Dr. Kira Bartlett April 20, 2020 Who knew a few months ago that we would be living through such a bizarre time, a global pandemic unlike anything most of us have seen in our lifetime? The myriad [...]
A Bridge Home now provides video sessions for our clients. During this time of social distancing, we are happy to provide our services in a safe and compliant manner. Birth waits for no one, nor do its emotional after effects. This time of uncertainty can be especially hard for new moms so please reach out!
You Are Not Alone
For many postpartum women, traveling to see a therapist for support is just too difficult. This unique service allows us to reach out and provide a bridge connecting the support of the maternity unit to the client’s home and family.
We are passionate about making treatment accessible to women in crisis, and women at risk for perinatal mood disorders. As clinicians with specialities in maternal mental health, we have extensive training and experience treating women who struggle, whether it be during pregnancy or postpartum.
We offer up to three IN-HOME psychotherapy consultations, helping to transition mom and baby to a longer term supportive office based therapy with one of our experienced clinicians.
Our services can be accessed in several ways. We may be contacted by a member of your care team during your maternity stay. With your permission they can make a referral and provide intake information and presenting concerns. We also welcome self referrals; new mothers may be unsure what to make of their feelings and may wish to to have a thorough assessment done to better understand if they are at risk for PPD. And, we also accept referrals from family members, friends and your health care professionals.
When we visit you in your home we provide support and reassurance while we get to know you and what you are experiencing. We also get a mental health history in order to provide a clear diagnosis. With a client’s consent we often ask family to join a part of a session as they may offer helpful observations concerns.
While our assessment continues throughout the 3 sessions we work with our client on specific wellness goals to focus on. We educate both the client and her family about maternal mood disorders, and we provide reassurance that treatment leads to recovery.
During the 3rd session we work together to make a plan of care so that treatment can continue if it is indicated. We offer options for treatment and help you choose a treatment that is right for you.
We work closely with Psychiatrists specially trained in reproductive mental health and make referrals when indicated. And we work as a team so that we are all aware of the care plan and are on the same page.
Maternal Mental Health
As many as 15 to 20% of women experience significant symptoms of depression or anxiety when becoming a parent. These illnesses are treatable. We can help. There is no need to continue to suffer alone. There are a number of helpful and evidenced based treatments to help you feel better.
Depression can occur during pregnancy (antepartum) or following child birth (postpartum) and is more common than people realize.
Approximately 15% of women experience postpartum depression and 10% experience depression during pregnancy. Perinatal depression is the most common complication of childbirth.
Symptoms can begin during pregnancy or within the first year following childbirth. They can include:
- Feelings of anger or irritability
- Crying and sadness
- appetite and sleep disturbance
- Lack of interest in baby
- Feelings of guilt, shame, hopelessness
- Loss of interest or pleasure in things you used to enjoy
- Possible thoughts of harming yourself
Certain factors put you at a greater risk for developing perinatal depression. Being aware of these factors can help you plan ahead by informing your medical provider.
- a personal or family history of depression and anxiety
- Premenstrual Dyshphoric Disorder (PMDD) & Premenstrual syndrome (PMS)
- Lack of a support system
- Having multiples
- Complication in pregnancy, birth or nursing
- Infertility treatments
- baby in NICU
- Financial stressors
- marital complications
- major life events such as a move, a death, a job loss.
Approximately 6% of pregnant women and 10% of postpartum women experience perinatal anxiety. Anxiety can be experienced by itself or can be mixed with depression.
Both pregnancy and postpartum depression can include:
- Excessive worry
- Feeling that something bad is about to happen
- Racing thoughts
- Appetite and sleep disturbance
- Physical symptoms like dizziness, nausea, hot flashes, rapid heartbeat
Postpartum Obsessive Compulsive Disorder
Postpartum OCD is quite misunderstood and often misdiagnosed. It can be diagnosed alone or as a symptom of postpartum anxiety. As many as 3-5% of new mothers experience these frightening, intrusive and repetitive thoughts. They can be quite graphic and disturbing and many new mothers avoid sharing them out of shame and fear. These images are not delusional and relate to the need to avoid feared causes of potential harm to the baby.
- Obsessions- these are intrusive thoughts or images which can be persistent and repetitive and are related to the baby. They can cause great upset and fear.
- Compulsions are rituals done over and over again in an effort to reduce the obsessions. This may include avoidance or repetitive washing and checking.
- Fear of being left alone with baby
- Hypervigilance about protecting baby
- Those with a history of anxiety or OCD are at a greater risk for PPOCD.
Postpartum Post-Traumatic Stress Disorder
PPTSD can be caused by a traumatic or complicated childbirth experience. Symptoms may include flashbacks of the trauma and avoidance of related events.
- Intrusive re-experiencing of the traumatic birth experience
- Flashbacks or nightmares
- Avoidance of anything associated with the birth; this can include the baby or partner
- Irritability, difficulty sleeping, hypervigilance
- Anxiety and panic attacks
- Feeling a sense of unreality and detachment
Approximately 9% of women experience postpartum post-traumatic stress disorder (PTSD) after childbirth. Generally, this illness is caused by a real or perceived trauma during delivery or postpartum. These traumas could include:
- Unplanned or emergency C-section
- Use of vacuum or forceps in delivery
- Baby going to NICU
- Feelings of powerlessness and/or lack of support during the delivery
- a history of trauma, such as rape or sexual abuse
- the experience of a severe physical complication during pregnancy or childbirth
Postpartum Bipolar Mood Disorder
Bipolar mood disorder consists of episodes of depression, mixed with episodes of mania or hypomania. Some women are diagnosed for the first time with bipolar depression or mania during pregnancy or postpartum.
Bipolar mood disorder can appear as a severe depression; It is important to examine a woman’s history to assess for any episodes of mania.
For many women, pregnancy or postpartum might be the first time she realizes that she has bipolar mood cycles.
- Periods of severely depressed mood and irritability
- Mood much better than normal
- decreased need for sleep and consistent high energy
- Racing thoughts, trouble concentrating, rapid speech
- Impulsiveness, poor judgment, distractibility
- Grandiose thoughts, inflated sense of self-importance
- In the most severe cases, delusions and hallucinations
Risk Factors for Bipolar Mood Disorder are family or personal history of bipolar mood disorder (also called manic-depression).
It is essential to consult an informed professional with experience in postpartum mental health assessment and treatment.
Postpartum Psychosis is a separate and very rare illness. It occurs in approximately 1 to 2 out of every 1,000 deliveries. The onset is usually very rapid, most often within the first 2 weeks postpartum.
PPP sufferers sometimes see and hear voices or images that others don’t, known as hallucinations. They may believe things that aren’t true and distrust those around them. They may also have periods of confusion and memory loss, and seem manic. This severe condition is dangerous, so it is important to seek help immediately.
- Delusions or strange beliefs
- Hallucinations (seeing or hearing things that aren’t there)
- Feeling very irritated, hyperactivity
- Decreased need/ability for sleep
- Paranoia and suspiciousness
- Rapid mood swings
- Difficulty communicating at times
The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode.
A woman experiencing psychosis is experiencing a break from reality. Immediate treatment is imperative.
Postpartum psychosis is temporary and treatable with professional help, but it is an emergency. If you feel you or someone you know may be suffering from this illness, know that it is not your fault and you are not to blame. Call your doctor, go to an emergency room, or call an emergency crisis hotline immediately.
Help in an Emergency
Emergency Hotlines are available all the time. It is very important that you reach out right now and find the support and information you need to be safe.
National Suicide Prevention Hotline:
Postpartum Support International
PSI Weekly Online Support Groups
PPD Support Page (Offers online, moderated discussion forums about perinatal mood and anxiety disorders.)
Caring Baby Nurses PPD Guide
MGH Women’s Mental Health Center
Action on Postpartum Psychosis Forum
Mental Health America (A postpartum depression fact sheet.)
National Institute of Mental Health
Suicide Prevention Lifeline.org
Blogs by Survivors and Advocates
I’m Listening by Jane Honikman, founder of PSI
Unexpected Blessing by Lauren Hale
Ivy’s PPD Blog by Ivy Shih Leung
Postpartum Psychosis and Mental Health by Jennifer Moyer
Beyond Postpartum by Amber Koter-Puline
PTSD After Childbirth by Jodi Kluchar
What to do if you think you might have postpartum depression?
