As soon as most expecting mothers hear the words postpartum depression, they tune out and skip over this topic. If you have never experienced depression, it is the last thing you think you need to know about, especially at a time in your life when you expect to be the happiest. Baby blues and postpartum depression are a complication of birth. The baby blues are estimated to occur in about 50% or more of women. Some studies show an even higher prevalence at nearly 80%. One in seven mothers will experience postpartum depression, and 40% of those mothers will have onset after birth. Over the last few decades, research shows that the number of new moms experiencing postpartum depression is increasing. This article covers the symptoms of the baby blues and postpartum depression, how to get help, and how to protect your mental health postpartum.
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Don’t Skip this Topic
As soon as most expecting mothers hear the words baby blues or postpartum depression, they tune out and skip right over this topic. If you have never experienced depression, it is the last thing you think you need to know about, especially at a time in your life when you expect to be the happiest. The baby blues are estimated to occur in about 50% or more of women. Some studies show an even higher prevalence at nearly 80%. One in seven mothers will experience postpartum depression, and 40% of those mothers will have onset after birth. The number of new moms experiencing postpartum depression is increasing. A study that examined over 39 million births from 2006-2015 found that perinatal mood and anxiety disorders and serious mental illness more than doubled during that decade. Numbers are only continuing to rise.
Another great reason to be educated about postpartum depression is that even if you do not experience it, you may have a friend who is having trouble. You can be a great resource to assist them in getting help. People with postpartum depression may not even be aware or acknowledge that they’re depressed. If you suspect that a friend or loved one has postpartum depression help them get professional attention immediately. Don’t wait and hope for improvement. The best thing you can do is get them to contact their care provider.
Changes After Birth
Why do so many mothers struggle with their mental health after birth? The baby blues and postpartum depression are a complication of birth due to the many changes you experience after you have your baby. While we don’t have a completely clear answer, there are factors we know to contribute.
A sharp drop in hormones after birth is one of the most significant causative factors. After the birth of your baby, your estrogen and progesterone hormone levels drop quickly, which can cause mood swings. Other hormones your thyroid gland produces may also decrease, making you tired, low energy, and depressed. Changes in the thyroid are common after pregnancy. If you have had thyroid issues or have a history of them in your family, request to get this checked after you have your baby.
Lack of Sleep
As a new parent, you can expect to get less sleep and to have your sleep disrupted by your baby. Infants do not sleep in one long stretch overnight. Instead, they sleep in a polyphasic pattern, on and off throughout the day and night. Babies are hard-wired not to sleep for long periods. Breastfed babies will sleep for shorter stretches than babies on formula because breastmilk is easily digested, and your baby needs to be fed more often. Even when examining studies on sleep for babies, researchers define sleeping through the night as 5-6 hours. They should start falling into a day-and-night rhythm around three or four months. By one year of age, they should be sleeping for a relatively long stretch at night with two naps during the day. By age four, they should sleep longer at night with one daytime nap. The takeaway is that few parents get eight hours of sleep each night.
The more scientists discover about sleep, the more we know how critical it is for mental health. Every single mental health condition is also associated with disordered sleep. If you are struggling with your mental health, it can negatively affect your sleep, and poor sleep can negatively affect your mental health. This can be particularly frustrating as a new parent when you have less control over your sleep schedule due to the demands of a new baby.
Pregnancy and birth are very physically challenging, and after you have your baby, it takes time for your body to recover. During pregnancy, your uterus increases in size by 500%. After birth, it takes 8-12 weeks for your uterus to return to pre-pregnancy size. You will experience lochia, which is like a period but heavier that can last up to eight weeks. Your breasts change as your milk comes in, and you adapt to breastfeeding your baby. Your body is working hard to recover from birth. There is a fantastic interview episode on birth recovery that goes through so many aspects of recovering from birth that no one tells you about, and you can check out that episode or read the transcript here.
