Mental health care during the postpartum season
For World Mental Health Day and every day thereafter, we’re shedding light on postpartum mental health. Content warning: Postpartum mental illness — and the potential gravity of symptoms — can be a triggering topic. But given how many parents experience mood disorders after giving birth, it’s important to understand the early warning signs and available treatment options.
The reality is up to 25% of new parents (both birthing and non-gestational parents) experience some type of PMAD (Postpartum Mood and Anxiety Disorder). We aim to clarify and destigmatize the spectrum of postpartum psychiatric disorders and equip you with resources on how to care for your own postpartum mental health — because caregivers also require care.
Postpartum illness overview
According to Harvard Medical School and the Massachusetts General Hospital (MGH) Center for Women’s Mental Health, postpartum psychiatric illness includes the postpartum blues or baby blues, postpartum depression and anxiety, and — the most severe — postpartum psychosis or puerperal psychosis. The blues are the most common, the mildest, and the most short-lived. However, 10-15% of postpartum parents develop more serious depression and anxiety symptoms, and 1-2 out of every 1,000 parents who give birth develop postpartum psychosis, “a psychiatric emergency that typically requires inpatient treatment.” These symptoms go much further than common concerns and worries about new parenthood. Affecting only about 0.15% of parents, postpartum psychosis is statistically rare. However, given that 385,000 babies are born each day around the globe, between 385-770 postpartum parents experience this crisis every single day.
What causes perinatal mood and anxiety disorders?
Like most body changes surrounding pregnancy and childbirth, postpartum blues, or postpartum psychiatric disorders are caused by rapidly shifting hormones. According to Harvard Medical School/MGH, “within the first 48 hours after delivery, estrogen and progesterone concentrations fall dramatically.” In some people, this drop in hormone levels can drastically impact well-being.
Who is at risk?
“Some investigators hypothesize that there is a subgroup of people who are particularly sensitive to the hormonal changes that take place after delivery. This population of women may be more vulnerable to PPD and to other hormonally driven mood disturbances, such as those occurring during the premenstrual phase of the menstrual cycle or during the perimenopause,” Harvard Medical School/MGH explains. People with a history of depression or bipolar disorder are also in the high-risk group. Beyond brain chemistry, stress and the lack of a solid support system also increase a new parent’s vulnerability to postpartum psychiatric illness.
Clinical PMAD conditions are caused by many other nuances, and risk factors can be:
- A personal or family history of mental health conditions, like depression, anxiety, perinatal depression, bipolar, or OCD.
- Premenstrual dysphoric disorder (PMDD or PMS)
- Inadequate support in caring for the baby
- Financial stress
- Lack of partner support
- Lack of social support
- High levels of stress
- History of abuse
- Marital/relational stress
- Unplanned pregnancy
- Unwanted pregnancy
- Complications in pregnancy, birth, or lactation
- A major recent life event, including loss, moving or relocation, and job loss
- Pregnancy and/or infant loss
- Parents of multiples
- Having an infant(s) in the Neonatal Intensive Care (NICU)
- Fertility challenges
- Thyroid imbalance
- Any form of diabetes (type 1, type 2, or gestational)
In addition, belonging to a high-stress parenting group may also be a risk factor. These groups might include:
- Queer and trans families
- Military families
- Teen parents
- Parent(s) of multiples
- Single parents
- Parents of color
- Those who experience a pregnancy and/or infant loss
Harvard Medical School/MGH makes it clear, though, that all postpartum parents are vulnerable, regardless of age, marital status, education level, or socioeconomic status.
Treatment for postpartum illness
Treatment is based on the severity and type of symptoms present, and medical causes for mood disturbance (like thyroid dysfunction) need to be ruled out before psychiatric treatment is prescribed. Harvard Medical School/MGH also notes that parents “who plan to breastfeed must be informed that all psychotropic medications, including antidepressants, are secreted into the breast milk.” Many medications for postpartum mental health have been studied and deemed safe for breastfeeding parents to take while breastfeeding, as the levels at which they are secreted into breastmilk vary and some are considered safe choices versus others. Talk to your doctor and International Board Certified Lactation Consultant about your options when it comes to psychiatric medication and breastfeeding.
Postpartum blues or baby blues
50-85% of postpartum parents experience the blues during the first few weeks post-delivery. As Harvard Medical School/MGH reports, “Rather than feelings of sadness, women with the blues more commonly report mood lability (changes), tearfulness, anxiety, or irritability.” Symptoms usually peak on the fourth or fifth day post-delivery and may last for a few days. While it can feel unsettling to experience the blues when you have a new baby to take care of, these symptoms should not interfere with your ability to function and no specific treatment is required. If symptoms persist for longer than two weeks, however, you should call your doctor to rule out a more serious case of depression — especially if you have a history of depression.
Postpartum depression (PPD)
PPD typically emerges during the first 2-3 postpartum months, but may occur at any point after delivery. Harvard Medical School/MGH cites that some parents even experience the onset of milder depressive symptoms while pregnant. Symptoms include tearfulness, loss of interest in usual activities, change in appetite, and sleep disturbance. Harvard Medical School/MGH notes that diagnosing PPD can be confusing because, “many of the symptoms used to diagnose depression (i.e., sleep and appetite disturbance, fatigue) also occur in postpartum women in the absence of depression.” More obvious and severe symptoms include feelings of worthlessness and suicidal thoughts. If you are experiencing postpartum suicidal thoughts, please seek immediate support from one of the following organizations:
Postpartum Support International: 1-800-944-4773
National Suicide Prevention Lifeline: 1-800-273-8255
Suicide Prevention Hotline: 1-800-SUICIDE
National Postpartum Depression Warmline: 1-800-PPD-MOMS
Your well-being is paramount, and you are not alone.
Postpartum anxiety
Generalized anxiety in postpartum parents is common — after all, you are learning how to care for a brand-new human. But Harvard Medical School/MGH states that some new parents also experience panic attacks and hypochondriasis (illness anxiety disorder). Furthermore, “recent studies show pregnancy and childbirth are frequently associated with the onset of Obsessive Compulsive Disorder (OCD).” Oftentimes, postpartum anxiety is masked as postpartum depression or mistakenly classified as normal. But Harvard Medical School/MGH warns that “given the potential adverse effects of untreated mood and anxiety symptoms on both the mother and child, careful screening and early recognition of anxiety symptoms during the postpartum period is recommended.” If you’re experiencing postpartum anxiety symptoms, call your doctor today.
Postpartum psychosis or puerperal psychosis
The rarest and most severe form of postpartum psychiatric illness, postpartum psychosis or puerperal psychosis, can present as early as the first 48-72 hours after delivery, but commonly develops between the first two postpartum weeks. Symptoms most closely resemble a manic or mixed bipolar episode, and include restlessness, irritability, insomnia, rapidly shifting and extreme moods, confusion, and erratic behavior. For those who experience postpartum psychosis, hallucinations and risk of harm to oneself and one’s baby are high and must be addressed immediately. If you or a loved one is experiencing signs of postpartum psychosis, please contact 911 for immediate support.
If you or someone you love is experiencing postpartum psychiatric illness — whether mild or severe — please contact your doctor and IBCLC right away, and remember that resources are available 24/7 if you need immediate care. Your mental health is crucial, and there’s never shame in seeking support.
*Illustrations by Jesse Zhang
We’re here for you, every step of the way. We work with your insurance to provide in-home, in-office, or telehealth visits with an IBCLC.
