Know the difference between “baby blues” and perinatal mood and anxiety disorders

Let’s talk about the difference between “baby blues,” perinatal mood and anxiety disorders (PMADs), and postpartum psychosis.

Baby blues are very common. About 80 percent of mothers experience mood swings and weepiness during the first two to three weeks after baby arrives. This is totally normal due to the huge hormonal changes that occur during and after childbirth. Acute sleep deprivation is also a factor. Baby blues usually disappear on their own with proper rest, nutrition and support.

If mom continues to struggle with mood or anxiety for longer than about two weeks, it could be a sign of a more clinical problem such as perinatal mood disorder or perinatal anxiety.

Mood disorder is an umbrella term that can include depression and bipolar disorder. Anxiety disorder is an umbrella term that can include anxiety, panic disorder and obsessive-compulsive disorder. Symptoms for mood disorders may include:

  • feelings of sadness
  • feelings of emptiness
  • crying spells
  • irritability or rage
  • sleep disturbances
  • apathy
  • lack of energy/motivation, decrease in personal care activities
  • feeling overwhelmed
  • appetite changes

*This is not an exhaustive list, just some common symptoms.

Symptoms for anxiety disorders may include:

  • frequent worry
  • panic, fear of losing control
  • physical symptoms such as increased heart rate and breathing, feeling keyed up or on edge, inability to relax or sleep
  • intrusive thoughts, obsessing over care for baby

*This is not an exhaustive list, just some common symptoms.

Fortunately, perinatal mood and anxiety disorders (PMADs) are very treatable. Moms do not need to suffer with symptoms. As we like to say at Postpartum Support International: “You are not alone. You are not to blame. With help, you will be well.”

There are two peer-to-peer support groups serving moms in the Huntsville/Madison area, including one run by Teresa Fleischmann through Postpartum Support International-Alabama. To attend this group, send an email to teresapsialabama@gmail.com. The other local support group is organized by Mama Circle. Check them out on Facebook.

There are also a number of national support groups with very specific topics that meet online. You can learn more about these groups here.

Postpartum Support International has coordinators in every state to provide moms with support and encouragement and connect moms with local resources. If you need help, just call 1 (800) 944-4773.

If mom or her support persons want to seek therapy, email psial@postpartum.net and they can provide a list of vetted mental health professionals in the Huntsville area who have specific training in treating perinatal mood and anxiety disorders (PMADs).

Prescription medications are another option. At Postpartum Support International, we support whatever decision a mom makes in regards to taking or not taking medication for PMADs. There is a lot of stigma and misinformation about mothers taking medication during pregnancy or while lactating, so we encourage moms to empower themselves with evidence-based information. A good place to start is here.

While up to 20 percent of new moms will develop a perinatal mood or anxiety disorder, postpartum psychosis is very rare. It is also a medical emergency. A mom who experiences postpartum psychosis may have a break from reality, experience hallucinations, become paranoid or act manic. Postpartum psychosis symptoms usually appear within the first 72 hours to two weeks after birth.

Even though we have focused on mom in this blog, we can’t forget our dads/partners. We don’t want them to fall to the wayside and silently struggle. Click here for more information about dads and PMADs.

 


Alicia Schuster-Couch, MA, LPC, PMH-C

Board Chair of the Alabama chapter of Postpartum Support International

What’s the difference between eclampsia and preeclampsia, and what are the symptoms?

Most births happen without incident, but sometimes excessive bleeding and high blood pressure can occur. These are the two leading preventable causes of childbirth harm to moms.

Make sure to pay attention to your blood pressure readings leading up to your due date. The changes that happen to a woman’s body during pregnancy put her at greater risk of developing high blood pressure (also called hypertension). It can occur before, during and after you deliver your baby.

High blood pressure during pregnancy is known as preeclampsia. It usually develops after 20 weeks gestation, often in the third trimester. You may also have protein in your urine.

Preeclampsia can lead to eclampsia, a dangerous condition that can cause seizures during pregnancy. Fortunately eclampsia is relatively rare, affecting about 1 in 200 women with preeclampsia.

The symptoms of preeclampsia and eclampsia typically disappear within days of giving birth. However, some women continue to be affected up to 6 weeks after delivery.

