By Susie Lee, AMFT
Women (and their spouses) are often told that having a baby is one of the most joyous times of their lives and they should cherish their time with their newborn. This is often why women feel confused and even guilty when they are not as happy as they feel they should be after they bring their baby home. They may also be confused by other symptoms that they were not expecting. Postpartum depression and mood disorders has gained more and more attention from the public and media over the last few years. This has helped remove some of the stigma around this time period and helped start the conversation on the importance of postpartum mental health. Let’s take a look at some of the mental health issues that can come up postpartum and what they look like.
It is important to understand that there is a broad spectrum of postpartum emotions that differ in how they look, their intensity, and how they’re treated. Whatever your postpartum journey looks like, know that you are not alone. Whether you come home and don’t notice much change at all, to feeling kind of down, to more extreme symptoms, your experience is valid and important. The categories of postpartum mood disorders that we will explore include, the “baby blues”, postpartum depression (PPD), postpartum anxiety (PPA), postpartum obsessive-compulsive disorder (PPOCD), postpartum post-traumatic stress disorder (PPTSD), and postpartum psychosis (PPP). Just as each of these categories vary from one another, you can also have varying experiences with each of them.
The “Baby Blues”
The American Pregnancy Association (APA) reports that 70%-80% of all new mothers experience some negative feelings that occur within four or five days after giving birth. The most common symptoms of the baby blues include mood swings, irritability, anxiousness, crying for no apparent reason, feeling overwhelmed, and changes in eating and sleeping habits. Most of the time these symptoms will resolve on their own within a few weeks after birth and are helped by engaging a good support system and resting.
According to the APA, around 15% of new mothers will experience symptoms that classify as postpartum depression (PPD). These symptoms typically begin a few days after delivery but can sometimes surface as much as a year after giving birth. While experiencing PPD, women will have both good and bad days, but the up and down will last for more than two weeks. Symptoms can range in intensity from very mild to severe and include feeling excessively tired, trouble sleeping and eating, feeling sad, losing interest in things they’ve previously enjoyed doing, feeling guilty and worthless, withdrawing from friends and family, feeling overwhelmed, not having interest in your baby, and thoughts of hurting yourself or your baby. If you think you or someone you know is experiencing postpartum depression, it’s important to talk to a healthcare provider. Keep up with your follow up appointments with your OB, make an appointment with your regular provider, and/or make an appointment with a therapist to process your experience.
The APA reports that about 10% of postpartum women will experience postpartum anxiety. This may be in connection with feelings of depression or can be anxiety alone. Postpartum anxiety may also induce postpartum panic disorder, which causes the new mother to feel panic attacks along with their feelings of anxiety. Much like postpartum depression, postpartum anxiety can surface anywhere from a few days post birth, to a year post birth and will having symptoms ranging from mild to severe. Symptoms of postpartum anxiety include changes in eating and sleeping patterns, constant worry, racing thoughts that are difficult to control, intense fear that something terrible is going to happen, trouble sitting still, trouble focusing, physical symptoms such as dizziness, hot flashes, nausea, and stomach pain. Postpartum anxiety will often go away if treated, treatment can include medication, therapy or a combination of the two.
Postpartum Obsessive-Compulsive Disorder
Postpartum obsessive compulsive disorder has been most recently recognized as a postpartum concern. Roughly 3-4% of women will have some symptoms of obsessive compulsive disorder postpartum. Symptoms include an intense obsession with keeping your baby safe, compelled to do things over and over – especially in relation to relieving any anxiety or fear over the safety of the baby, compulsions to count thing, put things in a particular order, constantly checking on actions that have already been performed, cleaning obsessively, making lists, and being overly obsessive about taking care of the baby. People will often recognize that these symptoms are happening, but feel ashamed and try to hide them, often being fearful of being left alone with their baby because of them. Symptoms can also focus on thoughts alone, these thoughts will be obsessive and persistent, as well as repetitive and somewhat disturbing, especially if they involve the baby. Women who suffer from postpartum OCD will often know that their thoughts, actions, and feeling are not normal and will refrain from acting on them. However, they can make it difficult for mom to take care of her baby or enjoy being with her baby. Postpartum OCD can be treated through both medication and/or therapy.
Postpartum Traumatic Stress Disorder
Postpartum traumatic stress disorder affects about 1-6% of women and often affects those who have a traumatic childbirth experience, a trauma close to the birth of their child, or a perceived trauma near or with childbirth. Some common traumas that may lead to postpartum PTSD include an unplanned cesarean – especially if this was being avoided at all costs, emergency complications with childbirth, invasive interventions during birth, baby staying in the NICU, lack of communication and support from medical staff or support team, feeling powerless and unheard by staff, or lack of emotional support during delivery. Symptoms include intense anxiety and panic attacks, feeling detached from reality, from life, or from their baby, irritability, avoidance of anything that reminds them of the event (people, places, smells, noises, feelings, etc.), sleeplessness, hypervigilance, and startling easily. It is important to address symptoms of PPTSD with a mental healthcare provider.
Of all the postpartum mental health concerns, postpartum psychosis is the most severe, but also the most rare. The APA reports that postpartum psychosis occurs in roughly 0.2% of pregnancies. The onset of psychosis is very severe, sudden and will occur within two to three weeks after giving birth. PPP is characterized by a loss of touch with reality, bizarre behavior, rapid mood swings, hyperactivity, hallucinations, suicidal thoughts, and thoughts of harming the baby. As the most severe postpartum mental health concern, psychosis should be taken seriously and treated immediately.
Therapy can be beneficial to reduce symptoms in any postpartum mental health concern, as can contacting a physician, friend, or family member. If you think that you or someone you know may be struggling with any of these mental health concerns, reaching out is the first place to start. Always take the concerns of those around you seriously and seek out the appropriate assistance. Postpartum mental health issues are treatable and not something you have to work through on your own.
Compiled using information from the following sources: