Postpartum Depression

Wednesday, February 12, 2020

Postpartum Depression

Last week, I got a message on Instagram from a sweet follower that said “Postpartum depression is a hormonal imbalance..unfortunately your surroundings don’t determine if you get it or not. I wish it did.” While it was not exactly accurate, it reminded me of just how many misconceptions there are out there about postpartum mood disorders. Around these neck of the woods, we prefer to call them “postpartum mood challenges” since a disorder isn’t often short-lived and PPD is often temporary.


I have seen the spectrum of postpartum mood challenges and they appear so different every single time. I have witnessed a mother with such severe postpartum psychosis that she refused to turn off the lights as her newborn slept. She wanted lights on every minute of the day. I have shared in the despair of a mother so depressed as she mourned the loss of her “pre-baby life.” I have also had mothers share dark thoughts like they wanted to throw their baby out of the top story window or fantasizing about leaving their baby and driving off into the sunset, never to return. On the lighter end of the spectrum, I have seen new mothers who get angered and irritated easier than normal or can’t control their crying. Sometimes, it’s not an outburst of emotions, rather extreme anxiety that is crippling and prevents everyday actions like sleeping and eating. 

The important thing to remember when it comes to navigating the postpartum period is that there is always help. For anything that comes your way, you’re never alone. There are local resources. There are online resources. There are free resources. There are paid resources. There are one-on-one resources and group resources. 

You are never alone.

What is it?

A depressiveness that includes irritability, anger, extreme sadness, and low moods that lasts more than 2 weeks after the birth of your baby. Up to 60% of birthing parents (that’s 2/3 of the birthing population to be clear) suffer from postpartum depression and that number will only climb if we include non-gestational parents in the mix.You may also be surprised to learn that postpartum “rage” (becoming angry over things that otherwise don’t seem to be “worthy” of anger) is a classic symptom of postpartum mood challenges. A few other symptoms are the inability to sleep, a lack of interest in eating, and a lack of interest in activities that used to elevate your mood or bring you joy. Intrusive thoughts are also a large red flag. 

Another common misconception about postpartum mood challenges is that it must appear soon after birth and that simply isn’t true. Postpartum mood disorders can impact parents up to the first year following birth. To think that you’ve made it out of the first month or even the fourth trimester unscathed is a mistake. For 12 months after your baby’s birth, you need to be supported, loved, and cared for while you have access to resources and the support of professionals specializing in new mothers and postpartum life. Do not hesitate to reach out to resources that can support you in this time.

Baby Blues vs. PPD

You may experience Baby Blues as your body and hormones realize that your baby has been born and it is time to begin shifting, you may experience weepiness, tearfulness, and light sadness in the first 14 days following the birth of your child. This is very common and even thought to be “normal.” If you’re new around here, you should know, I despise the word “normal.” Everything in life is a spectrum. Everything is a variation of normal and to classify something as normal either gives folks permission to be very sick and not seek treatment or to cause themselves unneeded emotional turmoil as they beat themselves up for not experiencing something considered normal. Neither are healthy and nothing across the board is normal. Postpartum Depression is not exclusive to females or birthing parents. Males and non-gestational parents can also suffer from postpartum depression, anxiety, OCD, and psychosis.

Other forms of Postpartum Mood Challenges

OCD- This is classified as consistent and uncontrollable compulsions or obsessions that interfere with your ability to care for your child. OCD is usually thought of as checking locks on doors multiple times or clouting cracks in the sidewalk, but in postpartum it may look like incessant thoughts of dropping your baby. So much so that you don’t pick up your baby at all. It may also present as manic thoughts of your baby suffocating in their sleep leading you to not allow your child to sleep out of your sight and not getting sufficient rest yourself. 

Psychosis- This is defined as paranoia, hallucinations, confusion that interfere with your ability to care for your child. These are the stories that make the news and usually end in harm being done to the child or others. Postpartum psychosis can lead new mothers (and fathers) to make extreme choice and irrational decisions that are not founded in any solid evidence or research. Usually these decisions seem far-fetched and are very concerning. 

Anxiety- While some level of anxiety is expected for new parents to experience, some new parents have crippling anxiety. If your anxiety is debilitating and prevents you from interacting with your baby (picking them up, holding them, feeding them, putting them down, etc), then it’s time to share this with someone. Your anxiety should not be causing you severe distress. Another symptom of postpartum anxiety is paralyzing and intrusive thoughts about your baby (Is your baby eating enough? Are they gaining enough weight? Are their diapers filled with enough output?). These obsessive thoughts may drive you to action (constantly weighing your baby).

Risk Factors You May Not Know About

- HORMONAL FACTORS
So many people blame just hormones for the shifts and changes that happen to your body and your brain after your baby is born. While they play a large role, they are not solely responsible for your postpartum journey. There are other factors that play a role but a history of depression and anxiety (in the gestational parent) will also increase your risk as well as history of alcohol abuse which has also been correlated with PPD (1). 

Immediately postpartum, the human body will experience an increase in amino acids which will result in a deficiency in serotonin (the “feel good” hormone). While a decrease in serotonin amidst the happiest time of your life may seem unusual, it is an expected bodily response. There has also been studies linking estrogen receptors variations and PPD (2). It is important to note that the studies and findings are not only new, but also there are very few of them. There needs to be more research to determine an exact link. 

