Most of my current clients know that I have recently returned from maternity leave with my second child. Maternity leave, for me, was full of mixed emotions. It was such an amazing opportunity to spend time with each of my daughters and begin to bond and create important connections between us. I’m so grateful that I was able to take ample time away from my job and had support from my husband to be afforded the possibility to take weeks at a time with each of my daughters to get to know them and let them get to know me. My gratitude for having that option and importance of the time I was able to spend with my children at that time cannot be overstated.
That being said, maternity leave was exhausting, difficult, and isolating. Long sleepless nights followed by longer, stressful and still sleepless days with little to no moments of rest took a toll on my emotional well-being with both leaves that I took. There there was the constant wondering. Wondering if I was doing the right thing for my child at every moment. Was she getting enough to eat? Was she sleeping too much? Too little? Is she too hot? Too cold? On and on the thoughts would come into my mind and at every moment I had an all too real awareness that this tiny, perfect little life was depending on me. Couple that with the extreme hormonal fluctuations that occur postpartum as well the physical recovery required after birth, it may be easy to recognize how a wonderful situation can be quite tying as well. And my experience immediately following the birth of each of my daughters was a quite positive one. I had financial, emotional, and social resources available to me and in the form of an employed spouse, good friends, and great family. I even had support from a group of helpful neighbors and kindness from my clients who were willing to sit tight while I was away from the office with my little one. Even with all the best laid plans and available resources, I know now, twice over, that having a new child can be incredibly exhausting and emotionally draining.
If the pregnancy was planned, if mother and child were healthy through the pregnancy and delivery, if social and environmental aspects hadn’t changed over the course the pregnancy, if a the child is easy to comfort and easily sleep and eats…even in these best case situations having a newborn is hard and the risk for postpartum depression (PPD) exists. Even with the best possible perinatal and postnatal experience, a new mother may feel a myriad of difficult and overwhelming emotions. And very few pregnancies, births, and early child rearing experiences go perfectly. More commonly situations include difficulties with birth for mom and/or baby, sleep deprivation, worry about being a new (or new-again parent), changes in social support, not being able to be home with your child because you need to return to work or not being able to return to work after your child is born, changes in income due to having a child, change in self-identity, and the list can go on, and on, and on. In these more common, more realistic situations the risk for PPD is significantly increased.
The “baby blues” has been reported to affect as many as 70-80% of women. More severe symptoms that can be categorized as PPD affects 10-20% of women(1) or up to 1 in 7 women(2). It’s also important to keep in mind that these are reported cases and that the prevalence rates are likely much higher as many women do not report or seek treatment for PPD. Additionally, PPD does not necessarily occur in the weeks or even early months after birth of a child and can begin anytime within the first year. Moreover, some women begin to experience feelings of depression while still pregnant(1).
Certain risk factors have also been found to increase the likelihood of developing PPD. A significant risk factor is prior mental health concern particularly previous experiences with depression and/or anxiety. Other factors that can contribute to PPD include having experienced PPD with a prior pregnancy, low socioeconomic status, first time mothers, younger or older mothers, hard to comfort babies, increased stress upon arrival of child, or having a child with special needs(2).
How to recognize postpartum depression:
It may be difficult to discern postpartum depression, particularly when mild, from pure exhaustion or even the more commonly referred to baby blues. If you have several of the following symptoms for 2 or more weeks, evaluation by a mental health professional is recommended:
Loss of interest in the things you used to enjoy
Thoughts of harming self or baby (see below for learning when PPD is a clinical emergency)
Disinterest in baby, family or friends
Fear of being alone with the baby
Change in appetite
Feelings of worthlessness, being a bad mother
Uncontrollable or frequent crying
Change in sleep (too much or too little sleep)
Difficulty concentrating, memory problems, mind going blank
What can I do if I think may be suffering from postpartum depression?
You are not alone
As discussed above, hundreds of thousands of women in the US experience PPD every year. PPD is a real condition that has real, useful treatments that help the majority of women who engage in treatment.
