What is postpartum depression?
Learn about the signs and how to find support.
Having a new baby brings on a lot of big feelings – love, joy, excitement, frustration, and nervousness to name a few. Experiencing highs and lows in the first weeks and months after birth are to be expected given the big emotional and physical changes that come with having and caring for a new little one. But for many, feelings of depression and anxiety can overshadow the celebration of welcoming your new family member. We spoke to Dr. Alison Stuebe, maternal-fetal medicine sub-specialist and professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine, about postpartum depression and the steps you can take to find support.
The topic of experiencing mental health challenges may be difficult for some readers. If you or a loved one is struggling with their mental health, please seek support by accessing the following resources: United for Global Mental Health and Open Counseling Suicide Hotline Database. If your country does not have a national helpline please seek professional support from a trained carer, especially before making any decisions on treatment.
What are the “baby blues”?
About two to three days after giving birth, feelings of depression and anxiety are common. You may experience crying for no reason, having trouble sleeping or questioning your ability to care for your new baby. “This is largely due to the shift in levels of progesterone” Dr. Stuebe explains. But changes in hormones are unlikely to be the only cause. Beyond these hormonal changes, there are other factors that can lead to these feelings such as extended periods of tiredness or exhaustion, challenges with breastfeeding and other postpartum complications.
Other factors might include:
- Previous experience of mental health problems
- Biological causes
- Lack of support
- Difficult childhood experiences
- Experience of abuse
- Low self-esteem
- Stressful living conditions
- Major life events
With good support from family, loved ones, and friends, these feelings usually go away within about two weeks without any need for treatment.
What is postpartum depression or postnatal depression?
Postpartum depression or postnatal depression is different from the baby blues. It usually occurs two to eight weeks after giving birth but can happen up to a year after the baby is born. “One of the important things about postpartum depression is it's not just feeling sad,” Dr. Stuebe explains. Feelings of intense anxiety are also a common feature of postpartum depression.
Some symptoms of postpartum depression to look out for include feeling overwhelmed, persistent crying, lack of bonding with your baby and doubting your ability to care for yourself and your baby.
“We all worry about our kids, but [those experiencing postpartum depression] are so worried that it impedes their ability to enjoy their baby and to enjoy their life.” Postpartum depression can make it difficult to care for yourself and your baby, too. “I think it's important for folks to understand that this is not just feeling sad or crying. It also can be feeling almost paralyzed by fear about something bad potentially happening to your child, and that is incredibly painful for the parent.”
Another warning sign for postpartum depression is not being able to sleep, even when your baby is sleeping. “If you’re exhausted, but you are lying awake because your mind is racing, your brain is not being your friend,” Dr. Stuebe says.
What are the symptoms of postpartum depression?
The symptoms of postnatal depression are similar to the symptoms of depression. They include:
- Feeling sad or low
- Being unable to enjoy things that normally bring you pleasure
- Tiredness or loss of energy
- Poor concentration or attention span
- Low self-esteem and self-confidence
- Disturbed sleep, even when your baby is asleep
- Changes in appetite
You may feel detached from your baby or partner, and even have thoughts of hurting yourself or your baby. It can be very frightening to have thoughts of harming your baby, but remember this doesn’t mean you’re actually going to hurt them. The sooner you talk to someone about your thoughts and feelings – a friend, relative, doctor or midwife, for instance – the sooner you can get the help you need.
“It’s really important to acknowledge and normalize that going from an independent adult to someone's parent is not something that happens in the blink of an eye.”
Is there any way to protect against postpartum depression?
Psychoeducation to develop positive coping strategies, manage stress and build supportive networks can be helpful in protecting against postpartum depression. This involves learning about and understanding mental health and wellbeing. It's similar to physical education, where you learn about how your body works, how to look after it and the impacts of different strains or stressors – but instead you apply this to the mind. Having a support system at home looking after your mental health is incredibly important. Involve your partner, friends and loved ones in learning about how they can support you through the postpartum period. Before your baby arrives, reach out to friends and family, and talk about how you’d like them to support you.