- GENETIC FACTORS

Genetics play a crucial role in this. If your mother, grandmother, or sister experienced challenging moods and emotional swings during postpartum, your risk is heightened a bit. They way our body adjusts to postpartum will vary from person to person, so your postpartum journey will not look like anyone else’s, but looking at your family’s history may give you a good insight of what is possible for you. Your postpartum journey will be an individual walk, no doubt, it may be similar to someone you know, but your journey is yours and everything is a variation of normal. A gene, known as HTR2A, and a serration receptor, known as 5HT2A, has been linked to a higher risk of postpartum emotional struggles, but education level and socioeconomic status can stand as “correctors” for these genetic predispositions (3). 

- ENVIRONMENTAL FACTORS
Turns out, as much as I love her (I have a personal relationship with her), this follower is very, very wrong. Your environment is very much an influence on your likelihood of developing postpartum depression…and anxiety and psychosis and OCD. The support of your partner is the number one indicator of much of your success as a new mother. Whether your partner is supportive and encouraging can have MASSIVE impacts on your breastfeeding success, your ability to avoid extreme sleep deprivation, your mental health, and your physical healing. Matter of fact, this study (4) determined that a distressed relationship was the top environmental factor impacting a mother’s postpartum mental health status. While mother’s with specific genetic markers were more prone to postpartum depression, their environment actually played a bigger role. This study (5) showed that even mother’s with “sensitive” genetic markers were less likely to develop postpartum depression if they were in a positive environment. Therefore, your environment does matter. This research paper goes on to share that the term “depression gene” is actually more of a sensitivity to their postpartum environment and the support of their surroundings.

- YOUR BIRTH STORY
The way your birth goes has a large impact on the way you heal (mentally, emotionally, and physically) after birth. This study (6) points out that obstetrical complications, difficult pregnancies, and challenges with breastfeeding can also impact your risk of developing a postpartum mood challenge. Let’s just take a quick minute to think about the obstetrical language we often hear in the birth room such as “incompetent cervix” and “failure to progress” that sets women up perfectly to question their body and their ability to confidently parent their child. How can we expect women to hear these negative terms about their bodies for hours leading up to the birth of their child and then automatically tap into an internal confidence to successfully parent? We can’t. I am a FIRM believer that the way your baby is brought into this world will ABSOLUTELY impact the way you heal and navigate during postpartum. This is why choosing a provider is not only a crucial point in planning for your birth, but also holds so much weight in achieving your ideal birth. Finally, for mothers who classify caring for a baby as “difficult” are also at a higher risk of developing postpartum depression. 

It’s also important to mention, if your birth starts with an unwanted or unplanned pregnancy, you are at a higher risk of postpartum depression. This should come as no surprise because as postpartum hormones plummet, this will feel more intense if you’ve already started behind the emotional eight ball.

What to do if you feel “off” after your baby arrives

Tell someone. Tell anyone. Just let someone in your life (that you trust entirely) know that you are not feeling well. Share with them the thoughts swirling in your head and the emotional struggles you are navigating. If you don’t have anyone in your life that you feel comfortable sharing this sensitive information with, tell your healthcare provider. Another option is to do a quick Google search to find a local mental health counselor that specializes in supporting parents during postpartum. 

Medication may not be the only answer. Not everyone wants to medicate when it comes to healing and that’s okay. Don’t let anyone bully you into taking medication if that is not what you feel is aligned with you. There are SO MANY OTHER OPTIONS available like support groups, one-on-one counseling, The Birth Lounge, meditation, exercise and diet changes, as well as positive affirmations and rewiring the neurons in your brain to better serve you during this time.

Be careful where you get your information & resources

While we all love our moms, mother-in-laws, and grandmothers, the truth is they aren’t always as educated about things as we’d like to think. This sweet follower has had three children of her own, but the research on this topic has changed drastically over the years and her opinions on postpartum depression were misinformed and could prove to be very dangerous if she passes this along to new mothers who might be suffering from postpartum mood challenges and needed some real help.

It’s IMPERATIVE that new mothers are supported by professionals and have access to evidence-based information rather than the opinions of folks who have simply given birth before. While giving birth give you a helpful insight of what happens before and after baby, it might require a bit more expertise founded in education rather than experience. The fact that experience doesn’t always translate to education is one of my biggest qualms with the birth world and motherhood in general. It seems today that every Tom, Dick, and Harry feels they are qualified to give advice to new mothers, yet we are only seeing maternal mental health declining. Go figure. One of the biggest ways we can combat misinformation is to be mindful that you aren’t confusing anecdotal experience with evidence-based education.

Final Takeaways:

  • -There is always help. You are not alone. Now, yesterday, tomorrow, next week. You are not alone.
  • -Tell someone, tell anyone. You can’t get help if no one knows you are struggling.
  • -Postpartum mood challenges are a spectrum and can manifest in many different ways and present as many different symptoms.
  • -There is real evidence that there is real reasons for postpartum depression and it’s deeper than just being “hormonal” or simply adjusting to your new role.
  • -If your provider isn’t listening to you, go get a second opinion. You deserve help in this transition.
  • -Make sure you are taking advice from professionals who are experts in the field. Your mother, mother-in-law, and grandmother may not be fit to support you in this sensitive time.
  • -Postpartum Mood Challenges are not a reflection of you as a person, as a mother, or as a partner. You are strong as hell and recognizing that you need some support is the strongest and bravest thing you can do for yourself and your baby.
Don’t forget to check out our newest adventure The Birth Lounge, listen in to The Birth Lounge Podcast, and follow us on Instagram at @tranquilitybyhehe! 


Resources:
  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849876/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849876/#B44
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849876/
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849876/
  5. https://www.sciencedaily.com/releases/2011/05/110519112915.htm
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849876/

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