- Ask for help and accept support
- Eat healthfully, exercise in whatever way you can
- Join a postpartum support group
- Find someone to speak openly about your struggles, ideally, a therapist with postpartum expertise.
Researchers are still unsure of the exact etiology or cause of postpartum depression. It appears to be a confluence of factors that varies from individual to individual. Some factors that are known to contribute are:
- tremendous hormonal changes during pregnancy/postpartum period
- psychological impact of shift to new mother role
Kira Bartlett, PsyD
Dr. Kira Bartlett is a NYS licensed clinical psychologist with over 18 years of successful clinical experience with individuals and groups in psychotherapy.
She maintains private practices in White Plains and NYC, specializing in perinatal mood disorders. Dr. Bartlett provides training and in-services for professionals and agencies interested in screening for postpartum mood disorders. Dr. Bartlett is a member of NYSPA, Postpartum Support International, the Postpartum Resource Center of New York and is the president of the Hudson Valley Birth Network. She is also a volunteer on the PSI Warmline and occasional blogger for PSI.
Catherine Daniels-Brady, MD
Dr. Daniels is a psychiatrist with a strong interest in treating emotional symptoms related to women’s reproductive events across the lifespan, and mental health disorders in adults with various chronic or complex medical conditions. Dr. Daniels has extensive experience treating patients with mood and anxiety disorders, and helping patients make needed lifestyle changes.
Dr. Daniels graduated with honors from Northwestern University and received her medical degree from The University of Illinois at Chicago. She completed her training at Mt. Sinai Medical Center, NYU Langone Medical Center, and Bellevue Hospital. Dr. Daniels is board-certified in both Psychiatry and Psychosomatic Medicine, the field of psychiatry that deals with the interface between physical and emotional symptoms. Dr. Daniels is on the faculty of the Icahn School of Medicine at Mt Sinai, and the New York Medical College. She is active in teaching, clinical work, and research.
In addition to providing psychiatric evaluation, medication management, and psychotherapy to adult patients, Dr. Daniels offers home visits for postpartum mothers.
Shelly Steinwurtzel, PsyD
Dr. Shelly Steinwurtzel is a NYS licensed clinical psychologist who has worked with children, adolescents, and adults in their pursuit of lasting positive change.
After receiving her B.A. in Psychology and Sociology from Brandeis University, she earned her Masters in Education and Doctorate in Psychology focusing on School and Clinical Psychology at Pace University.
Currently, Shelly is an Instructor of Clinical Medical Psychology at Columbia University Medical Center working in the Neonatal Intensive Care Unit and consulting with the Perinatal and Neonatal Comfort/Palliative Care Program. She is instrumental in helping parents and family members as they navigate the joys and traumas of having a baby born early, or with medical complications, and sometimes, life-limiting conditions. Shelly also works with staff to help them manage their own complicated feelings in the context of secondary trauma associated with their jobs. She is often a guest lecturer in graduate programs in Manhattan and provides workshops at national conferences discussing psychological perspectives relevant to perinatal and neonatal issues. In addition, she maintains a private practice in Dobbs Ferry, NY.
Adrienne Katzow, PhD
Dr. Adrienne Katzow is a NYS licensed clinical psychologist with over 14 years of clinical experience working with adults in individual and group psychotherapy. She specializes in women’s mental health with a focus on perinatal mood and anxiety disorders, reproductive concerns, and eating and body image issues.
Dr. Katzow graduated from Vassar College and received her Ph.D. in Clinical Psychology from The New School for Social Research and completed her clinical internship at Lenox Hill Hospital. She has specialized training in treating Perinatal Mood and Anxiety Disorders through Postpartum Support International and the Postpartum Stress Center and she has postgraduate training in the treatment of eating problems from The Women’s Therapy Centre Institute. She is a member of Postpartum Support International, The Hudson Valley Birth Network and The International Association of Eating Disorder Professionals. Her therapeutic style is empathetic, open, and interactive. She has a private practice in Dobbs Ferry, NY.