Treatment Options for PMAD

Trauma-Informed Care

Perinatal Posttraumatic Stress Disorder (P-PTSD) occurs in approximately 3-15% of women in the perinatal period.

If you have a history of trauma in your childhood or adulthood, or if there was something scary that happened during your pregnancy, birth or postpartum, it is important to tell your healthcare professional, so that they can help you find someone who understands trauma.

Only you get to define what felt scary or traumatic - not anyone else.

The risk of P-PTSD is 4X higher in African American women. It is also higher among all parents of color, refugees, and LGBTQ+ parents - even in non-birthing parents. It may feel safer or more comfortable to have a variety of options that fit with your cultural background, or services in your home. Explore these culturally informed resources available for BIPOC and LGBTQ+ communities.

What are the options for getting help?

Counseling and Therapy

When possible, finding a professional who has specialized training in perinatal mental health is ideal. People experiencing perinatal mood and anxiety disorders have unique needs and risks that can be misunderstood by those without specialized training.

You can ask your doctor’s office for resources or find additional resources on the Perinatal Mental Health Support Contacts and Resources webpage.

What will a therapist help me with?

• Process your pregnancy and birth experience, and give you space to work through feelings.
• Offer suggestions for different ways to cope with sadness, anxiety, fear, anger or worry.
• Give you a safe place to talk about whatever you want to talk about.
• Identify other resources that may be helpful.

Online therapy on a computer or phone offers parents more options, especially for those with limited access to care (rural, migrant, or parents from marginalized communities), childcare, transportation or parents who prefer the privacy of their home.

Questions to Ask a Therapist

You can ask questions in a phone call before scheduling an appointment or see if this information is on their website. You can also ask these questions in the first appointment.

• What kind of training in perinatal mental health (or pregnancy and infant loss, if applicable) do you have?
  • Look for training with national groups, such as Postpartum Support International or the 2020 Moms Project.
• How long have you worked with new and expectant parents?
• Can I bring my baby along? How about young children? A partner or other family member?
• What is your schedule? Do you have a cancellation policy?

Intensive Options

Sometimes, parents need more frequent support than what most therapists can offer. Day Treatment or Intensive Outpatient (IOP) programs, ideally one whose focus is on perinatal mental health, can offer this level of care. These programs offer a combination of individual and group therapy and meet for several days of the week for several hours. Many allow parents to bring their babies along and are offering services virtually.

Medication

Making the decision to take medication, especially when you are pregnant, or nursing a baby, can be very hard. This may be due to incorrect or scary information online, your cultural beliefs, or having a healthcare professional who is not educated about medication during this time of life. It is important to weigh the risks and the benefits, and the information here can help you know what questions to ask and make an informed decision.

NOTE: If you are worried about a medication that you are already taking, do not discontinue taking it without speaking with someone at your doctor’s office, or consulting with someone at one of the resources mentioned. Doing this is especially risky for those who have a personal or family history of bipolar disorder or psychosis and may lead to an emergency.

Debunking Common Myths:

• “There are no medications that I can take while I am pregnant or nursing.”
  
  While some medications have more risks than others, there are medications that can be taken. The resources below will share that information.
   
• “This medicine is a category ‘C’ medication, so it isn’t safe to use while pregnant or nursing.”
  
  In 2015, the labeling of medications was changed to make the risks more clear, and to make it easier for healthcare professionals to help patients make decisions. If someone mentions that a medicine is ‘class C’, ‘class D’, etc. they are using outdated information.
   
• “I was told that if I take this medication, I will need to stop nursing, or ‘pump and dump’.”
  
  While there are some medications that this is necessary, there are only a few medications for mental health that the risk of sharing through human milk truly requires a parent to stop nursing. If you DO decide to stop, work with a lactation consultant to wean slowly to prevent physical or emotional difficulty.

How do I find the right person to prescribe medication?

• Primary Care (Family or Pediatric Physician, Nurse Practitioner or Physician’s Assistant) or Obstetric (OBGYN or Nurse Midwife) health professionals can prescribe. Some have advanced experience and training in psychiatry, but most may not.
• Psychiatric (Psychiatrist, Psychiatric Nurse Practitioner) health professionals specialize in mental health and prescribing medication for these conditions. Ideally, find someone with Reproductive Psychiatry as a specialty. Unfortunately, there is a shortage of psychiatric professionals and they often have long waiting lists.

Suggestions

1. If the quickest option is meeting with your regular clinic, start there. Sometimes, if they have seen you recently, they will be willing to talk with you over the phone rather than having you go in. They could have you try starting a medicine, and you can keep working with them, or get on a waiting list with a psychiatric professional.
2. Contact your insurance company, home health nurse, case worker, or clinic for a recommendation to a psychiatrist. You can also ask a support person to help make phone calls for you.
3. If your doctor has questions about medications, there are places they can contact that will let them ask a specialist questions, free of charge. Postpartum Support International, InfantRisk Center and Massachusetts General offer these services.

Where can I find accurate information?

These organizations are updating their information regularly, so that you can have the most accurate information. Many of them also have a way to contact them to ask questions, free of charge.

• Mother to Baby has helpful fact sheets, articles, and podcasts (English & Spanish). You can also email an expert with questions.
• The InfantRisk Center offers free phone call for patients or professionals to speak with an expert for guidance or reassurance, as well as up-to-date research.
• LactMed provides details about drugs and chemicals impact pregnancy, and data on levels in breastmilk and infant blood, as well as possible adverse effects. Evidence-based data and alternative suggestions provided. 

Emergency Care and Self-Harm

Pregnant and postpartum people may have thoughts about dying, harming themselves, or taking their own lives. Many may not mention they are having these thoughts to their healthcare team, even if asked. Some people fear that their baby will be taken away or that they will be sent to a hospital. Fortunately, creating a safety plan can prevent this from happening, and keep you safe.

A safety plan asks the following questions:

1. What are the warning signs that I need more help (thoughts, images, mood, behaviors)?
2. What are some ways I can help myself feel better (things you typically enjoy, or used to enjoy, relaxation techniques, breathing, distractions, prayer)?
3. Who can I reach out to for help (people I know, neighbors, family members, therapist, support group, faith community)?
4. What do I need to do to keep myself safe (remove harmful things, get out of the house, ask someone to come over, call a crisis number)?
5. What is at least ONE thing that is important to me and worth living for?

You can create your own safety plan by downloading the Postpartum Wellbeing Plan. Take some time to also explore and familiarize yourself with local and national resources and organizations that support perinatal mental health.

If you need suicide or mental health crisis support, or are worried about someone else, please call or text 988 or visit the Suicide and Crisis Lifeline Chat to connect with a trained crisis specialist.