What's Postpartum Depression And How Do I Cope With It?
The months following welcoming a new child into the family can involve significant adjustment. A changing body, lack of quality sleep, and numerous other stressors lead some new parents to experience postpartum depression (PPD) in the year following childbirth or adoption.
Depression is serious. However, misinformation and a pervasive stigma about postpartum depression's causes may cause some people to believe they are alone in their symptoms. Postpartum depression is a mental illness, not an indication of one's fitness as a parent. To reduce stigmas surrounding this condition, it can be essential to know how it develops, the symptoms to look out for, and ways to find support.
How many people experience postpartum depression?
Postpartum depression is a common mental illness, and the National Institute of Mental Health (NIMH) encourages those experiencing it to seek professional support due to its prevalence and severity. Studies estimate that as many as 20% of new parents experience postpartum depression, though the prevalence may be higher. Non-gestational parents can also experience PPD following the birth of a child.
People with a history of depression are more susceptible to acquiring postpartum depression. However, regardless of mental health status or prior diagnosis, anyone can live with this condition.
When does postpartum depression occur?
Postpartum depression symptoms can begin any time during a child's first year of life or after the adoption of a child. Some symptoms may occur around four or five months with the new family. Some new parents may struggle to find emotional support after nine months of pregnancy, labor, and welcoming a new human life. Others may go through an adoption process that can also cause symptoms of depression.
What are the symptoms of PPD?
It can be normal for people who give birth to experience sadness during the first two weeks after childbirth due to the hormonal shifts that occur during that period. The primary symptom during this time is an underlying sadness and lack of energy. However, this sadness immediately after birth is not necessarily a sign of PPD.
Contrarily, postpartum depression is marked by persistent sadness past the initial two-week mark, with more functional difficulties. Some people with PPD may not experience sadness as a primary symptom, as the symptoms can be unique and varied, including but not limited to the following:
- Anger, rage, or irritability
- Difficulty sleeping
- Restlessness
- A lack of pleasure in previously enjoyed activities
- A shift in appetite or behaviors around food
- Apathy or a sense of having a "flat" mood
- Unexplained crying
- Thoughts of hopelessness or worthlessness
- Worrying, fear, or anxiety
- Intrusive thoughts of severe harm or death coming to your new child
- A lack of connection or love toward your new child
- Difficulty bonding with your new child
- Believing your new child isn't how you expected them to be
- Believing your child would be better off without you
In some cases, parents may struggle to attend to their children when living with PPD, which could lead to a delay in language development within the first year. With treatment, this delay may be preventable.
In more extreme cases of untreated postpartum depression, typically associated with postpartum psychosis, symptoms and side effects of mental health conditions can include:
- Hallucinations
- Paranoia
- Thoughts of suicide or of harming the baby
- Confusion and disorientation
Understanding PPD symptoms
Postpartum depression has symptoms similar to bipolar disorder, a mood disorder that can cause rapid mood swings. Get a proper diagnosis from your doctor if you are unsure what might be causing your symptoms.
Note that some high-profile media stories highlight new parents experiencing postpartum psychosis, potentially giving the impression that if one does not experience extreme symptoms, they're not experiencing postpartum depression. However, postpartum depression symptoms occur on a spectrum, and someone may only experience a few of the symptoms that someone else experiences. If you're unsure if you're living with PPD, talking to a professional can be one of the most effective ways to be sure.
Postpartum psychosis is rare in comparison with postpartum anxiety or postpartum depression. In addition, postpartum psychosis surfaces quickly after labor and birth. If you believe you may be living with psychosis, reach out to a professional as soon as possible, as psychosis can be severe and dangerous.
How is PPD diagnosed?
When a parent or caregiver seeks support with PPD, their healthcare professional may ask questions about the condition or request that they complete a depression screening questionnaire. Healthcare providers may want to know if parents have a history of depression or other mental illnesses. They might also ask if one has symptoms like extreme sadness, difficulty caring for the baby, or frightening thoughts.
Be honest in your responses to your doctor's questions to get the most effective support and accurate diagnosis. Having PPD is not a flaw, and many support options are available for treatment.
What causes postpartum depression?
There isn't one single cause or predictor of postpartum depression. This condition is often caused by complex risk factors, including but not limited to the following.
Hormones
Individuals undergo profound physical changes during pregnancy, impacting their feelings. During and after pregnancy, fluctuations of hormones can cause profound chemical changes in a person's body. These changes can cause significant disruptions to someone's life and ability to control their thoughts.
