Understanding postpartum depression and baby blues
This article was written by Molly Nourmand, LMFT for Robyn
After my daughter was born, a combination of risk factors coupled with birth complications, lack of support, isolation, sleep deprivation and marital challenges were the perfect storm for me developing Postpartum Depression (PPD). Since I’m a Psychotherapist armed with tools, resources and knowledge about Perinatal Mood and Anxiety Disorders (PMADs), I thought I would somehow be able to prevent it. I soon realized that I am not immune. As I began to recover, I felt called to hold space for the initiation into parenthood. I embraced the wounded healer archetype and created Life After Birth™ Since 2017 and I have been facilitating postpartum support circles and doing 1:1 talk therapy 1:1 with birthing people.
How to know if it’s the baby blues and not PPD
Up to 80% of new mothers feel the baby blues after giving birth. It’s caused by the sudden change in hormone levels (drop in estrogen and progesterone) after delivery, combined with stress and lack of sleep. You might be tearful, overwhelmed, emotionally fragile and experience mood swings. Sounds pretty normal to feel soon after birthing, right? The baby blues begin within the first couple of days after delivery, peak around one week, and resolve by the end of the second week postpartum without any intervention. While the baby blues and PPD have some overlapping symptoms, if they don’t go away after a few weeks, worsen, or the onset is after the first two weeks, then you may be suffering from a PMAD.
Postpartum depression
1 in 7 women experience Postpartum Depression. Symptoms of postpartum depression can appear any time during pregnancy and generally develop within the first year after childbirth. One of the key differences between baby blues and PPD is level of functioning. Symptoms differ for each individual, but may include the following:
Low mood, feelings of sadness or crying
Feelings of irritability, anger or rage
Decreased or increased appetite
Sleep disturbance (more than expected with new baby); sometimes manifesting as insomnia even when baby sleeps
Feelings of guilt, shame or hopelessness
Loss of interest, joy or pleasure in things you used to enjoy or in your new baby
Lack of interest or difficulty connecting with your newborn baby
Possible thoughts of harming yourself or the baby
If you or a loved one is experiencing any of these symptoms, please talk to a healthcare provider (e.g. OB/GYG or Psychotherapist).
Although Postpartum Depression tends to overshadow other PMADs, there are actually several other ways that a birthing person’s mental health can be impacted.
Postpartum anxiety
During pregnancy, about 6% of people develop anxiety, and 10% do so postpartum. Some experience anxiety alone while others experience it in combination with depression. The symptoms of anxiety during pregnancy or postpartum may include:
Constant worry
Physical symptoms such as dizziness
Inability to sit still
Racing thoughts
Feeling of impending doom
Disturbances of sleep and appetite
In addition to a more generalized anxiety as described above, there are other forms of anxiety to be aware of for new moms. One is Postpartum Panic Disorder. This is a form of anxiety which is marked by recurring panic attacks. During a panic attack, you may experience shortness of breath, heart palpitations, chest pain, claustrophobia, as well as numbness and tingling in the extremities.
Another way anxiety can manifest is Postpartum Obsessive Compulsive Disorder. Interestingly enough, most new parents experience scary and intrusive thoughts about their new baby. It makes sense though if you think about it--having the most precious thing you’ve ever been responsible for can lead your mind to worst case scenarios. It’s a similar feeling to being in a china shop and imagining breaking all the fragile items. However, if the disturbing images increase with frequency and intensity, include compensatory behavior, and/or interfere with your functioning, then you may have Postpartum Obsessive Compulsive Disorder.
Just to clarify, if these images of you have of hurting your child are very disturbing to you, this is known as ego-dystonic. Whereas if a woman is experiencing Postpartum Psychosis, then the images and thoughts of hurting her baby make sense to her, which is called ego-syntonic. Since she is experiencing a break from reality in her psychotic state, she may believe, for example, that she would be protecting her baby by killing it.
Although Postpartum Psychosis gets a lot of media exposure (e.g. Andrea Yates who drowned her five children), it is rare, occurring in only .1 -.2% of births. A psychotic episode postpartum should not be confused with postpartum depression. It is a serious condition and life-threatening emergency that calls for immediate medical attention in order to protect the lives of both the baby and mother.
