Postpartum Mental Health
Having a baby can be a joyous time. You are bringing new a new person into your family. This new addition is met with joy and happiness, but this is a time of high risk for the onset of maternal health issues including anxiety and depression. And it is not just mothers who are at risk. Fathers, or partners, are also at risk during the perinatal period.
PERINATAL MENTAL HEALTH
During pregnancy and in the postpartum period there is an increased risk of anxiety, depression, and mental health issues due to sudden hormonal changes, including thyroid hormones, and the dramatic life change when you bring a baby into your family.
We expect new mom’s to be filled with joy and excitement. But new moms might feel a lot of other feelings such as sadness, anger, languishing, or fear. ALL these feelings are normal. New mom may wonder who they are or who they are becoming. They may feel exhausted or pushed to their limits. They may have negative feels about their pregnancy, the birth, or their postpartum experience. They may be worried about their new child’s health and development. They may miss their new life and wonder if parenthood was the right choice for them. And these types of feelings can make a new mom feel guilty or ashamed. They may be embarrassed if they are feelings this way or struggling with parenthood. They may wonder if things will get worse or ever get better. They may wonder if these feelings are normal. They may compare their feelings with the ‘perfect” families they see in Instagram or other social media outlets.
Moms and families may also have many different feelings if they are deciding about having more children. A mom may worry about giving love and attention to another child, how a child will affect family dynamics, how a child will affect work or finances, or how your first child will do with a sibling. It may also cause worry about becoming pregnant, the pregnancy, the birth process and postpartum period.
These are all normal feelings. But how do you know if your feelings are more severe? Feelings that may result in mental illness depend on the magnitude of those feelings and how long those feelings last. It can be common to have many of these feelings during pregnancy and especially in the first few weeks after birth but by 3-4 weeks after birth, they should improve dramatically.
PERINATAL MENTAL HEALTH ISSUES
Perinatal mental health issues, including depression, anxiety, and psychosis, affect 2 in 10 moms. Over 75% of these mothers go without a formal diagnosis. This means these mothers are untreated and unsupported during their mental health struggles
Postpartum or perinatal depression (PPD) is the #1 complication of birth. PPD can be mild or severe. It can begin during pregnancy with a rate of 30-40% of women having signs of PPD before the birth. The rates of PPD are high with 1 in 7 women having PPD, 1 in 3 women of color having PPD, and 1 out of 10 dads or partners having PPD. Despite these high rates, over 40% of moms with PPD are undiagnosed. At Children’s Health Care, we follow the America Academy of Pediatrics recommendations to conduct PPD screening at the 1-month, 2-month, 4-month, and 6-month well check using the Edinburgh Postnatal Depression Scale. You can also find the scale here.
While every person is at risk for perinatal or postpartum depression, a mother is at increased risk if they
• Have history of anxiety, depression, or psychosis
• Have diabetes
• Have thyroid issues
• Have had premenstrual syndrome
• Have a history of trauma or abuse including sexual abuse
• Have a family history of mental illness
• Had traumatic pregnancy or delivery
• Are a single parent
• Are a teen parent
• Experienced infant loss or have a history of infant loss
• Experienced pregnancy loss or have a history of pregnancy loss
• Gave birth to multiples
• Had a baby who required care in a Neonatal Intensive Care Unit
• Have relationship issues or stress
• Have financial issues or stress
• Lack social support
• Are raising a child away from their home country
• Are experiencing breastfeeding challenges
Symptoms of PPD can include
• Crying a lot
• Feeling sad or depressed
• Feeling no emotions or flat
• Feeling hopeless
• Having no interest in your baby
• Having trouble concentrating or feeling foggy
• Feeling angry
• Feeling anxious or panicky
• Having physical symptoms including heart palpitations
• Being unable to sleep
• Having extreme worries or fears including about your baby
• Having flashbacks of pregnancy and delivery
• Avoiding talking or thinking about things related to pregnancy or your delivery
• Having scary thoughts
• Having the urge to repeat behaviors
• Having thoughts of self-harm
Postpartum Anxiety (PPA) affects 10% of new mothers. The risk factors for PPA are the same as those noted for PPD. The symptoms may include the above or may be different and include
• Constant worry or extreme worries
• Feeling like something bad is going to happen
• Racing thoughts
• Disturbed sleeping and eating
• The inability to sit still
• Physical symptoms including dizziness, hot flashes, and nausea
Postpartum Depression in Father’s and Partners
The parent who did not give birth also experiences a big life change by adding a child to the family and is also at risk for PPD or PPA. In the general population 1 in every 10 partners experiences PPD or PPA, but that number rises to 50% if the mother had PPD or PPA. Partners including male partners, can be screened with the same tool used for mothers, the Edinburg Postpartum Depression Scale.
