Part 2: The Healing Path Around & Through PMADs

Part 2 : the healing path around & through postpartum mood and affective disorders (PMADs)

a conversation with Jenevieve Russell, MA, LPC, CD & Kate Kripke, LCSW of Boulder, CO

Part 1 of our blog, “The Healing Path Around and Through Postpartum Mood & Affective Disorders (PMAD’s)” introduces the topic of postpartum mood and affective disorders, and explores the proactive strategy of learning to “mother the mother” so as to better meet PMAD’s wherever they may show up in the postpartum season.

Part 2 of this blog offers a more in depth look into postpartum mood and affective disorders in conversation with Kate Kripke, LCSW & Jenevieve Russell, MA, LPC, CD of Boulder, CO, who offer professional insight into how to recognize PMAD’s, and how to engage with the most effective navigational tools to successfully steer through the new postpartum season.

Perhaps the most vital place to meet the conversation about postpartum mood and affective disorders is to emphasize their prevalence, with intention to begin chipping away at the stigma and lore surrounding postpartum mental health.

Kate Kripke, LCSW states, “There continues to be so much stigma around PMADs. These mental health challenges are more common than many of the other challenges experienced during pregnancy, and it is the least talked about.”

PMADs are known to affect about 1 in 5 women, but these statistics only account for the women who reach out for help, the number is most likely much higher. The reality of PMADs is that every woman remains at risk for experiencing “the baby blues” on some level of the spectrum postpartum, simply due to the seesaw of immediate biological shifts in hormones compounded with the an increase of psychological and social stressors.

Kripke adds, “What we know is that every single woman is at risk for PMADs because within 24 hours of giving birth, her estrogen and progesterone drop below pre pregnancy levels. This is a huge shift in hormones. It’s not about where the hormones land, but its that dramatic shift of hormone levels, and some women are more vulnerable to that shift.”

Vulnerability to this hormonal shift can increase when there has not been a system of physical and emotional support implemented to care for a new mother as stressors in other areas of her life arise postpartum.

Jenevieve Russell, MA, LPC, CD states, “There are so many layers… biologically, some women are more sensitive to hormonal shifts. On a psycho social level, when there is inadequate support combined with this idea of perfectionism, this superwoman pressure to be a certain way as a mother, to not want to ask for help but also want everything a very specific way, this can impact stressors a lot.”

Kripke continues, “It all can become a perfect storm…sleep challenges, nutritional deficiencies, psychological challenges that happen around identity, relationship conflict, stressors with other children at home. One of the things no one talks about is that when we look at our child for the first time, all of the stuff from how we were mothered comes up as well.”

Bringing awareness to mothers about the reality and intensity of these shifts, on a biological, but also on a psychological and social level, is vital in the effort to get mothers to notice symptoms sooner and reach out. The faster a mother can get help, the less likely she will be to have to use drugs or more intensive care to combat anxiety and depression postpartum.

How can I recognize PMADs?

A common series of questions that arise for families ready to welcome a new baby into the home is, what is “normal”? What do PMADs look like? How can I prevent it?

Kripke states, “It is really important to distinguish between what is common and what is normal. When I have women in my office, it is not appropriate to tell them ‘depression and anxiety are normal.’ Depression and anxiety are common, but not normal.”

Kripke continues, “PMADs are a subjective illness. My level of anxiety might be different that your level of anxiety tolerance. What feels like a symptom to me may not feel like a symptom to someone else. We ask, what is someone’s baseline? What feels healthy to them or doesn’t? What I want to tell parents is, are you worried about how you’re feeling? If yes, we go into deeper assessment.”

As far as prevention, Russell states, “I don’t like to use the word ‘prevent,’ as it sets moms up for the anxiety of ‘I should have done something,’ but there are things we can do to reduce anxiety, reduce depression, and there are some risk factors to look at before hand. It’s about finding ways to set each mother up for success.”

Setting up a wellness plan before baby comes that situates around the individualized needs of each family is a crucial component in steering this path towards success. A willingness to shed the culturally constructed “DIY” mentality to motherhood, and lean into a support system that can “mother the mother” creates an environment where both mama and baby can thrive.

Russell adds, “There is not so much a checklist to use against PMADs, it is necessary to look at the whole person and create individualized planning. Set up your support ahead of time as much as possible. If lactation is important to you, find lactation support. Find food support, have people to bring in prepared food. Getting postpartum doula support can be critical.”

Baby’s needs are vital, but they are very much dependent on the mother. Mama can best meet her child’s needs if her own basic needs of food, sleep, hydration, fresh air, and compassionate emotional support have been fulfilled as well. A postpartum doula can offer this sort of individualized care for families, and also bear witness to the unique experience each mother goes through during her postpartum season.

Russell continues, “Wellness strategies can be really important to bring in. As a birth doula, often one whole prenatal visit just focuses on asking, ‘what does it look like when you bring baby home?’ and, ‘what is your support system?’ Asking these questions ahead of time is so important.”

Kripke says, “Too often moms are being told ‘you’re just a new mom, of course you’re not sleeping!’ We still have so much work to do in training our providers to know the difference between normal postpartum adjustment and more clinical suffering. We don’t want to overreact, but we also don’t want moms verging into the area of suffering and dismissing them. What we need is someone on the front line to see that mom and help her get there.”  A postpartum doula in the house is able to assess and pay attention.

Although a postpartum doula does not diagnose or treat illnesses, a doula can be a magnificent asset in providing in-home support, and helping mom distinguish whether her struggling has crossed the line from struggle to suffering, and a doula can direct mothers to the appropriate resources to receive the care that she may need.

If you or someone you love wants to include postpartum doula care in their wellness strategies, please learn more about Sanctuary Postpartum Doulas and contact us. If you live outside our service area or want to explore other professional resources, please enjoy our resources.

feature photo: Casie Zalud Photography

Joel Peterson Photography

Jenevieve Russell, MA, LPC, CD draws on her vast, eclectic experiences and specialized training in supporting families before, during and after birth. She has supported hundreds of families and new moms as a licensed professional counselor at Nurturing Strategies, as a certified birth doula with Doulas of Boulder and co-founder of JOY Collective – a pregnancy, parenting wellness center of 15 leading practitioners to serve families from fertility through early the heart of Boulder, Colorado. Jenevieve’s psychotherapy practice focuses on healing birthing experiences, pre and postnatal support, perinatal mood & anxiety disorders and couples counseling. She facilitates a weekly support group for Parents with BabiesShe also mentors newer doulas.





Kate Kripke, LCSW is the founder and director of the Postpartum Wellness Center of Boulder.  In addition to her clinical work with women and families around the prevention and treatment of perinatal mood and anxiety disorders, Kate is a state coordinator for Postpartum Support International and a member of the maternal mental health advisory committee for the Colorado Department of Public Health. She provides frequent training to physicians, nurses, birth professionals, therapists and educators around the state.


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