Online Therapy For Pregnant & New Moms

In the past decade and what I now call typical times, many of the pregnant and new moms I have worked with utilized remote counseling (also called online therapy or teletherapy), as it allowed them access expert help from a maternal mental health specialist without worrying about driving a long distance or weather conditions.

When you have a newborn, the unpredictability of the baby’s schedule, nursing and  your physical recovery or tiredness may mean that getting out of the house to an office appointment can be difficult and teletherapy means that you can get that extra support at the time you are most likely to need it.

Because we are in the middle of a global pandemic, these are not typical times! No woman who became pregnant in the last few months, or gave birth recently, expected to be facing social distancing or the fear and uncertainty Covid-19 has brought and now remote sessions are a necessity not an option.

Becoming a parent is one of the most life-changing transitions you will experience and research over the past two decades has shown that typically 1 in 5 (20%) new moms will experience pregnancy and/or postpartum anxiety or depression and approximately 5-9% of women will experience postpartum post-traumatic stress disorder (PTSD) following childbirth.

We don’t know the statistics yet, but I think the uncertainty, isolation and stress that has accompanied Covid-19, will mean a much greater percentage of women will experiencing anxiety, depression or trauma symptoms. What I do know though, is that when moms are supported, they have a much easier time navigating the challenges of pregnancy and early motherhood.

 

Currently many pregnant and new moms are struggling with these questions:

1. How am I going to cope with the added stress and uncertainty of being a new mom during a pandemic?

2. Is social distancing going to affect my support and leave me isolated?

3. I am typically an anxious person, but how am I going to cope now my anxiety is through the roof?

4. How am I going to cope if my labor experience isn’t how I expected it to be?

Whether you need a few sessions to help the transition, or perhaps longer treatment due to a prior history of anxiety or depression, or a traumatic delivery, it certainly can help to work with a professional who understands how treatment of maternal mental health issues are different from treating general anxiety and depression.

You are not alone in going through this and I know how to empower you by providing short-term, solution focused therapy to develop your coping strategies and process the difficult, conflicting emotions you may be experiencing.

Therapy provides a means of helping you gain a different perspective and insight about what you are experiencing and Cognitive Therapy (CBT) gives you the tools to manage overwhelming emotions.

The important thing at the moment is that you are carving out some time to look after your own mental health. During times of stress, you are more able to deal with your own stress or issues with your family or spouse, if you take time for your own self-care.

 

But Is Remote Therapy An Effective Treatment For New Moms?

Although I have been working with pregnant and postpartum women for 25 years, I only started thinking about offering remote therapy about 10 years ago. I found that because there weren’t enough therapists who had specialist training and experience treating maternal mental health issues, I was getting contacted by women from all over the state, many who traveled over an hour or more each way to see me.  That is when I began looking for research studies that showed postpartum depression can be equally effectively using online therapy.

One of the first studies I found was a British study that showed the women who received the remote counseling for postpartum depression reported better results for depression and anxiety scores immediately after they had received the treatment as well as six months after treatment. The study lead researcher, Dr. Heather O’Mahen, said that the results (published in the journal Psychological Medicine), indicated that internet-based treatment had a positive effect in reducing postpartum depression as a whole and because it provided support in their homes it was convenient allowing them to complete a course of therapy. She added: “Our hope is that this will allow more women to access and benefit from support, with all the knock-on positives that come from that: happier families, improved quality of life for moms”.

More recently, the American Psychological Association (APA) published an article stating that research demonstrates that psychotherapy delivered via the phone is as effective as the care delivered in person. A review of 13 studies found significant reductions in symptoms of anxiety and depression when therapy was provided via telephone (Coughtrey and Pistrang, 2018) and the World Journal of Psychiatry concluded that there is a large evidence base that supports teletherapy being as effective as in office therapy.

In addition to the research on postpartum depression and teletherapy, I have found that pregnant moms experience the same rates of depression and anxiety as postpartum moms and remote therapy is also effective during pregnancy as it can be very helpful to develop coping strategies to deal with anxiety before the baby arrives. Both pregnancy and postpartum anxiety and depression are very common and treatable. I do want to stress that whether support is provided remotely or in my office when social distancing is over, you don’t have to go through this alone.

 

Is Remote Therapy Confidential & Private?

Yes! At the moment I am conducting remote sessions from my home office which is in a separate area from the rest of my family so no one can overhear or interrupt our sessions. When we are no longer sheltering in place, I also conduct remote sessions from my Northbrook office.

I use a HIPAA compliant video conferencing platform that can work on wifi or cellular data, which means it enables my clients to find a way to talk to me in whatever way they can, whether it is a place in their house where they won’t be disturbed (I don’t mind if the only place you can get a bit of privacy at the moment is in your bathroom or closet!) or they sit in their car in their garage or parking lot or go out for a walk. We will find a way that works best for you!