All of the physical changes going on can also negatively affect your body image. A review that included 19 studies looked at body image and how it affected postpartum depression. Most studies found that body image dissatisfaction is consistently but weakly associated with the onset of prenatal and postpartum depression. Some studies even looked at the reverse and found that depression contributed to negative body image.
The Perfect Storm
In addition to everything going on after birth, you are responsible for caring for a new baby who relies entirely on you for survival. If this is your first baby, there may be even more anxiety about caring for a newborn. You can see that many contributing factors create the perfect storm to be bummed out after you have your baby.
The baby blues are prevalent and are estimated to occur in about 50% or more of women. Some studies show an even higher prevalence at nearly 80%. The baby blues include mood swings, crying spells, anxiety, and difficulty sleeping. Some other signs are sadness, irritability, feeling overwhelmed, reduced concentration, and a reduced appetite. Baby blues typically begin within the first two to three days after birth. The good news is that it disappears quickly, within one to two weeks.
One in seven new moms will experience a more severe, long-lasting form of depression known as postpartum depression. 40% of mothers who experience postpartum depression will have an onset after birth. Postpartum depression can be mistaken for the baby blues at first — but the signs and symptoms will be more intense and last longer. Eventually, it can interfere with your ability to care for your baby and handle other daily tasks.
Symptoms of Postpartum Depression
Symptoms generally develop within the first few weeks after birth, but they can take longer, sometimes up to six months after birth. The list of symptoms is long, but you should know what to look out for if you encounter this. Some signs of postpartum depression are a depressed mood or severe mood swings, excessive crying (by you, not the baby), difficulty bonding with your baby, withdrawing from family and friends, problems with your appetite, insomnia or sleeping too much, overwhelming fatigue, reduced interest in activities you used to enjoy, intense irritability and anger, fear that you’re not a good mother, feelings of worthlessness, shame, guilt or inadequacy, diminished ability to think clearly, concentrate or make decisions, severe anxiety and panic attacks, and can even include thoughts of harming yourself or your baby or recurrent thoughts of death or suicide.
A rare complication of postpartum depression is postpartum psychosis. This is a severe mental health illness and a psychiatric emergency. Symptoms usually start suddenly within the first two weeks and often within hours or days of giving birth. Symptoms include hallucinations, delusions, manic or depressed mood, a loss of inhibitions, feeling suspicious or fearful, restlessness, feeling confused, and behaving in a way that is out of character. Postpartum psychosis is rare, but it does require immediate treatment.
While it may seem extreme, if you ever have thoughts of harming yourself or your baby, you need to immediately seek help from your partner or loved ones to help take care of your baby and call 911 or your local emergency assistance number to get help.
Risk Factors for Postpartum Depression
Many factors can increase your risk of developing postpartum depression. These are broken down into four categories, psychological, obstetric, social, and lifestyle. Psychological risk factors include a history of depression and anxiety, PMS, or sexual abuse. A negative attitude towards the baby, the reluctance of the baby’s sex. Obstetric risk factors are related to your pregnancy and include having a high-risk pregnancy, emergency cesarean, and hospitalizations during pregnancy. Complications like meconium passage, umbilical cord prolapse, preterm or low birth infant, and low hemoglobin are also risk factors. There are social factors that can increase your risk, like a lack of social support or if you experience domestic violence. Your lifestyle also plays a significant role in your risk for postpartum depression. This includes your eating habits, sleep, and exercise. Smoking during pregnancy is also a risk factor for developing postpartum depression.
Having one or more risk factors does not guarantee you will experience postpartum depression, but it statistically increases your risk. Some of these things are in your control or that you can mitigate and consequently lower the risk of developing postpartum depression.
Screening for Postpartum Depression
Several tests may be used to screen for postpartum depression. A screening test cannot diagnose a condition and can only identify whether you should have further tests to rule out a condition or for a possible diagnosis. The most commonly used screening test for postpartum depression is the Edinburg Postnatal Depression Scale. This is a ten-question survey, and each question is scored zero to three with a maximum score of 30. A score of 10–14 often represents mild symptomatology, 15–19 describes moderate symptomatology, and a score higher than 19 is consistent with severe symptomatology and an increased risk for bipolar disorder. You can take this survey anonymously online here.
