Postpartum Depression

postpartum depression

You’ve spent the last nine months preparing for your new bundle of joy. Juggling work or other kids. Keeping up with your daily responsibilities all while managing the extras that come with growing another human. It’s a lot to take in. Now you’ve brought home your baby. By all accounts, you are supposed to be gloriously happy. And you ARE happy. But sometimes things are just not right after giving birth. Sometimes you can’t shake the anxiety or underlying sadness. How do you navigate when your expectations and reality don’t line up? Fifteen percent of women experience postpartum depression. Are you one of them?

The Reality

Childbirth (and pregnancy!) is not all rainbows and unicorns. Sometimes things go wrong. Miscarriages are common and often not discussed. And there is an ever-growing list of things that you should and should not do while pregnant. We live with the illusion that if we do everything right, if we can control all the variables, we can protect ourselves and our babies. But if you are struggling, you are not alone. In fact, you’re in good company. Up to 80% of moms experience baby blues. And 15% will experience more severe symptoms of postpartum depression.

Signs of Postpartum Depression

  1. Feelings of significant anxiety or sadness that are interfering with your ability to take care of yourself or your family
  2. Crying more than usual or for no apparent reason (BTW, dads LOVE this one… I once started bawling my eyes out when my husband brought me home lunch a couple of weeks after bringing my firstborn home from the hospital.)
  3. Losing interest in things you normally love
  4. Thoughts of hurting yourself or your baby
  5. Feelings of anger or rage, feeling out of control
  6. Noticing that you are having trouble bonding or feeling connected to your baby

What is the difference between baby blues and postpartum depression?

Many women experience baby blues. As I mentioned above, nearly 80%! So more of us than not will have some feelings that don’t easily line up with what we are expecting? Lots of stuff goes into this. Sleep deprivation and pain do not help. And I’ve not yet met a new mom who doesn’t have at least a bit of both going on.

Baby blues often start within the first week of giving birth. They are mild enough that they don’t interfere with your ability to hold it all together. And they usually go away on their own within a week or two. Postpartum depression is more significant. It can start any time after childbirth and affects a mom’s ability to get through her day. A mom with postpartum depression may find herself utterly exhausted, but unable to sleep worrying that something might happen.

Who’s at Risk?

Postpartum depression can affect anyone. It doesn’t care about your race or socioeconomic status. It can hit anyone from anywhere. But there are some risk factors that make you more likely to experience it.

  1. History of postpartum depression with another child
  2. A personal history of anxiety, depression, or bipolar disorder (past or present)
  3. A family history of mental illness (anxiety, depression, or bipolar disorder in particular)
  4. Personal history of drug or alcohol abuse
  5. Lack of social support system
  6. A stressful event occurring during your pregnancy or shortly thereafter. This could include a family death, unexpected complications with the pregnancy or delivery, or loss of family income.

How can you know if you have a problem?

This is one of those things that is easier to tease out after the fact sometimes. While you’re experiencing it, it can be difficult to recognize. It is really easy to put on a happy face for the world and pretend everything is just fine. I know this because I’ve lived it.

My Story

My first pregnancy ended in an early miscarriage. I was a nervous wreck when I found out I was pregnant with my firstborn. I had finally started to relax and feel safe around 19 weeks when the contractions started. We were certain I was just overreacting so lots of water and extra rest. It didn’t get better. When I started timing them and realized that they were regular and frequent, I went to the hospital. I was in pre-term labor. IVs, magnesium, Terbutaline, Procardia, monitors. It was terrifying.

We made it through that hospitalization and several others before finally delivering a healthy baby girl at 37 weeks. It took around the clock medications, bed rest, and weekly perinatology visits. I put on a happy face for the doctors. But when I got home from the visits I would cry. I couldn’t think about the baby and I didn’t want to plan for her.

The experience took a toll on me. By the time I delivered my baby, I had no muscle strength.  I couldn’t sleep at night waiting for her to wake up. And during the day, I couldn’t stay awake. I’d used up all my leave during my pregnancy, so I had to return to work when she was just 4 weeks old. I chalked up all issues to normal new mom stuff. Months passed before I started to feel half-normal again. And eventually I found my new normal. But when I look back at those first few months, what I remember is the bone-deep fatigue, the anxiety of waiting for something else to go wrong. I needed help. But I didn’t recognize it. And I didn’t know how to ask for it.

Screening tests

Fast forward nearly 14 years and we have a much better understanding of postpartum depression and postpartum anxiety. And many pediatricians routinely screen for it when seeing parents with babies under 6 months of age. In my practice, we give a screening tool called an Edinburgh at the 2 week, 2 month, 4 month, and 6 month visits.

Sometimes when I walk into a room, everyone looks great.  Mom is put together and smiling and seems appropriate. And then I look over her Edinburgh screening and realize that she’s not ok. Which is when I will say that the screening tool looks like she may be struggling more than is necessary. And the tears start. Turns out I’m REALLY good at making people cry. It’s my super-talent. But good things come after that. Sometimes we have to reach the bottom before we can claw ourselves back out.

If you are reading this and it is resonating with you, ask questions. Talk to your doctor. Ask your pediatrician. If you’re a fan on online quizzes, you can insert your answers to this online Edinburgh Postnatal Depression Scale. Print out your results and use them to talk with your doctor.

Getting help

If you are having trouble, there is no shame in asking for help. And although you may be feeling alone, you most certainly are NOT. Talk to your OB/GYN. Ask your little one’s pediatrician. Your doctors can help direct you to the next best step. We need healthy moms for healthy babies. You are important, so take care of you.

Resources

For further reading, you can check out the following resources.

  1. National Institute of Mental Health:  Facts
  2. Mayo Clinic: Overview
  3. Office on Women’s Health: PPD
  4. See PPD: About PPD
  5. Postpartum Support International: PSI Online Support Meetings

Author: Dr. Jenny Seawell

Dr. Jennifer Seawell is a board certified pediatrician currently practicing in Tennessee. She is married with 2 daughters aged 7 and 13.

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