If you are diagnosed with preeclampsia or eclampsia, your doctor may prescribe medication to lower your blood pressure, protect your organs and prevent seizures.

Know these preeclampsia warning signs:

  • High blood pressure during pregnancy (140/90 or greater) may be a sign that preeclampsia is developing
  • Know what your blood pressure was at the start of pregnancy — particularly if it is normally low

If you have any of the symptoms below during pregnancy, call your OBGYN provider:

  • Swelling of the face or hands
  • A headache that won’t go away, even after taking medication
  • Blurry vision
  • Seeing spots or flashing lights
  • Difficulty breathing
  • Sudden nausea or vomiting after the second trimester
  • Pain in the upper-right belly that feels like indigestion

 

 

A systolic blood pressure (the first number) of 160 or higher, or a diastolic blood pressure (second number) of 110 or higher during pregnancy, is dangerous — and needs urgent treatment.

Remember: Many women who get preeclampsia do not have clear risk factors. Talk with your provider right away if you have any of the warning signs listed above.

Here are some helpful tips for managing hypertension during pregnancy:

  • Go to all scheduled doctor’s appointments. Your provider will check your blood pressure and may order other tests.
  • Rest as directed. Your provider may tell you to rest more often if you have mild symptoms of preeclampsia.
  • Check your blood pressure as directed if you have chronic hypertension. Sit and rest for 5 minutes before you take your BP. Extend your arm and support it on a flat surface. Your arm should be at the same level as your heart. Follow the directions that came with your blood pressure monitor. Take your BP as often as directed. Keep a record of your BP readings and bring it with you to your follow up visits.

    Tammy Baer, RN
    Clinical Education Specialist for Labor & Delivery, Antepartum and the OB Emergency Department at Huntsville Hospital for Women & Children

Everything you need to know about your Labor & Delivery experience

Before coming to the hospital to deliver your baby, you should always discuss your birth expectations with your OB provider.  They will let you know what is realistic for your situation.

Also, don’t forget that you can take a virtual hospital tour by clicking one of the links below:

Huntsville Hospital for Women & Children virtual tour:
https://www.hhwomenandchildren.org/images/PDFs/Women-and-Children-Maternity-Tour-web.pdf

Madison Hospital virtual tour:
https://www.madisonalhospital.org/images/PDFs/Madison-Maternity-Tour-web.pdf

Now that you are here to have your baby, let’s get to the good stuff! What can you expect during your stay, and what do you need to bring with you?

After you are checked into Labor & Delivery, the fun begins. As you prepare to meet your new baby, your nursing team will be doing everything to ensure a safe arrival. Your baby’s heart rate and your contractions will be monitored by advanced fetal monitoring and continuously evaluated by your nurse and OB.

No worries, they are trained to care for anything that comes their way! Check out our blog post on pain management options while in labor.  https://ohhbaby.org/know-your-options-for-pain-management-in-childbirth/

Once baby makes his or her entrance by vaginal or Cesarean delivery, baby will be placed skin to skin on mom’s chest. If for any reason baby needs extra help at delivery, he or she will come back to mom as soon as possible. Specially-trained nursery nurses are on standby for that extra help, if needed.

We recommend that baby stay skin to skin with mom for the first hour of life (known as the Golden Hour). This will help regulate baby’s breathing, blood sugar and temperature. It also helps mom bond with baby and establish breastfeeding.

Mom, while you enjoy meeting your baby, your nurses will be rubbing your belly and monitoring your bleeding. This is the most unpleasant part of post-delivery, but we need to make sure your bleeding is controlled.

Once your bleeding is under control and you are able to stand, you and baby can be safely moved to a postpartum (Mother Baby) room. This is where you will remain for 2-3 days, depending on the type of delivery.

Baby will room-in with mom and only needs to go to the nursery for circumcision (for boys) or if they are having difficulties. Throughout your stay, our Mother Baby nurses will be providing lots of education on how to care for yourself and your baby. If you have questions, don’t be afraid to ask!

You will spend most of your time in Mother Baby feeding and changing baby and getting rest. It’s a good idea to rest when baby rests – you’ll need energy to care for baby once you get home.

Baby will have several tests done before going home. The doctors and nurses will ensure that baby’s bilirubin/jaundice level is OK and that they are eating, peeing, and pooping normally. You will need to make plans to follow up with your pediatrician within 2-3 days of leaving the hospital.