Partners may be at risk if they have difficulty forming attachments in relationships, if they have no male or parental role model or if they lack support from their family and friends. They can also be at risk if they feel excluded from the mom-child relationship, feel jealousy towards this relationship or bonding, or feel that parenthood lacks rewards. The partner may also be at risk if they negatively experience a change in the romantic relationships including changes to intimacy. And like mothers, they may be at risk if they have financial or work stress. Low testosterone in males can also result in increased risk for PPD or PPA.
Partners may have the same symptoms as the mother, but their symptoms can include
• Feeling fear or hopelessness
• Escaping into work, cell phones, or hobbies
• Withdrawing from family life
• Increased irritability, anger, or rage
• Physical symptoms such as muscle tension, headache, and stomachache
• Sleep problems
• Increased alcohol or drug use
Postpartum psychosis (PP) is a severe form of mental illness that happens after having a baby. It can happen to any new mother but is more likely to happen in women with a history of bipolar disorder. PP can get worse very quickly and needs to be treated as a medical emergency since the mom or baby may be in an unsafe situation. PP can require admission to a hospital and treatment with medication. With the right treatment, a woman with PP can make full recovery.
Symptoms can include
• Extreme confusion
• Feelings of elations
• Signs of depression or anxiety (see above)
• Extremely irritable
• Having delusions or strange beliefs
• Excessive talking
• Racing thoughts
• Out of character or out of control behaviors
• Unable to sleep even if tired
• Refusing to eat
• Distrust in others or paranoia
• Feeling special connections to things, TV characters or stories
• Feeling baby is connected to God or the Devil
• Seeing or hearing things others do not
• Thoughts of self-harm
Children whose mothers experience PPD, PPA, or PP are at risk for decreased physical and social interaction and increased risk of failure to thrive or growth issues. They are also increased risk of developmental delays, sleep problems, behavior, or emotional problems, and learning problems. They are also less likely to be up to date with routine physical exams and immunizations. They are also at risk for injury due to parents not following safety advice including childproofing and correct car seat use.
When a dad or partners suffers from PPD or PPA and their mental illness goes untreated, there is an increased risk of domestic violence in the household as well as increased risk of problems in their romantic relationship. PPD and PPA increase the risk of using corporal punishment, such as spanking or hitting, with the child. It results in less play between the child and parent. It also increases the risk of behavior issues and developmental delays. The infant and mother are also less likely to continue breastfeeding.
Identification is the first step in treatment. Regular screening by your OB/GYN and pediatrician can help you learn if your symptoms are more than expected in the perinatal period. Treatment for PPD and PPA include social supports, therapy and sometimes medication.
To treat PPD and PPA, it is important to engage in self-care activities and seek help with your child or children during this time. Self-care activities can include sleep, a walk or other exercise, a hot bath, reading, talking with friends, watching a show, or grabbing coffee or a meal with a friend. It should be an activity you enjoy and one that helps you relax and reset. REMEMBER, A HAPPY MOM IS A GOOD MOM AND YOU ARE THE ONLY ONE WHO CAN GIVE YOUR CHILDREN A HAPPY MOM! Remember from our behavior blo9s, you must fill your own cup before you can fill your children’s or partner’s cup.
Parenting takes a community. Your community can involve friends, families, online support groups, and newly made mom friends. Do not be afraid to reach out to your family and friends to ask for help. The saying “it takes a village” is true, but your village sometimes needs to be reminded that you need help.
Finding a community of moms or making mom friends is very important in the postpartum period. In addition to providing adult interaction, a community can provide support. You can share common struggles or challenges with your group. You can vent in a judgement free space, and you can celebrate milestones with your peer group. You can get tips from mom’s going through similar experiences such as feeding issues and sleep regressions. This type of support helps you feel less alone and fosters connection. There are also many supports out there for partners.
If you are a new mom or new to the area, you may not know the resources available. You may struggle to find a mom friends if you are shy or introverted. Your OB/GYN or primary care provider as well as your child’s provider can help link you to local resources.
Finding a group can be hard! It can be hard to find like-minded people. It can be hard finding time to maintain these relationships or coordinating schedules. Sometimes you may have issues with childcare or support from your partner if you would like to have adult only interactions to foster new friendships. If in person interactions are not available to you due to time or location, there are great online support groups. Here are some suggestions:
This group has information and online support groups for:
- Pregnant moms
- NICU parents
- LGBTQ+ parents
- Military parents
- Black moms
- Desi moms
- Parents who experienced pregnancy or infant loss
- Birth moms during or after adoption
- Apoyo (A Spanish speaking group)
- Loss support
- People experiencing PPD or PPA
- Postpartum Psychosis Survivors
Many mothers face experiences that are challenging or distressing but don’t meet criteria for a mental illness. These experiences or feelings are very common and deserved to be addressed.
