Part 1: Welcome to the club
Whether it’s your first or your fifth, having a new baby comes with its own unique set of stresses and challenges.
Having a baby changes a person: it just does. Physically, emotionally, and mentally, there are two births: the birth of the baby, and the birth of the new parent/s.
To begin with, pregnancy and birth ain’t no joke. During pregnancy, a pregnant person’s body makes all kinds of accommodations for its newest creation, including growing an entirely new organ- the placenta- to manufacture the additional hormones required for pregnancy.
This means all kinds of new hormones are present that influence mood, energy level, libido, and physical changes. According to the American Pregnancy Association, several of these hormones directly affect brain function and mood.
The hormonal hits don’t stop coming after giving birth, either! The baby and the placenta are both delivered and some hormones wax and others wane while the postpartum body figures out its new normal.
Beyond the physical changes that can easily be seen such as postpartum hair loss and body shape changes, others are not as well-known.
According to Elseline Hoekzema, the neuroscientist at Leiden University in the Netherlands that conducted research into structural brain changes of new moms, brain scans revealed a loss of gray matter that Hoekzema says indicates a “fine-tuning of connections.” This sounds to me like maybe the brain is deciding that it needs to increase its processing speed in ways related to baby, so maybe some other parts of the brain (like the part that’s responsible for remembering where you put your car keys) have to give a little to make way for baby! Most of us just call this phenomena “mommy brain.”
Creating a new human requires some adjustment in lifestyle and priorities. Almost everyone has to shift some to accommodate a newborn, because life changes once baby arrives. Priorities shift and creating a safe, secure, and stable home for baby is usually priority #1 for new parents.
There is so much new information to learn about baby: infant nutrition, safe sleep practices, shot schedules, diaper brands, car-seat safety, etc.
In addition, financial stress is common in these early days as families reorganize their finances and figure out their new normal. It often happens that right when all these new costs are added to the family budget, one income is typically reduced or removed entirely, depending on how families organize the primary care-giving role and decide when/if baby will have outside care.
This isn’t even taking into consideration non-traditional family setups such as families that may only have one parent, or one parent living with grandparents, or two parents living separately but still co-parenting, and all the other varieties of arrangements that come with their own unique stresses and considerations.
To state the obvious, having a new baby is stressful!
It’s no wonder then, that the Massachusetts General Hospital’s Center for Women’s Mental Health reports that up to 85% of women will experience some kind of postpartum mood disorder during the postpartum period. The postpartum period is defined as beginning immediately after delivery and can last until approximately a year out.
Another fun fact: postpartum mood disorders can also start during pregnancy, and the term perinatal encompasses that period, too. Culturally, we tend to lump all of these together as “postpartum” mood disorders, so that’s what I have done here as well.
The most commonly reported postpartum mood disturbance is referred to simply as postpartum blues, and the Center for Women’s Mental Health states it affects about 50-85% of new moms in the first few weeks after delivery and it is considered a typical experience.
They report the following symptoms as indicating postpartum blues:
- Feelings of irritability
- Moodiness
- Tearfulness
- Mild anxiety
According to the Center for Women’s Mental Health, these symptoms don’t typically interfere in everyday life, but it is when these symptoms continue beyond these first few weeks, worsen and shift, or maybe don’t even show up until some time later during the postpartum period, that it becomes a part of the wild, wacky, and not so winsome world of postpartum mood disorders that we are going to delve into in the next section.
Part 2: The Road Map
If you are reading this because you suspect either yourself or someone you love has a postpartum mood disorder, you are not alone. This road can be treacherous and the path is not always clear, but by reaching out for information and support, you will find your way. Many of us have traveled this road before you, and many will pass this way after you. Keep truckin’ and keep this road map handy. You got this.
Massachusetts General Hospital’s Center for Women’s Mental Health states that while there are some risk factors associated with postpartum mood disorders, any person that has given birth within a time span of about a year can develop a postpartum mood disorder, even without any of the following risk factors:
- Personal or family history of depression
- Anxiety
- Bipolar disorder or other mental health disorders
- Stressful life events (loss of a loved one or socioeconomic shift such as loss of income)
- Relationship issues
- Health issues for mom and/or baby
- Inadequate social support/lack of support system resources such as child-care
Postpartum Depression
Up until the last few years, most postpartum mood disorders were commonly combined under the umbrella term, “Postpartum Depression,” or PPD. The unfortunate side effect of this is that some women- including myself- suffering with postpartum mood disorders have had a difficult time getting accurate diagnoses because we were not presenting with a typical presentation, and other postpartum mood disorders were not as readily written and talked about. Most of our healthcare providers weren’t screening for postpartum mood disorders outside of postpartum depression. As of this writing in 2019, this seems to be changing, thankfully.
