Having a baby is a life-changing event and can trigger many different (and powerful) emotions. There is often an expectation that having a baby should be one of the happiest times of your life, and while joy and excitement is common, so is fear and anxiety. Most new mothers face some “baby blues” after birth, but some experience more severe and long-term depression and/or anxiety called postpartum depression (PPD) and postpartum anxiety (PPA).
I was dealing with depression and anxiety before and during pregnancy – how is postpartum depression/anxiety any different?
PPD and PPA are different from typical depression and anxiety in a few ways. There isn’t enough research on what exactly causes PPD or PPA, but we do know that depression and anxiety after giving birth (or during pregnancy) are likely caused by a combination of factors like low serotonin and hormonal shifts that happen around pregnancy, delivery, and during breastfeeding. Early parenting also has elements related to poor mental health outcomes, particularly surrounding sleep – so if you’re prone to depression or anxiety, it can be worsened by lack of sleep and hormones.
You may be used to what depression or anxiety feel like to you if you’ve dealt with them before, but they may be a little bit different after having a baby. Caring for a newborn takes up tremendous amounts of time and energy, so as a parent, you may stop thinking about taking care of yourself. For many, PPD and PPA feel like a more extreme version of their typical depressive and high anxiety symptoms. If depression makes you feel unmotivated, you may find yourself completely exhausted and unable to accomplish even small tasks; if anxiety or depression make you irritable, you might start feeling deep anger. Often, your thoughts and energies will be similar to your other experiences with depression and anxiety but heightened and with a baby in the mix.
With PPD and PPA, you may have thoughts of hurting yourself, your child, or your partner. If you have had thoughts of self-harm before, those thoughts can extend to wanting to harm your baby. In rare cases, these thoughts could be related to postpartum psychosis (PPP), which affects about .1 percent of new mothers. PPP symptoms usually occur within two weeks of giving birth and are similar to general psychosis symptoms like delusions and hallucinations. If you think you are having thoughts of hurting yourself, your child or your partner, or think you may be experiencing psychosis, contact your doctor immediately for professional help—it is essential to get help early.
How do I know if I'm dealing with PPD or PPA OR if I'm just adjusting to hormonal changes/being a parent OR dealing with other COVID-19-related stress?
The short answer: unfortunately, you can’t know for sure. Our brains don’t work that way – they interpret all stress as just that: stress. It’s especially hard to determine what exactly is wearing on you during the pandemic because general stress and anxiety levels are heightened for many people. Facing the uncertainty of today’s world on top of the already vulnerable transition into having a newborn can be a heavier burden than only dealing with one thing at a time. While there hasn’t been enough time for large-scale studies on the connection between the pandemic and PPD/PPA, some smaller studies have shown an increase in anxiety and depression during pregnancy due to the COVID-19 pandemic[i], which is associated with intensified postpartum symptoms. It’s normal to want to make sense of where things are coming from, but most likely, all of these things – stressful situations/events, changes in the brain, and hormones – are contributing to your feelings.
Pinpointing the exact reason why you’re struggling right now isn’t what’s really important. What matters is the solution. Managing stress and fitting in sleep whenever possible are two of the best things you can do for yourself. Having a new baby is hard, especially during a pandemic and time of great uncertainty – so don’t be afraid to ask for help when you need it. Ask trusted family and friends (who have been taking measures to stay safe from COVID-19) to come and help out with the baby so you can try to squeeze in a nap. Take things as they come, remain flexible, and avoid putting pressure on yourself as much as you can. If you have a history of hormone sensitivity (like severe premenstrual syndrome or premenstrual dysphoric disorder), talk to your doctor about hormones and breastfeeding. This is especially important if you were on birth control or anti-depressants before pregnancy. You and your doctor may decide to get you back on these medications sooner rather than later. If so, anticipate the mental and hormonal shifts that will occur when you reintroduce these medications.
How do I deal with visitors? I’m scared to expose myself and my baby to COVID-19, but I don’t want to be isolated and I need the help.