Mom shame is the bullying of other moms for their parenting choices. The bullying or shaming may be done by a partner, friends, or family. We can also see the bullying on social media outlets. Common mom-shaming topics include criticizing whether you are staying at home to care for your child, working out of the home, body appearance or size of your child, how you choose to feed your child, birth choices, how may children you have, how your child develops or behaves, and engaging in self-care behaviors.
It is hard enough to raise a child and with increasing social media presence in our life, we are more likely to compare our parenting and children to others and more likely to question those choices. This comparison to unrealistic standards can result in disappointment, anxiety, insecurity, and feelings of failure. Feelings of shame and insecurity can lead to moms withdrawing from their support systems. This further increases the risk for feelings of depression and anxiety.
Mom rage is the term used to describe the uncontrollable anger many women feel during the postpartum and child rearing experience. It is not an uncommon experience. Parenting is challenging and our expectations often don’t meet our reality. Mom rage generally comes from the build-up of stress, resentment and frustration. These feelings build and once a person is triggered, they experience rage. Common triggers include noise, children crying, children not listening, or children not sleeping. Often the rage is taken out on our children or families.
Mom rage is usually due an unmet need or an unresolved issue. Many moms spend so much time caring for others that they do not have time or energy to care for themselves. Mom’s lack alone time. Mom’s may feel overwhelmed by being needed constantly or having to provide physical comfort to another constantly. Other causes of mom rage can be hormone related, the result of tension with your partner, past trauma, lack of sleep, work strain, or financial strain.
Mom rage obviously results in anger causing discomfort. It can be scary. Mom rage can make a mom feel overwhelmed, powerless, ashamed, or guilty. They may feel like it won’t ever get better. It can also result in intrusive thoughts that you are a bad mom or not caring for your children. Mom rage does not mean you are a bad mom! It is a warning sign that indicates you may be burnt out, need help, and need to focus on your own needs.
Mom brain is also called mom brain overload. Mom brain happens when a mom is sleep deprived and emotionally overwhelmed. This stress causes changes in brain function. These can happen in the 2 years after adding a baby to your family. Mom brain results in difficulty concentrating, feeling foggy, decreased reaction times, and problems with memory or creativity. It may also result in becoming easily sensory overloaded and easy to anger. It may also make it harder to start or engage in tasks.
Moms can often feel resentful because of parenthood. This resentment can be towards themselves, their partner, their children, family, and friends. Resentment brings feelings of anger and frustration. It can result in feelings of shame, guilt, and unworthiness.
Moms who feel resentful identify the causes of their resentment to include
• Needing a break but not knowing how to do that or having the support to do that
• Not feeling appreciated
• Having an unequal share of workload
• Comparing themselves to others
• Not feeling seen
• Not having the exhaustion of the physical work of motherhood acknowledged
• Not having the exhaustion of the mental load of motherhood acknowledged
• Feeling like they are working hard and seeing no changes or progress
• Feelings of not measuring up to others or others’ expectations
• Being the default parent
• A default parent is the parent who takes more of the workload to
• feed the family and children
• manage family schedules
• manage the children’s emotions and behaviors
• plan events for the family
• organize and maintain the family home
• waking at night to provide care to children
Maternal gatekeeping is when mom blocks other parent from providing care or directs the care provided to the child. They may direct their partner on basic parenting tasks including diaper changes, feeding, dressing, bath, and bedtime care. They may also try to control how and when the other parent plays with their child or children. Maternal gatekeeping affects maternal mental health and functioning of the family or the parent team.
Maternal gatekeeping happens when the primary care giver insists it must be done the “right way” and their way is the only right way. If the care is not up to their standard, often they will stop the other parent or care provider to just do it themselves. In this scenario, the mom ends up taking on an increased workload. This can create feelings of burnout or resentment. Maternal gatekeeping can be a sign of PPD or PPA.
The partner can also feel resentment. The message they receive from the mom is that they don’t know how to do the task or care for their child. This decreases the partners confidence in providing caring for their child and it can result in that parent withdrawing and providing less care. This can be a hard cycle to break.
Mommy wine culture has exploded over the past decade. Mommy wine culture glorifies the use of wine, or alcohol, to cope with your day, parenting, or your children. It often is the focus of jokes we see in memes, t-shirts, drinking glasses, or drink “koozies”. These “funny” items focus on the socializing and relaxing aspects of drinking wine or alcohol. It makes the behavior more desirable and emphasizes the ability of alcohol to help you unwind and have a shared experience.
This is not to say having a glass of wine or alcohol is “bad”, but where it takes an unhealthy turn is when you NEED alcohol to cope with your day, if it is your only way to relax, or you start anticipating the time when you can use alcohol. Using wine to relieve stress is not a healthy coping mechanism. It compounds problems and can create feelings of hopelessness or helplessness. It can also prevent you from getting help for mental health issues or challenges.