While both Huntsville Hospital for Women & Children and Madison Hospital will provide any essential items for you or your baby, many women find it more comfortable to have their own care items. Here’s a check list of what to bring with you to the hospital:

  • Birth plan (contingent on medical advice and safety)
  • ID for all caregivers
  • Insurance cards
  • List of home medications
  • Comfortable clothes
  • Pajamas
  • Robe
  • House shoes
  • Nursing bra
  • Hair brush
  • Shampoo and conditioner
  • Toothbrush and toothpaste
  • Deodorant
  • Hair ties
  • Contacts or glasses if you wear them
  • Cell phone and chargers
  • Camera
  • Cash for vending machines
  • Portable speaker and playlist for labor
  • Going home/picture outfit for baby (we recommend a onesie because baby will still have umbilical cord stump attached)
  • Car seat (the hospital will not provide this for you). Hospital staff is not certified to secure or inspect your car seat, so be sure to have it checked prior to arrival.

This blog post is intended for uncomplicated/well deliveries. Please consult with your physician for special requests or needs.

Renee Colquitt, CRNP, NNP-BC
Renee Colquitt, CRNP, NNP-BC
Director of Perinatal Services at Madison Hospital
What to expect when expecting

What to expect when you’re expecting

Your bag is packed, you’ve lined up a pediatrician and finished decorating the nursery.

But do you know what to expect when you arrive at the hospital to deliver your baby?

At Huntsville for Women & Children and Madison Hospital, our goal is to make the entire childbirth process – from check-in to postpartum care – as smooth as possible for you and your family. And that starts the moment you step onto our campus.

At both Huntsville Hospital for Women & Children and Madison Hospital, expectant mothers can drive right up to our covered front entrance. Please let our attendant know if you need a wheelchair. Once inside, you will be directed to take the elevator to the Labor & Delivery Unit on the second floor.

If you are coming for a scheduled delivery, after checking in we’ll screen you and any support persons for COVID-19. As of March 6, 2021, Labor & Delivery, Mother Baby and Antepartum patients can have two designated caregivers at the bedside. For the most up-to-date visitor guidelines at Huntsville Hospital for Women & Children click here. For Madison Hospital guidelines click here.

Vaginal births take place in our modern, spacious, labor-delivery-recovery suites. For Cesarean deliveries, we have a dedicated surgical team and multiple operating rooms specially designed for childbirth. These areas are meticulously cleaned and disinfected daily by our professional environmental services staff.

Your safety is our top priority. Our staff is vigilant about sanitizing their hands and will wear the appropriate PPE while caring for you. You can help us by please wearing a mask when hospital staff is in your room.

If you are not scheduled for delivery but suspect you are in labor, it’s still important that you come to the hospital to be assessed – even if it’s the middle of the night.

At Huntsville Hospital for Women & Children, after checking in you will be taken across the hall to the region’s only OB Emergency Department. Here our board-certified OB hospitalists will determine if you are in labor and baby is coming. If so, you will be admitted to the Labor & Delivery Unit.

At Madison Hospital, our highly-trained labor and delivery nurses or an on-duty obstetrician will assess your labor and determine if it’s time to admit you to the hospital for the big moment.

As soon as baby arrives, our goal is to place your precious newborn on your chest for skin-to-skin time. Multiple studies have shown this is one the best ways to relax your baby, stimulate their interest in breastfeeding, and create an immediate bond between mother and baby.

On behalf of our entire staff, thank you for allowing us to care for you and your baby.


By Jade LeCroix, RN, BSN, MMHC and Renee Colquitt, CRNP, NNP-BC

Jade LeCroix, RN
Jade LeCroix, RN, BSN, MMHC
Director of the Labor & Delivery, Antepartum and OB/GYN Emergency Department at Huntsville Hospital for Women & Children
Renee Colquitt, CRNP, NNP-BC
Renee Colquitt, CRNP, NNP-BC
Director of Perinatal Services at Madison Hospital
Neonatal ICU at Huntsville Hospital for Women & Children

What do Neonatal ICU levels mean?

You may have heard that Huntsville Hospital for Women & Children has a Level III Neonatal ICU and that Madison Hospital has a Level II Special Care Nursery. But what does that mean?

