It was exactly two years ago. My husband and I had just come home from the hospital with our new baby. Our first child had arrived two days earlier. As any new parents know, those first few days (nights) can be rough. Everything was new, exciting, exhausting and overwhelming. We were navigating our new jobs as parents and our tiny boss was demanding to say the least.
I was so happy to hold my little one in my arms, but why was I also so sad? Why did I spend those first few days feeling completely overwhelmed? I would hold him tight and stare out the window at the crisp autumn leaves just starting to turn colors and wonder if I was doing this parenting thing right. I was anxious about every little noise that he made. I worried that he wasn’t sleeping enough as we were all sleep deprived. I was worried that I wasn’t feeding him enough, changing him enough, or that I was holding him too much. My body was recovering at the appropriate rate but my emotions were rampant – something that I was not used to. I had always been even-keeled, calm, rational-but those first few days had me shaken. Tears stained my cheeks and dropped onto my son’s sweet newborn head. They were tears of happiness, exhaustion, anxiety, frustration. I thought, “Why do I feel this way? What is going on? How am I going to handle all of this?”
Those first few days were hard. Within a week or two that overpowering flood of emotions seemed to have washed over me. I felt better. I was getting the hang of this parenting thing. The little one and I were figuring each other out and our family had made our own routines and rhythms. Some level of constant mommy anxiety or vigilance will always be there, but I have never felt the way I did in those first few days. With the support of my husband and family I had come out of my funk and was enjoying mommy-hood. I had great friends who had just gone through the same experience and their support was empowering. I was lucky. For me the baby blues were short lived. For thousands of women out there the baby blues become something more, postpartum depression.
Do you see yourself in my story?
You may be reading this while you are pregnant, feeling those little flutters as baby rolls around inside, and already causing you anxiety. You may be reading this during a middle of the night feeding session with your newborn when you won’t be able to fall back asleep. You may be reading this months or years into motherhood. You may be reading this as the concerned spouse who feels helpless watching your partner struggle. But if you are reading this and can relate to my experience you are not alone. And if you are reading this thinking that I got off easy, that what you have experienced was much worse – you are not alone. And mama, please don’t think that no one understands.
Depression is the most common mood disorder and women are twice as likely as men to be diagnosed with depression. When you think about that statistic it becomes obvious why up to 23 percent of women suffer from depression at some time during pregnancy and why 1 in 7 women will suffer from postpartum depression.
So how do you know if you have the “blues” or something worse?
There is a difference between the mommy or baby blues and postpartum depression. The “blues” are typically going to start around postpartum day two or three. This is right when you may be leaving the hospital and getting back home to your own environment and new role as mommy. The blues can make you feel depressed, anxious or angry. They can make you have difficulty sleeping, eating, or keeping your temper. You may question your ability to make decisions or care for your baby. You may cry for no reason. These feelings can come and go and typically do not last longer then two weeks. Most women do not need treatment for the baby blues.
Sometimes the blues don’t resolve. You may have feelings that last longer then two weeks, or don’t start until weeks after delivery. These feelings tend to be much more intense. You may feel extreme sadness, despair or anxiety. These feelings may not be just emotions. They can interfere with your ability to do daily tasks. You may lose interest in caring for yourself or your baby. You may have scary thoughts or feelings about yourself or your child. In extreme cases of postpartum depression women have been suicidal or may try to harm their children. Postpartum depression, postpartum anxiety and postpartum psychosis need to be treated and you need to tell your family, friends and doctor if you are having these or other intense feelings.
How do you know if you are at risk for having postpartum depression?
Women who have a previous history of depression or anxiety anytime in their life are at higher risk to have depression during pregnancy. Women who have a lack of support and resources during the pregnancy are more at risk. You may be higher risk for depression if the pregnancy was unintended, stressful or high risk.
Also, women who battled with depression or anxiety throughout the pregnancy are at higher risk for postpartum worsening of their moods. Moms who delivered preterm babies or have a child with medical complications that require the baby to be in the neonatal intensive care unit (NICU) tend to have more postpartum depression. There is also a link between postpartum depression and difficulty with breastfeeding. Lack of support from your spouse, family and friends make you higher risk too.