Unfortunately, mommy wine culture has resulted in an increase in alcohol dependence, binge drinking (for a woman that is 4 glasses in 2 hours), and alcoholism. Alcohol can cause physical harm in women, more than seen in male counterparts, including brain damage, liver damage, heart disease, cancer, hormone problems, and osteoporosis. Alcohol can also Increase the symptoms of anxiety and depression that may already be present. A parent with alcoholism or alcohol dependence is a major risk factor for a child becoming an alcoholic in the future.
Mommy wine culture can also have a negative impact on children. They are observant and the messaging of mommy wine culture is that parenting is awful, boring, and hard because of children. This can make children feel devalued and like a burden. It also shows them that you need to use a substance to cope with this challenge and to regulate your emotions. Mommy wine culture can teach them to avoid or mask issues instead of dealing with them.
Warning signs that you or your partner may have problems with alcohol include
• blackouts or memory loss after drinking
• increased irritability
• extreme mood swings
• making excuses to drink including to relax, to deal with stress, to feel normal
• choosing drinking over other activities
• becoming isolated or distant from friends or family
• drinking alone
• drinking secretly
• feeling hungover when NOT drinking
• changing friends or appearance suddenly
How To Avoid or Improve Life as a Parent
Part of improving the parenting experience is communication! You need to communicate about
• divisions of roles in your family
• parenting styles
• what your needs are and what your partners needs are
• how your family is functioning
• any issues that arise in your family
You and your partner cannot change or help each other if you do not communicate. You can set regular intervals to check in or plan discussions as feelings or issues arise. Try to pick a time where you are calm and not stressed to have discussions. Try to tackle one issue at time. Be specific about your needs and expectations. Be honest. Be willing to be creative with solutions.
Discussing the division of roles with your partner can be done before you add children to your family as well as being an ongoing discussion as your family and life changes. It is important to divide the family workload equally. It can be hard for a mom to participate in equal parenting if there is any maternal gatekeeping going on. Equal parenting involves letting go of the need to lead or direct parenting. It may challenge your own perfectionism. It requires the primary parent not give instructions and let the other parent find their own best way to do things. It requires patience.
It is also important to show appreciation to your partner as well as receive appreciation back for your role in the family. Communicate what needs you must have met to be your best self and best parent. That may be needing to fit in a nap or sleep in on the weekends. It may be scheduling exercise time during the day or social time with friends or other adults. By laying out your needs to your partner and learning about their needs, you are both more likely to meet those needs and provide your children with the best parents you can be.
Make sure you are check in with your partner about your feelings and touch base frequently to see how you both feeling your family is functioning. It is important in a family to make sure all family members are thriving within your family structure. Leaving a parent out of that equation, and often mom’s leave themselves out, is only a detriment to the family.
Parents must take the time to take care of themselves. In addition, the ways listed above, you may also utilize meditation, journaling, deep breathing, sensory breaks, or therapy. ‘
Part of self-care is also asking for help. No one can parent alone, and the expectation never should be to shoulder that burden alone. Ask for help and ask for support. You can rely on your partner, friends, family, medical providers, a therapist, or online supports.
Positive mantras can help remind ourselves that we are good, and we are enough. Remind yourself:
• I am enough
• I am the parent my child needs
• I care for my child, and I care for myself
• There are lots of good ways to be a parent
• All parents struggle at some time
• I give myself permission to meet my own needs
• It won’t be like this forever
• A bad moment does not equal a bad parent
• I can’t meet everyone’s needs all the time or at once and that is ok.
Parenting is hard. Parenting choices can be different and varied, and these different choices can all result in healthy and happy children. Supporting parents and providing care for all members of the family is essential to raising healthy and happy children. Mental health illnesses or challenges, especially during the perinatal period, require identification and treatment to ensure both parents can be the best parent to their child. If you are worried about your mental health or your partner’s mental health, please reach out to your provider at CHC for assistance.
Children’s Health Care of Newburyport, Massachusetts, and Haverhill, Massachusetts is a pediatric healthcare practice providing care for families across the North Shore, Merrimack Valley, southern New Hampshire, and the Seacoast regions. The Children’s Health Care team includes pediatricians and pediatric nurse practitioners who provide comprehensive pediatric health care for children, including newborns, toddlers, school-aged children, adolescents, and young adults. Our child-centered and family-focused approach covers preventative and urgent care, immunizations, and specialist referrals. Our services include an on-site pediatric nutritionist, special needs care coordinator, and social workers. We also have walk-in appointments available at all of our locations for acute sick visits. Please visit chcmass.com where you will find information about our pediatric doctors, nurse practitioners, as well as our hours and services.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.