Postpartum Emotional Wellness
“My new baby is here! Aren’t I supposed to be feeling overjoyed and excited? So why do I feel so let down and so exhausted, like I’ve been run over by a truck?”
You’re not the only one feeling this way. All too often, portrayals of new moms paint an idealistic picture of her happily gazing into her newborn’s eyes, easily breastfeeding, balancing parenting and the rest of life, and returning to her pre-pregnancy shape in a matter of weeks. In reality, most women experience a range of emotions and difficulties: Anxiety, sadness, increased stress, changes in important relationships, body image concerns, and the loss of your former self are all difficult to navigate, and even more challenging while caring for a newborn.
Pregnancy and the postpartum period are times when women are more vulnerable to mood and anxiety disorders. Nearly 80% of new moms will experience the “baby blues,” which is characterized by sadness, weepiness, and lack of energy. Most often arising 3-5 days after birth and lasting no longer than 14 days, it will usually remit with some extra sleep and support. More intense and persistent, postpartum depression (PPD) affects 15-20% of moms, and is the number one complication of childbirth. PPD usually occurs 1-3 months after birth, but can emerge anytime within the first year. Symptoms persist beyond two weeks and include depressed mood, frequent crying, difficulty sleeping and eating, irritability, lack of interest in your baby, withdrawal, and difficulty concentrating. Anxiety and agitation, feelings of worthlessness, and guilt are also typical. Thoughts of harming yourself or your baby may also occur.
Postpartum anxiety disorders, including anxiety and obsessive compulsive disorder, impact approximately 10% and 5% of new moms, respectively. Symptoms include excessive worry, racing thoughts, and physical symptoms such as nausea, dizziness, and heart palpitations. Intrusive thoughts or images of harming one’s baby may also occur. Most women feel horrified by these thoughts and avoid being alone with the baby and/or engage in compulsions or repetitive behaviors to control fears. It is important to note that feeling disturbed by these “scary thoughts” is a good sign, suggesting you are unlikely to act on them.
Though extremely rare, a woman may experience postpartum psychosis (PPP), which is characterized by hallucinations, delusions, mania, and extreme confusion. Onset is often abrupt, occurring within the first four weeks postpartum. PPP constitutes a true emergency as the risk for suicide and harm to baby significantly increases. Medication and hospitalization are often necessary.
While there is no one known cause for PPD and the above related disorders, research suggests that the vast hormonal shifts taking place postpartum, profound life changes, and physical demands of caring for a newborn all contribute. Risk factors include a genetic predisposition or prior history of depression, maternal or infant medical complications, chronic sleep deprivation, conflict with one’s partner, limited social support, and a recent life change such as a move, illness, or loss.
I think I may have postpartum depression, now what?
Hold onto hope
Know that PPD is a temporary and highly treatable condition. With proper attention and follow through, you will get better. You did nothing to cause PPD, and the best thing you can do for you and your family is take care of yourself.
Avoid procrastination
Many women hope their symptoms go away, believing they are just a natural part of new motherhood. Motherhood is challenging but suffering doesn’t have to be endured. Because symptoms can worsen over time, don’t delay seeking help.
Request blood work
Because physical factors (e.g., thyroid dysfunction) often can cause depression, it is important to rule these out first. Ask your Ob/Gyn or family doctor to do a complete physical.
Seek out help
Your Ob/Gyn is often a good starting place to identify treatment options and obtain referrals for providers who specialize in treating postpartum issues.
The following recommendations for self-care during the postpartum period are important for all new moms, especially those who are struggling.
Talk about how you are feeling
The pressure to appear as if you have it all together and are feeling 100% positive can take a toll. Acknowledge your mixed feelings to yourself, your partner, and friends/family.
Self-care is not selfish
Seek out opportunities to do something nice for yourself, however simple it may be (e.g. take a bath, get a manicure, or meet a friend for lunch.) Plan to do several self-care activities weekly.
Ask for help
It’s not only okay, but important to ask for help. Seek out and request support from your partner, family, and friends. People often ask what they can do to help. Instead of automatically declining the offer, let them know specific tasks they can do (e.g., pick up food, come for a visit, babysit).
Sleep
While it may sound nearly impossible, put a priority on sleep. Make a rule that baby’s naptime is yours too regardless of how much you believe needs to get done. If you have trouble sleeping, simply resting with your eyes closed can help.
Get proper nutrition
Focus on eating balanced meals, minimize sugar, and avoid caffeine and alcohol as it can induce jitteriness and exacerbate anxiety/depression.
Exercise
As soon as you are physically able, make an effort to do some physical activity daily. Getting out and moving even for 10 minutes can boost your mood, help your physical recovery, and facilitate sleep.
Challenge perfectionism
Now is not the time to try to do everything 100%. There is no such thing as a perfect mom—it’s okay to be “good enough.” Relax your stance on your to-do list (the dishes, thank you notes, returned phone calls, and laundry all can wait).