Keep in mind, postpartum mood disorders are never really a one-size-fits-all kind of thing, so your symptoms and experience may vary.
The National Institute of Mental Health (NIMH) describes PPD as clinical depression that occurs in the postpartum period, with symptoms that can include the following:
- Extreme sadness
- Fatigue
- Loss of interest in things you normally find joy in
- Sleeping too much or too little
- Appetite changes
- Inability to connect and bond with baby
- Suicidal thoughts
- Rage, inability to control anger
- Fear of being left alone with baby
- Fear of harming baby
Again, this is not a one-size-fits-all condition. You may present with only a couple of these symptoms, or with almost all. NIMH states the biggest indicators that what you are experiencing may be postpartum depression is that your symptoms are interfering with your ability to complete daily tasks and that these symptoms are new to you. If you’ve always had insomnia, then insomnia during the postpartum period is likely not an indicator for you that something is awry. If you didn’t have insomnia prior to giving birth, but you do in the postpartum period, then that could be a signal to you that something needs addressed.
Postpartum Anxiety, Postpartum Panic Disorder, and Postpartum OCD
Postpartum anxiety is getting a little more of the postpartum mood disorder spotlight these days and that is wonderful. According to Postpartum Progress, postpartum anxiety often presents with other postpartum mood disorders, but sometimes she flies solo and she can come in like a frickin’ wrecking ball to a new mama’s peace of mind.
Just like PPD, these postpartum mood disorders can happen to anyone in the postpartum period regardless of if they have any of the following known risk factors:
- Personal or family history of anxiety and/or panic disorders and/or OCD
- Personal or family history of depression
- Thyroid issues
Postpartum Anxiety:
- Pervasive generalized anxiety and concern
- Racing thoughts
- Difficulty focusing
- Appetite changes
- Irritability
- Inflexibility
- Dizziness, hot flashes, nausea
- Sense of impending doom
Postpartum Panic Disorder:
- Easily distracted
- Difficulty making decisions
- Insomnia/fatigue
- Irritability/easily agitated
- Loss of appetite
- Difficulty focusing and remembering things
- Overwhelming anxiety and fear, leading to avoidance of places, people, and things
- Agoraphobia, or fear of being out in the open and in public
- Suicidal thoughts
- Specific fears include fear of losing control of oneself, fear of “going crazy,” and fear of dying
- Panic attacks
- Chest pain, difficulty breathing
- Heart racing
- Hot flashes/shivering
- Trembling and shaking
- Nausea
- Sweating profusely
- Sense of detachment from those around you
Postpartum Obsessive-Compulsive Disorder
- Obsessive thoughts, typically about baby and baby’s safety
- Compulsions to do or check things, which brings a momentary sense of relief
- Being hypervigilant with baby and baby’s safety
- Afraid to be alone with baby
- Feeling afraid of these obsessive thoughts and compulsions
As you can see, PPD and other postpartum mood disorders do a great job of sticking together. Many symptoms overlap and it can be difficult to sort out what exactly is happening to ourselves and our loved ones while in the thick of it. This is where reaching out for help from a knowledgeable healthcare provider comes in.
Rest assured that ALL postpartum mood disorders are treatable, are manageable, and are able to be moved on from and left behind with proper treatment, management, and support. The only dead end here is the one where we don’t reach out for the help we need.
Postpartum PTSD
Postpartum post-traumatic stress disorder, (PTSD) likely feels pretty familiar to most readers as most of us are familiar with the idea of PTSD in the non-postpartum world. According to Postpartum Support International (PSI), a person can have experiences during pregnancy and during and immediately following birth that can trigger a postpartum PTSD experience.
Postpartum Support International acknowledges that while anyone can have postpartum PTSD from traumatic pregnancy and birth experience, additional risk factors include:
- Women who have a history of sexual trauma, abuse, and rape
- Health scares during pregnancy and birth for both mom and baby
- Non-planned events during birth such as emergency induction and/or c-section
- Obstetric violence such as invasive practices (forced cervical checks, episiotomy, etc)
- Denial of or forcing of medications
- Verbal and/or physical bullying, coercion, humiliation, and/or abuse at the hands of medical staff or those in positions of physical power
- Lack of adequate communication during labor and delivery
- Significant physical complication in mom such as preeclampsia, hemorrhage, hysterectomy, etc
- Physical complications in baby, such as those that require a NICU stay
PSI lists symptoms of postpartum PTSD as:
- Flashbacks
- Nightmares
- Exaggerated startle response
- Anxiety
- Panic attacks
- Obsessively thinking about the experience
- Attempts to avoid anything associated with the experience
- Especially difficult because this can mean avoiding doctor’s offices, hospitals, and healthcare professionals
Personally, I believe that sometimes a person’s postpartum PTSD experience can be further complicated by people offering well-meaning platitudes intended to make the person feel better, such as, “at least you and baby are healthy, that’s all that really matters,” or “well, the doctor knew what they were doing, I’m sure,” because unfortunately, they don’t.
