Maternal Mental Health Spotlight

Brittany Kai, a Licensed Mental Health Therapist and mother of five, shares how her personal journey with perinatal mental health issues led her to specialize in Reproductive and Maternal Mental Health. 

My name is Brittany Kai and I am a mother of five children within a blended family. I have been a Licensed Mental Health Therapist for seven years. Following my own journey with perinatal mental health issues, I sought training and began specializing in Reproductive and Maternal Mental Health. This term is used to include the focus of working with those who are family planning, struggling with infertility, currently pregnant or postpartum, experience of pregnancy or infant loss, as well as mothers to young children. I currently provide individual counseling to the perinatal population via telehealth at Banyan Tree Counseling.

I worked with Central Carolina Doulas twice, including antepartum, labor & delivery, as well as postpartum support. My experiences with Aida and her team were invaluable and a huge influence on my passion for advocacy and support of maternal mental health. I truly believe my perinatal journeys would have looked significantly differently if I did not discover doula services. They connected me with countless local resources to assist me in creating my professional support system, it truly changed my life.  

When working with clients, I ask “when did your reproductive journey start and how did you envision your childbearing years?” Often times, we have ideas of what our life will look like. “I want two children by the age of 30”, “getting pregnant will be easy”, “pregnancy will be such a special time in my life”, etc. However, life has plans of its own. When our plans for our life differ from what starts to unfold, mental health symptoms such as anxiety and sadness can be triggered. For me, I had a fear of pregnancy and childbirth my entire life. I honestly was not sure I would ever conceive or carry a pregnancy. With a history of chronic illness and a few doctors discouraging me, I did not take the decision to begin family planning lightly.

Ultimately, I spent close to a year planning and preparing my body as much as I could before trying to conceive. In the midst of all the preparation, my husband received a job offer out of state. Very soon after, we made our move, 600 miles away from our family, support system, and the medical team I worked to create. Within a month of the move, we received our positive pregnancy test and we were elated.

Very quickly into my pregnancy I realized all the support we left behind. My morning sickness was so severe, I vomited dozens of times all day and night – this I definitely was not prepared for! There I was, sick as can be, a stay at home mom to three kids, no support system, not working for the first time since I was 14, and I was not established with any doctors in town. Very quickly, it sunk in – just how many adjustments I was going through. I focused my energy into learning everything about pregnancy and postpartum, I wanted to do everything “right”.

At 13 weeks, just as I entered the mirage of safety within the 2nd trimester, I started bleeding. As my midwife struggled to find our baby’s heartbeat, tears began rolling down my face, this will forever be one of the longest few minutes of my life. Ultimately I was diagnosed with a subchorionic hematoma and so began the bedrest and the fear. Luckily, after some time this resolved.

With several risk factors of postpartum depression, this became my goal: preventing PPD. How could I be a stay-at-home mom to 3 kids and a newborn while my husband did not qualify for paternity leave options? So I added doulas to my team. The rest of my pregnancy was bumpy but we made it to a full-term delivery. Although on paper, my labor and delivery appeared to have gone well, I felt alone, and things did not go as I hoped. Unfortunately, birth trauma or struggling to process your birth story is far too common and often is a contributing factor to PMADs (Perinatal Mood and Anxiety Disorders).

Immediately after the birth of my daughter, I started experiencing symptoms. I would go days without sleep, I would watch as my baby slept, while I incessantly worried about all the things that could go wrong. More symptoms followed, I was all consumed in everything related to my daughter. I had very specific routines for everything: breastfeeding, washing her clothes, soothing her, and the list goes on. I was convinced I had to do a 100% of everything and she could not be out of my sight.

At follow ups with my midwife she gave me medication to help me sleep. I was asked if I had thoughts to harm her, but from a professional standpoint, it was not concerning to be all consumed with caring for my baby and not being able to handle anything else outside of her world. In a lot of ways, I just thought this was “normal first time mom worries”, while everyone around me thought I was being a helicopter parent. Eventually time passed and things improved.  Looking back, I had undiagnosed and untreated Postpartum Obsessive-Compulsive Disorder (POCD).

Postpartum OCD and Postpartum anxiety are not talked about as much as PPD. Per Postpartum Support International (PSI), it is estimated 3-5% of new mothers will experience symptoms of POCD, while roughly 90% of childbearing people experience intrusive thoughts (The Blue Dot Project). Intrusive thoughts are thoughts and images related to the baby, which are frightening or distressing, repetitive, and seem to come out of nowhere. The mother does not want to experience or act on these thoughts, however she will engage in compulsions or routines to reduce the fears she is experiencing. It may also include fear of being left alone with their baby or hypervigilance to protect them. POCD is treatable with professional help.