More specifically, the hormones estrogen and progesterone are significantly elevated during pregnancy. Within 24 hours of childbirth, the hormone levels drop in the body, leading to a quick fluctuation in mood. These hormones may be a significant contributor to sadness after birth. However, if this sadness persists for over two weeks, it may be a sign of PPD.
In addition to hormonal challenges, individuals may experience challenges with their thyroid gland after pregnancy. Postpartum thyroiditis is a condition where the thyroid gland becomes inflamed after birth, potentially impacting mood.
Lifestyle
Various challenges of parenting a new baby or child exacerbate the hormonal effects of PPD. These changes may include the following:
- A lack of sleep
- The added stress of parenting a newborn
- Added challenges in the parental relationship
- Loss of flexibility and free time
- Lack of a support system
- Lack of time to exercise
- Poor nutrition
- Confusion about one's newfound role as a parent
- Loss of sense of self
- A desire or pressure to be the "perfect parent"
- Unexpected challenges after birth
Social factors
Teen parents and people living in poverty have higher rates of postpartum depression. The added stress experienced by these groups of people as they enter parenthood may exacerbate the other factors and lead to their increased risk of postpartum depression. To compound this situation, some teen parents lack the support of their own parents, a close loved one, or others in the family. A lack of support can further increase the risk of depression.
Medical history and genetics
As with other depressive disorders, there is a genetic component to PPD. Those with a personal or family history of depression or postpartum depression are at an elevated risk for this condition. Those who experience premenstrual dysphoric disorder (PMDD) before and during their regular menstrual cycles may also be at a higher risk.
Fertility challenges and trauma
Struggles with fertility and difficulty conceiving increase a person's likelihood of experiencing postpartum depression. In addition, a traumatic or medically complex birth experience can lead to the formation of this condition.
If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.
Treatment options for postpartum depression
Many treatments are available to combat postpartum depression; you don't have to go through treatment alone. If you believe you are struggling with symptoms of depression, speak with your doctor about your symptoms. Your primary care provider can ask more detailed questions to see if a diagnosis of postpartum depression makes sense for your case. They may also refer you to a specialist in the condition to receive quick support.
Some people can manage their postpartum depression with lifestyle adjustments, while others benefit from more comprehensive medical interventions to treat depression. Regardless, postpartum depression is often a chemical issue. It is not a personal failure if you struggle to improve your symptoms without medical support. PPD is temporary, so some parents take medication while coping with the symptoms. However, consult your doctor before starting, changing, or stopping any medication. Below are further support options for PPD.
Ask for support
Be open about your struggles with postpartum depression with other parents in your social circle. Your family and friends may want to help, but it may be challenging to understand if they haven't had PPD. If you don't have friends who are parents, contact your birth hospital or obstetrician and ask them about local parent and baby groups in the area. These groups may allow you to socially connect and talk about your experience with people who understand.
While you may not know how to talk about PPD with your family, try to prioritize time with them. It might not be possible to partake in activities you enjoyed before your new child. However, gathering with others in a social setting can improve mental and physical health, so find ways to connect that don't require too much energy or time.
Online support groups or education videos can also help those living with stress and depression after adding a child to the family. You may be able to find an online support group for those seeking support. Online support groups can be a convenient and time-saving option for you and your partner and may be a starting point if you don't have groups in your area.
If local groups are available, consider a group specifically for those with PPD. These groups may help you learn more about postpartum depression and what it looks like in everyday life. In addition, you can connect with parents who have PPD and know what it feels like, even if their symptoms are different. Ask your local hospital, doctor, or obstetrician for help finding one in your local area.
Make lifestyle adjustments
Physical and emotional challenges can take a toll on a new parent. However, there are a few steps you can take to combat symptoms at home, including but not limited to the following:
- Ask your partner to take an overnight feeding to help you get restorative sleep
- Schedule regular exercise
- Go on walks in the sun
- Pay attention to your nutrition
- Avoid substance use
- Eat a piece of dark chocolate
- Do a puzzle
- Write in a journal
- Spend time in nature
- Create a scrapbook about your new baby or child
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.
Seek professional support
In some cases, lifestyle adjustments may not be enough, and social support systems fall short. When this occurs, talking to a licensed therapist about your symptoms may be beneficial. Therapy can be an effective way to manage PPD, and a therapist can accompany you throughout the duration of your condition. Counseling has been proven significantly effective in treating postpartum depression.
If you struggle to find a professional in your area, you may also benefit from working with a provider on an online therapy platform like BetterHelp. A trained online counselor can help you identify the root causes of your emotions, offer guidance to process them effectively, and coach you on ways to improve specific aspects of your life impacted by PPD. Making time for self-care when you have a newborn can be challenging, so online therapy can break this barrier. You can schedule appointments when you know your infant may be sleeping, and you can attend from the comfort of your home.
