and You

Written by: Lauren DePaola, LCSW 

Self portrait by Amanda O'Donoughue 

Self portrait by Amanda O'Donoughue 


What is Perinatal Mental Health? Perinatal means “surrounding birth;” this includes pregnancy and after delivery.  Perinatal mood and anxiety disorders (PMAD) include: Perinatal (during pregnancy and after delivery) depression; perinatal anxiety and panic; perinatal obsessive compulsive disorder; perinatal bipolar; postpartum posttraumatic stress disorder; and postpartum psychosis.  

How is this different from what I’ve heard called “the baby blues?” The baby blues is a term coined to describe the normal emotional adjustment of hormones in the immediate days following delivery.  Your hormones reach unprecedented levels as your pregnancy progresses; hormone levels scramble to go back to pre-pregnancy levels after you deliver.  The symptoms of weepiness, vulnerability, forgetfulness, stress resolve on their own without the need for special intervention or support within about two weeks after delivery.  If they continue outside of this time frame or if the symptoms DURING these first two weeks are more than “mild” and interfere with your daily routine, causing discomfort- it’s time to seek out specialized support.

Postpartum depression has been in the news with more consistency in the recent past.  It is important; however, to understand that this is not a blanket term for all perinatal mood disorders. The reproductive years present the highest probability for mental health problems.  While PMAD are the #1 health complication related to pregnancy and birth, they are the least screened and treated.  Research reveals that 1 in 7 women (as high as 1 in 4 in lower income areas) and 1 in 10 men will experience symptoms within the PMAD spectrum.  Where PMAD symptoms exist, the male or partner in the household has a 50% chance of experiencing their own emotional complications.  Suicide is second only to postpartum hemorrhage as a cause of death related to pregnancy and birth.  

To put this in local perspective: between the years of 2012 and 2014 there were 8618 live births reported.  Given the prevalence rate mentioned above, this would mean at least 1700 women and men/partners experienced struggles with a PMAD. (Source: FloridaCharts.com) So knowing all of the statistics only goes so far if the process by which getting support is unknown, non-existent or difficult.  Postpartum Wellness & Family Counseling opened in Gainesville, FL in January 2015.  We specialize in perinatal and reproductive mental health.  A large part of our time and energy is spent educating and providing training for medical providers and organizations in our community on the importance of screening and opening a door to conversation. The second half of this equation is convincing each of us of the importance of speaking up when we are experiencing difficulties with emotional and psychological health.  The good news? By reading this, you now know that there is a resource in this community that exists with specialized education and attention to mental health during the reproductive years.  Relief of PMAD symptoms most often comes quickly once the right kind of support and intervention is applied.  Whether you prefer solely talk-therapy, or only medication, a combination of both, etc.- the first hurdle is acknowledging what you are experiencing is important and making the choice to seek help.

At Postpartum Wellness & Family Counseling, we provide psychotherapeutic interventions that are proven to reveal relief of symptoms.  Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) have the largest amount of research to back up the usefulness of the techniques used with regards to Perinatal Mood and Anxiety Disorders (PMAD).  We also provide practical support in the way of postpartum doula services.  We do not prescribe medications but instead refer you (if you request) to resources in our community who have experience and knowledge working with psychotropic medications during the reproductive years.  

How can you begin seeking relief today? What does the therapy process look like? My best suggestion would be to call and discuss what your specific questions and concerns are.  Most often when we receive phone calls and meet with clients for initial sessions, we hear “I can’t believe it took me this long,” “I didn’t think my symptoms were bad enough,” “I didn’t think I fit the description of what I think of as depression,” “I was worried I was the only one experiencing these thoughts/feelings, etc.,” “I was told it was all hormones and it would go away by itself,” “I had never heard of anxiety, depression, etc. during pregnancy or after.”

We can help you find out if you need a referral from your primary physician in order to receive reimbursement for session fees.  Not everyone needs a referral and some clients prefer to not file therapy information with their insurance for their own personal reasons.  We offer a free initial phone consultation and we also do sessions in the comfort of your home if you prefer, as well as via telehealth/videoconferencing if you live a distance away, lack transportation or simply prefer sessions via videoconferencing.  

The first session you can expect to answer diagnostic questions and survey/questionnaires, medical history and current medical status, for your therapist to get an idea of symptoms present, when they began, frequency and severity.  We will also talk about “why now?”  What will you be looking for to feel as though your investment of time, energy and money is worth it?  We will develop goals based upon your preferences.  We will also identify if there are other resources you aren’t aware of or discovered during session(s) that may be useful to you. 

Subsequent sessions begin by talking about the basis and usefulness of therapeutic interventions such as Cognitive Behavioral Therapy and Interpersonal Therapy; as well as utilizing your “natural supports.”  These are thing such as exercise, nutrition, family/friends, spirituality, etc. that you identify as being helpful for you.  You, as the client, are guiding the goals of the therapeutic relationship.  The greatest factor in finding relief can be found in practicing techniques that we may discuss in therapy during your day-to-day life.  Feedback on what works and what doesn’t is welcomed and asked routinely.  We will discuss at regular intervals how you feel your progress is taking place and when you feel confident your symptoms are being relieved and new skills to deal with emotional health feel comfortable, to determine when sessions will discontinue.  You are also welcomed to return to regular sessions at any point in the future. 
You can be sure that your baby is welcome to attend session with you and that feeding your baby, changing your baby, walking/bouncing/shushing, etc., is fully acceptable.  

You can also feel free to use sessions as “ME TIME,” and come by yourself. We also offer group therapy series for women called Circle of Moms.  This is a therapy group that utilizes the benefits of brief Cognitive Behavioral Therapy model.  It is a unique opportunity to connect with other Moms at all different stages of motherhood, learning new strategies for processing life’s daily challenges and sharing in the “me too” moments.  Each series of Circle of Moms, the comment has been made that the specific skills learned in the group have brought relief.  We’ve heard Moms say something like “this is what I’ve been looking for that online or in-person peer support groups are limited by.”  Adding skills learned from therapeutic models such as CBT can be very helpful in addition to seeking support from family, friends, etc.

Couples therapy and individual and couples’ prenatal courses are also offered.  The prenatal course is focused on the emotional and psychological journey of pregnancy and parenthood.  We also offer grief and bereavement counseling to those who have experienced pregnancy and infant loss.  **Stay tuned to our website for a loss support group coming soon.

Currently, there is positive conversation and movement in our country and abroad in the realm of perinatal mental health.  While the media can oftentimes get some of the information they communicate about perinatal mental health wrong, it is promising to hear and see more personal experiences and a growing number of resources available, as well as engaging medical providers to screen for PMADs.  We are thankful to be a part of this conversation here in North Central Florida and honored to be a part of our clients’ emotional and psychological journeys during the reproductive years.

Please remember that you are NOT alone and you do NOT have to experience the challenges during this period of life by yourself.  Relief and support are near.

You can contact Lauren DePaola, LCSW at (352) 278-2538 or via email: ppwandfc@gmail.com Visit our website at: www.postpartumwellnessandfamilycounseling.com At our website on our Resources page, you will find many local and national sites and contact information that may also be helpful to you.