In August of 2020 and the thick of COVID, and the start of another pregnancy. I felt confident this time would be better, I had an established team of medical providers and support, and I had been through this before. Just shy of 13 weeks I asked my midwife “are you sure the baby is ok?” I received comfort as everything seemed to be progressing, less than 48 hours later and it happened, again, only much worse. I had been bleeding less than 5 minutes and my bathroom looked like a crime scene. We rushed to the ER, however due to COVID I had to go in alone.

The next 13 hours was some of the loneliest in my life, except I was in an extremely crowded room. The ER was packed, so much so I was treated from the waiting room. Everyone sat with masks on, 6 feet apart, being called back for testing and sent back to the chair to wait. There I sat heavily bleeding, alone, crying behind a mask, thinking the worst. I was eventually discharged with “the baby has a heartbeat but the cause of the bleeding was inconclusive.” I was later diagnosed with a subchorionic hemorrhage and placenta previa. “All we can do is bedrest and hope to get the baby to viability.” I was devastated and every day I thought, “is this the day I will lose my baby?” And there it was, what I worked so hard to prevent, PPD, only now it was happening during pregnancy.

Postpartum Depression is considered the most common of all PMADs and tends to be the most discussed and watched for by medical providers. Symptoms can start during pregnancy or within the first year postpartum and can include: irritability, lack of interest in the baby, disruption to appetite and sleep, sadness, feelings of guilt or hopelessness, decreased interest in things you previously enjoyed, and thoughts of harm to yourself or the baby. Suicide is the leading cause of pregnancy-related death (CDC). PPD is treatable with therapy and sometimes medication.

With my mental health symptoms beginning in pregnancy, I gathered my support team, including doulas, medical specialists, and a midwife specializing in Perinatal Mental Health. I began an anti-depressant and started seeing her regularly to monitor my mental health. I did my best to survive the pregnancy, keep my baby alive, and keep my mental health afloat.

With constant medical monitoring due to my complications, including testing, rounds of steroids, regular contractions, and eventual hospitalization for pre-term labor. Attending all of these appointments completely alone was isolating and traumatizing as medical staff was overworked and run down, I became adverse to medical settings. Living a life with chronic illness, this fear was new to me. So I prepared with my doula for labor and delivery, focusing on self-advocacy. I delivered my son full term, feeling empowered on getting us both through the pregnancy.

Once home, I was hopeful things will only get better from here. However, on the day of a pediatrician visit, I had panic attacks all morning, there was a misunderstanding with the front desk staff, I was irritable, yelling thinking they made a mistake with scheduling, only to realize the mistake was mine. I sobbed the entire visit. As I completed the PPD screener scoring highly, I left mortified and apologizing profusely, I was a wreck. A month or so later I realized I was struggling with Postpartum PTSD, triggered by the medical trauma I experienced throughout pregnancy.

Postpartum PTSD or Post-traumatic Stress Disorder occurs in approximately 9% of women following childbirth (per PSI). The PTSD is most often caused by real or perceived trauma during pregnancy, delivery, or postpartum. Symptoms can include:  anxiety and panic attacks, flashbacks, nightmares, avoidance of anything associated to the event, irritability, sadness, disruption of sleep, or feeling detached from reality or daily life. Postpartum PTSD is treatable with professional help including therapy and possibly medication.

It is not a few years later and I carry all of these experiences with me, it has shaped who I am as a mother and a mental health professional. Through personal and professional experiences, I have learned first-hand that we as a society can do better. There is a lack of information, support, prevention, and treatment resources available to mothers, fathers, birthing partners, and families at such a crucial life and developmental stage. It is estimated that as many as 1 in 5 women will experience a maternal mental health disorder making this the #1 complication of childbearing, according to The Blue Dot Project.

What I think we can do is share more, talk about each of our experiences, share resources, and have mental health treatment be more accessible to all families during the perinatal period. My advice is to talk about what you are experiencing and advocate for yourself in medical settings. Learn the risk factors during pregnancy and have resources lined up in case you need them. If you feel like something isn’t right, it doesn’t mean you are a bad mom. It means you are a mother doing everything you can within your power to keep you, your baby, and your family healthy and happy. You are not alone!

If you or someone you know is pregnant or postpartum and need Perinatal Mental Health support:

Find a local providers supporting Perinatal Mental Health at the PSI Provider Directory.

Postpartum Support International Helpline at 1-800-944-4773

National Maternal Mental Health Hotline 24/7 at 1-833-943-5746

National Suicide and Crisis Lifeline 24/7 at 988

For more information on Maternal Mental Health and resources, visit Postpartum Support International and The Blue Dot Project.



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