In addition to its benefits, online therapy has been proven effective for PPD. In one study, researchers implemented online therapy workshops for 403 mothers with PPD during the COVID-19 pandemic. Results indicated that those who engaged in the session were four times more likely to experience a clinically meaningful improvement in PPD symptoms than those assigned to the control group. The workshops took place over videoconferencing and included activities like group exercises, roleplay scenarios, identifying and changing thought patterns, and learning strategies to improve mood and anxiety.
Takeaway
What type of therapy is best for postpartum?
The type of therapy that is often recommended for postpartum depression (PPD) is known as "postpartum therapy" or "postpartum support therapy." Postpartum depression is a common mental health condition that affects as many as one in seven women after giving birth, and it can involve symptoms like persistent sadness, irritability, changes in sleep patterns, and difficulty bonding with the baby.
Postpartum therapy typically involves talk therapy, such as cognitive-behavioral therapy (CBT) or interpersonal therapy (IPT), which can help individuals address their feelings, thoughts, and behaviors related to postpartum depression. These types of therapy provide a safe and supportive environment for mothers to express their concerns, develop coping strategies, and explore the emotional challenges associated with motherhood.
In some cases, a postpartum therapist may also prescribe medication, such as antidepressants, to help alleviate the symptoms of postpartum depression. The decision to use medication is made after carefully evaluating the individual's condition and the potential benefits and risks of treatment.
The choice of therapy and treatment approach should be discussed with a healthcare provider or mental health professional who specializes in postpartum depression. They can provide an accurate diagnosis, develop a tailored plan for treating PPD, and offer the appropriate support needed to help mothers navigate this challenging period.
What are the three types of postpartum?
There are three main types of postpartum experiences that new moms may encounter:
- Baby blues: Baby blues is the mildest and most common form of postpartum emotional distress. Research indicates it typically occurs in the first few days after childbirth and lasts up to two weeks. Mothers with baby blues may experience mood swings, tearfulness, irritability, and anxiety. The baby blues is often considered a normal response to the significant hormonal and emotional childbirth-related changes.
- Postpartum depression: Postpartum depression is a more severe and persistent form of postpartum emotional distress. PPD can develop within the first year after childbirth, with symptoms including persistent sadness, feelings of hopelessness, loss of interest in activities, changes in appetite and sleep patterns, and difficulty bonding with the baby. Postpartum depression requires clinical diagnosis and treatment, which may include therapy and medication.
- Postpartum psychosis: Postpartum psychosis is the rarest but most severe form of postpartum emotional disturbance. It typically emerges within the first two weeks after childbirth and is characterized by symptoms such as hallucinations, delusions, severe mood swings, confusion, and disorganized thinking. Postpartum psychosis is a psychiatric emergency and requires immediate medical attention and treatment.
It's important to note that these postpartum experiences can vary among individuals, and the severity and duration of symptoms may differ. New mothers who suspect they may be experiencing any form of postpartum distress should seek support and professional help from healthcare providers or mental health specialists. Timely intervention and appropriate treatment for postpartum can significantly improve the well-being of both the mother and the baby during this period.
What is the psychological treatment for PPD?
Psychological treatment for postpartum depression (PPD) is a critical component of managing this condition. Treatment aims to provide new mothers with the necessary tools and support to manage the emotional challenges they may be facing.
Here are some key aspects of psychological treatment for PPD:
- Individual Therapy: Individual therapy, often in the form of cognitive-behavioral therapy (CBT), is a common approach. A trained therapist works one-on-one with the mother to identify and address negative thought patterns and behaviors that may contribute to PPD. This type of postpartum depression therapy helps individuals develop healthier coping strategies and reduce symptoms related to PPD.
- Group Therapy: Group therapy sessions for PPD involve a small group of mothers who tell their experiences and feelings. Group therapy can create a sense of community and reduce feelings of isolation. This type of therapy can allow participants to learn from others and receive support from those who can relate to their struggles. Postpartum Support International (PSI) offers online peer-to-peer support groups for mothers experiencing PPD.
- Family therapy: PPD can affect not only the mother but also her family. Family therapy involves the participation of family members to improve communication, understanding, and support within the family unit. Family therapy can also help address any conflicts or stressors that may be contributing to the mother's depression.
