We went into pregnancy knowing that I had the extra risk factor of high blood pressure. We knew it put the risk of developing superimposed preeclampsia at the forefront of our worries. I always thought we managed it well; I continued with my usual behavior of taking my blood pressure on a daily basis, noting any unusual ups or downs.
But there was something more insidious lurking in the shadow of the preeclampsia that I developed. Perinatal mood disorders. The Mayo clinic recognizes that illness during pregnancy is a risk factor for postpartum depression. The Preeclampsia Foundation notes that post traumatic stress disorder often presents; one of the defining factors in diagnosing PTSD is fear for one’s life, or the life of a loved one.
PPD, PPA, PTSD/birth trauma and other perinatal mood disorders beginning during or after pregnancy can be exacerbated by any number of factors. The Mayo Clinic notes that your risk increases if:
- You have a history of depression, either during pregnancy or at other times
- You have bipolar disorder
- You had postpartum depression after a previous pregnancy
- You have family members who’ve had depression or other mood stability problems
- You’ve experienced stressful events during the past year, such as pregnancy complications, illness or job loss
- Your baby has health problems or other special needs
- You have difficulty breast-feeding
- You’re having problems in your relationship with your spouse or significant other
- You have a weak support system
- You have financial problems
- The pregnancy was unplanned or unwanted
(Unmentioned is having a premature/NICU, or ill child, but other studies show additional risk based on these factors.)
The Edinburgh Post Natal Depression Scale needs to be a staple in OBGYN offices both during and after pregnancy. I was conscious enough to know myself, recognize my risk, and ask for help (though it still took a significant effort to get the correct help, another subject that needs to be addressed). Resources need to be provided swiftly and accurately for women with perinatal mood disorders, and risk factors should be noted by OBGYNs during and after pregnancy. Just a few simple questions could save lives: have you ever been depressed? How are you feeling about this pregnancy? Do you have any problems at home or work?
Doctors should be aware that pregnancy-related illnesses and unfulfilled birth plans (such as an emergency c-section where a vaginal birth was planned for) significantly raise the risk of postpartum mood disorders – and inform their patients of the increased risk immediately and provide appropriate and vetted resources to them.
Perinatal mood disorders rarely exist in a vacuum – there are almost always signs, symptoms, and risks that can be identified even before delivery. We must better inform providers and patients alike of the risks, and provide clear paths to treatment.