When to See a Therapist During Your Pregnancy
By: Emily Griffin
Tags: Parenthood, Pregnancy, Mental Health, Family, Parenting

By Emily Griffin, MSW, LICSW, LCSW-C

There’s recently been a lot of attention and improved awareness around Postpartum Depression and Anxiety. As a mom of five and psychotherapist working with perinatal parents, I am encouraged by the dialogues new parents are having and by seeing more of them be proactive with their mental health during the postpartum period. Many of them are prompted to reach out for therapy when they return to their midwife or OB and take the Edinburgh questionnaire that covers some of the main signs of Postpartum Depression. But do most of us know what to do and when to seek help during pregnancy?

For many years, we’ve thought that healthy and secure attachment starts when babies are born. We now know that babies and parents begin their attachment process and bonding as soon as baby’s brain begins to develop. Building your bond with your baby can be complicated by many things, like current situational stress (i.e. partner/marital conflict, abuse of any kind, recent moves, an older child’s challenging needs, work demands, financial hardship, recent losses, or other big changes).

Other significant factors that influence your early relationship/connection with Baby (even in the womb) include:

- your own relationship with your parents

-family history of mood disorders, abuse and neglect, and substance use

-your feelings about becoming a parent and the current pregnancy (i.e. was it planned?)

-family or personal history of trauma

-eating disorder and body image concerns, infertility

-previous experience of birth trauma and pregnancy complications

- previous breastfeeding stress and difficulties

-grief and loss, or if you experienced chronic stress and/or emotionally unavailable parents as a child

If you are typically someone who doesn’t like to ask for help, you need to practice before Baby comes. Because you will absolutely need it, from your current support system and others you have yet to meet who can help. We were not built to cope with the many challenges that come with new parenthood alone.

What we all need to be clear on is this — mental health heavily impacts the early connection we have with our babies, and how we enter parenthood. When mental health during pregnancy is treated as less important than physical health, there can be long-lasting implications for the family.

Much of the stress that new parents experience is rooted in the difference between our expectations and the reality of this new pace of life. Feelings of not measuring up and perceived (and real) judgment from others run rampant, like somehow if we’re not Instagram ready with our glowing bellies and coordinated nurseries, we’re falling behind everyone else. Adjusting expectations to allow for some self-compassion, imperfection, levity, and room for conflicting feelings is essential for us to be able to enjoy our experience during the third trimester and entering into the postpartum period, when we are even more vulnerable.

Here are some indicators that it’s time to reach out for support:

-You’re not enjoying things you have typically enjoyed in your daily life.

-Your thoughts are keeping you awake.

-You’re noticing an increase in irritability and less patience for those you love, or people you interact with when you’re out driving, at the store, or at work. You may notice a sense of rage that’s unfamiliar.

-You’re feeling persistent dread and worry, either about specific things (i.e. childbirth, crowded places) or generally/about numerous things.

-You’re having a hard time letting things go- repetitive thoughts, habits, or rituals.

-Mood swings, crying for no apparent reason, difficulty connecting feelings with present circumstances.

-Feelings of major resistance to change, feeling closed off to your partner or friends, disconnected from the present moment.

-Increased conflict with your partner, feelings of resentment and disconnect.

-Persistent negative feelings about your body, the pregnancy, previous pregnancies, or the current pregnancy. Negative feelings about the future are hard to move on from.

-It’s too difficult to forgive yourself for mistakes; you may blame yourself for things that you rationally know are not your fault.

-Daily basic functioning feels like a big chore and overwhelming to keep up.

-Coping and relaxation strategies that were previously helpful are no longer effective.

-Frequent fatigue, rapid heartbeat, or other physical symptoms of stress, not otherwise explained.

-Intrusive thoughts, feelings of wanting to harm yourself or others, and delusional beliefs should be treated as soon as possible.

Many expecting parents may avoid seeking out help- due to stigma, fear of being judged, lack of support for seeking therapy by family members, cost of therapy, time constraints, or lack of accurate information. Fearing that medication will be prescribed, they want to protect the baby from potential risks associated with psychiatric medicine in utero and while breastfeeding. As I can professionally and personally attest to, and as the research confirms, there are many safe options to help if medication is warranted. Always go to a reproductive psychiatrist whenever possible to discuss medications, as they are the best sources of this information and will not prescribe if not the best option for you and baby. One factor that thoughtful reproductive psychiatrists take into account is the cumulative impact of chronic stress on the baby. If medication helps you to be happier and more stable, and better able to take advantage of therapy, then this is important to consider!

If you or someone you know is pregnant and dealing with any of these concerns, it is best to reach out for support early. Seeking help sooner will ensure less stress is passed on to baby, as well as better coping strategies and improved mood for the pregnant parent to enjoy the new chapter of life when baby is born and comes home. In a safe and secure therapeutic relationship, expecting parents can emotionally prepare themselves and their relationship with meaningful tools and insight that have short and long-term invaluable impact. With this therapeutic support in place, I’ve witnessed new parents in my practice find strength and resilience within themselves — they can focus on what matters, practice gratitude, and find joy and fulfillment in their lives and with their children.

To learn more, check out Postpartum Support International, 2020 Mom, and any of Karen Kleiman’s books.

To learn more about me, my psychotherapy practice, and new parenting classes, go to www.happyparentshappybabies.com or email me directly at emilygriffinlicsw@gmail.com with any questions!