How to tell the difference and get the support you need

Along with all the physical changes of pregnancy and childbirth come a host of emotional changes, from euphoria to sadness. That sadness also has a spectrum, from a mild and temporary condition to a more serious mental health concern.

The most common occurrence is known as the baby blues. “New moms can experience self doubt, low motivation and difficulty thinking straight due to fatigue and hormone changes. The ‘happy hormones’ that increase up to 200 times during labor drop within two days following delivery, meaning moms go from the top of the chart to the bottom. It’s a roller coaster right after delivery,” said Keiko Yoneyama-Sims, MS, LMFT, therapist at Maria Droste Counseling Center. “This is normal. Baby blues are not mental illness.”

Adding to the physical changes are the pressures that comes from the realization that I now have a living human being that I have to keep alive, and the changes in sleeping patterns with a baby that keeps mom up during the night. Keiko explained, “With baby blues, mom can function, even if it is not optimal. Baby blues are temporary and usually go away naturally, without intervention, medication or treatment such as counseling, after two weeks.”

Postpartum depression (PPD) and postpartum mood disorder and anxiety.

Studies find that depression and anxiety go hand-in-hand in postpartum women. Anxiety comes from worries around keeping the baby alive and well. Depression arises from the combination of physical changes, emotional changes and social status changes such as the loss of one’s work identity and not feeling economically productive.

Anxiety can manifest as racing thoughts, checking things in a meticulous way or worrying too much. “Some degree of anxiety is normal. When it starts affecting your health, wellness, self care, or other functions in your day such as doing chores or going out, then it becomes significant enough to diagnose,” said Keiko.

“Some moms confess to having scary thoughts and even vivid images of something bad happening to their baby and get very scared,” said Keiko. “They may, for example, see the baby falling while they just stare and don’t react. They wonder, ‘Am I the one who is going to hurt the baby? I don’t want to have this thought.’”  The important distinction, she said, is that they can distinguish reality despite the scary thoughts. This is a good indication that she is not experiencing mental illness, but rather normal anxiety. “The brain fires off strong urges to protect baby and fatigue causes these thoughts to be extreme in order to warn mom. The imagery can become too much. I call it ‘protective mother nature in overdrive.’ We needed that kind of natural instinct in the cave, but now in modern day we don’t need that level of  heightened alertness, yet the body works the same way.”

Postpartum psychosis is a concern when the mom cannot distinguish reality and feels compelled to do things that don’t make sense or may even be harmful to herself or her child. If the mom is already taking psychiatric medication, it is important that she continue to work with her doctor. “This is the worst time to stop medication in terms of supporting mom. Talk to the prescriber to change to a medication that doesn’t affect breast milk, or to change the dosage, instead of going cold turkey,” cautioned Keiko.

A mom who is experiencing postpartum depression and anxiety may not want to reach out for help due to fears that her baby will be taken away if people know how she really feels. “Moms are scared to be away from their babies even though the pregnancy and birth are the cause of the turmoil they are experiencing. They hear scary stories and urban legends about mothers and babies being separated in these instances,” Keiko said. “It is especially sad for moms who have been hospitalized for suicidal ideation, but that is changing. Many hospitals now let moms bring their babies to postpartum treatment centers for care and for the attachment that needs to happen. And in cases of less severe depression, a baby is not going to be taken away.”

Partners notice changes too

Keiko pointed out that sometimes the mom does not notice her mood change or that she is different than before. Sometimes her partner is the one who sees the difference in her demeanor:  She was always nice, and now she has a short temper and is snappy. Or she has gotten quiet, not talking much. Or she can’t stop talking and the intensity is different than before.

3 stages of support

Crisis phase

In the beginning, when everything starts happening, it is all very intense. Now is the time to outsource tasks around the house. Creating an environment in which mom is stable will allow her to get the most from treatment, which may include medication.

• Bring in people to help out and also to be around mom for company so she is not left alone.
• Make sure mom has time for herself and is not on constant baby care duty, and that she has adequate nutrition and rest.
• Think outside of the box for getting help, such as delivery/doula services, housekeeping, a mom co-op (moms help each other with household chores and keep each other company).

Getting better phase

At this stage, expectations begin to change. Explore what works to help mom feel better instead of focusing on why this is happening. Borrow talents from other areas of your life. What competencies do you have from work or as a good student?  What talents do you have that made you feel successful? If you’re good at planning, make a chart instead of trying to remember everything. “It can be easy to forget what you are good at. I remind moms by talking about what worked before,” Keiko said. “How do you learn new skills best? Use that to find a solution that works for you and actively change your life so that you feel better.”

• Create a self-care plan with instructions. Do familiar things.
• Practice self-kindness and self acceptance.
• Take time to explore. Find out what your strengths and inner-resources are.

Maintenance phase

Notice what is going well, but know your limits. It is normal to feel better and think you can do more, but at this stage doing too much can cause you to burn out.

• Resist the temptation to overachieve.
• Continue to take time for yourself and practice self-care.
• Connect with others.

Keiko reminds new moms that having one bad day does not constitute a diagnosis. Postpartum.net is an excellent resource for learning more about the signs and symptoms of postpartum depression and when they should be considered a diagnosis.