PPD: What it is, Who’s at a Greater Risk, and my Personal Experience Navigating it
Written by Kaci Smith
We read about it all the time – Postpartum Depression. Prior to having my first child, I never thought PPD (or Postpartum Anxiety aka PPA) was something I’d have to worry about. I’d never had experience with depression and didn’t think I was at any sort of risk. In fact, I was so blind sighted that even during and after I had experienced symptoms – I still found myself thinking something was just wrong with me – not that I had any sort of mood disorder.
I distinctly remember one night – probably about a month in – and I was googling things like “is it normal to feel helpless after having a baby” and “feeling like you’ve lost yourself after having a baby” or “when will I feel like myself again”…desperate to find blogs from other moms who had felt the same way. Articles about postpartum mood disorders would pop up, and I’d skim right over them. “I’m not depressed,” I would think to myself. “That isn’t relevant to me…” Oh – but it was! I know it sounds extremely obvious now when I write it out like that – but at the time I just felt like I was a bad mom who wasn’t enjoying her first crack at motherhood.
It’s well documented on this site that I realized after about a full year that I was experiencing Postpartum Anxiety. However, it wasn’t until after I had my second baby late last year (Scottie) that I finally acknowledged that I’d likely had Postpartum Depression as well. Because Shep was my first, I didn’t know what was normal. After having Scottie – and feeling 100x better (on most days) — I was shocked at how much I could enjoy the newborn phase that I’d felt traumatized by just two and a half years prior.
Along my journey of researching and understanding postpartum mood disorders, I found that I was angry at the fact that nobody (including myself) had noticed, raised a red flag, or knew that I was actually at a pretty high risk of having a postpartum mood disorder after my first (based on a few things). I felt that if I’d been more educated at my prenatal appointments, or even asked more than one question about my mood at my 6 week postpartum check up – I could’ve felt better a lot faster.
Anyways – all of this to say – I wish I would’ve done more than read the headlines about postpartum depression and anxiety when I was pregnant and newly postpartum – so that I could’ve understood that I was a.) at risk for developing a mood disorder and b.) knew how to handle it so I could enjoy my everyday life more. Below I’ve done research, interviewed healthcare professionals, and compiled as many resources as I could so that if you’re in a similar situation – or if you have a friend or family member who is going to have a baby or already had one – you can be there for them if they need it.
First things first – let’s talk baby blues.
After bringing up my concerns to my doctor when I was pregnant with my second baby, she suggested that I’d had baby blues. After I told her that I’d struggled for over a year. I was so frustrated – after the appointment I got in my car and cried – fearing I would experience the same thing and that my doctor wouldn’t be a resource in helping me through it. I called my mom, who is a nurse in an OB-GYN clinic in another town – and she talked me off a ledge. She then suggested that she’s seen doctors and nurses interchange the words “baby blues” with “postpartum depression” – that in some places, it was sort of the old school way of describing PPD. My doctor likely wasn’t trying to minimize my experience, we probably just had a difference in vocabulary going on. That being said – baby blues are NOT the same as postpartum depression – and it’s important to know what’s what – and how to manage both.
So what ARE the baby blues?
It’s understood that somewhere between 70% – 80% of women experience negative feelings or mood swings after having a baby. The exact cause is unknown, but it’s thought to be related to significant hormonal shifts that can produce chemical changes in the brain, causing depressive thoughts. There are also obviously lots of changes happening – recovering from childbirth, change in routines and relationships, lack of sleep, etc.
Baby blues commonly include mood swings, crying spells, anxiety and difficulty sleeping. They typically come in full force around day 4-5 and should subside by 14 days (at the most) after delivering.
Okay, so what is Postpartum Depression and how is it different?
It can be easy to confuse Postpartum Depression with Baby Blues – but the biggest difference is intensity and how long it lasts. If you’re feeling any of those symptoms after 14 days, it’s important to bring it up to your doctor (call the office – don’t wait for your postpartum checkup) or you could also bring it up to your pediatrician in one of your baby’s many follow up appointments. It’s reported that approximately 1 in 9 women experience postpartum depression (roughly 11% of women in the USA). That being said, many women do not report it, and some studies suggest as many as 50% of mothers experience it. African American women are more than twice as likely to experience PPD as white women, and Hispanic women are also almost twice as high.
Postpartum Depression can begin shortly before giving birth, and kick in as late as one year post delivery. Typically, it onsets between birth and the first six months. Though the term “postpartum” is used to describe the first twelve months after having a baby, the depression can last well after the child’s first birthday if untreated. A 2020 study found that 25% of parents had elevated depressive symptoms as long as three years postpartum. More info on that study here.
Here’s where I say – you do not have to live with this for three years! Talk to a doctor or get yourself help. Be an advocate for yourself!