The experience that lies at the heart of the PTSD should never be dismissed as insignificant because everyone survived it or because the trauma was at the hands of a medical professional. People with postpartum PTSD should be supported, period. No qualifiers, no “at least,” just loving support and acknowledgement of their experience. Attempting to make it seem “less” can make the person feel unheard and misunderstood. Trauma doesn’t go away simply because someone else says it should, although that sure would make things simpler, wouldn’t it?
Postpartum Bipolar Disorder
Less well known than postpartum PTSD is postpartum bipolar disorder, defined by PSI as the presentation of bipolar disorder that begins during pregnancy or after giving birth. Postpartum bipolar disorder is similar to non-postpartum bipolar disorder in that it all too often goes unidentified and is associated with a high risk of suicide when untreated.
According to PSI, risk factors for postpartum bipolar disorder include:
- Family history of mental illness, including but not limited to bipolar disorder
- Personal history of extreme mood swings even if these have never been diagnosed as symptoms of bipolar disorder.
PSI states that symptoms of postpartum bipolar disorder include:
- Depression
- Hyperactivity
- Feelings of euphoria
- Racing thoughts
- Excessive sleepiness during the day
- Insomnia
- Decreased need for sleep
- Impulsivity
- Inflated self-image, “delusions of grandeur”
- Rapid speech
- Overconfidence
- Poor judgement
- Prior poor experience with antidepressants, such as antidepressants not working for them or working very quickly, inducing manic states
The Psychiatry Adviser urges people to recognize that disorders such as bipolar disorder can look radically different from one person to the next; When in doubt, get it checked out. Bipolar disorder shares a close association with the next postpartum mood disorder on the list.
Postpartum Psychosis
The last stop on our postpartum mood disorder road map is the one that is often the most feared: Postpartum psychosis.
Postpartum Support International states that while postpartum psychosis is very rare, occurring in only about 1-2 out of 1000 births, it is a significant risk to mom and baby. It is associated with a 5% suicide risk and a 4% infanticide risk, and is the postpartum mood disorder that often pops up on the news with high-profile tragedy cases.
PSI lists the following risk factors as being the most significant for postpartum psychosis:
- Personal or family history of bipolar disorder
- Previous psychotic episode
As with all of the postpartum mood disorders, it can occur in people with no risk factors.
According to PSI, symptoms of postpartum psychosis include:
- Delusions, often religious in nature
- Hallucinations
- Irritability
- Paranoia
- Mood swings
- Communication issues
Quick note about the delusions and hallucinations associated with postpartum psychosis: Postpartum Support International makes it clear that while there are those who experience delusions and hallucinations that are violent and dangerous, there are many that do not. Regardless of this, postpartum psychosis is almost always considered a psychiatric emergency, because the break from reality that is being experienced has the potential to become violent and dangerous at any time and the person will be unable to understand this as they are going through it.
If you or someone you love is exhibiting signs of postpartum psychosis, seek emergency medical help right away. Better safe than sorry, always.
There is Hope.
Every single one of these postpartum mood disorders is treatable. Every single one of them has an excellent prognosis- as long as a person gets treatment. Understanding the variety of ways that postpartum mood disorders can present can be helpful in understanding what is happening and moving towards the treatment and support that is needed.
The journey doesn’t end here; There is a brighter road ahead, and now you have a road map.
Part 3: The Road Ahead
The only dead end on this road is the one where a person doesn’t get the help they need in managing their postpartum mood disorder.
Every single one of the postpartum mood disorders written about in this series is treatable. Every single one of them.
There are a variety of treatment routes for postpartum mood disorders that span the range between self-care and support of family and friends to medication and hospitalization, depending on the severity of a person’s situation. In order to determine what is the right path for someone with a postpartum mood disorder, getting professional help is always the first step.
Talk to a therapist, OB/Gyn, or primary care provider to learn what path to recovery will work best for you and your specific needs.
