Perinatal health encompasses multiple women’s mental health issues related to pregnancy and the postnatal period. During these times, clients may be at increased risks for depression, anxiety and related mental health needs. Perinatal care providers often see clients for other needs such as infertility, miscarriage and infant/child loss and grief.
Why is this important for clinicians to know?
Clinicians can provide preventative care and screenings to access for specialized service needs. Early intervention can help minimize the impacts of these issues on the mother and child. Maternal health services can also provide support for life changes as a part of routine perinatal progression.
Many women receive benefits such as education and planning related to finding a trauma-informed provider, developing a birth plan that is empowering and fits their lifestyle, and planning for support needs during and after pregnancy. Providers can also aid in finding and advocating for appropriate support services (e.g., physical therapy for pelvic floor wellness) during and after pregnancy.
Similarly, early intervention and preventative care impacts the development of the child and can serve as a protective factor. The Adverse Childhood Experiences studies and related studies provide the rationale for providing a healthy, safe and nurturing environment for children. This includes the period of being in the womb because epigenetics and maternal health impact a developing child in many ways. In this aspect, preventative care for mothers acts as a protective factor for children.
How can I tell if my client needs specialized services?
Proactive and ongoing mental health services have an array of benefits for clients. As part of your services, providers can monitor and assess the need for specialized perinatal care.
The first step is to receive education on the risk factors and what to look for when working with this population. Risk factors for perinatal issues include a history of mood disorders or related mental health conditions such as depression, anxiety, posttraumatic stress disorder or obsessive-compulsive disorder. Physical symptoms such as hormonal imbalances or prior complications from a past pregnancy, labor, delivery or loss of a pregnancy can also increase these risks. Social factors, such as a lack of support from family or friends, or stressors such as poverty can also heighten the risks for perinatal support needs.
Warning signs may include mothers who are experiencing feelings of guilt, hopelessness or anger, sleep disturbances and related physical symptoms. This can also manifest as mothers having thoughts of hurting themselves or the baby and experiencing a loss of interest in activities that used to bring them joy.
See the screener at the end of this article for added specifics on what to look for with perinatal clients. This screener can be used to assess the need for specialized referral services and can also help you, as a provider, to gather information and monitor ongoing changes during the client’s perinatal period. This helps you to effectively plan for treatment and any related support services, as appropriate.
How do I know if a counselor is trained to provide perinatal services?
PMHC is the official credential for perinatal mental health counseling. If you have access to a certified professional in your area, you can recommend them for perinatal services as part of stand-alone or support services to use in conjunction with the current therapy the client is receiving.
Some locations have limited certified professionals in their area. Other geographic areas have no certified professionals for this population. Clinicians can recommend competent service providers after asking the providers about their training, experience and credentials related to providing these services. Some providers are not certified but still have training in this area or are receiving supervision/consultation to become certified in this specialty.
How can clinicians receive further education and support to provide perinatal services?
Clinicians can attend specialized trainings and also engage in consultation and supervision to build competency in this area. Many continuing education providers now offer trainings related to women’s issues and provide sessions on postpartum depression or anxiety. These can help to increase your awareness of women’s issues.
For clinicians wishing to provide services exclusively to this population, certification is another great way to build your skills for this focused area of counseling. Perinatal mental health certification is available at https://www.postpartum.net/professionals/certification/.
Integrative screener for perinatal health and well-being
The purpose of this screener is to provide a brief reference guide for the identification of specialized service needs. Adjustments and changes to typical routines and day-to-day life are part of pregnancy and postnatal times. To help best meet your needs during this time, a certified perinatal mental health provider can evaluate and assess your specific mental health needs and goals.
This screener can be utilized along with the PHQ-9 and Edinburgh Postnatal Depression Scale. This questionnaire more broadly encompasses base-level indicators for postnatal depression, postnatal anxiety and traumatic birth syndrome symptoms. This screener can be self-administered or administered by a provider, spouse or friend. Please remember that regardless of your screener results, proactive and maintenance counseling can be part of an integrative health plan to help your reach your wellness goals.
Please rate the below statements based on a scale of 1-4: 1 being strongly disagree, 2 being somewhat disagree, 3 being somewhat agree and 4 being strongly agree.
- A) Postnatal depression symptoms
__ I regularly engage in activities that I enjoy.
__ My relationships are as strong as they were before pregnancy/childbirth.
__ I feel as happy as I did before pregnancy/childbirth.
__ I can acknowledge my strengths and appreciate myself as much as I did before pregnancy/childbirth.
__ Total score
- B) Postnatal anxiety symptoms
__ I am able to accept my mistakes and do not dwell on them.
__ I let things go and do not spend time worrying about things I cannot control.
__ I feel as calm and centered as I did before pregnancy/childbirth.
__ I have the skills needed to manage concerns as they come up.
__ Total score
- C) Traumatic birth symptoms
__ I had a positive birth experience.
__ I felt listened to and heard during my birth experience.
__ My wishes were respected during labor and delivery.
__ My providers and supports met my needs during labor and delivery.
__ Total score
- D) Recovery complication symptoms
__ I have recovered physically from labor and delivery.
__ I have recovered mentally and emotionally from labor and delivery.
__ I have the support needed to fully recover.
__ I have the resources needed to fully recover.
__ Total score
- E) For pregnant women only
__ I appreciate my body as much as I did before I was pregnant.
__ I have a healthy perspective.
__ I have the emotional support I need to be well while pregnant.
__ I have the resources I need to be well while pregnant.
__ Total score
Scoring criteria for all indicated areas:
Scores of 3 and 4: Continue your current wellness plan. Continue to monitor symptoms using the screener as needed. Remember to seek a specialist if you feel it is needed, regardless of your scores.
Any scores of 1 or 2: Seek a perinatal specialist.
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Rebekah Lemmons strives to improve outcomes for children, emerging adults and families. For the past decade, her practice and research have primarily been based in the nonprofit sector, with an emphasis on conducting program evaluation, teaching, engaging in service leadership, consulting and providing supervision to clinicians. Contact her at rebekahlemmons@yahoo.com.
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