Despite all of our efforts as birth professionals and postpartum doulas, when people hear the word “postpartum”, depression is the very first thing that they think of. I’ve always thought that this association says a lot about our expectations for life with a new baby. Postpartum, for the record, is just a time period- the time soon after birth.
But with how common it is to have mental health challenges soon after birth, it’s no wonder that we as a society expect new mothers to experience mood and anxiety disorders. Some estimates suggest that 15% of new mothers in the US experience postpartum depression or a perinatal mood and anxiety disorder (PMAD).
If we’re going to improve the postpartum time period, it’s important to know what’s a normal part of adjusting to a huge transition- adding a new baby and the end of pregnancy- and what are signs that a new parent may need some additional support.
Before we go on, an important note: that this blog is not a tool for diagnosis- we’ll include some resources for that. I want you to trust your gut if you feel that something is off, and trust your mental health provider as well. We do hope to normalize some things though! Good moms (and parents) have mental health struggles.
Baby Blues
In the US, it is considered common and not a cause for concern if your mood seems “off” for the first couple of weeks after birth. Baby blues occurs in up to 85% of mothers soon after birth. It may begin within 3-5 days after birth, and resolves within the first three weeks.
Symptoms of baby blues include:
- Weeping
- Exaggerated mood swings
- Irritability
- Anxiety
- Sadness
- Envy of partner/spouse’s role
- Feeling dependent
- Difficulty feeling affection
This is more than the normal daily fluctuations of your moods, but typically goes away without much intervention. As doulas, we recommend letting the people around you care for you, a nutritious and satisfying diet and getting lots of rest. Remember, your whole world just changed, your body is making major adjustments.
If you find that things aren’t getting better, or you are worried about yourself or your baby, something more serious may be happening. SOme of the PMADs that may benefit from treatment and support include:
Postpartum Depression
Depression during pregnancy or soon after delivery affects many new parents. Symptoms include:
- Overwhelmingly sad mood
- Experiencing a lack of pleasure
- Inability to concentrate
- Excessive guilt
- Anger and irritability
- Being hyperactive OR physically inactive
- Appetite changes
- Inability to sleep, or sleeping more than typical (beyond tiredness with a new baby)
- Thoughts of death
Anxiety Disorders
While it’s discussed less, anxiety disorders are common during the perinatal time period. Anecdotally, we see a lot of anxious parents at DC Metro Maternity (not always clinically). Sometimes being a bit more anxious is a side effect of being a “type A” personality who gets shit done. Sometimes it’s a by-product of being a Black woman or woman of color in the US. The specific diagnoses that may come up as a PMAD include:
Generalized Anxiety Disorder
This is often pre-existing, and during pregnancy and postpartum is likely to be focused on the health and safety of the baby. Some mothers are also anxious about their new role. “Excessive” worry, the kind that interrupts your ability to enjoy your baby, is something to get support with. You may notice symptoms like:
- Inability to sleep- even when the baby sleeps
- Nausea, stomach aches or feeling tense
- Loss of appetite
- Trouble sitting still and inability to relax
- Racing thoughts
- Irritability
- Feeling on edge or fearful
- Forgetfulness or trouble focusing
You should also seek help if you experience symptoms of panic disorder such as a higher heart rate, heart palpitations, or shortness of breath. Even if you’ve not had a panic attack before, some new parents have their first panic attack in the postpartum time period.
In addition to general anxiety, some new mothers experience Obsessive Compulsive Disorder, which may include symptoms such as:
- Scary, intrusive thoughts, especially about worse-case scenarios.
- Obsessing over irrational fears or things that are unlikely to happen.
Intrusive thoughts are often difficult to discuss- they may be scary visions about the baby getting hurt, or even the parent causing harm to the baby. But it’s important to remember that any recognition of these thoughts means that you’re likely to be extra careful not to harm your child. If you’re having these distressing thoughts, please share them with a safe person and get support so that you can enjoy motherhood.
Post Traumatic Stress Disorder
While we may associate PTSD with veterans, or survivors of violence, unfortunately birth can be a traumatic event in some instances. If you believe that you, your baby or your partner were in danger during your birth, you may experience PTSD symptoms such as:
- Nightmares
- Flashbacks
- Avoidance
- Hypervigilance, threat of death
Addressing this trauma with the appropriate professional will help you cope and heal.
Bipolar Disorder
Because of the sleep deprivation, stress and hormonal fluctuations, bipolar disorder is more likely to present in the postpartum period than any other time for adult women. Symptoms include those of depression AND Mania or Hypomania:
- feeling suddenly very happy, elated or overjoyed with sudden bursts of energy
- talking very quickly.
- feeling self-important.
- feeling full of great new ideas and having important plans.
- being easily distracted.
- being easily irritated or agitated.
- being delusional, having hallucinations and disturbed or illogical thinking.
Postpartum Psychosis
While rare, psychosis is often the source of the scary stories on the news about mothers harming their infants. It typically emerges within first few days or weeks and can happen quickly. Symptoms include:
- severe mood shifts
- hallucinations or delusions that happen when the mother is not in touch with reality
A previous diagnosis of bipolar disorder increases the possibility of experiencing psychosis, and both should be treated by a professional. Psychosis is an emergency and if you think that a loved one or yourself is experiencing it, please get help immediately.
How can you screen for issues?
What can you do if you think you’re experiencing postpartum depression?
If your symptoms are not severe, sometimes there are things to be done at home:
- Getting more sleep
- Getting help with the baby so that you can take better care of yourself with nourishing food, showers or having time to do things you enjoy
- Get some sunshine
- Some gentle movement like walks or postpartum yoga
- Social time to reduce isolation. This may be a support group (we love those) but can also be friends from before the baby, family, mom groups or even breastfeeding groups
We want to reduce the stigma around seeking support from a therapist or counselor. Your OBGYN or primary care doctor may have a referral, and so may your postpartum doula. You can talk with your medical provider or mental health professional about medication as well.
There are medications that are safe to take during pregnancy, or while breastfeeding.
Sometimes people worry that admitting to a PMAD, or having issues adjusting to life with a new baby will make them seem like a bad mother or parent. You may worry about someone not trusting you with the baby, or social services getting involved. But taking care of your mental and emotional well-being is a loving act. It helps you (and you deserve that) and also makes you a better mother/parent.
Where can you be screened for postpartum depression and other PMADs?
If you’re reading this because you are concerned that you may be experiencing postpartum depression, you can use this postpartum depression screening tool to learn if you’re experiencing something normal.
- Pediatricians will often ask about the birthing parent about postpartum depression and other PMADs
- Your visit with your provider after birth will likely include mental health screening
- Your labor doula will often want to know about your mood at a postpartum visit
- Your postpartum doula has been trained to recognize symptoms of PMADs
When is a PMAD an emergency?
If you feel that you’re a risk to yourself or your baby, know that it is a sign of a GOOD parent to ask for help, not the other way around. And if you believe that your partner or loved one has lost touch with reality, please seek help quickly.
If you are looking for resources in the US, we recommend postpartum support international.
For therapists for Black women, you can check the directory at https://therapyforblackgirls.com/.