Self-Care
If self-care at home with supportive family and friends is a treatment option that is offered to manage the postpartum mood disorder, it might include instructions to enlist extra help in caring for baby, to make a plan that allows for adequate sleep and adequate nutrition, and to engage in complementary self-care practices such as exercise, yoga, meditation, and support groups.
Small steps towards better self-care practices can make a huge difference in mental health, especially in the postpartum period. It can be easy for new parents to lose themselves in the shuffle after baby arrives. Sometimes we need the reminder that we need to take care of ourselves, too.
Therapy
Therapy or counseling is an important piece of the postpartum mood treatment puzzle. The Massachusetts General Hospital’s Center for Women’s Mental Health states that there are a variety of therapies that may be used, including Cognitive Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT) and many others; a therapist can help determine which is the best fit.
One of the biggest advantages of therapy is that tools learned here can be used for the rest of the person’s life and will often help a person find greater peace and strength in other areas of their life as well. An additional bonus of therapy in the digital age is that there are many practitioners that now offer therapy sessions via telephone and video call, which helps if getting out of the house to a physical appointment is an obstacle.
If you are unable to afford therapy via traditional channels, click HERE for alternative options.
Medication
Sometimes medication is a necessary piece of the postpartum mood disorder recovery puzzle, and the Center for Women’s Mental Health states it can be life-saving for both mom and baby. Medication is often prescribed in tandem with therapy and self-care techniques and there are a variety of options, many of them breastfeeding safe.
Because most therapists, OB/Gyns, and primary care practitioners are not lactation experts, the Infant Risk Center runs a hotline (806-352-2519 Monday-Friday, 8am-5pm central) that gives the most up to date and accurate information regarding specific medications, dosages, and mother’s milk. About 10 years ago, it was true that many medications required mom to wean. This is not the case now, so don’t let this be an excuse to postpone treatment!
In-Patient Care/Hospitalization
In some cases, postpartum mood disorders may be dangerous to mom and those around her and a more focused care plan that can only be delivered on an in-patient basis is necessary.
If a healthcare practitioner determines that in-patient care or hospitalization is necessary, then that is the path to get back to wellness. Sometimes we might think we can’t take time out of our daily lives for things like inpatient, intensive therapy, but if a trusted doctor believes this is the best path for a postpartum parent, then daily life is probably already very disrupted by the postpartum mood disorder that the doctor is being seen for.
According to the Center for Women’s Mental Health, another treatment with high success rates can often be administered before the in-patient route must be taken, and that is electroconvulsive therapy, or ECT. ECT is an outpatient procedure that is very safe, well-tolerated, and can lead to quick results and recovery.
A tip from a mama who has been there, done that:
It may be helpful to keep a journal of what treatment plans you are following. Be sure to mark the date and how long you have been on each treatment plan and how your postpartum mood disorder has responded to it. Sometimes medications need to be switched around or treatment plans may need adjusted and having a personal paper or digital record can be incredibly helpful in tracking what works for you and what doesn’t, especially if you are seeing multiple practitioners.
The Path to Recovery
Getting the help that is needed is what puts us back on the path to health and wellness for ourselves and our family. We are so fortunate to be living in a time where we have so many efficient treatments and tools available to us on the road to recovery.
There are a number of organizations that are devoted to postpartum information, education, support, and resources. What follows is a brief list of some of the major ones:
Massachusetts General Hospital, in conjunction with Harvard Medical School, runs the Center for Women’s Mental Health, and their website contains lots of information, educational tools, and resource guides: https://womensmentalhealth.org/
The American Pregnancy Association’s website has a wealth of information and resources for all things pregnancy, birth, and beyond, including mental health: https://americanpregnancy.org/first-year-of-life/forms-of-postpartum-depression/
For more information regarding “Mommy Brain” and the research into structural brain changes after giving birth, check out this link to The Scientific American:
Postpartum Support International has a very thorough website filled with information and resources for postpartum mood disorders, including helplines that can be called for more information and resources, online meeting groups for information and support, and chat functions for both moms and dads: https://www.postpartum.net/
Postpartum Support International help lines:
Call: 1 800 944 4773
Text: 503 894 9453
The Psychiatry Adviser is an online publication that has many informational and educational articles about postpartum mood disorders, among other psychiatric issues: https://www.psychiatryadvisor.com/home/bipolar-disorder-advisor/bipolar-postpartum-depression-frequently-missed-requires-screening/Postpartum Progress is an award-winning online educational advocacy site created by a postpartum mood disorder survivor, and contains helpful information, educational tools, and resources for moms