Neonatal refers to the first 28 days of life. Some babies require more advanced care during these first days because they were born prematurely or with certain medical conditions. Our community is fortunate to have access to this specialized care, but understanding the different levels of neonatal care can be confusing.

It’s important for expectant parents to learn about neonatal care especially if they are aware of a risk for premature birth or congenital defect. Alabama law does not require hospitals to meet certain standards in order to claim an elevated level of care, so I recommend that parents talk directly with their hospital to be sure they understand the specialty care available.

As recently as 2012, the American Academy of Pediatrics (AAP) published a policy statement which recommends “uniform, nationally applicable definitions and consistent standards of service for public health to improve neonatal outcomes.” The AAP also listed the following classifications for neonatal care:

  • Level I
    A hospital nursery able to evaluate and provide care of healthy newborn infants and babies born as early as 35 weeks whose condition is stable;
  • Level II
    A hospital special care nursery able to care for infants born at 32 weeks’ gestation or more and weighing 1500 g (3.3 lbs) or more at birth;
  • Level III
    A hospital neonatal ICU that provides specialized care for premature babies and babies with critical illness. Level III units routinely provide ongoing assisted ventilation, have ready access to a full range of pediatric medical subspecialists, and have advanced imaging with interpretation on an urgent basis;
  • Level IV
    A hospital neonatal ICU with the same capabilities as a Level III NICU but can also provide surgical repair of serious congenital or acquired malformations.

Huntsville Hospital for Women & Children has the only Level III Neonatal ICU (NICU) in North Alabama. It is staffed by a team of five board certified Neonatologists and a Neonatal Hospitalist. Our physician team is supported by neonatal nurse practitioners and neonatal registered nurses certified by the American Heart Association’s Neonatal Resuscitation Program (NRP). Many also hold an additional Neonatal Intensive Care Certification.

Also unique to North Alabama, several of our nursing team members make up an innovative dedicated Small Baby Team, which is specially trained to care for the smallest and sickest babies. The NICU routinely adopts innovative care practices like the Small Baby Team as well as advanced treatment methods including high frequency oscillatory ventilation, nitric oxide and induced therapeutic hypothermia. Recently the hospital opened the region’s only Infant Nutrition Lab.

The same highly qualified physician team at Women & Children also oversees the care of babies in Madison Hospital’s Level II Special Care Nursery, allowing families who live in communities closer to Madison more specialized services than a Level I hospital nursery.


By Lee Morris, MD

Lee Morris, M.D.
Neonatologist
Huntsville Hospital for Women & Children Level III Neonatal ICU

Know your options for pain management in childbirth

Your pregnancy brings with it many choices. You pick a physician, a hospital, baby names, paint colors and the list of decisions doesn’t stop there. Making an informed choice about pain management during labor and childbirth should be at the top of your decisions list. Some of the pain management options discussed below are not available to everyone because of existing medical conditions and side effects. Your OB-GYN can help you determine what’s best for you and, at the very least, needs to know your preferences and expectations.

Natural Childbirth

Nursing staff at both Huntsville Hospital for Women & Children and Madison Hospital are experienced with helping women through natural childbirth, which is childbirth with no medications. Many women want to prepare for natural childbirth by relying on techniques such as relaxation and controlled breathing to manage pain. The best way to learn more about and practice these techniques is through a certified childbirth class. We have a variety of labor tools including birthing balls and birthing stools. With your physician’s approval, you can also labor immersed in water, called hydrotherapy. At Women & Children this can be done in your room’s bathtub. At Madison Hospital, our staff is happy to accommodate hydrotherapy but you will need to bring your own inflatable tub. It’s important to understand that circumstances may arise during labor that lead to a determination by your care team that hydrotherapy is not a safe option.

Nitrous Oxide (laughing gas)

Nitrous oxide is a colorless, odorless gas that’s mixed with oxygen and used to help pregnant women cope with labor pains during active labor. It does not numb any part of your body and doesn’t reduce pain like a narcotic, but it can reduce anxiety and provide a disassociation from your pain. This means you might still feel pain, but you won’t be as bothered by it.

Patients inhale the gas through a mask placed over the nose and mouth. It is self-administered so women can use it as needed during labor, pushing, and after-birth repair. Nitrous oxide quickly leaves the body’s system in three breaths allowing laboring moms to walk, stand and use other labor techniques in combination with nitrous oxide.

