There may be times in our lives when we feel overwhelmed or anxious. For women, pregnancy is one of those times. Aside from the physical changes, women may also feel overcome with unfamiliar emotions. University of Iowa Hospitals and Clinics Departments of Obstetrics and Gynecology and Psychiatry formed a joint venture in creating the Women's Wellness and Counseling Service to address women's mental health needs. Joy Moel, MD, counseling psychologist at UI Women's Health Clinic located in UI Hospitals and Clinics, talks about the counseling services:
Are all pregnant and postpartum women screened for mental concerns while pregnant or postpartum?
Surprisingly, no. Some places around the state have started to implement universal screening for depression during pregnancy and within the postpartum period, but this is really a relatively new phenomenon. The primary concern for providers has been that they didn't have anywhere to send women if they identify a woman who might have a clinical mood disorder. Now that we have opened the Women's Wellness Clinic at the University of Iowa Hospitals, we can offer providers a place to send women for help once they have been identified as possibly depressed or anxious in the postpartum or perinatal period.
What is considered 'normal' for pregnant and postpartum women to deal with emotionally?
Obviously having a baby is a major life transition, whether it's your first or your fourth. Like all life transitions, there are normal changes, worries, and stresses that come up. Having a baby, obviously, presents some physical changes for women. Some symptoms of depression and anxiety overlap with appetite and weight fluctuations, feeling fatigued, and having difficulty with sleep—common things for women to experience during pregnancy and postpartum. Often these symptoms can be overlooked by women and their doctors, when they may also be indications of depression.
Are there particular indications that women and their families should be aware of to know if she may need professional help?
Symptoms and signs to be looking for include:
- Sadness
- Hopelessness
- Losing interest or pleasure in things usually enjoyed
- Worrying
- Difficulty sleeping when the baby is asleep
- Guilt
- Low self-worth,
- Frequent crying spells
- Thoughts of death or harming herself or the baby in any way
Mom is usually the most important person in the newborn's life, and she can be overlooked.
It's really important, not only to the woman's health, but to the newborn and the family's health, that mothers are cared for.
After her baby is born, does the risk of depression or anxiety subside, or can it get worse?
Most women don't suffer from clinical depression or anxiety. We've found that about 13 percent of women do have clinical depression or anxiety. It can be higher in certain groups of women and lower in others. The postpartum blues, for instance, is very common—about 80 percent of women experience that right after delivery.
We have found that it doesn't necessarily get better in the postpartum period, and in fact it can get worse. Women, who experience depression or anxiety during their pregnancy, are at higher risk to experience it after they deliver. After the baby is born, women are more likely to be fatigued and overwhelmed by all the demands and responsibilities of care taking. Marital satisfaction has been shown to decline after the birth of a child. All of these factors put women at greater risk to experience difficulties after the baby is born.
What is your role as a counselor when you see someone for the first time? How long does the average patient remain in counseling?
Women should seek help if they have symptoms and they:
- Occur more days than not for more than two weeks
- Interfere significantly with their functioning at home or work
- Interfere significantly with their ability to care of her children, or they're
- Impact her significant relationships
My role as a counselor is to get to know her, to understand her experience, develop a shared understanding of what's contributing to her difficulties, and collaborate with her on developing goals and a plan for treatment. We offer brief services at the Women's Wellness Clinic and that's usually on the order of maybe 10 or 12 weekly sessions. Typically these sessions are an hour long. However, some women are seen for a much shorter time and others are seen for a somewhat longer period of time. Some women who travel longer distances aren't able to make weekly appointments and we are flexible to meet the needs of all the women we serve. My experience is that it's most helpful to meet regularly and weekly for at least six to eight sessions to get a good response from treatment.
We have focused more on pregnant and postpartum women this morning. Does the Women's Wellness and Counseling Service also counsel woman on other issues and stages of their lives?
Our primary area of expertise is in working with perinatal women, however we do see and work with many other issues. We hope to extend our services as we grow our staff and space. We often refer to counselors in the community. In the near future, we hope to extend services to women struggling with issues surrounding infertility or pregnancy loss, reproductive cancers, or menopause.
If someone wanted to learn more or perhaps make an appointment, where would she start?
I recommend that women talk with their doctor or their women's health care provider. Currently, we're not able to accept self-referrals, but UI Hospitals and Clinics doctors can make an internal referral. Providers outside the hospital can visit our Web site for referral information. Women can also visit the Web site or call at 319-356-2294.
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