Healthy You Healthy Hennepin

Emily was diagnosed with perinatal mood and anxiety disorder

Not just the baby blues

June 2017

Emily Larson’s first pregnancy was relatively routine – morning sickness, food cravings, and an excitement to meet her son Oakley.

But, when 27-year-old Larson was induced a week after Oakley’s due date, she was in labor for 54 hours.

After more than two days of painful pushing and ineffective medical interventions, doctors administered anesthesia and performed a C-section. When Larson awoke afterward, she was wheeled into another room to meet Oakley.

Within hours of this traumatic experience, Larson’s mental health issues began – flashbacks about her labor and delivery, anxiety, and a fear of falling sleep (because she worried that she would stop breathing and never wake up).

Larson was later diagnosed with perinatal mood and anxiety disorder. But, like many moms, it took her months to receive help.

Within hours of giving birth, Larson’s mental health issues began – flashbacks about her labor and delivery, anxiety, and a fear of falling sleep (because she worried that she would stop breathing and never wake up).

15% - 20%

Percent of

mothers who

develop perinatal

mood and anxiety

disorders

Many women experience mood changes before or after the birth of a child, but for 15 to 20 percent of them (and even more among those with preexisting mental health issues) these mood changes are more severe.

People often describe this experience as “postpartum depression,” but “perinatal mood and anxiety disorders” (PMAD) is more medically accurate, because the term comprises the period before and after birth and includes more symptoms than just depression.

Women of every age, culture, income level, and race can develop perinatal mood and anxiety disorders. The illness takes several forms, including: depression during pregnancy and postpartum; anxiety during pregnancy and postpartum; pregnancy or postpartum OCD; postpartum post-traumatic stress disorder; bipolar mood disorders, and postpartum psychosis.

Luckily, there are effective treatment options for all forms of PMAD.

Many women experience perinatal mood and anxiety disorder after the birth of a child

 

 

When Larson experienced flashbacks, anxiety, and a fear of falling asleep at the hospital, the doctors suggested she go back on an antidepressant medication she’d been on before her pregnancy. She did, and was later released. But the symptoms persisted.

Although Larson had no issues bonding with Oakley, she continued to have flashbacks about her labor and delivery. Everyday things could cause a flashback, like the sight of a doctor in a white coat, the sound of someone yelling, or the smell of her sister’s car (which was the same smell as the fragrance Larson had placed on her bedside table at the hospital).

Other emotions cropped up, too, like sadness, confusion, hopelessness, shame, and guilt. Larson experienced insomnia. And she became fixated on hearing people say that she looked like Oakley. “I had this irrational fear that somehow this baby wasn’t really my baby, so any comment about how he looked like me gave me hope that he really was mine,” she explains.

During her two-week checkup, Larson confessed that she was still having flashbacks. But when her provider gave her a number to call for support, she resisted. “Because Oakley was my first child, I was like, ‘This is just how motherhood is!’” she says.

Because Oakley was my first child, I was like, ‘This is just how motherhood is!'
Emily Larson

 

 

It wasn’t until Larson, a fourth grade teacher, went back to work in October 2016, that she realized that something was wrong.

“For weeks, I cried whenever I had to drop Oakley off [at daycare],” Larson says. “I couldn't figure out why every interaction I had with the daycare workers was so uncomfortable … I cried when they would ask me how our night was. I felt empty on the car ride to school.”

Although she managed to hold it together at work, her emotions would catch up to her at home, culminating in angry outbursts.

Larson also began having extreme panic attacks at home. She’d see things that weren't there, like a girl in her closet or a spider hanging over her bed. She’d hear voices on the baby monitor that she knew weren't there.

She became convinced that she was going crazy, but was too scared to tell anyone, because she didn’t want people to think that she couldn't handle being a mom.

But then two things happened that convinced her to seek help.

Emily was diagnosed with perinatal mood and anxiety disorder after the birth of her son Oakley

 

 

The first thing happened at home.

It was two in the morning in late October 2016, and Larson had been up for hours caring for Oakley, who was ill. Suddenly, she found herself pacing her dark kitchen with tears streaming down her face. Words tumbled out of her mouth: “This is it. This is just what life is like now. It's never going to get better. I just have to accept that this is what life is like now. I have to do this all on my own. It's never going to get better."