Is Remote Therapy Covered By Insurance?

Although there are some variations depending what policy you have, most healthcare insurance plans provide coverage for teletherapy in the same way they cover in-office therapy.  I am out of network with all insurance companies and you can read more about my fees and how out of network insurance works, including questions to ask your insurance company before you start therapy on this page Dr. Allen’s Fees and Out of Network Insurance.

 

Dr. Allen offers online or telephone sessions to make it more convenient for pregnant and new moms to get specialist help.

Click here to read more about accessing help via online or telephone support.

 

Other articles by Dr. Allen you may be interested in:

When Your Baby’s Cry Causes You Anxiety

 

 

 

The Facts About Pregnancy and Postpartum Anxiety

 

 

 

When Your Childbirth Experience Wasn’t What You Hoped For

 

 

 

Is It Postpartum Depression or Something Else?

 

 

 

 

Click to read more articles on  Dr. Allen’s Pregnancy & Postpartum Blog

 

If you want to read more about maternal mental health download the FREE Guide To Pregnancy & Postpartum Stress, Anxiety & Depression. It is full of information about symptoms, different types of maternal mood disorders and advice about what to do to start feeling like yourself again.

Dr. Sarah Allen has 25 years experience as a psychologist empowering women as they transition through pregnancy and being a new mom, whether it is your first or not. She is also the Director of the Postpartum Depression Alliance of IL, a non-profit offering info and support to pregnant and postpartum moms and their families.

She offers telephone or online counseling as they are the most convenient way for pregnant and new moms to access support and help. Unfortunately, Dr. Allen’s professional license only allows her to work with IL residents.

If you have questions after reading this article or the Guide To Pregnancy & Postpartum Stress, Anxiety & Depression or have any questions about how counseling can be useful to your particular circumstances please contact me at 847 791-7722 or on the form below.

 

I expect you are reading this article because you, or a person close to you, has experienced a miscarriage or still birth.  When you lose a baby, at whatever stage of development it was at, it can be totally devastating and it is normal to feel a mix of overwhelming emotions such as shock, numbness, grief, sadness, guilt, anger, as well as a sense of failure and vulnerability.

You began your journey as a mother as soon as you got a positive result on the pregnancy test. Perhaps you imagined what the baby was going to be like and of course, what is was going to be like to be their mother.  These dreams are crushed with the loss, but just as every woman navigates their pregnancy in a unique way, processing grief and loss is a unique journey as well.

 

In this article I am going to share 6 tips that will hopefully help you in the process of healing from your loss.

 

1. Understand That It Not Your Fault

Pregnancy loss or complications can happen to anyone and is more common than you think, as many OB/GYNs do not prepare women about the possibility of miscarriage.

When someone experiences a pregnancy loss, they often try to understand what has happened by looking for a reason as to why it occurred and often thoughts are about what they could have done differently (or not done) to have prevented it from happening, but the truth is there’s probably nothing you could have done that would have made a difference.

The March of Dimes has some useful statistics listed on their website

• As many as half of all pregnancies may end in miscarriage. We do not know the exact number because an early miscarriage may happen before a woman knows she’s pregnant.
• Most women who miscarry go on to have a healthy pregnancy later.
• Miscarriage is usually a one-time occurrence.
• Most women who miscarry go on to have a healthy pregnancy after miscarriage. Less than 5% of women have two consecutive miscarriages, and only 1% have three or more consecutive miscarriages.

Early Miscarriage affects one in every four women with most early miscarriages happening in the first trimester due to chromosomal abnormality – meaning that something is not correct with the baby’s chromosomes. By the second trimester (between 13 and 19 weeks) miscarriages occur 1 in every 5 pregnancies.

Such losses, though common, are often invisible. Because many miscarriages occur early on in pregnancy, typically before a woman has even told people that she is expecting, women are often mourning their loss without much support. Even when loved ones know about the pregnancy, well-meaning people often fail to recognize the depth of emotions a loss can cause.

If the loss is after 20 weeks, it is called a stillbirth and the risk of this happening is lower, roughly to 1 in 160 pregnancies. For nearly half of all stillbirths the cause can be evaluated, but that means that in over 50% of cases cause cannot be determined, and we do know that there is no predictor of who will be affected by stillbirth and who won’t.

The takeaway from these statistics is that even if you carefully planned your pregnancy and did “everything right” you cannot have done anything to prevent your loss happening and you are not to blame.

 

2. Understand The Grieving Process You Are Going Through

Grieving is not a tidy process and we don’t really pass through the stages of grieving in a one stage follows another type of way. Typically, people jump back and forth between the stages for as long as the mind needs to, but the first stage of the grieving process is usually denial, “This isn’t happening, this can’t be happening”, where you may feel numb until your mind is able to start processing what has happened.