- Medical treatment: In some cases, medical treatment may be necessary alongside psychological therapy. Antidepressant medications can be prescribed by a healthcare provider to help alleviate the symptoms of PPD. Medication is often considered when symptoms are severe or persistent or when psychological therapy alone is insufficient.
The choice of treatment, whether psychological, medical, or a combination of both, depends on the individual's specific needs, the severity of the depression, and their preferences. New mothers experiencing PPD should consult with a healthcare provider or mental health specialist to determine the most appropriate treatment plan.
Early intervention and personalized treatment can significantly improve the well-being of both the mother and her family during this challenging time. Health insurance or employee assistance programs may cover the cost of therapy, so it's crucial to inquire about coverage options. The right therapist can offer guidance, support, and help new mothers navigate through their postpartum experience with compassion and empathy.
How do you manage a postpartum patient?
Most providers are familiar with the physical care of postpartum patients, but managing their emotional well-being requires specialized knowledge and sensitivity.
Here are some tips for effectively managing a postpartum patient:
- Education: Educating patients and their families about what to expect during the postpartum period, including potential emotional changes, can help reduce anxiety and provide a sense of control.
- Screening: Routinely screening for postpartum depression using standardized tools such as the Edinburgh Postnatal Depression Scale (EPDS) can identify at-risk patients who may benefit from early intervention.
- Open communication: Creating a safe and non-judgmental space for new mothers to express their feelings, fears, and struggles can help them feel supported and understood.
- Encouragement: Encouraging new mothers to prioritize self-care, set realistic expectations, and ask for help when needed can help promote emotional well-being.
- Collaboration: Working closely with other healthcare providers and mental health specialists to coordinate care and provide comprehensive support for postpartum patients is crucial.
- Involving partners/family members: Involving partners and other family members in the patient's care can create a supportive environment and promote bonding.
While managing a postpartum patient can be challenging, providing compassionate and empathetic care can significantly improve their recovery and well-being. It's essential to remember that every new mother's experience is unique, and offering personalized support can make all the difference in their journey toward emotional wellness.
What is the 5-5-5 postpartum rule?
The 5-5-5 postpartum rule is a concept aimed at supporting the rest and recovery of new mothers in the weeks following childbirth. It's designed to help reduce the risk of postpartum depression and promote overall well-being during this critical period. The rule involves three phases:
- 5 days in bed: During the first five days after giving birth, the focus is on rest and recovery. New mothers are encouraged to spend most of their time in bed, allowing their bodies to heal from the physical demands of labor and delivery. This phase helps reduce the risk of physical complications and exhaustion.
- 5 days on the bed: In the next phase, which spans the following five days, mothers can spend more time sitting or reclining on the bed. This gradual transition allows them to regain some mobility while still prioritizing rest. New mothers must listen to their bodies and not push themselves too hard during this phase.
- 5 days near the bed: The final phase of the 5-5-5 rule involves spending the next five days close to the bed. Mothers can gradually engage in more activities but should prioritize self-care and rest. This phase acknowledges that the postpartum recovery process is ongoing and requires continued attention.
The 5-5-5 rule recognizes the physical and emotional toll that childbirth can take on a woman's body. Adequate rest and self-care during this time are crucial not only for physical healing but also for emotional well-being. The goal is to provide new mothers with the support and resources to navigate their postpartum experience comfortably and confidently.
What not to do during postpartum recovery?
The postpartum period is a crucial time for new mothers, both physically and emotionally. Here are some things to avoid during postpartum recovery:
- Rushing back into daily activities: While it may be tempting to jump back into your normal routine, it's vital to prioritize rest and allow your body time to heal.
- Isolating yourself: The postpartum period can be emotionally challenging, and isolation can worsen feelings of loneliness and sadness. Reaching out to friends, family members, or support groups can provide connection and social support.
- Neglecting self-care: Mothers may feel pressure to prioritize their baby's needs over their own, but self-care is crucial for emotional well-being. Finding small ways to care for yourself, such as taking a shower or going for a short walk, can make a big difference.
- Comparing yourself to others: Every mother's postpartum experience is different, and comparison can lead to feelings of inadequacy, guilt, or shame. It's essential to focus on your unique journey and not compare it to others.
- Ignoring physical or emotional symptoms: It's common for new mothers to experience various physical and emotional symptoms during the postpartum period. It's important not to dismiss these symptoms and seek help if needed.
What are the 4 T's of postpartum hemorrhage?