Nitrous oxide has no negative effects on fetal heart rate and it does not affect breastfeeding or breast milk. It cannot be used if you are receiving pain medicine through an IV.

Epidural

An epidural is technique of using a catheter – a very thin, flexible, hollow tube – that’s inserted into the epidural space just outside the membrane that surrounds your spinal cord and spinal fluid. The catheter delivers continuous pain relief to the lower part of your body while allowing you to remain fully conscious. This is a popular choice for women who don’t want to feel pain but also don’t want to feel medicated or “fuzzy” during labor and childbirth. With an epidural, you must stay in bed because it causes your abdomen and legs to feel numb. Before the procedure to place the epidural can begin, you will provide written consent, your physician must write the order, your nurse will start an IV to deliver fluids and your blood will be collected for lab tests. Some women may also need a urinary catheter.

IV Sedation

Pain medicine can also be given through an IV. Typically this method of pain control causes the mother to feel sedated because the medicine distributes throughout the entire body. Women who use IV sedation must stay in bed to labor because they are at risk of falling.


By Jade LeCroix, RN and Renee Colquitt, CRNP

Jade LeCroix, RN
Jade LeCroix, RN
Jade is the Director of the Labor & Delivery Unit, Antepartum Unit and OB/GYN Emergency Department at Huntsville Hospital for Women & Children.
Renee Colquitt, CRNP, NNP-BC
Renee Colquitt, CRNP, NNP-BC
Renee is the Director of Perinatal Services at Madison Hospital.

Why we needed breastfeeding support

A collection of thoughts and comments from members of our breastfeeding support groups

Madison Hospital and Huntsville Hospital for Women & Children host several breastfeeding support groups on their campuses. An Internationally Board Certified Lactation Consultant facilitates the group and provides assistance to mothers in attendance. At their request, we’re sharing thoughts and comments from these appreciative breastfeeding moms.

I was ready to quit and give up on breastfeeding. I hated pumping and didn’t feel like I was getting enough to keep with it, but my husband encouraged me to call breastfeeding support. I found the group experience to be nothing like what I’d thought it was going to be. It was welcoming and forgiving, and I wished I’d gone sooner.

It’s a place to go to get help, but it was also a great opportunity to connect with other moms, which made me feel like I had a team who really wanted me to succeed. I needed this outlet to express my frustration of knowing I had enough milk, but still not being able to get my baby to breastfeed. I needed to talk with other moms who were having their own challenges – and triumphs. I learned that I had experiences that could help some less experienced moms, and at the same time I was learning from other veteran moms.

I would encourage every Mom to attend the breastfeeding support group. We’re five months strong now, and I know I’ll continue to attend on Saturdays with Harper until we reach a year.

AMANDA TOWRY
Amanda is a nursing mom of two. She breastfed her son for one year until her son self-weaned when she became pregnant with her daughter. She’s been breastfeeding her daughter for six months.

I wanted to have a successful breastfeeding relationship, and I needed help weening myself off a nipple shield. But, the single most valuable thing I learned was that I was enough for my child. My nursing relationship with my baby has been so easy because of the support I have through this group. Now I’ve realized that this is my passion. I’ve decided to become a certified lactation consultant.

JESSICA DARBY
Jessica is a first-time mom to a 14-month-old boy. She has lived in the Madison area for three years with her husband, Ethan. She works part time as an office manager and hopes to become an International Board Certified Lactation Consultant in the future.

When I went back to work my baby became frustrated at the breast. I started coming to the support group to get help to keep him at the breast and now I feel much more confident in my ability to breastfeed. On top of that, I have found friends for my son and for myself and I have more emotional support than I could of ever imagined.

LAUREN PATTERSON
Lauren is a first-time mom to an 18-month-old son who was born four weeks early and spent eight days in the Neonatal ICU at Huntsville Hospital for Women & Children. He is now thriving and exclusively breastfed.

I joined the support group because it had been five years since I breastfed my first set of twins. Although I had learned a lot of new breast-feeding information from a breastfeeding class I attended, I needed assistance to help my baby girl latch. She was significantly smaller than her brother and spent some time in the NICU, which meant she had some extra challenges.