But what actually causes postpartum depression?
Depression is caused by a change in certain chemicals in the brain called neurotransmitters. If you have had previous depression or anxiety those chemicals may be slightly out of balance or they may be more sensitive to the intense changes that you are going through after delivery.
Even if you have never had depression or anxiety in the past there are many things that come into play to cause or worsen postpartum depression. Your hormones crash shortly after delivery; your estrogen and progesterone levels drop rapidly leading to some very rapid body and mood changes. You just went through the stress of delivery and in some cases major surgery to deliver. You are fatigued, physically and emotionally. You may be dealing with very intense new feelings for the first time. Your body is going through new and awkward changes. You may be in pain. You may be struggling to produce breast milk for your baby. You may not feel good about yourself. You may not have anybody around you that tells you that you are doing great and looking great. You may not believe anyone even if they did say that. Relationships may be strained as you learn to fit into these new roles. You may have other children at home who need your attention too. You may feel that you are not fulfilling your roles, you may feel like a failure. But you are not alone in these thoughts and you are not a failure!
What can you do while you are pregnant?
During your prenatal appointments, especially the first OB appointment, it is important to discuss any mood concerns that you have. Please let your doctor know if you have had depression or anxiety in the past and if you have ever been or are currently on medications for this. Please let your doctor know if your mood changes during the pregnancy.
Worsening depression and anxiety can be managed during the pregnancy in many ways. The most common treatments are talk therapy and medications. There are excellent resources and therapists available that specialize in mood concerns for pregnant and postpartum women. They are available to talk through your fears and concerns and help you recognize and handle those feelings better. There are also medications that can be safely used in pregnancy to help treat depression and anxiety. There are many medications that are totally safe in pregnancy, but there are also many medications that are not as safe for the baby. Some medications cross the placenta and can cause harm. This needs to be discussed with your doctor and medication adjustments should be monitored by your physician. You should never start or stop these medications without the help of your doctor and therapist.
Having depression or anxiety during pregnancy may also put your baby at risk for certain things and having an uncontrolled mood disorder is often more dangerous to your baby then using the safe medications to help keep your mood stable.
What can you do after you have the baby?
Before you leave the hospital you will be screened for postpartum depression. Many women do not develop symptoms or feelings of depression until much later. After delivery it is important to share your feelings with not only your partner, family and friends but also with your OB provider. Do not wait until your postpartum visit at six weeks.
Postpartum depression can sneak up on you and sometimes does not develop until months after delivery. There are people trained to help you, but you need to ask for help. Please do not hesitate to call your doctor’s office if you are having any bothersome feelings of anxiety or depression. Talk therapy and medications can also be used in the postpartum period. We can set up an appointment with a therapist quickly, but medications used to treat this can take three to four weeks before you notice a real difference in your mood. Three to four weeks can feel like a lifetime when you are struggling with postpartum depression. It is our goal to keep you and your baby healthy and happy and there are so many resources available to help you. You are not alone.
What are ways that I can help myself too?
Talk therapy and medications are the main effective treatments for postpartum depression, but that doesn’t mean that you are helpless in this disease. You need to ask for help, not just with the mood concerns but with life demands, too. You may be surprised to know how many people care about you and your child and would be willing to give you a helping hand if you would only ask. Maybe you need someone to pick up a few groceries at the store or sit and hold the baby for an hour so you can shower or rest. Find time to spend just a few minutes a day doing something that you enjoy, just for you. Go for a walk. Get out of the house. Get dressed (in clean yoga pants – who are we kidding), eat healthy foods, stay hydrated. Sleep, anytime you can, sleep! Forget that load of laundry, forget that the house is a mess. You need to take care of you so that you can take care of your baby.
In this day of instant information online you can find support groups and stories of other women who are struggling with or have gone through postpartum depression. You will quickly see that this experience is more common then you may have thought. Many women find support in social media groups and mommy-bloggers, but there are also medical online resources that can help you decipher your feelings and point you in the direction of help including:
If you or someone you love if suffering from postpartum depression or anxiety, please ask for help. You are not alone.
- Baby blues vs. postpartum depression
- Recovering from delivery: What’s common and how to ease it
- Podcast: Protecting our mental health postpartum