After giving birth, most women experience mood swings. Lots of people call it the “baby blues.” It’s completely normal and (thankfully) goes away after a few weeks. However, some women become depressed, anxious, or panicked – and that’s something altogether different. The old term for that disorder, post-partum depression, focused on the symptoms of depression. Now, it’s called Perinatal Mood Disorder, or PMD, to encompass all the symptoms, which include anxiety and OCD, both during and after pregnancy.

Ann Smith, the president of Postpartum Support International, is a nurse midwife and women’s health nurse practitioner who is also a perinatal mood disorder survivor. She’s got the 411 on perinatal women’s health, and the importance of having the right support system.

What kind of feelings and experiences are normal after having a baby?
There are emotional ups and downs in first two weeks of what people commonly call the “baby blues.” Nearly 80% of new moms experience this, and it should go away in 2-3 weeks. Other emotions new moms have include concern, insecurity, exhaustion, grief for their old life, boredom, and thoughts of: Will I be a good parent? and Is my baby normal?. Feeling this way is a normal adjustment to having a newborn.

How do you define postpartum depression?
Postpartum depression is the old term for this disorder. The problem was that it missed a huge chunk of people for whom this condition starts in pregnancy – so it’s not just something that happens postpartum, and it’s often not depression. About 14% of all new moms experience this condition. It’s now called perinatal mood disorder, because 3 out of 10 of the moms who have this disorder start experiencing these symptoms during pregnancy, instead of after the baby is born. Your obstetrician should be screening you for PMD during your pregnancy, because for many women, that’s when this starts.

It’s not just depression?
No. Depression is a very specific set of symptoms including excessive sadness, fatigue, the inability to get anything done or care for the baby, feeling that you aren’t bonding with the baby, and not wanting to do the things that used to give you joy. However, PMD’s most common symptom is anxiety, which includes the inability to concentrate, frantic worry, the inability to sit still, feeling like you’re going to jump out of your skin, insomnia, and panic attacks.

What are other general symptoms of PMD?
Anxiety is the most common symptom PMD, followed by insomnia, then intrusive/obsessive thoughts. Intrusive/obsessive thoughts are when mothers have disturbing thoughts, maybe as often as 50 times a day. They’re a form of anxiety and OCD, with moms needing to check things over and over, or they have horrible thoughts of awful things happening to baby, to themselves, or their partner.

Maybe a mom will take their child to the pediatrician many, many times because they believe that something is seriously wrong with their child. This is way beyond regular anxiety. There’s a reason why obsessive thoughts don’t get as much attention as others: mothers don’t want to admit because they are afraid someone will take their baby – and their other children – away. PMD is not the same as the concerns of being a new mother.  This is an illness, and it’s crippling. You are frantic – or you’re paralyzed with fear. However, this is treatable and curable if the mom gets help!

How does postpartum psychosis fit into all of this?
Postpartum psychosis gets a lot of media coverage, but people should keep in mind that it’s a rare illness, with only 1-2 moms out of 1,000 experiencing it. It usually presents itself quickly after the baby’s birth, within the first couple weeks. It is NOT a PMD and it is NOT a mood disorder, like PMD, that morphs into psychosis. It is its own illness that is a break with reality –

as opposed to the obsessive thoughts common with PMD—and includes hallucinations, delusions, and paranoia. This is a medical emergency and is never to be ignored. It ALWAYS means that you should immediately call 911 and get the mom to the emergency room. You must stay with the mother until help arrives or you can get her somewhere to get help. This psychosis is temporary and treatable, but requires immediate attention.

What are the risk factors for PMD?
The top two risk factors are a previous episode of PMD, followed by a history of anxiety or depression in the past. Other risk factors include poor support or relationship problems, having a baby in NICU care, having a traumatic childbirth, being in poverty, having multiples, being a teen mom, or a having a military career in the family. PMD crosses all socioeconomic lines – it doesn’t pick and choose.

How do moms get better?
I always tell moms: Remember, you are not alone. With PMD affecting 1 in 7 moms, there are many, many others who are experiencing this too. Also, you are not to blame. It is NOT bad mothering, and it is not something you did or didn’t do during your pregnancy. PMD is an illness, not a weakness. With proper help, everybody can get well. Unfortunately, only 30% of the moms who experience PMD get help, and the symptoms of those 70% who do not get help can last for a very long time.

Treatment is available for symptoms that range from mild, to moderate, to severe. The treatment depends where you are on this spectrum, and ranges from different types of therapy to medication that is combined with therapy. All of the treatment options are very successful, and women can be assured that if they get the right treatment, they’ll get well.

How can moms get help?
Start with your OB/GYN or your family doctor. Keep in mind that not every medical professional is trained to treat women with PMD. In many parts of the country, there are programs connected with health networks that have all the resources moms will need.

Postpartum Support International has information on pregnancy and postpartum mental health for women. Their helpline, at 1-800-944-4773, is manned by trained staff who can give them information, provide support, and give them the contact information for local resources. Staff will provide referrals to people who have been trained to treat women who are experiencing PMD.