For those with significant risk factors, such as a personal or family history of depression, low income, intimate partner violence, having an unwanted pregnancy or current stressful life events, there are a number of counseling interventions – such as cognitive behavioural therapy and interpersonal therapy – that have been found to be effective in preventing postpartum or perinatal depression. Speak to your health care provider to learn more about the options that would be best for you.
I’m feeling emotionally numb after giving birth. Is this common?
Absolutely. “I think that we put a lot of pressure on people to feel like ‘hold your baby and it'll be love at first sight and you’ll be filled with joy!’, and certainly lots of people feel this way when they meet their baby for the first time, but not always – particularly for those who have had a traumatic birth experience, a long labour or an emergency C-section,” says Dr. Stuebe. “I think, it’s really important to acknowledge and normalize that going from an independent adult to someone's parent is not something that happens in the blink of an eye. However, if you are feeling like you can't see the bright parts and there aren’t moments of joy mixed in with the exhaustion, then that is a sign that things are not quite right. Talking to a trusted friend, birth worker, doula, midwife or doctor and just ‘this is harder than I thought it was going to be’ or 'can you help me through this? Is this common?’ is really, really helpful.”
What are some of the ways to support yourself if you are experiencing postpartum depression?
- Make sure you are getting enough care and support at home. Are you getting enough sleep? Are you eating adequate meals? “A lot of new parents are taking care of their baby and they're not getting a decent meal,” says Dr. Stuebe. “Getting a nutritious, protein-filled meal can help you feel just a little bit more human.”
- Psychotherapy (talk therapy). “There are a number of psychotherapies [such as cognitive behavour therapy (CBT) or interpersonaltherapy (IPT)] that work really well for postpartum depression and anxiety.” Talk to your healthcare provider about finding a mental health professional to help you navigate these feelings.
- Medication. There are a number of medications that are effective for managing and reducing symptoms of postpartum depression. While small amounts of antidepressants can be passed through breastmilk, there is generally minimal impact on milk supply and infant well-being. Because breastfeeding has so many benefits for your baby, it is important to look at these benefits against your baby being potentially exposed to the medication in your breast milk. “In the absence of a clear harm signal it makes a lot of sense to treat and continue breastfeeding,” recommends Dr. Stuebe. Before starting any medication, make sure to talk to your health care provider about an option that works best for you.
- Speak to people with similar experiences. Often, we can feel that we are the only ones feeling how we do. Speak to your health care provider about peer support and advice groups available to share thoughts, feelings and experiences. It is also important to speak with your friends and family members about how you are feeling.
- Be kind to yourself. You might have many expectations for yourself as a parent, but none of us can meet all our expectations all the time. Don't worry if you don't do something you planned to, or if you find yourself feeling worse again. Try to treat yourself as you would treat a friend, and be kind to yourself.
How can my partner support me at home?
Throughout human history, communities have cared for babies together. “Everybody needs a village, and it's incredibly important that people who have just given birth have someone taking care of them while they're taking care of their baby.” Dr. Stuebe recommends that partners or other loved ones can be supportive by doing the following:
- Make sure that your partner is eating enough and often enough
- Ensure that your partner has time to bathe themselves
- Allow your partner to get adequate sleep by sleeping in shifts
“You are not alone, you are not to blame, and with help you will get better.”
When should I reach out for help?
“I tell parents, as soon as you think, ‘this doesn't seem right to me,’ then reaching out to a trusted healthcare provider is really helpful,” recommends Dr. Stuebe. “In the same way that if you had a high fever, you would call for help. Postpartum Support International says, and I love this, ‘You are not alone, you are not to blame, and with help you will get better.’”
If any of your symptoms are becoming stronger after two weeks or lasting more than two weeks, you should consider seeking support. Though there can be stigma surrounding reaching out for help, the most important thing is to take care of yourself and put your health – and your baby’s health – first. There are many trustworthy medical professionals who will respond to your questions confidentially and with kindness.
You are dealing with a lot of change right now. “Give yourself grace. Recognize you may not be as calm and collected as you usually are,” says Dr. Stuebe. “Also know that if these feelings stick around for some time, it's not that you aren't a good parent, it's just that your brain has been asked to do some gymnastics.”
Interview and article by Mandy Rich, Digital Content Writer, UNICEF