More Than the “Baby Blues”: An Overview of Perinatal & Postpartum Mood Disorders
There are many dualisms inherent in becoming a parent: it’s exciting, joyful, hopeful AND we can feel anxiety and grieve the loss of our “old” life at the same time. Many of us have heard the term “baby blues” in relation to the period following the birth of a child. When people speak of this, they are generally referring to the sense of sadness, irritability and overwhelm that as many as 60-80% of new birthing people experience in the first few days after birth (Allen, n.d.). We can credit dramatically falling hormonal levels (estrogen and progesterone) with these symptoms (Allen, n.d.). Usually, they dissipate within two weeks of giving birth. But, what happens if they don’t? It’s important to be aware of the fact that for many birthing people, the “baby blues” are normative as this can be a very validating piece of knowledge. However, it is also vital to know that Postpartum Mood and Anxiety Disorders (PMADs) exist; 1 in 7 new birthing people experience these distressing but treatable symptoms (Postpartum Support International, n.d.). A new parent does not have to suffer in silence, thinking: “oh, it’s just the baby blues—everyone feels this way…” Here is what you need to know if you (or someone you’re close to) is pregnant or recently had a baby.
A lot of people have heard of “postpartum” and usually think this is limited to depression. Postpartum depression is, indeed, one of the PMADs but in addition to this, women (and men!) can experience postpartum anxiety, PTSD and OCD (Postpartum Support International, n.d.). In rare instances, the birthing person can also experience psychosis following birth. To get more specific and accurate, the better term for mental health issues in this period is “Perinatal Mood and Anxiety Disorders” because these issues can also be present during pregnancy, not just after (Postpartum Support International, n.d.). “Perinatal” refers to the period before and after birth.
So, what are the symptoms of each? This is an overview to give you, the reader, a broad sense, but I encourage further reading if something resonates with you.
Perinatal depression: crying and sadness, irritability, lack of interest in baby, feeling hopeless, guilt, anhedonia, sleep and appetite changes as well as thoughts of harming self and/or baby (Postpartum Support International, n.d.)
Perinatal anxiety: persistent worrying, a sense of dread that something awful will occur, racing thoughts, being fidgety or unable to sit still, physical symptoms (such as racing heart, nausea, dizziness) as well as changes to sleep and appetite (Postpartum Support International, n.d.).
Perinatal OCD: obsessions (also known as intrusive thoughts) usually relating to the baby, compulsions that are done to quell the anxiety brought on by intrusive thoughts, hypervigilance about baby’s safety, and a sense of deep distress over the presence of these thoughts (Postpartum Support International, n.d.). It is important to note that the birthing person does not want to act on them, which is why it can feel so scary!
Postpartum PTSD: this refers to real or perceived traumas (most often) during the time of delivery, such as the baby going into distress, needing an unplanned intervention (like C-Section), losing a lot of blood, etc. In addition, there is a sense of not having control over the outcome of events (Postpartum Support International, n.d.), which results in a perceived sense of powerlessness.
Postpartum Psychosis: this is a very rare (.1-.2% of births) but serious condition in which the birthing person experiences delusions, hallucinations, severe depression, paranoia, a decreased need for sleep, irritability and/or mood swings (Postpartum Support International, n.d.). Birthing people exhibiting these symptoms should be taken to an ER immediately since this is a medical emergency as she/they may harm themselves or the infant.
This is by no means exhaustive but is meant to give you a sense for how the “baby blues” and PMADs are different and call for different interventions. The important thing to remember is that there are interventions! Having knowledge of the signs to watch out for is empowering and the vital piece needed to seek help. Some of the most useful steps to take include:
Find a psychotherapist who is specially trained in treating Perinatal Mood and Anxiety Disorders: Postpartum Support International has a directory.
If you are planning on becoming pregnant, or are pregnant already, build your support system early as low social support is a known risk factor for PMADs (MGH Center for Women’s Health, 2005):
connect with friends who have had kids or are pregnant.
join groups for pregnant women.
interview a labor and/or postpartum doula--affordability can be an issue but some HSA/FSA plans let you use these for payment. Many cities also have Community Doula Programs that offer sliding scale or are free!
talk to a lactation consultant if you want to breastfeed since there can be a learning curve with this! Many insurances cover these types of visits.
Do you feel comfortable/safe with your OB or midwife to the extent that you feel you have a say in your care and can ask any questions that come up?
Find a psychiatrist who specializes in women’s mental health as well as the perinatal period.
Couples therapy can be very helpful in preparing for the transition to parenthood and can also act as a space to share concerns/worries about the postpartum period.
Engage with a support group with others who are also experiencing this major life transition. Postpartum Support International offers some of these .
Call a hotline that is specifically for new parents, if you are in a pinch and need to talk to someone immediately. In the Chicagoland area, the Northshore MOMS Line is open 24/7: 866.364.MOMS (866.364.6667).
Read “Good Moms have Scary Thoughts” by Karen Kleinman.
Read “Expecting Better” and “Cribsheet” by Dr. Emily Oster to help dispel some common misconceptions (using data!) that may lead to increased anxiety about pregnancy and/or the period after birth.
Postpartum Support International, MGH Center for Women’s Mental Health and Marce Society are leading organizations in the perinatal mental health space; they have great resources, many of which are free!
References
Allen, S (n.d.) What are the baby blues? Retrieved September 25, 2023, from https://drsarahallen.com/baby-blues/
MGH Center for Women’s Health (2005, June 20). Postpartum depression: Who is at risk? Massachusetts General Hospital Center for Women’s Mental Health: Reproductive Psychiatry & Resource Center. https://womensmentalhealth.org/posts/postpartum-depression-who-is-at-risk/
Postpartum Support International (n.d.) Perinatal mental health disorders. Retrieved September 25, 2023, from https://www.postpartum.net/learn-more/
Photo by cottonbro studio: https://www.pexels.com/photo/pregnant-woman-in-white-long-sleeve-dress-5853667/
