Maternal health: A clinical psychiatrist on the battle for mental health in perinatal and postpartum patients

Welcoming a new baby is an exciting time for many growing families. However, for some parents, physiological changes and disruptions to normal daily functions can lead to symptoms of depression and anxiety, and if left untreated, can potentially lead to a psychiatric illness. As someone well-versed in the complexities of maternal mental health, clinical psychiatrist Camila L. Arnaudo, MD, seeks to remind everyone suffering from perinatal and postpartum depression of the Postpartum Support International (PSI) motto, "You are not alone. You are not to blame. With help, you will be well.”

Maternal Health Awareness Day on Jan. 23 and Maternal Mental Health Awareness Month in May aim to bring awareness to these isolating mental health illnesses that often occur during the perinatal and postpartum periods and to remind everyone that no matter how dark things feel, help is available if they reach for it.

Arnaudo, a clinical perinatal and addiction psychiatrist and co-medical director of the Indiana Consultations for Healthcare Providers in Addiction, Mental Health and Perinatal Psychiatry (CHAMP) Program, offers care to patients at Riley Children’s Health and IU Health centers struggling with mental health concerns including those brought on by perinatal and postpartum depression.

To provide her patients with exemplary psychiatric care in Indiana, Arnaudo offers hour-long evaluations to help better understand the patient's postpartum mental health disruptions and formulate a diagnosis and treatment plan.

“Perinatal and postpartum depression is the number one complication of pregnancy,” Arnaudo said. “We also know that untreated mental health has impacts that relate to people’s ability to care for their own health.”

Along with postpartum depression making it more difficult to keep appointments, practice good habits such as eating a healthy diet and resting; postpartum depression symptoms can make it more difficult to bond with the new infant.

For family members and clinicians, there are symptoms that can signal a perinatal and postpartum mental health concern. Some signs include:

• The baby blues: One of the most common and normal symptoms of postpartum period. The baby blues is often experienced during the first days or weeks of postpartum when a person may experience symptoms such as uncontrollable crying or mood swings. These symptoms often resolve without treatment
• Guilt: Experienced by many parents. Although it is normal to have some guilt, for some, guilt can escalate and lead to withdrawing into isolation and possibly suicidal thoughts.
• Irritability: A person might exhibit extreme irritability to those around them, including their support system.
• Intrusive thoughts: Often come in the form of parents fearing that harm will come to their baby or older children, and the perinatal person is doing all they can to prevent these harmful things from coming to pass. These thoughts frighten the perinatal person and can be a reason they avoid treatment or talking to family members.
• Sleep disruption: New babies require attention at all times of the day which disrupts birthing parents' physical and mental healing from delivery. Being unable to rest when the baby is sleeping or being cared for by another person can be a sign that someone is suffering from postpartum anxiety or depression.

Of all the symptoms, Arnaudo pinpointed sleep disruption as one of the most prominent and modifiable symptoms to try addressing with perinatal people.

“For people who develop psychiatric illness, sleep disruption can be one of the first things that impact them,” she said. “For many people, just protecting their sleep is actually enough to get them better.”

Arnaudo recommends creating different plans to tackle sleep disruptions. For some, practicing shift sleeping can make a world of difference. Others may have to determine those around them who can help. It could be a spouse, parent, sibling, good friend, neighbor or doula. Whomever the person, multiple contingency plans that make sense for each person and their support system should be developed.

When dealing with these perinatal and postpartum symptoms, it is important for a person to ask themselves the following questions: What symptoms do I have? How impactful are they? What have I already tried? Did it help? Did it not help?

If nothing is helping, then the symptoms may have turned into an illness that requires medical intervention.

Many of Arnaudo’s patients’ emotional well-beings are shaped by stressors including social isolation, economic pressures, health inequities and limited mental health care.

When experiencing mental illness, people begin to move towards self-isolation, removing themselves from support systems. However, connecting socially is one of the most powerful interventions for mental illness.

“Our most vulnerable patients like our BIPOC population, LGBTQ+ patients and immigrant parents, who are already feeling a lot of stressors from lack of access to care to the fear of being deported, are more concerned about being detected and being seen as broken or problematic or dangerous to their babies,” Arnaudo explained. “It's a whole next level of finding out that they need the help and then matching the help to the internal and community resources that they have and what we can offer that aligns with the needs.”

It is imperative to recognize the symptoms of perinatal and postpartum depression. If self-managed methods of care are not controlling the symptoms, the affected person should be offered additional support and treatment.

Relaying mental health concerns to an OB/GYN, midwife, family physician, psychiatric provider, family and friends can be an important first step. Additionally, there are many free, confidential hotlines available for both English and Spanish speakers. Arnaudo recommends:

• 1-833-TLC-MAMA, the National Maternal Health Hotline provided by the Maternal and Child Health Bureau.
• 1-800-944-4773, a helpline provided by Postpartum Support International.

Arnaudo envisions a hopeful future that is currently developing as more medical students and residents delve into the field and as social media influencers and celebrities alike speak publicly on their struggles, bringing perinatal and postpartum difficulties out of the shadows. For people experiencing these perinatal and postpartum symptoms, she stressed that we must help parents feel comfortable taking their time as they adjust to new responsibilities and reaching out for support when they need it.

“You are not a bad parent because you have these common struggles,” she said. “There is help and treatment. Taking advantage of these resources doesn’t mean you don’t care about your baby. Don’t do this alone. Tell somebody you feel comfortable with. Don’t let it fester.”