Here’s a more comprehensive list of typical symptoms:
- Depressed mood or severe mood swings
- Excessive crying
- Difficulty bonding with your baby
- Withdrawing from family and friends
- Loss of appetite or eating much more than usual
- Inability to sleep (insomnia) or sleeping too much
- Overwhelming fatigue or loss of energy
- Reduced interest and pleasure in activities you used to enjoy
- Intense irritability and anger
- Fear that you’re not a good mother
- Feelings of worthlessness, shame, guilt or inadequacy
- Diminished ability to think clearly, concentrate or make decisions
- Severe anxiety and panic attacks
- Intrusive thoughts or thoughts of harming yourself or your baby
- Recurrent thoughts of death or suicide*
For me personally, I thought that because I didn’t have some of the more “extreme” symptoms – like suicidal thoughts or thoughts of harming myself or the baby – that I wasn’t experiencing PPD. But I was experiencing severe anxiety, difficulty bonding with the baby, reduced interest in activities I used to enjoy, hopelessness, withdrawing from my family and friends, and major insomnia.
What are some of the risk factors for PPD?
Any new mom can experience postpartum depression and it can develop after the birth of any child, not just the first. However, your risk increases if:
- You’ve experienced stressful events during the past year, such as pregnancy complications, illness or job loss (hi, 2020 pandemic?!?)
- Your baby has health problems or other special needs
- You have multiples (twins, triplets, etc.)
- You experienced a traumatic birth – can lead to PPD, PPA or postpartum PTSD
- Difficulty breastfeeding
- Relationship challenges
- Lack of a support system
- Socio economic status
- Unplanned pregnancy
- History of depression and/or bipolar disorder either during pregnancy or at other times
- Previous postpartum depression after a previous pregnancy
- Family members who’ve had depression or other mood disorders
But what happens if I bring it up to my doctor?
It’s pretty clear that I personally was in a lot of denial when I was experiencing PPD and PPA. I didn’t want to acknowledge that I was struggling. I also think I sort of worried, in the back of my mind, that if I did bring it up to my doctor or to friends, they’d take my baby away or be worried about me being alone with him. I don’t remember having thoughts of harming the baby or myself, but I did have a lot of what I’d call “intrusive” thoughts – things like falling down the stairs while carrying him, getting hit by a car while walking with the stroller on the sidewalk, him stopping breathing in the middle of the night, etc. I built up an imaginary scenario in my head where I thought it would be worse to bring it up than to just deal with it. I was wrong. I could’ve gotten help a lot sooner, and nobody was going to take my baby away or think I was a bad mother.
Typically, your doctor will talk with you about your feelings and thoughts to try and distinguish between baby blues and PPD. It’s important that you share all of your symptoms with your doctor so that the right treatment plan can be created for you.
As part of an evaluation, your doctor may do a depression screening or have you fill out a questionnaire. She may also order blood tests or other types of tests to determine if there are thyroid issues or something else that could be contributing to your symptoms.
Most commonly, antidepressants and / or mental health therapy and counseling are recommended as ways to treat PPD. Talking with your doctor about your comfort levels and what might work best for you is essential to get the right strategy set.
I am not a medical professional (all sources I referenced for this article are listed below) – but in my own opinion and the research I’ve done, as well as anecdotal statements I’ve read or heard from friends and family members, I strongly believe that hormones also have a huge impact on postpartum mood issues. I personally experienced challenges with both of my kids every time there was a drop in my own estrogen levels.
After having Scottie, my doctor and I decided I would go on the mini-pill as a form of birth control after 6 weeks. The mini pill contains progestin – but no estrogen (which I couldn’t have because I was nursing). Almost instantly after starting that pill pack, my mood shifted for the worse and I felt awful. I found myself crying in my car and desperate to get out of the house. My kids’ pediatrician (who has been a true Godsend and I trust more with these issues than my own doctor) swiftly recommended that I get my thyroid checked and stop taking that mini pill immediately, as well as look into a non-hormonal form of birth control, which I did. I had the copper IUD inserted, and felt much better.
Fast forward several months to just recently – I began to struggle again after I stopped breastfeeding Scottie. It wasn’t as extreme as it was with Shep, but I felt almost numb, found myself not wanting to do things I typically like to do, and the insomnia was starting to pick up again. My husband also brought up the fact that he noticed I was acting differently – and that he was concerned. I had to agree. After talking with my mom (the OB-GYN BSN) – she suggested I try getting back on a birth control that has estrogen in it to see if that helps. I called my doctor’s office, they got a prescription sent over, and I already feel 100x better.
Obviously, that is only my personal experience, but it has helped me in ways I can’t explain.
I hope this was helpful. Just know, if you are experiencing any of this – you are not alone and IT DOES GET BETTER. Advocate for yourself.
Next week, we’ll be covering Postpartum Anxiety. Please leave your comments below if you have any specific questions! I’d be happy to research them and bring answers for you in next week’s post!
If you are having suicidal thoughts – please consider the following options to help yourself:
- Seek help from your primary care provider or other health care professional
- Call a mental health professional
- Call the National Postpartum Depression warm line: 1-800-PPD-MOMS
- Call a suicide hotline. In the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or use their web chat on suicidepreventionlifeline.org/chat
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