Postpartum post-traumatic stress disorder
Approximately 9% of birthing people experience postpartum Post-Traumatic Stress Disorder (PTSD) caused by trauma during delivery or postpartum. Some examples are:
Baby spending time in NICU
Cord prolapse
Emergency C-section
Use of forceps or vacuum during delivery
History of sexual trauma
Lack of communication and support during the delivery, as well as feeling powerless
Experience with a complication or injury such as hysterectomy, postpartum hemorrhage, perineal trauma (3rd or 4th degree tear) or preeclampsia
Symptoms of postpartum PTSD might include:
Intrusive re-experiencing of a past traumatic event (perhaps the birth itself)
Panic attacks
Avoidance of stimuli associated with the event
Feeling a sense of detachment or dissociation
Nightmares or flashbacks
Persistent increased arousal (hypervigilance, exaggerated startle response, irritability, difficulty sleeping)
Bipolar mood disorders
Many birthing people are diagnosed for the first time with mania or depression during pregnancy or postpartum. These emotions are more than the usual ups and downs of the perinatal period. In fact, these states may look like severe forms of depression or anxiety.
That said, it is important to distinguish Bipolar Disorder from Depression. Your mental health practitioner needs to assess whether you have had a persistently elevated mood, decreased need for sleep, inflated self-esteem or grandiosity and/or engagement in risky behavior. To be diagnosed with Bipolar Disorder, a person must have experienced at least one episode of mania or hypomania. A Bipolar I diagnosis includes mania; whereas a Bipolar II diagnosis includes hypomania, a milder form of mania.
If you already have a Bipolar I or II diagnosis, then it would be ideal to consult a Reproductive Psychiatrist to create the best plan for you medication-wise prior to getting pregnant or while gestating (if the pregnancy is unplanned). They will help you weigh the benefits and costs of using mood stabilizers during pregnancy and while breastfeeding.
Knowing the risk factors of PMADs
Around 50% of perinatal mood and anxiety disorders start in pregnancy and continue into the postpartum period. The factors that may put a birthing parent at risk for developing PMADs include:
A personal or family history of depression, anxiety or other mental illnesses
A history of infertility treatment or miscarriages
Severe mood issues around the time of your menstrual period or premenstrual dysphoric disorder
Medical complications during the pregnancy or birth
Financial or relationship stressors
Limited emotional support
If the birthing parent has any of the aforementioned risk factors, or have had a history of PMADs in previous pregnancies, then it is crucial to plan ahead for care.
Prevention
While no one is exempt from developing a PMAD, there are some things you and your partner can do during pregnancy to bolster yourself should something go awry:
Prior to giving birth, establish a relationship with a Psychotherapist who specializes in PMADs (and depending on your mental health history, a Psychiatrist, too).
Develop a postpartum plan while pregnant (check out my other article for Robyn: Postpartum Planning in the Time of COVID-19).
Have the birthing person and their family members or support system familiarize themselves with signs of PMADs and treatment options.
Education & resources
Even though there is no way to fully prepare for the drastic transformation of becoming a parent, education can of course help lower anxiety and empower new parents. Look for classes that take perinatal mental health and postpartum planning into consideration, such as Robyn’s Parentbirth course. In addition, The Postpartum Husband is a helpful book for those whose partner is at risk for PMADs (if needed, swap out “husband” for a term that is more applicable.) It’s an easy read and offers specific things to say and avoid saying. It can help with communication and teaches you how to support someone coping with perinatal depression and mental health issues. For many families, the anticipated joy of a new baby can yield disillusionment, resentment, fear, sadness and anger when a PMAD occurs. Research has shown that supportive relationships during postpartum depression treatment is associated with a reduction in depressive symptoms.
Conversely, the birthing parent is not the only one at risk for a developing depression or anxiety—so is their partner. Factors such as vicarious trauma, childhood issues surfacing, or not getting attention from a partner can yield mood issues in the non-birthing parent. It is important to acknowledge this truth so that partners seek help if symptoms occur. The consequences to a developing child can be detrimental if one or both parents are experiencing a PMAD.
If you or someone you love is suffering from any of these aforementioned mental health issues, know that it is not your fault and you are not to blame. Postpartum Support International has a warm line and will call you back within 24 hours to help connect you with resources in your area. In addition, there is a National Suicide Prevention Lifeline: 1-800-273-8255, or you can call 911 if it is a true life-threatening emergency. The good news is, perinatal mood and anxiety disorders are temporary and treatable mental health problems with professional help. The more we can let go of the stigma associated with mental health issues in the perinatal period, then more they become normalized. The day I was able to let go of shame for having postpartum depression was the day that I started to heal from it. Now being vulnerable by openly sharing my story is medicine for others who are struggling.
Statistic and information on PMADs from Postpartum Support International
