The postpartum period is a time of significant adjustment and transformation for new parents. While it can be a joyous time, it is also normal to experience a range of emotional and physical changes. Understanding these common experiences can help normalize the feelings new parents may encounter and reassure them that they are not alone. Awareness of perinatal mood and anxiety disorders is critical in being able to differentiate what is healthy versus unhealthy. Below is a cheat sheet on the common experiences versus perinatal mood and anxiety disorders, prevalence, symptoms and resources.
Common Postpartum Experiences
Baby Blues:
Prevalence and Duration: Up to 80% of new mothers experience the baby blues, typically starting a few days after childbirth and lasting up to 2-4 weeks.
Causes: The dramatic hormonal changes following childbirth, particularly the drop in progesterone and estrogen levels, coupled with increased levels of oxytocin and prolactin, contribute to the baby blues.
Symptoms: Mood swings, crying spells, anxiety, irritability, and difficulty sleeping are common. These symptoms are usually mild and self-limiting.
Management: Support from family and friends, rest, and self-care can help manage these symptoms. It's important to note that baby blues are a normal part of the postpartum experience and usually resolve without the need for medical intervention.
Book Recommendation: The Fourth Trimester: A Postpartum Guide to Healing Your Body, Balancing Your Emotions and Restoring Your Vitality by Kimberly Ann Johnson.
Intrusive Thoughts:
Prevalence and Nature: About 90% of new mothers report experiencing intrusive thoughts. These are unwanted, often disturbing thoughts that can be quite distressing.
Causes: Hormonal changes, sleep deprivation, and the intense responsibility of caring for a new baby can trigger these thoughts. They are a normal response to the heightened awareness and protective instincts that come with parenthood.
Symptoms: Intrusive thoughts may involve fears about the baby's safety or well-being. While these thoughts can be alarming, they do not indicate that the parent will act on them.
Management: Understanding that intrusive thoughts are common and normal can help reduce their impact. Discussing them with a partner, friend, or healthcare provider can also provide reassurance and support.
Book Recommendation: Good Moms Have Scary Thoughts by Karen Kleiman
Physical Changes and Recovery:
Postpartum Body Changes: The body undergoes numerous changes after childbirth, including uterine contraction, weight gain/loss, possible pain, vaginal discharge (lochia), and breast engorgement or soreness.
Healing and Recovery: Recovery times vary, but it is common to feel fatigued and sore. Proper rest, nutrition, and following medical advice are crucial for recovery. If you have any pelvic pain, pain during intercourse or incontinence, a pelvic floor therapist could be the best referral.
Exercise and Activity: Gradually resuming physical activity as advised by a healthcare provider can aid in recovery and improve overall well-being. If there is a history of disordered eating, it is recommended to work with a nutritionist and/or counselor who specializes in this area.
Sexuality: It’s normal to experience ambivalence or wanting to avoid resuming sexual activities. Many women do not want to resume sexual activities when medically cleared to do so and that’s completely ok! It can take time to want or desire re-engaging in sexual activities. Book recommendations: Not Your Mother’s Postpartum Book by Caitlin Slavens, Chelsea Bodie. Come As You Are by Emily Nagoski.
Emotional Adjustments:
Bonding with the Baby: Developing an emotional connection with the baby can take time. It's normal for some parents to feel an immediate bond, while others may take longer. Bonding can take weeks and even months.
Changes in Relationships: The arrival of a new baby can alter dynamics in relationships with partners, family members, and friends. Healthy communication and mutual support are key to navigating these changes. Expectations and disappointment are common.
Book Recommendation: Matrescence: On the Metamorphosis of Becoming a Mother by Aurelie Athan; TED talk on A New way to think about the transition to Motherhood.
Sleep and Fatigue:
Sleep Disruption: New parents often experience significant sleep disruption due to the baby's feeding and sleeping patterns. This can lead to chronic fatigue and increase risk of postpartum mood and anxiety disorders.
Coping Strategies: Trading off nights with partners (sleeping in a separate room postpartum can be a game changer), partner taking night-time responsibilities or late mornings to let mom sleep longer, deciding in night pumps or feedings is right for you, and seeking help from family or friends can help manage sleep deprivation by assisting at night or pitching in for a night nurse or postpartum doula.
Night Nurses and Postpartum Doulas: Hiring a night nurse or postpartum doula can provide much-needed rest and support for new parents. These professionals offer overnight care, assistance with breastfeeding, and emotional support.
Doula Organizations: DONA International and CAPPA
Recommendations: The Sleep Lady's Good Night, Sleep Tight by Kim West, Taking Cara Babies
Breastfeeding Challenges:
Learning Curve: Breastfeeding can be challenging for many new mothers. Even though breastfeeding is “natural”, that doesn’t equate to easy or right for the family. Common issues include latching difficulties, nipple pain, mastitis, and concerns about milk supply. Fears over whether the baby is eating enough can increase anxiety. Sleep deprivation can also be significant for the well-being of the mom and partner.