Reach out to family and friends
Let family or friends know that you are struggling. Ask a trusted, helpful family member or friend for help with the baby so that you can find an opportunity to connect with the resources needed to learn to better manage your symptoms and improve your life.
If you feel that your symptoms are mild, currently manageable, or you are interested in finding support or more information, there are plenty of online resources available. A few are listed here:
Therapy has been found to be successful in treating 80% of women with PPD(1). It is a treatable condition that you can recover from. Therapy can provide you with support from a trained, licensed professional who can not only provide you with much needed support but can teach you meaningful skills and strategies to change the way you think and feel. Therapy can allow you to move out of depression and engage with you child in a values-based way.
Medication is often an alternative or adjunctive treatment to psychotherapy and can help to alleviate symptoms of depression. There are medication options available for breastfeeding mothers. A visit to your primary care physician or scheduling with a psychiatrist can be one step to accessing care if you think you’re experiencing symptoms of PPD.
Shame around postpartum depression may be one of the biggest barriers for a woman to talk about or seek help for her depression. For many, the thought of sharing that they may be less than joyous after the birth of their child or may having trouble coping or connecting with their child is unbearable. Shame alone may account for the large number of women who delay treatment or never choose to seek treatment. There is nothing wrong with you if you are experiencing PDD. You are not alone. You can overcome PPD and there are many resources available to help you in doing so.
How you can support your partner/loved one if she is (or you're worried she may be) experiencing postpartum depression:
Don’t shy away from asking your partner/loved one how she feels, even if you don’t know what to say, how to respond, or are made uncomfortable by her feelings. If you have difficulty talking about PPD, imagine what she may be going through. Don’t minimize feelings and avoid language that may invite shame (e.g., what do you mean you don’t feel connected to our baby? You get to stay home with the baby all day, what’s so hard about that? I don’t have any trouble with the baby/my baby).
Keep asking questions. Keep checking-in and providing support.
Offer support - both physical and emotional
Try to jump in and be helpful. If you’re a coparent, look for ways that you can help with the baby and encourage your partner to rest, engage in self-care, and offer resources for PPD. Be open to talking about and listening to your partner’s difficult thoughts and feelings. Meet her with openness and willingness to support her, despite your ability to understand or empathize with what she is going though.
Remember that PPD isn’t always immediate. Keep looking for and talking to your partner/loved one throughout the first year of parenthood. Look for changes in behavior, energy levels, and stress levels and talk to your partner/loved one if you notice changes.
When PPD is an emergency?
For most women, PPD is incredibly difficult, but treatable in outpatient psychotherapy with or without the use of medications. However, there are some severe cases that constitute a clinical emergency and needs immediate action. These include:
If you (or your loved one ) are thinking about harming yourself or your child(ren). This is cause for immediate intervention and assessment at an emergency room or mental health crisis clinic. If you are experiencing thoughts like these, put the baby in a safe, comfortable place (such as their crib or pack-and-play) and call a trusted friend/family member to watch your child so that you can seek immediate assistance (see the help resources and numbers below).
If you (or your loved one) appears to be seeing or hearing things that others cannot see or hear (auditory or visual hallucinations), expressing strange or unusual thoughts or paranoia (delusions), or seems detached from reality. In these situations you/your loved one may be experiencing what is called postpartum psychosis and immediate intervention is warranted.
In either of these situations, you can call 911 and ask for the PERT (psychological emergency response team) to come to you/your loved one and be escorted to a local emergency room for evaluation and safety.
Support lines and resources in case of emergency, crisis, or difficulty coping:
If you’re already meeting with a therapist, psychiatrist, or other mental health professional, you can reach out to them if you’re struggling or think that you may be experiencing a mental health crisis.
You can call 911 and ask for PERT (psychological emergency response team) to come to you/your loved one and be escorted to a local emergency room for evaluation and safety.
Postpartum Health Alliance
For immediate support call the San Diego Access and Crisis Line at (888) 724-7240. the toll-free call is available 24 hours a day, seven days a week.
Talk to mothers who have recovered from PPD.
Postpartum Support International
(800) 944-4PPD or (800) 944-4773