When it’s more than the Baby Blues
“This should be the happiest time in my life. So why am I feeling this way?”
When our personal lived experience does not line up with our culture’s expectations, the mental health difficulties we experience are frequently compounded by guilt or a belief or feeling that one is going “crazy.” This is seldom more true than when we find ourselves experiencing mental health difficulties during pregnancy and after delivery. Since we tell ourselves that the way we are feeling is inappropriate at best, and downright unnatural at worst, we often get in the way of receiving the appropriate help and support from friends, families, and professionals, or even our own partner, by working to pretend that everything is fine, when the reality is much different.
Thanks to the efforts of a lot of dedicated mental health and birth professionals, most people have heard about Postpartum Depression. What people often do not realize, however, is that a range of mental health difficulties can occur both during pregnancy and the postpartum period—up to twelve months following the birth of a child. These difficulties are referred to collectively as Perinatal Mood and Anxiety Disorders (PMADs), and they include the following:
- Major Depressive Disorder – Those with symptoms of MDD experience depressed mood, increased tearfulness, and loss of interest. Some people feel angry or “numb.” While some experience an increased need for sleep or increased appetite, insomnia or loss of appetite can also be symptomatic of MDD as well. Excessive or inappropriate guilt is often present for birthing parents, especially guilt surrounding the belief that they “should” be happy during this time of life. Some birthing parents who have MDD may experience trouble in bonding with the baby.
- Generalized Anxiety Disorder – Symptoms of GAD include difficulty sleeping, unexplained muscle tension, irritability, and feeling fidgety or restless.
- Panic Disorder – Panic Disorder involves recurrent panic attacks, during which the person may experience tightness in chest, difficulty breathing, racing heart, uncontrollable crying, dizziness, and feelings of impending doom. These may occur with or without an identifiable trigger and tend to be limited in duration, usually lasting around 10-20 minutes.
- Obsessive-Compulsive Disorder – People with Postpartum OCD may find themselves frequently checking on the baby or on other items around the home. Often, symptoms of OCD are centered around safety. Some birthing parents with OCD will experience intrusive, upsetting thoughts about situations in which they harm the baby or the baby is harmed in some way. In these cases, the thoughts are distressing and the birthing parent does not want to follow through on these ideas. This is in contrast to Postpartum Psychosis, which is discussed below.
- Posttraumatic Stress Disorder – Symptoms of Postpartum PTSD include intrusive and upsetting thoughts and memories of the birth experience or even of difficulties that occurred during the pregnancy. It is most important to note that events experienced as traumatic by the person suffering from symptoms of Postpartum PTSD do not need to be perceived as having been traumatic or life-threatening by outside observers. Other symptoms include hypervigilance, exaggerated startle response, and preoccupation with concern about own health or health of the baby.
- Postpartum Psychosis – The most serious of mental health difficulties occurring in the postpartum period, this disorder is characterized by delusional beliefs that the birthing parent and/or the baby is in danger or dangerous. In these cases, thoughts of harming the baby seem logical and rational rather than distressing or upsetting. This is a life-threatening situation for both the birthing parent and the infant, and immediate medical intervention is needed. Care may include hospitalization to stabilize the birthing parents’ mental health via medication. Follow-up care after discharge includes psychotherapy and ongoing medication management. To access help, call 911 or go to your nearest emergency room.
It is important to note that, while “baby blues” are to be expected following the birth of a child, symptoms that persist beyond the first ten to fourteen days following birth warrant further evaluation. If symptoms continue past that timeframe, the best course of action is to reach out for help from mental health professionals with specific training in PMADs.
If you are experiencing symptoms of any of the conditions listed above, the most important piece of information to know is that you are not alone. Recent studies have indicated that up to 15-20% of those who give birth experience symptoms of one or more PMAD. The second most important piece of information is that all of these conditions are treatable, with best practice consisting of a combination of psychotherapy and medication management.
While all of the above listed disorders can occur at any time in people’s lives, they are especially challenging to recognize and seek help for during the perinatal period due to our expectations of what we “should” be feeling during and immediately after pregnancy. If you are experiencing any of the aforementioned symptoms, obtaining professional help is the key to getting back to your previous level of functioning. Even if you suspect that your symptoms may fall within the window of the “baby blues,” you are still able to reach out to be assessed by a professional to determine whether treatment of your symptoms may be appropriate for you.
More about the author
Stephanie R.W. Phillips, MSW, LISW
Clinician at PsychBC
Stephanie Phillips is a native Ohioan who spent nearly two decades living in Kentucky before happily returning to her home state. She earned her Master of Social Work from the University of Kentucky and has dual licensure as a Licensed Clinical Social Worker in Kentucky and a Licensed Independent Social Worker in Ohio. She has extensive training in the treatment of trauma and, as a result, views many of our current mental health difficulties as a result of the experiences we have lived through that keep us “stuck” in the stories we tell ourselves about who we are and how we function in the world and in relationships. Her favorite interventions include those that focus on mindfulness practices, including Acceptance and Commitment Therapy (ACT) and Eye Movement Desensitization and Reprocessing (EMDR). She became interested in the treatment of Perinatal Mood and Anxiety Disorders after discovering how trauma related to childbirth can impact new parents. This led to learning more about prenatal care and labor and delivery practices in the United States and the ways in which aspects of this system of care can impact pregnant and birth people’s mental health and well being, eventually leading her to obtain specific training in the treatment of PMADs, as well as pregnancy and infant loss. Stephanie is a strong advocate for reproductive rights and recognizes that this is not limited to birth control access, but includes empowering pregnant and birthing people to partner with their care providers to make involved, informed choices about their own care, as well as supporting and caring for new parents in the postpartum period. Stephanie lives in Shaker Heights with her husband and their two children.
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