The lactation consultants taught me how to supplement with formula appropriately so both my babies would benefit from my breast milk, and I could ensure they received all the nutrition they needed to grow. They also helped me realize that I am doing the best I can for my babies.

I really appreciate the support towards breastfeeding but also their support when I’ve had to use formula to supplement. They celebrate the small and big victories with everyone. I really enjoy getting out each Tuesday to see how my babies have grown and talk about the successes and challenges we have faced the week prior. This is an amazing group of LC’s, mothers and babies.

ANYA FREUDE
Anya is nursing mom of two sets of twins – five-year-old fraternal boys and four- month-old boy/girl fraternal twins. She nursed her first set of twins for one year and is breastfeeding her younger twins with some formula supplementing.

What’s in a birth plan and do you need one?

The birth of a child is an amazing and wondrous event. It can also be scary, especially if it’s your first. The fear of the unknown can be crippling and terrifying. A birth plan is a way to communicate your wishes to those caring for you during your labor and after the birth of your baby. It is a tool to let the team caring for you know about your preferences.

When you pick your obstetrician, you are choosing the person who will play a huge part in the most amazing, wonderful and scary event in your life. Your obstetrician should be a partner – someone you trust with your new bundle of joy. As obstetricians, we are there to inform, guide and assist in this most intimate moment.

But in order to give you the very best birth experience, we need to have a detailed understanding of your preferences. That’s where the birth plan comes in.

Birth plan worksheets and templates can be found in pregnancy books and of course, online. No matter where you find the template, the birth plan should be a simple, clear, one- or two-page statement of your preferences. Many women, especially first time moms, may need to talk with their doctor to help them decide what their preferences are.

Typical birth plans will include preferences for:

  • Pain medication (none, IV, epidural or nitrous oxide)
  • Movement/position during labor and delivery
  • Labor props (tub, birthing ball, squatting bar, stool, etc.)
  • Induction/intervention/augmentation (breaking of water, pitocin)
  • Support people (spouse, parents, Doula, extended family)
  • Fetal monitoring (intermittent vs. continuous)
  • Position and timing of pushing
  • Episiotomy
  • Delivery assistance (vacuum, forceps)
  • Fluid management (to have an intravenous line (IV) or not) and food/liquid intake
  • Ability to photograph or video (this will differ at each facility and with each health care provider)
  • Environmental preferences (lights, music, scents, etc.)

After delivery preferences

  • Cord clamping
  • Skin to skin (putting baby on your bare skin immediately following delivery)
  • Medication/bathing
  • Breastfeeding vs. bottle feeding
  • Pacifier use
  • If male child – circumcision

Keep in mind you can’t control every aspect of labor and delivery. During childbirth many women feel like they are losing control. A birth plan can help maintain focus and it also serves as a refresher for your healthcare provider and serves to inform new members of your medical team about your preferences when you are in active labor.

A birth plan can be a way to ‘marry’ your idea of the birth experience with the obstetrician’s idea of a safe and ‘normal’ labor and delivery. It is important to ensure that everyone is on the same page and is comfortable with the plan of care. Also, each hospital and obstetrical department has its own policies and procedures. Discussing the birth plan gives an opportunity to gain information about those policies and procedures.

It is important to stay flexible in case something comes up that requires your birth team to depart from your plan. Remember, the important thing is having a safe birth.

Our goal with every new mom (and dad) is to have a happy healthy mom and a healthy baby.


By Whitney Dunham, MD

Whitney Dunham, MD

Whitney Dunham, M.D.
Dr. Dunham is the Medical Director of the OB Hospitalist Program at Huntsville Hospital for Women & Children. She also cares for patients at Huntsville Hospital Obstetrics & Gynecology.

This information highlights the services of the HH Health System as well as current health topics important to families. The information is not intended to replace the advice of a physician. Every person is different, so please contact a physician to help you make the appropriate health care decision. HH Health System has made an effort to ensure the accuracy of the information at the time of publication.

Huntsville Hospital for Women & Children
245 Governor's Drive • Huntsville, AL 35801
Driving Directions | Website
(256) 265-1000

Madison Hospital
8375 Highway 72 • Madison, AL 35758
Driving Directions | Website
(256) 265-2012

Copyright © Huntsville Hospital
Website Development by Red Sage Communications, Inc.

Maternity materials order form for OB offices