If You Have Symptoms
If you’re bummed out after your baby’s birth, you may be reluctant or embarrassed to admit it. Don’t be! It is essential to know that baby blues and postpartum depression are not due to anything you did wrong; they are birth complications. If you are struggling with some signs of depression, you do not need to be embarrassed or ashamed and know that you are not alone. Many women deal with this, and very few openly talk about it. If you seek help early on, you can manage your symptoms and return to being a happy mom and enjoying your baby sooner. If you are having any symptoms of baby blues or postpartum depression, call your care provider and let them know.
If not treated, postpartum depression can last for months, interfere with bonding with your baby, and make daily life more challenging. Do not wait until your next postpartum visit to talk to your doctor or midwife. Getting help as soon as possible allows you to access tools and resources to improve your mental health quicker.
Treating Postpartum Depression
Treatment and the time to recover will depend on the severity of your depression and the particulars of your situation. If you have thyroid issues or other underlying illnesses, your doctor may treat those conditions first or refer you to an appropriate specialist. Your care provider may also refer you to a mental health provider. Treatment for postpartum depression is often treated with mental health counseling, medication, or a combination of both. With treatment, postpartum depression usually goes away within six months.
Talking through your concerns with a psychiatrist, psychologist, or another mental health provider can be beneficial. Therapy will assist you in finding better ways to cope with your feelings, solve problems, set realistic goals, and respond to situations in a positive way. Sometimes involving family or your partner in therapy can also be helpful.
Your care provider may recommend an antidepressant for postpartum depression. If you are breastfeeding, many medications will transfer to your baby in your breast milk. Some antidepressants are approved to be used during breastfeeding with little risk of side effects for your baby. A decision to take an antidepressant will require talking to your doctor to weigh the potential risks and benefits of a specific medication.
The LactMed Database is an excellent resource for information on medications and breastfeeding. You can type in the name of any medicine and get research-backed information on how the drug can affect you, your baby, or your milk supply.
Hedging Against the Baby Blues and Postpartum Depression
There are some things you can do that can both hedge against the baby blues and postpartum depression and will help speed up your recovery if you are affected. Many of these tips may sound familiar because they all refer to causative factors or symptoms. While you may not be able to do anything about drops in hormone levels, there are many steps you can take to improve your mental health after birth. One of these interventions alone may not make a massive difference. When stacked together, these tips can help to protect your mental health.
Diet and Supplements
Your diet and ensuring you have the necessary vitamins and nutrients can help your birth recovery, energy levels, overall health, and mood. You should focus on healthy whole foods and continue to take a high-quality prenatal vitamin after your baby is born. There is some evidence that vitamin B6 has a positive effect on reducing postpartum depression scores among mothers at risk for postpartum depression. As long as you eat a wide variety of foods and take a high-quality prenatal, you should get all the vitamins and nutrients you need, including B6. If you are considering taking any supplements, please run them by your care provider.
All you can do is prioritize sleep as much as possible within the constraints of your parenting responsibilities. Once you have your baby, the cliché “sleep when the baby sleeps” is good advice. If your baby is taking a nap, try to close your eyes, even if it is just for a short time. Doing this in the real world can be challenging because your baby’s nap times are a convenient opportunity to get other things done. Anything on your to-do list can wait.
Naps can help make up for some lost sleep during the night. In a TED talk from Dr. Matt Walker, he discusses that humans are hardwired to have a drop in alertness in the afternoon, somewhere between 1:00-4:00 pm. Naps can have benefits, but they can also disrupt sleep. Dr. Walker advises avoiding naps if you struggle to sleep at night. If you are not struggling with sleep and can regularly nap during the day, a short 20-minute nap earlier is fine. A nap too late in the afternoon can make it hard to fall asleep that night. Andrew Huberman recommends limiting daytime naps to less than 90 minutes, the length of a sleep cycle, or don’t nap at all.
