May 30, 2020
Written by Jessie Bohnenkamp, LPC, NCC
You just brought your sweet baby home a few weeks ago, and your days are spent in a haze of snuggles, sleepiness, and spit-up. You’re trying to soak up this magical newborn time, but you find yourself crying at the drop of a hat, acting moodier than a teenage girl, and feeling so overwhelmed that you just want to run away and hide sometimes. You knew it would be hard to adjust to a new baby, but how hard is too hard? Are these feelings normal, or are they a sign of something more serious?
Surveys have shown that 85% of women report significant emotional distress either during or after pregnancy, so no matter what you’re feeling, you’re definitely not alone in your struggle. However, it is important to know what constitutes a “normal” level of distress (that will likely resolve on its own) and when your symptoms could be a sign of postpartum depression or anxiety so that you can get the help and support you need as soon as possible.
Postpartum reactivity, commonly known as the “baby blues,” is experienced by about 80% of women who reported struggling after baby’s arrival. It usually occurs within the first few days after birth and resolves within two or three weeks. Postpartum reactivity is a very normal response to the exhaustion of early newborn days (both in terms of physical recovery after labor/C-section as well as the disruption to your sleep routine), as well as the huge hormonal shifts following birth and the massive emotional adjustment to your life, family, and personal identity. Symptoms include tearfulness, mood swings, irritability, and feeling overwhelmed. If you’re feeling any of these things in the first few weeks after birth, it’s totally normal. That being said, you should absolutely reach out for help and support from your family, friends, or even a mental health professional if you need someone to talk to beyond your personal network. Just because something is normal and expected doesn’t mean that you can’t benefit from some extra support to get through it! However, most of your symptoms should resolve as your hormones level out and you adjust to your new normal.
If you’re a few months postpartum and you’re still experiencing significant emotional distress, you might be among the 15-20% of women who develop a postpartum mood or anxiety disorder (PMAD). PMADs are a diagnosable mental health condition and the most common complication of pregnancy. Symptoms usually develop within two to three months after delivery, but they can also begin during pregnancy or even up to a year after baby arrives. The two most common PMADs are Major Depressive Disorder (postpartum depression or PPD) and Generalized Anxiety Disorder (postpartum anxiety or PPA). Other PMADs include postpartum obsessive compulsive disorder, post traumatic stress disorder (typically following a traumatic birth experience), panic disorder, and postpartum psychosis, which is a rare and dangerous condition that requires immediate psychiatric treatment.
Postpartum depression (PPD) is marked by feelings of sadness, guilt, and hopelessness. You might find yourself struggling to bond with your baby or lacking motivation to care for yourself or the baby, and you might have difficulty sleeping (even when you have the opportunity), feel exhausted all the time, and experience significant weight or appetite changes. You might also have difficulty concentrating or enjoying things that you normally like to do, and feel constantly irritable and angry. Women with PPD report feeling inadequate and worthless as mothers, and often have recurring thoughts of death or suicide (such as “everyone would be better off without me”). They experience intrusive negative thoughts about themselves, their babies, and their ability to properly care for their baby. If you’re constantly thinking that you’re doing a terrible job or that your baby would be better with a different mother, and you’re experiencing any of the physical/emotional symptoms listed above, you should be evaluated for postpartum depression. Moms with PPD are at a higher risk for death by suicide, so it’s critical to get the support you need. Therapy – particularly the type that helps you assess and reframe your negative thoughts and beliefs, such as Cognitive Behavioral Therapy – and medication are highly effective in treating postpartum depression.
Postpartum anxiety (PPA) can also cause difficulties with sleeping, eating, and concentrating, but is also marked by constant worry, obsessive thoughts (particularly about the baby’s health and safety), and physical symptoms such as stomach pain, headaches, and muscle tension. Mothers with PPA tend to overestimate the threat of potential harm to their babies while underestimating their ability to cope with challenges. This might show up as excessive worry about baby’s sleeping or eating habits or inability to sleep for fear of something happening to baby. It’s important to note that 90% of parents experience intrusive and scary thoughts about things happening to their babies (such as, “what would happened if I suddenly dropped him on his head?!”), but for moms with PPA, the thoughts are more exaggerated, feel much more threatening/likely to happen, and are therefore highly distressing. Therapy can help you recognize when your fears are out of proportion, develop tools to tolerate the anxiety and distress more effectively, utilize your body to help calm your mind, and reframe your thoughts and abilities to increase your confidence about keeping your baby safe.
It can be scary and intimidating to reach out for help when you’re struggling with a new baby, especially due to cultural misconceptions (and irrational self-talk) that “good” moms don’t have any of these difficulties. Remember, if you are diagnosed with a PMAD, that you did NOT do anything to “cause” this to happen, and it wasn’t due to lack of effort, ability, natural talent, knowledge, or anything else. Even therapists, healthcare providers, and mental health experts experience postpartum depression and anxiety! Even if things feel hopeless and overwhelming right now, these conditions are very treatable. Taking care of your own mental and emotional health isn’t selfish or weak – it’s the best thing you can do for yourself, your baby, and your family.
If you are struggling, you can find support and resources at Postpartum Support International (PSI), including a helpline, support groups, directories for therapists who are trained to work with postpartum issues, articles, and more. You can even get in touch with a PSI Coordinator in your area who can connect you to local resources. If you feel that you’re experiencing a mental health crisis and fear that you might harm yourself or your baby, please contact your local emergency services, text HOME to the National Crisis Textline at 741741, or call the National Suicide Prevention Hotline at 1-800-273-8255. You don’t have to settle for feeling this way – please reach out to get the support and help that you need and deserve!
Written by Jessie Bohnenkamp, LPC, NCC
Jessie is a professional counselor, licensed in Virginia and Louisiana. She holds a Masters degree in Marriage & Family Counseling, and has completed additional training in Perinatal Mood and Anxiety Disorders as well as Telemental Health & Digital Ethics. She is passionate about supporting women, with a special interest in maternal mental health and Highly Sensitive parents.