pmadSo What Can I Do?

Managing Risk Factors for Perinatal Mood and Anxiety Disorders

The previous two articles about Perinatal Mood and Anxiety Disorders (PMAD) dealt with myths and risk factors. This article will focus on what to do with all this information; how to manage any risks you may have so you can feel prepared instead of scared.

If you have not done so, I recommend reviewing my previous two articles, so you can be as informed as possible about PMAD, and to examine and become aware of any risk factors specific to you. There may be some factors outside of your control, but even simply becoming aware they exist can help you watch for symptoms and have a plan ready with your healthcare professional. A plan doesn’t have to be complicated: it may simply be asking for a screening to detect PMAD. It could be helpful to do some research ahead of time by finding out how your healthcare professional would handle your treatment and see if it is in line with how you feel about treatment. Do research on your own as well. People, and this includes medical professionals, have a wide range of personal opinions when it comes to medicating pregnant and lactating women, and often it can be unsupported by the research. There is a fact sheet at and a blog at There is a resource for lactating mothers at Become as informed as you can, then be sure you and your healthcare provider(s) are on the same page.

If you have a history of PMAD or any other mood or anxiety disorder, discuss your risk with your healthcare professional and ask for a screening. If you are not currently in treatment, establish contact with your therapist (or find one, so that not having one won’t create a delay for you getting treatment if you need it). This can help you determine if your therapist is currently accepting your insurance (or if not, how much the out-of-pocket fee is), has an opening in their schedule, and lets them know that you are at risk and may be returning to treatment in the near future. A pro-active option would be to do some “booster sessions” to review and practice coping skills you learned in past treatment, or a brief course of CBT to learn skills ahead of time that could be useful for you to call upon if you start to develop symptoms. Counseling is also a good option for those whose risk factors include previous pregnancy losses, a tendency to be perfectionistic, and low self esteem. Working out these issues and developing coping skills ahead of time can set you up to better reduce and manage symptoms, should they arise.

My previous article mentions exacerbating factors such as pain, sudden discontinuation of breastfeeding, and lack of sleep. Again, these are likely unavoidable, but perhaps there are things you can do to manage things differently. If you are avoiding pain medications due to breast feeding, discuss alternatives such as acupuncture, chiropractic, or biofeedback with your doctor. There can be a number of reasons women stop breastfeeding, but it is best to do so slowly. Consider using the services of a lactation consultant, if you can. Often, only a couple of sessions can do a world of good to get you started and help avoid abrupt discontinuation. Rest, sleep, exercise, and proper nutrition all become super important and yet so hard to come by when caring for an infant. I encourage parents to think of it like an instruction from a flight attendant. When the oxygen masks come down, you have to put yours on first, or you won’t be able to function well enough to help your child put theirs on. In the same way, you need to take care of yourself. Without proper nutrition, exercise, and rest, you will fall apart and not be able to give the best care you can to your child. Taking care of yourself is taking care of your child.

Avoid any big life changes if at all possible. This can involve moving house, getting a new pet, remodeling, you or your spouse getting a new job, or starting a school program, etc. Sometimes these things cannot be avoided, and yet, a large upheaval on top of the upheaval of bringing a new, tiny, helpless person into your life can simply be too much. Try to put big changes on hold until next year, if you can. If you see that a big change will happen around the time baby arrives, do what you can to make it as gentle as possible, and “turn down the volume” on the rest of your life. Try not to take on too many commitments, focus on self-care, and keep things as simple as possible for yourself. Engage your partner, if you have one, in this effort as much as possible.

Speaking of partners, increasing and strengthening your support network is also very helpful. Look for local mom’s meet-up groups and support groups. Utilize offers of help from family or friends. Take advantage of home visitor programs offered in your area, or any professional resources to which you may have access. Take childbirth education classes offered by your local hospital. Finally, if you are struggling financially, access any aid resources you can. Contact your local government office to see if they have a Human Services department that can help you obtain Medicaid, WIC, and food assistance. Every little bit helps.

Look for ways to reduce stress, and incorporate these things into your way of life before baby comes, so you don’t have to learn a new skill while in the sleep deprived, stressed state of being a new parent. Yoga, meditation, deep breathing, exercise: research whatever works for you.

Lastly, even though it was written for women about to have another baby after having had PMAD once before, the book What Am I Thinking? Having a Baby After Postpartum Depression by Karen Kleiman, MSW is a useful resource for anyone at risk for developing PMAD. The book offers self-help strategies, treatment recommendations, advice, hope, and support.

As I’ve mentioned in a previous article, there is no “checklist” of symptoms that you need to fulfill as a requirement for getting treatment. If you are struggling, if you are distressed, if you feel you aren’t doing as well as you could be or want to be doing because of your mood or thoughts, it is time to seek help.

If you feel it is time to seek help for your symptoms, please don’t hesitate. Untreated Perinatal Mood and Anxiety Disorder can have long term and adverse implications for parent, child, and family.  

You can contact a therapist, counselor, or social worker. We offer PMAD counseling services at the Adult Therapy and Cohesive Families Institute. You can also contact your OB/GYN for screening. You can contact a psychiatrist. You can contact Postpartum Support International through their helpline at 800-944-4773 or for support in your area. Just reach out to someone.

“You are not alone. You are not to blame. With help, you will be well.”

To see the two other articles in this series please visit our blog.

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