Question 1

What measures and screening tools for postpartum disorders do you find most effective?

Anne Buist · Accepted Answer

The EPDS is really the only one that is useful but only as a mass screening tool. I don't use any in clinical practice - I take a detailed history which is the only real way to get a diagnosis. In research - it depends what I want to measure. I do however use the Adult Attachment Interview and the Strange Situation Procedure in my parenting assessments (and the Maternal Q sort is also useful for this).

Question 2

What do you see as the critical differences between clients presenting with PND and clients presenting with “baby-blues”?

Anne Buist · Accepted Answer

I don't see the baby blues because they are further down the track by the time I get them. But 80% have the blues to some degree...and unsurprisingly, most women with PND started with the blues. Only  postpartum psychosis, which often starts at the same time, can be readily differentiated (more marked anxiety, mood and behaviour change, but beware, some women can hide it so always good to listen to those who know the woman best).

Question 3

What role do you see sleep (or total lack thereof!) playing in postpartum disorders?

Anne Buist · Accepted Answer

The number one differential diagnosis! If possible have their mother or partner care for the baby overnight (and provide sleeping tabs). It doesn't however cause a disorder (though it an be one of many factors); sleep deprivation is quite often caused by the disorder, especially anxiety. These mothers have been noted to get up more often and wake their baby (fear of SIDS) as much as the other way around (babies can sense tension and may have disturbed sleep in response). These mothers often have babies who sleep amazingly well - but the mother still can't sleep.

Question 4

What are the main criteria for flagging or diagnosing a postpartum mood disorder?

Anne Buist · Accepted Answer

Mood and anxiety symptoms that are there for most of the day, most days, for two weeks. More likely to be anxious than other depressive disorders.
But...women are good at denying/covering up so anyone frequently presenting especially with baby symptoms, and if its sleep related, having a night off doesn't help. Sleep disruption and breastfeeding changes physiology so physical symptoms need to be carefully elucidated.

Be sure not to miss postpartum psychosis - behaviour usually changes significantly and anxiety or mood symptoms quite prominent.

Question 5

What are best practices to supporting women experiencing a perinatal mood disorder? How do I best support them as a therapist?

Anne Buist · Accepted Answer

Probably all the same things you would do for anyone. Flexible times to see them, seeing them more often when needed. Women need to feel heard, and evidence suggests just a supportive nonjudgmental ear can help many. The difference is to remember they are battling the anxiety not just of having a mental illness, but also fear being seen as a bad mother (and some will fear their child might be removed). Be sensitive to them and their particular issues. They won't all be the same, but be aware of the common themes:
fear of being seen as a bad mother if they aren't perfect
not feeling supported or understood (nb by partner)
everything being about the child not them
resentment of the child but guilt about this
awakening of their own unmet emotional needs/childhood trauma

Some are going to need practical anxiety management skills and don''t rush in too early with trauma/attachment work about their own childhood until they are well enough to manage it (and many then won't need it). The child on the other hand can't wait and their attachment is happening, so don't forget them - the Circle of Security is very good at helping mothers not feeling blamed but at seeing their child's cues more clearly (without their own issues getting in the way), and therapists can work on this too.

Question 6

Hello, I am wondering whether a person's past experience of postpartum mood disorder would ever mean that a future pregnancy would not be advised? Or would be always the case that instead you might advise on ways to reduce the risk?

Anne Buist · Accepted Answer

I mostly think it is my role to give the risks and likelyhood but never actually advise one way or another. Two people given exactly the same advice can make opposite decisions! Mostly there are ways to help improve outcomes, but needs a serious discussion with both parents. If someone is on very high/multiple medications and can't get off them then given this is an added risk, I might be stronger re the risks but ultimately there is no zero risk. If they decide not to go ahead then its helping support the grief/what that means for them.

Question 7

What would be a good postpartum book for clinicians to begin reading more into the treatment models and how to help patients?

Anne Buist · Accepted Answer

Treating Postnatal Depression by Jeannette Milgrom
Look at COPE with Nicole Highett - I think she does practical education sessions.
The Circle of Security Intervention by Bert Powell et al (but its rather dry and attending training much more interesting and very useful!)
Good Enough Parenting by Andrew Wake - designed for parents but useful to understand attachment and the message for parents and where things go wrong

Question 8

What do you wish people knew about postpartum mood disorders?

Anne Buist · Accepted Answer

Interesting question! I think primarily that this is an unique opportunity for true early intervention and prevention. Most women are highly motivated to be the best mother than can be - more so than any other time of their lives, so you can eg get them onto methadone, start a new relationship (with their baby) with a clean slate. And it can make a huge difference for outcomes for the child

Question 9

Are outcomes for babies impacted by maternal PPMDs different from the general public?

Anne Buist · Accepted Answer

Yes - though current evidence suggests that antenatal depression and anxiety has the biggest impact because of biological changes (ie increased cortisol) that the infant is exposed to, altering their stress response and possibly making them more vulnerable to depression/anxiety alter in life). Postnatally emotional neglect/ attachment issues can impact if the woman isn't treated, and there are her own attachment issues to her own primary carer. These can occur in nondepressed mothers but a higher rate in those with depression (probably because attachment issues/chlidhood trauma is a risk factor).

Question 10

What is the risk factor for developing postpartum mood disorders?

Anne Buist · Accepted Answer

Roughly 1 in 7 women giving birth; increased if family or past history of affective disorder, lack of support, childhood abuse, and multiple stresses of any type.

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