Most childbirth educators are covering postpartum depression in their classes. Some are also covering other postpartum mood disorders such as anxiety and obsessive compulsive disorder which are quite common. (Depression affects 10 – 20% of new moms, Anxiety or panic disorder affects ~10% and OCD affects 3 – 5%). And hopefully they’re also pointing out that a person can experience multiple disorders at once – for example, she can have depression AND anxiety.
A few educators are remembering to include partners – about 5% of new dads have a postpartum mood disorder.
But I wonder how many of us are talking about mood disorders in pregnancy?
Incidence of Mood Disorders in Pregnancy
Of women who experience depression after birth, a third say it started during pregnancy. (Source) Sometimes, depression is missed because symptoms can be mistaken for the fatigue or appetite disturbances associated with pregnancy. Estimates of incidence of depression in pregnancy range:
Rates determined by structured interview have ranged from 2 to 21% and up to 38% for women of low SES. Estimates derived from self-report questionnaires have ranged from 8 to 31% and 20 to 51%, respectively. Source.
Almost one third of women with manic depression (aka Bipolar disorder) report onset during pregnancy. OCD often begins in pregnancy (pre-existing OCD is usually exacerbated by pregnancy). Interestingly, pre-existing anxiety / panic disorder may actually decrease in pregnancy due to hormonal effects. Source
How do we talk about this in childbirth classes?
I see multiple places we could address this:
1) when talking about discomforts of pregnancy and the physical changes of pregnancy, you could also address emotional changes and challenges
2) when discussing self-care in pregnancy, could include emotional self care and talk about mood disorders there
3) when talking about postpartum mood disorders.
I find it works well for me to cover it when talking about postpartum mood disorders.When I’m almost done with that topic I say “Although you may hear a lot of talk these days about postpartum mood disorders, we know that they begin in pregnancy for a third of the women who experience them. If you were just listening to my description of symptoms and thinking ‘I feel that way now’, then you may be experiencing a prenatal mood disorder. All the resources for support and techniques for self care I just talked about can also help with pregnancy mood disorders. I would encourage you to reach out for support now – the sooner someone gets support, the sooner they start feeling better. If you have concerns or questions, you can talk to me after class or by email.”
So, it works well for me to cover it near the end of the series when I’m talking postpartum. But, I could also make an argument that it would be better to cover it as early in the series as possible so that parents who are experiencing it get support as early as possible.
When do you (could you) cover it in your classes?
For more resources on perinatal mood disorders, see http://ppmdsupport.com/index.html
photo credit: Maria & Michal P. via photopin cc
Transition to Parenthood 
I had postpartum onset bipolar disorder, which manifested as postpartum hypomania immediately after I gave birth. I’m completing my book about my experience, which includes a foreword by Dr. Walker Karraa. Dr. Karraa’ s new book “Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth” is receiving wonderful reviews and it is helping women who have had or have postpartum depression.