"I loved my baby, but I didn’t feel this instant connection with motherhood. I struggled with breastfeeding and it became something I despised between me and my baby. I constantly had mom rage and shouted at her when she wouldn’t feed. I had frequent breakdowns where I would scream and hate my life... I wanted to just disappear and never return. It felt like an out-of-body experience with a complete loss of identity and sense of who I was."
On This Page
This is how one Cayman parent describes her emotional state following the birth of her first child.
Her experience is not unusual. Perinatal depression, also known as postnatal depression, is the most common obstetric complication in high income countries, with one in five women experiencing it. And yet, only half of women seek treatment.
Whether this is because they believe these feelings are a ‘normal’ part of new motherhood, they hope it will clear up naturally, they feel ashamed of not feeling joyful and fulfilled, or because they fear they will be regarded as an unfit mother, too many women are suffering in silence.
So let’s take an honest look at what perinatal depression looks and feels like, and the help that is available.
What are Perinatal Mood & Anxiety Disorders?
Although most people have heard of postnatal or postpartum depression, there is actually a variety of mood disorders that can affect women in the postpartum weeks and months. In addition to depression, anxiety, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and postpartum psychosis can all occur after birth. Depression and anxiety may also begin during pregnancy, so the more accepted term, which refers to the full range of mental health disorders that occur during pregnancy and postpartum is Perinatal Mood and Anxiety Disorders, or PMADs.
Signs & Symptoms
Many who are experiencing PMADs do not realise that this is the reason they do not feel like themselves. The signs and symptoms of perinatal depression, anxiety, OCD and other disorders are generally consistent with the symptoms of these conditions at other times in life, but frequently relate to the baby.
Signs and symptoms of the various mood disorders include:
- Depression Anger, lack of interest in the baby, appetite and sleep disturbances, feelings of guilt or hopelessness.
- Anxiety Constant worry, intrusive thoughts, sleep disturbances, dizziness and nausea.
- Bipolar Disorder Mood swings, rapid speech, delusions and impulsivity.
- OCD Obsessions, compulsions and hyper-vigilance.
- PTSD Flashbacks, avoidance, irritability and exaggerated startle response.
- Psychosis Delusions, hallucinations, severe depression and paranoia.
Laura Kelly, who holds her Perinatal Mental Health Certification (PMH-C), stresses that while intrusive thoughts of harming oneself or one’s baby can be very distressing, it’s important to know that mothers rarely act on them. She says, “Most women are frightened by these thoughts. They don’t recognise themselves and are afraid to be left alone with the baby.”
Perinatal psychosis, however, is a rare but severe form of PMADs that affects between 1 and 2 in 1000 mothers. The onset can occur anywhere from two weeks to a year postpartum and can lead mothers to act on intrusive thoughts and hallucinations. It is a medical emergency and treatment should not be delayed.
PMADs are so common and treatable. No woman should feel alone. Help is out there.
Is it the Baby Blues?
At least two thirds of new mothers experience the 'baby blues', characterised by low mood, fatigue and tearfulness in the first days after giving birth. However, the baby blues typically dissipate within two weeks postpartum. If such feelings persist beyond two weeks, this is not the typical baby blues.
How Common are PMADs?
PMADs do not discriminate. Women of every ethnicity, culture, age and income level can be affected. However, the prevalence is hard to gauge. This is due in part to a lack of adequate screening — there is no routine screening in Cayman — but also a reluctance to talk about it, out of shame, fear of being regarded as a bad parent, or worry that the baby will be taken away from them.
There are no specific statistics for Cayman but according to Postpartum Support International, an organisation that exists to raise awareness of perinatal emotional changes internationally, statistics include:
- Up to 1 in 5 women, and 1 in 3 women of colour, experience depression and anxiety in the perinatal period
- 1 in 10 new mothers experience symptoms of OCD
- 1 in 10 women experience PTSD following childbirth
- 1 in 10 fathers experience PMADs
- Over 70% of women with bipolar disorder who stop medication when pregnant become ill during the pregnancy
- Up to 100% of individuals have intrusive thoughts.
PMADs in Fathers
Like any major life event, the arrival of a new baby can be emotional and stressful. The dynamics of the relationship change, fathers may feel isolated or excluded in the face of a strong mother-baby bond, they may be sleep deprived, overwhelmed by the new responsibility, and if they have witnessed a traumatic birth, may experience PTSD.
However, in men the symptoms can be ‘masked’: they may work longer hours, stay out late, abuse alcohol or drugs, or spend more time online or gaming. Due to societal expectations that men must be ‘strong’ they are also less likely to seek help.
If one parent is depressed, it doubles the chances of the other becoming depressed. One review which looked at nearly 30,000 couples from 15 countries, found that in 3% of families, both parents were experiencing postpartum depression at the same time.
Whether it is the mother, the father or both, the treatment options for PMADs are the same.
Causes of PMADs
There is no single cause of PMADs. There are both biological and psychological factors at play. The hormonal changes a woman experiences are one part of it, but the lack of sleep, exhaustion and stressful life events can also be a trigger.
Some people are more prone to PMADs than others. Single parents, very young mothers, those whose pregnancies were unplanned or unwanted, and those who are socially isolated are at higher risk.