Next could come anger; perhaps directed towards those close to you, the medical professionals and/or yourself and your body. In my private practice where I work with women who have miscarried I often hear women say they are angry at their body for “letting them down” and not being able to do what other women seem to do easily. Or angry at medical staff who they felt were unhelpful or partners who don’t understand what a sense of loss they are feeling.

The bargaining stage is where the mind starts to try to understand why the miscarriage happened and is what we might have done to prevent it. “If only I had done xyz, this wouldn’t have happened.” This stage is closely tied up with blame and anger, but please remember, pregnancy complications and loss can happen to anyone, you didn’t cause this to happen by something you did or didn’t do!

Once someone begins to acknowledge to themself that a loss has happened, they might want to withdraw from everyone (depression stage) as they experience sadness, crying, shame and inadequacy or a sense of hopelessness.

Lastly, there is acceptance. Even though you feel sadness at the memory of what has happened, your thoughts are no longer consumed by what has happened. Although please remember that there isn’t a time frame for how long it takes to reach acceptance. Give yourself time to heal. Don’t pressure yourself to get past the sadness quickly. Allow yourself to deal with your grief as it comes.

There is no right or wrong way to deal with grief or trauma, but allow yourself to accept your feelings as they are right now and don’t judge yourself for how you are responding.

When we mourn the loss of a family member or friend, we have a shared past with that person with photos and memories of the shared experiences you had with the loved one. One way that grieving a miscarriage is different from other grieving is that it is a mourning of the loss of the story in where you imagined what your future child was going to be like and what you were going to be like as mother. I think that there is often a lack of recognition from the medical field and society in general about the depth of emotions miscarriage can bring. This can further heighten a woman’s feeling of isolation and belief that they are supposed to move on quickly.

 

3. Try Not To Close Yourself Off From Others.

If you don’t feel ready to face the world right after your loss, then don’t. It is totally okay to take some time off from work to focus on yourself. After a while though, try not to withdraw from others.

Although it may seem painful to talk about, sharing your story with others will allow you to feel less alone and help you heal. If you feel ready to open up about what has happened, you might be surprised by how many of your co-workers, neighbors, friends and even family members have also experienced their own losses.

Someone who has not gone through a loss probably can’t really know what it’s like to miscarry. Most people want to say something comforting, but might not know what to say and may even say something dismissive such as “You’re young, you can always try again”.  Try not to take it personally if someone says the wrong thing or in some cases, says nothing at all because they do not know what to say.

Be honest with people about what you need. If you are back at work or out with friends, you might need to not talk about it for fear that you won’t be able to hold it together. Thank them for their condolences and say you can’t talk about it at the moment, but do talk to someone about your feelings, whether in a support group or to a friend that understands, rather than keeping all your feelings inside.

You may also want to seek out a therapist who specializes in pregnancy loss to help you cope with the difficult emotions you’re experiencing right now, and ultimately, to process and come to terms with your grief.

 

4. Look After Yourself Physically

Even when your world feels confusing and sadness makes ordinary tasks like eating and sleeping difficult, it is important to care for your physical health after a miscarriage because your body is vulnerable right now. You are recovering from all the hormonal and physical changes of pregnancy and you are grieving on top of that. The physical recovery and healing after a stillbirth can take longer as your body will go through the same hormonal and physical changes as if you had delivered a baby.

I do not think that the length of pregnancy before the loss changes the emotions and grief you go through afterwards. It is important to eat nutritious foods, drink plenty of fluids, and get enough rest as these are all part of nurturing your physically healthy so you can focus on your emotional health.

 

5. Writing Out Your Feelings Can Help

When someone has experienced a distressing event, the brain tries to make sense of what happened, but because it is distressing to think about your loss, you might be trying to push away the thoughts. Try not to avoid how you are feeling though, as it only festers and comes out at times you don’t want it to, typically as anger or anxiety. Schedule time to think and process what you experienced/ are still experiencing. One way to do this is through journaling.

Journal writing is a great way to explore your feelings and emotions and because a journal is private, you can allow yourself to reflect on just what it is that you are feeling and thinking without censoring yourself.

Studies have found that writing in a journal can speed up the recovery period during sad times. If you are finding it hard to stop thinking about what has happened, I find it is useful to set a short period of time, once or twice a day where you explore those feelings, then close the journal. When thoughts come into your mind at other times outside of journal writing time, tell them that you are going to deal with them later today, you don’t want to think about them right now. This puts a boundary around thinking so you’re not constantly ruminating about what has happened and what it might mean.

Tips for journaling: Find a place where you won’t be interrupted for fifteen minutes (or however long you decide). If you find it hard to get started or think you might not like writing, set aside a short amount of time i.e. five minutes, and write in bullet points or notes. Don’t worry about grammar, spelling, or sentence structure.

