I’d like to start a series of posts about postpartum care. Because I’m pretty sure people will not stop having babies anytime soon, these topics are important to everyone since we are all affected even if you aren’t a parent. We continue the march toward being kind humans to one another and the postpartum time is one of those magic moments to shower parents with kindness, support and education in celebration of their new baby. Why not do what we can to give each other a strong start? 

This is a really big topic and there are many good resources out there for support and information. I’m going to add a few things that I think are important when facing a postpartum mood disorder (PMD). PMDs can come up anytime within the first year after the baby is born (issues can still come up after that but they are no longer labeled as postpartum). The PMD spectrum includes: depression, anxiety and panic, OCD, PTSD, anger and psychosis.

Facts:

• Depression during pregnancy is a major risk factor for PMDs after the birth.
• Approximately 15% of birthing parents are affected by postpartum depression (the other PMDs occur to a lesser degree but are still very significant). This percentage is higher if there are any complicating factors such as poverty, being a teenager, having a preterm or high needs baby, etc.
• Around 10% of men also experience postpartum depression, especially if their partner is also depressed.
• Affects on the baby: parents are less likely to interact with baby (singing songs, talking, playing games, etc.), rough handling of baby, acting angry or hostile towards baby, negative impacts on breastfeeding, babies experience more sleep disturbances, higher heart rates, and more cortisol (stress hormones) released when interacting with a depressed parent, etc.
• But this isn’t the Baby Blues? No, the baby blues onsets within the first three weeks postpartum, will resolve soon after, and is due to major hormonal fluctuations, sleep deprivation, and generally adjusting to having a newborn (all of which affect PMDs too). The symptoms of the baby blues include feeling up and down, weepiness, anxiety, lack of concentration, and feelings of dependency. Overall, though, mothers have a positive outlook and the baby blues improve without treatment.

Symptoms of PMDs (only some of the varied list of symptoms):

• Guilt, like you aren’t a good enough parent
• Impatient or angry with others, especially their partners and older children
• Sadness
• Sleep problems such as being overly tired or experiencing insomnia, nightmares
• Appetite changes
• Lack of feelings towards the baby
• Lack of feelings of pleasure or fun
• Being overly worried or anxious about everything
• Lack of focus or concentration and difficulties making decisions
• Intrusive, persistent, upsetting thoughts, usually about the baby
• Compulsions such as needing to keep things clean, needing to keep checking something or count things, etc.
• Feeling overly protective of the baby and paranoid
• Flashbacks to a traumatic event either involving the pregnancy or birth (cesarean, baby in the NICU, feeling powerless during the birth, etc.) or events before the pregnancy (rape, accident, miscarriage, etc.)
• Hallucinations
• If you or someone you know is having thoughts of hurting yourself or your baby please seek immediate help by calling 911 or going to the nearest emergency room.

How others can help:

• Listen with an open mind and heart, don’t judge, follow up with support and resources.
• Use the Edinburgh Postnatal Depression Scale. These questions are a screening tool to help recognize parents who may be experiencing a PMD.
• Help the parent make an appointment with their midwife or doctor, or with a therapist who has experience with postpartum mood disorders. Offer to take them to the appointment or watch the baby. Sometimes picking up the phone to make an appointment and getting out the door is the hardest step.
• Finding a support group: many midwife, doctor, or therapy practices have support groups specifically for PMDs, and these are sometimes less expensive than therapy while still having many benefits. Here are some resources for finding support groups: here, here and here. There are online support groups too (like here, here, here and here) and phone numbers to call, here.  If you cannot find a support group in your area, consider helping by forming your own. This doesn’t have to be anything fancy, just a group where parents with new babies can meet to talk. These groups can be incredibly helpful but therapy or medication may still be needed.
• Start in pregnancy: If someone was prone to depression, anxiety, anger, OCD, or other mood disorders before the birth of the baby, chances are they might be triggered after the baby’s birth as well. Here are some suggestions during pregnancy:
  • Have some open discussions about this sensitive topic before the birth happens. It’s so much harder to talk about things after the baby is born.
  • Contact a therapist during pregnancy. People are much more willing to see someone whom they’ve met before than try to establish a relationship during a crisis with a total stranger.
  • Schedule an appointment for 3-4 weeks postpartum. If things are truly going ok, the appointment can be canceled.
  • Have the contact info of other helpful people available like postpartum doulas, lactation consultants, and support groups on the fridge. Don’t be afraid to call!
• Find ways for the parent to socialize. This can be really difficult at first and they might be very resistant. Be understanding and go slow. Start with a very small group of close family or friends, maybe in the home, and then go from there.
• Other important life style tips to support a parent in need of help: good nutrition, exercise, sunlight, meditation (or finding moments of quiet) and adequate sleep.

Of course there are many other ways to help. Postpartum mood disorders are not a joke or an exaggeration and they can affect anyone. If you are experiencing a PMD, know this, it is not your fault, you are a good person, you are not alone, there is help out there for you and you deserve to feel better.