Mothers with a prior history of mental health issues, or who stopped taking medication for depression or anxiety during pregnancy, are also more prone to PMADs, as are those who have experienced a traumatic birth.
Risks of PMADs
Left untreated PMADs can become a long-term condition that impacts the wellbeing of both parent and child. For the infant, the risks include low birth weight, pre-term delivery, insecure attachment and developmental problems. For the parent, the symptoms may impair their ability to function, impact their relationships and lead them to neglect the child. Perinatal depression can lead to long-term depression and suicidality. It is also worth noting says Dr Walton, a psychologist at The Wellness Centre who has a special interest in perinatal mental health, that alcohol and drug abuse can be a consequence, as some may use these to self-soothe.
Treating PMADs
Treatment for PMADs fall into two categories, therapy and medication, with a combination of the two often being optimal. If you believe you are experiencing PMADs, your first port of call should be your midwife, OB/GYN or mental health practitioner.
There is now a small but growing number of mental health professionals in Cayman who are certified in perinatal mental health. Treatment typically includes interpersonal therapy and Cognitive Behavioural Therapy (CBT).
“Interpersonal therapy creates a safe space where parents can be heard and understood, and start to make sense of their difficulties,” Dr Walton says, “while CBT identifies the thoughts that lead to behaviours, and seeks to reframe these thoughts to be more solutions-focused.”
Medication is also a very effective way to relieve symptoms and make you feel like yourself again. Although many women worry about taking medications while pregnant or breastfeeding, this should not prevent you seeking help.
“Some medications are contraindicated but there are many that can be used safely and some that require additional monitoring of the baby during the pregnancy and after birth,” Dr Hole, OB/GYN at Integra, assures. “If you are on medication and planning a pregnancy, it is best if you can see your prescribing practitioner or OB/GYN to check that you are on a safe medication, or whether it might be best to change medications prior to trying to conceive.”
Personal Stories
I experienced the baby blues within hours of giving birth and my depression and anxiety symptoms progressed from there. My thoughts were very fast and I felt like I didn’t have time for anything. I felt angry and resentful towards my husband and would yell at my baby for not sleeping. I had intrusive thoughts about falling down the stairs with my baby — or worse, throwing her down the stairs.
I had (and still have) immense guilt about not spending enough time with my baby, not being present, not working out enough, not seeing my friends, being a bad wife, not being a good mom....
I love my baby so much, but I didn’t have that rosy feeling of love when I first met her. I mourned my old life, I was sad that I was no longer my husband’s number one priority, and I missed my freedom.
I have always been a bit of an anxious person and being a first-time mother, I didn’t know what to expect, so I thought that my anxiety was normal.
I tried therapy, meditation, acupuncture and supplements, but none helped enough. I tried to see a counsellor certified in perinatal mental health but she was on maternity leave at the time. Then I ran into my GP who ultimately prescribed me a low dose antidepressant, and that turned out to be the best thing I have done for myself and my relationships since having my baby.
My daughter was born in March 2021. Our borders were still closed and everyone was working hard to try to stay afloat financially so there was not much family support. My symptoms started about four to six weeks postpartum. I was extremely confused, overwhelmed, anxious and had tremendous rage.
I didn’t know this wasn’t normal: I thought it was all part of the process. Everyone prepares you for the birth of the baby, but not for the changes you go through afterwards.
I had stopped therapy during pregnancy as I didn’t want the conversations to subconsciously reach the baby, but when I did go back, my therapist wrote to my OB/GYN indicating my symptoms were consistent with a major depressive disorder with perinatal onset. I was then able to see a psychiatrist who prescribed an anti-depressant and the improvement was almost immediate.
I am still on medication and continue to see my therapist and psychiatrist and I am proud of that, and of how hard I fought to be taken seriously even when I had so little to give so that I could be the best mum, wife and partner I could be.
Reading Recommendations
Support in Cayman
Therapy and counselling can be hard to access for new mothers, both due to the cost and the difficulties of getting to an appointment with a baby. That is why finding support is so important.
Talk openly with partners, family, friends and other mothers about your struggles. Discuss practical ways that you can be supported, whether that's help with grocery shopping, cleaning and laundry, or someone to watch your baby so you can get some exercise or catch up on sleep.
When Laura Kelly, a two-times survivor of PMADs, moved to Cayman, she discovered that there were no classes available to women in this period to help them with their mental health and emotional wellbeing.
Motivated by her lived experience and desire to help others with PMADs, Laura became the first person in the Cayman Islands to gain a Perinatal Mental Health Certification (PMH-C) through Postpartum Support International. She now runs The Mom Hour Perinatal Support, an online support group on Facebook and Instagram, dedicated to educating, supporting and empowering women during the perinatal period.
“It’s a safe space to share stories without judgement,” she says. “The education part started online and has extended to in-person groups. It is a social support model, rather than a therapeutic model, led by PMADs Survivors with lived experience. Social support is key to recovery. PMADs are so common and treatable. No woman should feel alone. Help is out there.” The group is free to join and runs on an entirely voluntary basis. Email: themomhourcayman@gmail.com for more information.