This is entirely up to you and your comfort level with risking exposure. Whatever feels right is the right decision for you. Maybe visitors have to sit outside and keep masks on. Maybe only people who live in your household can hold the baby, or maybe you want to determine things on a case-by-case basis after finding out what safety precautions your visitors are taking. If visitors aren’t strictly quarantining, there is always some risk of exposure, so ensure that they are washing their hands or using hand sanitizer and wearing a mask upon entering your home or holding the baby. Plan in advance – if someone has been strictly isolating for 10 days (or 7 with a negative test), they should be safe to come and stay for a period of time to help you out. In addition to COVID-19 safety practices, visitors should have a current Tdap (Tetanus, Diphtheria, Pertussis) vaccine to prevent transmission of whooping cough and a flu shot if they are able.
How do I handle my postpartum mental health issues when I can't easily get away from my home/family/baby or get any time to myself?
Finding both alone times and help with the baby is even harder because of the pandemic. Due to social distancing recommendations, you may be hesitant to trust someone with taking care of your baby for you. With COVID-19 restrictions in place, it can be hard to figure out what to do with yourself if you do get that alone time. Feeling trapped like this is often extremely overwhelming. Evaluate your own needs – a single mom at home alone with their firstborn might want a different type of support than a mom with three other kids running around.
When you’re dealing with postpartum mental health symptoms, self-care is crucial. If you are parenting with a partner, work with them so that you can make taking care of yourself a priority – it won’t just benefit you, but also your relationship and your baby. If your partner isn’t supportive or dismisses your struggles, know that your feelings are valid. It is not your fault for feeling low, and asking for help is a sign of strength, not weakness. Many people find themselves in this situation, but you need (and deserve) to find someone who supports you.
Having help can be a privilege. If you’re a single mom, feeling like you have to do everything alone can be scary and exhausting. Call on your support system – family, friends, and neighbors can help with things around the house to lessen the burden of chores. Ask someone to stay the night so you can get some sleep, or to take care of the baby for the afternoon so you can take an uninterrupted nap for a few hours or go run errands by yourself for some much-needed alone time. If you don’t have a strong support system nearby or they aren’t readily available, you’ll need to get a bit creative. Could someone from out of town come to visit and stay for the week (or longer) to help out? You can also look into local organizations, services, or mutual aid programs – depending on what’s around you, you may be able to get support with things like grocery shopping and childcare. There are also lots of online mom groups and virtual meet-ups that can be helpful if getting out of the house isn’t an option. Basic self-care can go a long way in helping you feel in control, so make sure you’re drinking water, eating food that will fuel you, and getting some fresh air each day.
If your mental health struggles get severe, talk to your doctor about getting more intensive help. This may include frequent therapy (multiple times per week), an intensive outpatient program, or a hospital stay. If you need to try out one or more of these options, that’s okay. And if you need to take some time off work, the Family and Medical Leave Act (FMLA) covers mental health (though not all employers are required to follow FMLA). Taking care of yourself is the foundation of taking care of your baby and your family. Work with your loved ones, doctors, and community supports to determine which treatment path is best for you and how to make it a reality. Talking about your mental health can be hard, especially if you haven’t done it before – you can find some tips on how to start that conversation here.
If you think you’re dealing with PPD or PPA, you aren’t alone. These complications after childbirth are treatable and it is entirely possible to manage your symptoms and bond with your baby. You can start with taking a postpartum depression screen or a screen for other mental health conditions and use your results to start a conversation with your doctor, or a trusted friend or family member. If at any point you’re concerned about your safety or someone else’s, seek emergency care right away – call your doctor, 911, or go to the nearest emergency room.
If you are having intrusive thoughts but know that you and others are safe, check out MHA’s podcast episode, I’m Worried I’ll Hurt My Baby; hearing from others who have been through the same thing can be a relief. Massachusetts General Hospital’s Postpartum Psychosis Project website has additional resources as well as suggested Facebook groups and community forums for you to connect with others for support. If you are feeling hopeless, scared for yourself or your baby, or just need some personal support, text MHA to 741-741 or call 800-273-8255 to reach a trained crisis counselor 24/7.
[i] Perry, C. (2020, July 28). COVID-19 is increasing risk of anxiety, depression in new moms. Verywell Family. https://www.verywellfamily.com/covid-19-increases-anxiety-and-depression-in-new-moms-5071580