Support and Resources: Lactation consultants, breastfeeding support groups, and healthcare providers can offer valuable guidance and support.
Flexibility in Thinking: Breastfeeding may not be the best fit or even an option for all birthing people. Being supportive to new parents, especially mothers, with the understanding that “fed is best,” is important to avoid shaming new parents about how they feed their baby. There should be zero un-solicited advice on how a mother feeds her baby.
Book Recommendation: Expecting Better by Emily Oster and Cribsheet: A Data-Driven Guide to Better, More Relaxed Parenting, from Birth to Preschool by Emily Oster
Self-Care and Mental Health:
Importance of Self-Care: Taking time for self-care is essential for mental and physical well-being. This can include activities like short walks, hobbies, or relaxing baths. Working with your partner and family to make a plan for postpartum self-care, time away and rest is essential for well-being. You can’t get self-care without support to engage in it.
Seeking Connection: Postpartum can be isolating and bring up feelings of loneliness. Joining other new moms and parents can increase a sense of connection and well-being. Search for local story hours at libraries, mom meet-up groups, Bumble BFF and Peanut to connect to new friends, church groups, meetup groups or make conversations with other parents at playgrounds and on walks. Postnatal yoga and workout groups can also be a great way to connect with others. Increasing connection and normalizing the experience with others is key to navigating postpartum.
Seeking Support: It’s important for new parents to seek support when needed. This can be from healthcare providers, support groups, or mental health professionals who are trained and certified in Perinatal Mental Health.
Provider Search: Postpartum Support International and LowtherCS.com
Relationship Changes and Challenges:
Impact on Partner Relationship: The dynamics between partners can change significantly after the arrival of a new baby. Increased responsibilities, sleep deprivation, differences in sexual drives and desire and differing parenting styles can lead to tension and misunderstandings.
Communication: Open, kind and honest communication is crucial. Discussing feelings, expectations, and concerns while pregnant can help partners understand each other better and work together more effectively.
Shared Responsibilities: Dividing childcare and household responsibilities fairly can reduce stress and prevent resentment. Both partners should feel supported and involved in parenting. Often, postpartum women continue
Intimacy: Physical and emotional intimacy may be affected by the demands of parenthood. Sexual intimacy may also be impacted and appear different from what was previously desired. Finding time for each other, open and kind communication as well as maintaining a connection outside of parenting duties can strengthen the relationship.
Seeking Help: Couples counseling or therapy can be beneficial in addressing relationship challenges and improving communication and understanding. 1 in 10 dads/partners will experience a perinatal mood and anxiety disorder. For more information and support for partners, visit PSI- help for dads. For partners who’ve experienced a maternal near-miss, risk of trauma and p.t.s.d. for partners increases significantly. To learn more, read more on Invisible Victims.
Book Recommendations: Fair Play: A Game-Changing Solution for When You Have Too Much to Do (and More Life to Live) by Eve Rodsky. And Baby Makes Three by John and Julie Gottman
Understanding and acknowledging these common postpartum experiences can help new parents feel more prepared and less isolated. It is important to remember that while many of these experiences are normal, persistent, or worsening symptoms should be discussed with a healthcare provider to ensure appropriate support and care.
Perinatal Mood and Anxiety Disorders
When common experiences start impacting daily functioning and become more severe, they may indicate a disorder. PMADs encompass a range of mental health conditions that require treatment and support. These disorders can significantly affect a parent's well-being and their ability to care for their baby. Recognizing the symptoms and seeking timely help is crucial for recovery.
Prevalence and Treatment Outcomes:
PMADs are estimated to affect 1 in 5 women and 1 in 10 men during the perinatal period. The prevalence can be higher in populations with additional risk factors, such as low income or teenage parents. All these disorders are 100% treatable with counseling and medication. Like any medical condition, if left untreated they can worsen and go on for years.
Depression:
Prevalence: Impacts 21% of women and 60% of those with low income and teenagers.
Symptoms: Hopelessness, lack of interest in the baby, anger, fear and/or guilt, sleep and appetite disturbances, difficulty focusing or making decisions, and possible thoughts of harming the baby or self.
Book Recommendations: The Postpartum Husband by Karen Kleiman and This Isn't What I Expected: Overcoming Postpartum Depression by Karen Kleiman and Valerie Davis Raskin. For men or partners experiencing Postpartum Depression, Sad Dad by Olivia Spencer. Postpartum Support International: Help for dads is also a great resource.