The 4 Ts of postpartum hemorrhage are a helpful mnemonic device used in healthcare to categorize the common causes of primary postpartum hemorrhage, which occurs within the first 24 hours after childbirth. These 4 Ts are Tone, Trauma, Tissue, and Thrombus:
- Tone: Tone refers to the contraction and tone of the uterus. Atony, or the inability of the uterine muscles to contract effectively after childbirth, is a significant cause of postpartum hemorrhage. Atony can result from factors like overdistension of the uterus, multiple pregnancies, or the use of certain medications during labor.
- Trauma: Trauma-related bleeding can occur due to injuries sustained during childbirth. These injuries might include lacerations or tears in the birth canal, cervix, or uterus. Instrument-assisted deliveries or rapid childbirth can increase the risk of trauma-related postpartum hemorrhage.
- Tissue: Tissue-related causes involve the retention of placental or fetal tissue in the uterus after childbirth. Tissue can obstruct proper uterine contraction and lead to bleeding. Incomplete placental expulsion is a common example of tissue-related hemorrhage.
- Thrombus: Thrombus, or blood clotting disorders, can also contribute to postpartum hemorrhage. Conditions like coagulation disorders or the improper use of anticoagulant medications can increase the risk of excessive bleeding.
Identifying the specific cause of postpartum hemorrhage is critical for prompt and effective intervention. Healthcare providers use the 4 Ts as a framework to evaluate and address the underlying factors contributing to excessive bleeding after childbirth. Prompt recognition and treatment of the cause can help prevent severe complications and ensure the mother's and newborn's safety and well-being.
It's important to note that postpartum hemorrhage is a medical emergency, and any signs of excessive bleeding or symptoms of shock should be immediately reported to healthcare professionals for assessment and intervention. Timely and appropriate care can significantly reduce the risks associated with postpartum hemorrhage.
How long are you considered postpartum?
The postpartum period refers to the time following childbirth when a woman's body undergoes various physical and emotional changes as it recovers from pregnancy and childbirth.
This period is typically divided into three phases:
- Initial or acute period (6-12 hours postpartum): This phase immediately follows childbirth and typically lasts for the first 6 to 12 hours. During this time, healthcare providers closely monitor both the mother and the newborn for any immediate postpartum complications. Vital signs are assessed, and any potential issues like excessive bleeding or complications related to anesthesia are addressed. The mother begins the initial stages of recovery, including the first breastfeeding attempts if she chooses to breastfeed.
- Subacute postpartum period (2-6 weeks): The subacute postpartum period spans from the first day after childbirth to approximately 2 to 6 weeks postpartum. During this phase, the mother's body continues to recover and adapt to its non-pregnant state. Physical changes such as uterine involution (the uterus returning to its pre-pregnancy size), vaginal discharge (lochia), and abdominal muscle tone restoration occur. Emotionally, mothers may experience various feelings and emotions as they adjust to their new roles and responsibilities.
- Delayed postpartum period (up to 6 months): The delayed postpartum period extends from the end of the subacute phase and can last up to 6 months postpartum. During this time, the mother's body continues to heal, and she may gradually resume normal activities.
While these phases provide a general understanding of the postpartum period, it's essential to remember that each mother's experience is unique and may differ regarding physical and emotional recovery. Healthcare providers typically recommend avoiding strenuous activities or sexual intercourse for at least 6 weeks postpartum to allow the body time to heal fully. However, if a woman experiences any ongoing issues or complications during this period, she should seek medical attention.
When are you no longer postpartum?
There is no specific timeline for when a woman is considered no longer postpartum. The postpartum period can vary in length from woman to woman, and it may take several months for the body to recover from pregnancy and childbirth fully.
Some women may experience ongoing physical or emotional symptoms beyond the 6-month mark, while others may feel like they have fully recovered sooner. Additionally, it's crucial to remember that the end of the postpartum period does not mean that a woman's journey to motherhood is over. Transitioning into parenthood can bring new challenges and joy as the child grows.
What is the root cause of PPD?
While the exact cause of PPD is unknown, healthcare professionals believe that it may be due to a combination of physical, emotional, and social factors.
Some potential root causes of PPD include:
- Hormonal changes: After giving birth, hormone levels in a woman's body drastically change. This sudden shift can affect brain chemistry and contribute to symptoms of PPD.
- Genetics: Some research suggests that women with a family history of depression may be more likely to experience PPD.
- Stress and lack of support: The challenges of caring for a newborn, adjusting to new routines, and coping with sleep deprivation can all contribute to feelings of stress and overwhelm, which may increase the risk of PPD.
- History of mental health conditions: Women who have a history of depression or anxiety are more likely to experience PPD.
Every woman's experience with PPD can be unique, and there is no single root cause for this condition. Supportive care, therapy, and medication can help manage symptoms and aid recovery.
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