For this 3-part series on postpartum depression, we interviewed Mary Wise, MA, MFA, BSN-RN, who is the Chief of Maternal Health Services for Delaware Health and Social Services’ (DHSS) Division of Substance Abuse and Mental Health (DSAMH). Mary will talk about what postpartum is, common and myths, and how to get help.

1. What is postpartum depression?

“Postpartum depression” (PPD) is a term often used to refer to the emotional struggle that some birthing people experience postpartum, which is the period after their pregnancy ends. This emotional struggle, however, is more accurately described by the broader term Perinatal Mood and Anxiety Disorders (PMADs). Pregnancy can trigger a spectrum of mood changes that can begin at any time during the perinatal period, which is defined as the time from when the person becomes pregnant to the end of the first 12 months after their pregnancy ends. Hormonal changes along with the stress and pressure of everything that comes with pregnancy, contribute to the onset of PMADs. As a result, the pregnant individual and/or their partner may experience a shift in mood, outlook, and behavior that affects all areas of the person’s life in a negative way. This shift can range from mild to catastrophic, causing the loss of life. For that reason, and because it can affect anyone and have a sudden onset and progression, it’s important to consider it as a possible outcome with every pregnant and postpartum person. Screening and education (including provision of supportive resources) during and post pregnancy is extremely important for all individuals and involved family members, as is educating all people of reproductive age before pregnancy to increase awareness.

2. What are common signs that someone may have postpartum depression?

According to Perinatal Support International, 1 in 7 birthing people and 1 in 10 fathers/partners experience postpartum depression. However, those numbers are likely higher because everyone who needs to be diagnosed or screened isn’t yet and because PMAD is a spectrum of pregnancy-related disorders. Depression, anxiety disorders (such as generalized anxiety or panic disorders), Obsessive Compulsive Disorders (OCD), Post Traumatic Stress Disorder (PTSD), Bipolar Mood Disorders, and Postpartum Psychosis fall within the PMAD spectrum, creating a very wide range of possible signs and symptoms. Some common symptoms are: feeling sad, depressed, and/or crying a lot; ruminating, obsessing, or worrying excessively; losing interest in things that they once cared about or enjoyed; isolating or withdrawing socially; expressing feelings of guilt; apologizing or blaming themselves for mistakes; making statements that suggest they feel worthless or incompetent; sleeping more or less than needed; having nightmares; avoiding certain subjects either in discussions or in media (such as movies, books, social media); not wanting to be touched; being easily angered or upset or having less patience; changes in appetite or eating habits; having poor concentration, difficulty remembering things, thinking of words, or being creative; feeling like a bad parent or mother; expressing suicidal thoughts; giving away items; talking about the future as though they won’t be there; taking risks; or engaging in other self-destructive behaviors. All of these symptoms may indicate an acute emergency, so should be addressed immediately. It is always better to act than take a “wait and see” approach. This is especially true if someone is experiencing delusions (fixed thoughts that are clearly not based in reality) or hallucinations (hearing, seeing, or feeling things that aren’t there). Those symptoms indicate a clear-cut emergency situation, and a professional should be called immediately.

Guest Blogger: Mary Wise, MA, MFA, BSN-RN

Mary Wise, MA, MFA, BSN-RN, is the Chief of Maternal Health Services for Delaware Health and Social Services’ (DHSS) Division of Substance Abuse and Mental Health (DSAMH). In this role, she leads initiatives designed to support the mental health and substance use disorder (SUD) treatment needs of birthing people in the state of Delaware. She is part of the core faculty for the Peer Recovery Specialist ECHO series, created in partnership between the Weitzman Institute, DSAMH, Help is Here Delaware, and the Substance Abuse and Mental Health Services Administration (SAMHSA). Mary also provides subject-matter expertise to inform policy and standards and to support grant-funded projects. In addition, Mary serves as a Commissioner for Delaware’s Maternal and Child Death Review Commission (MCDRC) and is a participating member of the Commission’s Maternal Mortality Review Committee (MMRc).

She is an active member of the Delaware Perinatal Quality Collaborative (DPQC), the Delaware Healthy Mother and Infant Consortium (DHMIC), and DHSS’s Multi-divisional Perinatal Workgroup and Advisory Committee. She is also a writer and has previously worked as a registered nurse and as an educator of children and college-level adults. Adding to her professional background, Mary is a single mother of 2 teenagers and has a wide variety of lived experience that informs her work in all areas. These help fuel her passion about reducing maternal mortality and morbidity, eliminating health disparities and stigma, and supporting the mental health and substance use disorder treatment needs of this population. She believes the path forward is through a holistic approach that addresses the needs of the entire family unit. This ideally incorporates a web of multi-disciplinary care and resources, which address not only behavioral health and medical needs but also social determinants of health, including those nuances well beyond what is traditionally thought of as basic needs.