Anxiety:
Prevalence: Impacts 20% of women.
Symptoms: Tension, frustration, guilt or self-blame, fear of being left alone with the baby or not wanting anyone else to hold the baby, trouble sleeping, difficulty with focus, rumination, intrusive thoughts, and heart palpitations. Agitation is also a symptom as parents can be highly sensitive to touch and sounds.
Book Recommendation: Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood by Karen Kleiman and Amy Wenzel. The Pregnancy and Postpartum Anxiety Workbook by Pamela S. Wiegartz, Kevin L. Gyoerkoe,
Panic Disorder:
Prevalence: Impacts 11% of women.
Symptoms: Feeling very nervous, recurring panic attacks (fear that you will die), and many worries and fears that come out of nowhere.
Book Recommendation: The Panic Attack Recovery Book by Shirley Swede
Postpartum Rage/Anger:
Prevalence: The prevalence of postpartum rage is not well-documented but is increasingly recognized as a significant issue.
Symptoms: Intense anger, irritability, and feelings of being overwhelmed or out of control. Rage can be directed towards oneself, partners, or even the baby.
Management: Identifying triggers, practicing relaxation techniques, and seeking support from healthcare providers or therapists can help manage these feelings.
Book Recommendation: Body Full of Stars: Female Rage and My Passage into Motherhood by Molly Caro May.
Postpartum Obsessive-Compulsive Disorder (OCD):
Prevalence: Impacts 3-5% of women.
Symptoms: Obsessive, intrusive thoughts often related to the baby's safety, and compulsive behaviors to reduce anxiety. Common compulsions include excessive cleaning, checking on the baby, and avoiding certain activities out of fear. There can also be unwanted sexual intrusive thoughts and images.
Book Recommendation: Dropping the Baby and Other Scary Thoughts by Karen Kleiman and Amy Wenzel
Postpartum Post-Traumatic Stress Disorder (PTSD):
Prevalence: Impacts 9% of women.
Symptoms: Flashbacks, nightmares, severe anxiety, and avoidance of reminders related to a traumatic childbirth or other traumatic events during the perinatal period.
Recommendations: When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women by Penny Simkin and Phyllis Klaus. EMDR for trauma/ptsd. Invisible Victims: How Maternal Near-Misses Result in Trauma and PTSD in Birthing Partners by Tiffany Lowther
Bipolar Disorder:
Prevalence: Affects 1-2% of the population, and symptoms can be exacerbated during the perinatal period.
Symptoms: Extreme mood swings, including episodes of mania (elevated mood, increased activity, and decreased need for sleep) and depression. Postpartum psychosis, a severe form of bipolar disorder, can occur in rare cases.
Book Recommendation: Understanding Bipolar Disorder: A Developmental Psychopathology Perspective by David J. Miklowitz and Birth of a New Brain: Healing from Postpartum Bipolar Disorder by Dyane Harwood
Postpartum Psychosis:
Prevalence: Affects 0.1-0.2% of women.
Symptoms: Severe symptoms including delusions, hallucinations, severe mood swings, and disorganized thinking. This condition is a medical emergency and requires immediate attention.
Urgency: If a partner is experiencing postpartum psychosis, they should be hospitalized as soon as possible due to high rates of infanticide and suicide.
Recommendations: PSI Psychosis Resources, Understanding Postpartum Psychosis by Teresa M. Twomey. Dangerous Motherhood: Insanity and Childbirth in Victorian Britain by H. Marland.
Recognizing the symptoms of PMADs and seeking timely help is crucial for recovery. PMADs impact mother and partner. Early intervention and treatment can significantly improve outcomes for both parents and their babies. If you have any concerns about your mental health or are pre-disposed to mental health disorders, make sure to speak openly with your providers and reach out to a licensed counselor or psychologist certified in perinatal mental health.
Resources and Support:
Postpartum Support International: Postpartum Support International
The National Perinatal Association: The National Perinatal Association
PSI Helpline: 1-800-944-4773 (4PPD); Text Text “Help” to 800-944-4773 (EN) Text en Español: 971-203-7773
Pregnancy and Postpartum Resource List: Located on LowtherCS.com https://www.lowthercs.com/post/pregnancy-and-postpartum-support-resources
Pregnancy and Postpartum Medication Resource List: Located on LowtherCS.com https://www.lowthercs.com/post/resource-pregnancy-postpartum-medication-and-breastmilk-is-it-safe-for-my-baby
In case of an Emergency:
National Crisis Text Line: Text HOME to 741741 from anywhere in the USA, anytime, about any type of crisis.
National Suicide Prevention Hotline & Website: dial 988 or visit www.suicidepreventionlifeline.org
Lowther Counseling Services, www.LowtherCS.com, 2024
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