The arrival of a new baby brings many challenges. First-time mothers have to learn how to provide around-the-clock care for a newborn while managing their own physical and mental health as they recover from labor and delivery. The first three months of a baby’s life are often thought of as the “fourth trimester,” as mothers must be so closely connected to every function of their child’s life.
This intense period of caregiving can be incredibly isolating and may lead to loneliness among new mothers, a key factor in the causes of postpartum depression. One in eight new mothers experience postpartum depression, according to the U.S. Centers for Disease Control and Prevention.
Many women who have just given birth often suffer in silence. Feelings of embarrassment or guilt about being depressed during a time when they think they are supposed to be happy may keep them from talking about what they’re going through – and further cause them to isolate themselves from others.
It’s important for health care providers, mental health professionals and others working to support new mothers to help them maintain good social connections – both through friends and family support.
Symptoms of postpartum depression
The body’s hormonal changes in response to the birth of a child, coupled with the stress and exhaustion of caring for a newborn night and day, can be overwhelming. It is normal for women to experience feelings of isolation and sadness. During this time, women can experience transient feelings of depression and anxiety called the “Baby Blues.” These symptoms typically start within a few days of birth and can last up to two weeks, but usually resolve on their own without treatment. However, it’s important to watch how long these feelings persist and how severe the symptoms are. If the feelings persist or are severe, they could be related to postpartum depression.
Postpartum depression is a serious mental illness that affects an individual’s behavior and physical health. It usually begins during the first month after having a child – but it can begin during pregnancy or up to a year after birth. Symptoms for new mothers can include:
- Feeling restless or moody
- Feeling sad, hopeless or overwhelmed
- Frequent crying
- Thoughts of hurting the baby or themselves
- Feeling unconnected to their baby, not having any interest in the baby or feeling as if the baby belongs to someone else
- Having no energy or motivation
- Eating or sleeping too little or too much
- Difficulty focusing or making decisions, or having memory problems
- Feeling worthless or guilty
- Withdrawing from friends and family
- Headaches, aches and pains, or stomach problems that won’t go away
If symptoms persist for longer than two weeks or if the symptoms are severe, women need to talk to their doctor right away. Postpartum depression is common, and nothing to be ashamed of and it is important to seek help.
The symptoms can develop rapidly and about six percent of women with postpartum depression have suicidal or homicidal thoughts. In its most severe form, women can even develop psychosis. This is why it is so important for all women with symptoms of postpartum depression to seek treatment as soon as possible.
Postpartum depression can occur among women who had a healthy pregnancy and birth. Some experiences may put women at higher risk, including a previous history of depression, complications during pregnancy and birth, stressful life events, having multiples and delivering before 37 weeks of pregnancy.
Symptoms of postpartum anxiety
Becoming a new parent brings a host of new concerns and worries – which is to be expected when an individual is taking on big responsibilities for the first time. However, when these worries become all-consuming – or lead to feelings of worry all day and night, it may be postpartum anxiety.
Postpartum anxiety can include irrational fears or excessive worries about things that are unlikely to happen. The fears may be related to past incidents – or they may feel more like a constant sense of danger that’s unconnected to any specific incident. Here are some examples:
- Staying up all night, afraid the baby will stop breathing
- Being unable to leave the baby alone for a few minutes or with a trusted adult, like a partner
- Being afraid to leave the house
Postpartum anxiety can include physical symptoms – including sleep disruptions, heart palpitations, stomach aches, loss of appetite, trouble sitting still and muscle tension. Symptoms can also be emotional: an inability to relax or keep calm, racing thoughts, obsessing over irrational fears, difficulty focusing, irritability or feeling on edge. Behavioral symptoms can also include avoiding activities, people or places, being overly cautious about situations that aren’t dangerous, checking things over and over, and being controlling.
Postpartum anxiety may occur at the same time as postpartum depression. It is very common for women to have some symptoms of both depression and anxiety, and it’s important to be evaluated by a physician so that they can develop a treatment plan with the patient based on her symptoms.
Seeking help for postpartum depression and anxiety
Women need to talk to their health care provider about their feelings and emotions. Often, during the six-week postpartum visit, doctors may ask screening questions for depression and anxiety. That visit is a good time to discuss mental health concerns – and to ask for help. However, it is important that if you experience these symptoms prior to that visit, that you schedule an interim appointment with your physician.
Women can talk to any care provider about their mental health – including their OB/GYN, family physician or other primary care provider. These physicians are capable of screening for mental health disorders and treating or making referrals to the appropriate behavioral health providers.
Open and honest conversations with providers are critically important for postpartum women to ensure they get the help they need and are as healthy as possible to care for themselves and their newborn.
Martha Walsh, M.D., is a senior medical director and associate chief medical officer at Blue Cross Blue Shield of Michigan. For more mental health tips and information, visit MIBluesPerspectives.com.