What are PMADs?

Baby Blues

60% and 80% of women/birthing people experience the “baby blues,” or feelings of exhaustion, irritation, and sadness after having given birth.

These symptoms typically begin anywhere from one to three days post-delivery and may last between two and fourteen days.

If feelings persist past two weeks, your patient may be experiencing a perinatal mood and anxiety disorder (PMAD).

Prenatal and Postpartum Depression

Any woman/birthing person who is pregnant or has given birth within the past 12 months can receive this diagnosis if she/they experience some of the following symptoms:

Symptoms include:

• Low mood, sadness, tearfulness
• Loss of interest, joy, or pleasure in things you used to enjoy
• Agitation or anxiety

• Lack of energy or feeling slowed down physically
• Difficulty concentrating
• Appetite or sleep disturbance

• Feelings of guilt, shame, or hopelessness
• Possible thoughts of harming the baby or oneself

Prenatal and Postpartum Anxiety

Most new pregnant and/or new mothers/birthing people feel as though they have a thousand things to worry about after having a baby. However, if your patient’s feelings of anxiety are interfering with their overall functioning, they may be experiencing perinatal anxiety.

Symptoms Include:

• Constant worrying
• Feeling that something bad is going to happen

• Feeling like you can’t turn your brain off
• Disturbances of sleep and appetite
• Physical symptoms like dizziness, heart palpitations, and nausea

Prenatal and Postpartum OCD

Many mothers experience perinatal OCD without ever having any previous diagnosis of an anxiety disorder. Your patient may be experiencing perinatal OCD if they encounter any of the following symptoms during the pregnancy or postpartum period:

Symptoms include:

• Obsessions also called intrusive thoughts, which are persistent, repetitive thoughts or mental images regarding the baby. These thoughts are very upsetting.

• Compulsions, where the mom may do certain things over and over again to try to reduce her fears and obsessions. This may include things like needing to clean constantly, checking things many times, and counting or reordering things.

It’s important to know that mothers/birthing people with postpartum OCD understand the strange nature of their thoughts and are disturbed by them. Therefore the likelihood of ever acting upon these intrusions is very low.

• A sense of horror about these obsessions
• Fear of being left alone with the infant
• Hyper-vigilance in protecting the infant

Prenatal and Postpartum PTSD

Many pregnant/postpartum women and birthing people experience perinatal PTSD as a result of previous trauma, including physical or sexual abuse or due to a traumatic birth. These symptoms can include:

Symptoms include:

• Intrusive reexperiencing of a past traumatic event (which may have been childbirth itself)
• Flashbacks or nightmares

• Avoidance of stimuli associated with the event, including thoughts, feelings, people, places, and details

• Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response)
• Anxiety and panic attacks
• Feeling a sense of unreality and detachment

Postpartum Psychosis

If your patient is seeing or hearing things other people are not, feeling as though others are out to get them, hearing or seeing things that others may not, or experiencing highly unusual thoughts regarding themselves or their child, they may be suffering from postpartum psychosis.

Postpartum psychosis is rather rare, affecting only 0.1-0.2% of all births. However, it is a serious disorder and requires immediate medical attention.

Symptoms include:

• Delusions or strange beliefs that feel real
• Hallucinations (seeing or hearing things that aren’t there)
• Feeling confused

• Feeling disconnected from reality
• Decreased need for or inability to sleep
• Paranoia and suspiciousness
• Difficulty communicating at times

While acts of harm to oneself or the baby are uncommon, women suffering from postpartum psychosis may do things they might not otherwise do, given their altered state. Therefore, urgent intervention from professionals is paramount in ensuring that the mother and baby are safe.

Please call 911 if you believe your patient is experiencing postpartum psychosis.