At one point, she glanced at her husband and registered deep concern in his eyes; it was enough to snap her out of her thought process and made her realize she needed help.

A few days later, Larson participated in a school staff training about what to do if there was a dangerous person in the building. As she listened to the presenter describe various scenarios, she started to feel like each was actually happening. She started shaking, left the room, and found a bathroom. In a stall, she began hyperventilating and called her mother.

“This was the cherry on top, the final event that pushed me over the edge and made me realize that I could not keep living this way,” Larson says. A few days later, she met a therapist and was connected to the Mother-Baby program at Hennepin County Medical Center.

Practitioners at HCMC's Mother Baby Program

 

 

The HCMC Mother-Baby program offers a range of mental health services for pregnant women and families with children below five years old, including a telephone support line, outpatient support groups, an outpatient program, and one of the nation’s only partial hospitalization programs.

A key tenant of the Mother-Baby program is the recognition that babies struggle when their mother does not feel well. So, program providers focus their interventions on identifying the ways that the mother’s mental health is affecting her baby and in treating the relationship between the mother and baby.

After doing an intake, providers recommended that Larson enroll in the partial hospitalization program. People in this program receive five hours of group psychotherapy and education four days a week (Monday through Thursday). Most women attend the program for four weeks.

HCMC’s Mother-Baby program is the first of its kind in Minnesota and only the fourth in the country.

 

 

On the first day in the program, Larson was completely baffled to find herself there. “I couldn’t believe that I was in a ‘partial hospitalization’ program,” she explains. “It just seemed too drastic a step for me.”

But as she listened to the other women share their experiences, something shifted. “I realized that these other women were actually a lot like me,” Larson says. “They were just normal moms going through a rough transition … I learned that this space was a safe space where moms were accepted for who they were without judgement or shame.”

By about the third day, Larson was desperate to share her story. “I realized how much I needed someone, anyone, to listen,” she says. “I needed someone to say that what I experienced was ‘traumatic’ … to say ‘I'm so sorry you had to go through that’ … to say ‘I get it. Me too.’”

A practitioner at HCMC's Mother Baby Program

 

 

Therapist Kathryn Geffert-Anderberg worked closely with Larson. Like many patients in the program, Geffert-Anderberg says Larson presented as “someone who looked too good to get the help she needed.”

But Larson was not good.

With Geffert-Anderberg’s help, Larson began psychotherapy to address her symptoms. During this process, they delved into Larson’s past, something that can contribute to perinatal mood and anxiety disorders.

“When a mom has a baby two things are delivered to her doorstep – her baby and her past,” Geffert-Anderberg explains. “Suddenly past wounds need to be healed.”

“I grew up in an alcoholic home and we buried a lot of our emotions,” Larson explains. “Our family functioned on this ‘pretend everything is OK’ vibe. We swept emotions under the rug. I didn’t realize I still do that in my adult life until the [Mother-Baby] program.”

Not only did Larson realize she was sweeping emotions under the rug, but she also recognized that she was being too hard on herself.

“There is a lot of pressure for women to put on all these different hats and do everything perfectly and that’s not realistic …” she says. “I learned that accepting myself, not as a perfect mom or a mediocre mom but as a good-enough mom, models self-acceptance for my son. I am learning to accept that I have inherent value no matter what, and that I don't need to earn that or prove that to anyone.”

When a mom has a baby two things are delivered to her doorstep – her baby and her past. Suddenly past wounds need to be healed.
Kathryn Geffert-Anderberg, a therapist at Hennepin County Medical Center’s Mother-Baby program

 

 

After six weeks in the Mother-Baby partial hospitalization program, Larson transitioned to the outpatient program for 10 weeks.

“Recovery is not a light switch,” Larson says. Still, she’s made progress (with the help of medication, therapy, and the application of coping skills), and is now trying to give back; she currently serves on a committee that discusses how to provide better care for people in the community with PMAD.

“I think there was a reason I went through this,” Larson says. “And I don’t think there are enough people that speak up about perinatal anxiety and mood disorders. And that’s unfortunate because a lot of people go through it. So I want to be open about my experience with it and try to help other women.“

 

Written by: Lori Imsdahl

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