Set Realistic Expectations
Make sure that you set realistic expectations. You have a new baby, and no one expects you to have a spotless house and Pinterest-worthy meals prepared. Do not look to perfectly curated social media posts to set your expectations of what being a mother looks like. What you see on Instagram or any social media platform is the highlight reel. A study found that mothers who spend more time online engage in greater levels of social comparison, leading to increased stress and negative emotions. We are still learning about the consequences of social media and how it can have a negative impact on your mental health. If you feel mentally or emotionally drained after scrolling online, take a break and limit your time on social media.
Connection and Support
A large body of evidence supports a connection between social connection and physical and mental health. Humans are social creatures that are wired to connect to others. A study examined 27 stress indicators during pregnancy, including psychosocial, physical, and lifestyle. 66.8% of women were in the healthy group, and 17.1% were in the psychologically stressed group and had clinically meaningful elevations in perceived stress, depression, and anxiety. 16% were physically stressed with higher blood pressure and increased caloric intake. The researchers found that social support contributed most to differentiating the three groups. They looked at three forms of social support; others with whom to talk and spend time and on whom to rely for material help.
Starting or growing your family involves significant life changes that can significantly impact your lifestyle and the people you connect with. Going through pregnancy and parenting in isolation or with little support from a larger community of friends and family will make everything more difficult. If you feel like you need a better support system right now, that is something you have the power to change. There will always be people going through pregnancy and having babies in your community or area. You can meet other expecting or new parents through an in-person birth class, a local Facebook or Meetup group, or even at your neighborhood park. Pregnancy or having children around the same age is an instant common ground to connect with others.
The American College of Obstetricians and Gynecologists recommends that all women have contact with their care providers within the first three weeks postpartum. This initial assessment should be followed up with ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth. ACOG acknowledges that the National Institute for Health and Care Excellence guidelines recommend screening all women for resolution of the “Baby Blues” at 10–14 days after birth to facilitate early identification of and treatment for postpartum depression.
Although there are some guidelines in place, it is estimated that as many as half of cases of postpartum depression go undiagnosed. The longer you go without a diagnosis, the longer you will struggle without valuable resources that can help. Please be honest with your doctor or midwife about how you are feeling after you have your baby. If you have any questions about your symptoms being a sign of the baby blues, postpartum depression, or something more serious, please get in touch with your care provider. Do not wait until your next scheduled appointment. You may also request a referral to a mental health provider who may be better equipped to assist you.
Support groups can be a great tool in dealing with postpartum depression. Support groups meet regularly and are moderated by a knowledgeable professional. You will also be able to connect with other new mothers going through similar struggles. There should be a support group available in your local area. Your doctor or midwife may be a good resource for finding a local support group for new moms or women with postpartum depression.
You can join an online support group if you cannot locate an in-person support group or prefer virtual meetings. Postpartum Support International offers online support meetings. They have over 20 support groups, many of which cater to specific populations like parents of NICU babies, single parents, and military mothers. Smart Patients is an online community that partners with Postpartum Support International to offer groups to connect you with resources and peer support.
Depression and Your Partner
You are not the only one who may have challenges to your mental health after having a baby. Fathers also experience many challenges after the birth of a new baby, including lack of sleep, anxiety, and even changes in hormone levels. Research shows that partners and fathers can also experience the baby blues. One study found that at least 17.5% of fathers experienced postpartum blues. Researchers found that symptoms of postpartum blues were positively correlated with impairment in the father-to-infant bond. Feelings of sadness or depression in fathers after the birth of a baby happen most often during the first three to six months but can develop up to a year after birth. If you think your partner is having difficulty, please encourage them to contact their doctor.
Talk to Your Doctor or Midwife
Many moms try to power through the baby blues and postpartum depression without assistance. Please talk openly with your doctor or midwife about how you feel during pregnancy and after your baby. You do not need to wait until your next appointment, and you can reach out to them anytime with questions or concerns. Seeking the assistance of your care provider can connect you with resources and tools that can make a massive difference in how you cope and how long your symptoms last.
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