In your writing, try to be aware of your thoughts and feelings about your loss and remember, you are in charge of this process, there is no right or wrong way to do this but pace yourself. If you feel more distraught, ease up and write about a different aspect until you are ready to dig deep again.

Keep your mind focused on what is happening now and try to resist the urge to make predictions about what might happen in the future, particularly catastrophic ones.

Expect to feel negative emotions after a journaling session, but if you have been sitting deep in thought, change things up by moving your body, even if that just means cleaning up the kitchen while listening to a favorite song or going for a walk.

 

6. Understand Anxiety and PTSD Can Occur After A Loss

We know that most women experience some degree of psychological distress after a miscarriage, or a stillbirth and we have discussed the emotions that can arise during the  grieving stages, but for some people the symptoms of anxiety and/or depression are more long lasting and can severely interfere with a person’s ability to function.

My blog post Types of Anxiety Disorders goes into more detail about all the different types of anxiety disorders, but the ones more commonly seen after pregnancy loss are generalized anxiety disorder (GAD), acute stress disorder (ASD), and post-traumatic stress disorder (PTSD).

Typical anxiety and depression symptoms following a pregnancy loss can include:

• Depressed or irritable mood for most of the day
• Anger outbursts or irritability
• Withdrawal from family and friends and other social interactions
• Difficulty falling and staying asleep
• Feelings of shame, guilt and inadequacy
• Difficulty concentrating and making decisions
• Coping with stress through unhealthy behaviors such as excessive drinking or eating
• Ruminating over what has happened
• Spending an excessive time online researching miscarriage and other health concerns

Generalized Anxiety Disorder (GAD) after a pregnancy loss is typically linked to fears that there is an underlying medical or genetic condition that may have caused the loss and worry that a future pregnancy will also end in loss.

Acute Stress Disorder (ASD) is directly associated with a traumatic event (the pregnancy loss) and can manifest within hours and lasts for at least two days, but no longer than four weeks. Symptoms of acute stress disorder may include:

• A sense of numbness or lack of emotional responsiveness
• Feeling dazed or outside of oneself
• Inability to recall aspects of the trauma
• Reliving the event through recurrent thoughts, dreams, or flashbacks
• Avoiding anything that is a reminder of the miscarriage
• Persistent edginess and/or distress

The symptoms of PTSD are similar to ASD, but they last longer than four weeks.

• Intrusive re-experiencing of a past traumatic event (which in this case may have been the childbirth itself)
• Flashbacks or nightmares (which can be about the events leading up to, during or shortly after labor)
• Avoidance of stimuli associated with the event, including thoughts, feelings, people, places and details of the event (frequently this involves avoidance of the hospital or doctors’ office, magazines about childbirth, other new moms)
• Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response)
• Anxiety and panic attacks
• Feeling a sense of unreality and detachment

The severity of continued psychological distress has no association with the number of weeks a person was pregnant and can equally affect women who have experienced an early miscarriage or stillbirth. An interesting study from the Imperial College in London, found that among 186 women who experienced an early pregnancy loss, 28 percent met the criteria for PTSD after three months of follow-up.

Whether you are impacted by continued anxiety, depression, or stress disorders, it is important to remember that you are not alone in going through this and professional support can really help you move forward. Healing doesn’t mean forgetting what happened, it is more about accepting that your loss occurred and then starting to be present in your life again rather than trapped in the past or in fear of the future.

I hope you have found this information helpful in taking steps to heal. Looking after your emotional health is as important as your physical health. Allow yourself to grieve, acknowledge what you are feeling without self-criticism or blame and when you are ready, find support from talking to others who have also experienced pregnancy loss.

Everybody’s journey is different, but please allow yourself time to grieve for what might have been and process what has happened. If you are experiencing fears, sadness or trauma reactions that are affecting your daily functioning and you feel stuck, don’t be afraid to reach out for professional help. If you are not in a state I am licensed in (Illinois or Florida), your doctor will be able to refer you to local mental health professionals who have specialist training in treating loss and trauma resulting from miscarriage and stillbirth.

 

Articles I have been interviewed for that you may also find interesting.

 

 

When Mother’s Day Is A Hardship – Chicago Tribune

 

 

Dr. Sarah Allen has 20+ years experience as a psychologist helping women during their reproductive years to look after themselves while they develop practical tools to feel back in control after a miscarriage, stillbirth or when going through infertility treatment. We all need a little support sometimes. You don’t need to feel alone.

At the moment she is only offering remote therapy via telephone or online counseling. Unfortunately, Dr. Allen’s professional license only allows her to work with Illinois and Florida residents.

If you have questions after reading this article or have any questions about how counseling can be useful to your particular circumstances please contact me at 847 791-7722 or on the form below.