The major life transition of bringing a baby into the world can bring about a rollercoaster of emotions, from excitement to nervousness to anxiety. Understanding the science behind your mood shifts can give you the tools to advocate for your mental wellness.
Although serious mental health issues in the postpartum period are rare, the majority of birthing individuals experience some shifts in moods in the postpartum period. The isolation that birthing individuals face in the postpartum period has been exacerbated by COVID-19 quarantine: according to a May 2020 report by the New York Times,1 birthing providers are more concerned about the development of mood disorders postpartum than before.
What are postpartum mood shifts?
According to official publications by the National Institutes of Health (NIH),2 postpartum mood shifts are caused by hormonal changes associated with pregnancy and birth, as well as changes in sleep patterns that occur after birth. Fears anticipated by new parents - about what can go wrong during or after birth - can also contribute.
There are three types of postpartum mood conditions and their symptoms:
Baby blues/postpartum blues - Postpartum blues is a period of depressed mood that follows the birth of the baby. It lasts for a few days to a couple of weeks immediately following birth. During this period one might experience mood swings, sadness, irritability, crying, reduced concentration and issues with eating and sleeping. Baby blues are very common - About 80% of individuals postpartum experience it. It does subside after the acute period postpartum.
Postpartum depression (PPD) - PPD is the most commonly known postpartum condition. It is similar to baby blues but has a longer duration and greater intensity of symptoms to the point where it can interfere with parenting. For example, depressed moods are more intense and can lead to withdrawal from family. There is potential for disruption of appetite and sleep. There are larger elements of hopelessness and potential for shame. Many who experience PPD have symptoms that interfere with parenting - difficulty bonding with the baby and feeling inadequate as a parent. Some cases of PPD can also lead to thoughts of harm - towards yourself or baby and recurring thoughts about death and suicide. PPD can develop immediately following birth or up to a year after birth of the baby.
Postpartum psychosis - This is a very rare condition that occurs in 0.1-0.2% of births. It occurs in the early weeks after birth. Symptoms include confusion, obsessive thoughts about baby, hallucinations, sleep disturbances, paranoia and attempts to harm oneself or the baby. Postpartum psychosis requires immediate attention to protect the parent and the baby.
Knowing the three conditions, their symptoms and duration that they last can help you identify what your mood fluctuations might be and start discussions with your providers.
What can pregnant individuals do to get ahead of postpartum mental health issues?
The pillars that are of the essence during pregnancy are just as important after pregnancy - educating yourself, involving your partner in the process, engaging with a supportive care team, and researching for mental health professionals. Just as you monitored your physical condition during pregnancy, the postpartum period requires careful attention, especially given the mental and physical depletion that happens after birth.
Communicating with your birthing providers before birth:
One way to advocate for yourself is to be open and proactive in your communication about mental health with providers, especially if you have a personal or family history of it. Often, the emphasis is on caring for the baby and the changes in the birthing individuals’ body postpartum, rather than their mood shifts.
According to a study by the Center for Disease Control (CDC) in 2018,3 about 13% of individuals who had recently given birth were screened for depression during postpartum visits. The study also found that 20% of pregnant individuals were not asked these questions during prenatal visits.
Set aside time before labor to talk through a mental health care plan with your OB-GYN, midwife, or doula. If you are experiencing mood changes and your provider is not prompting you to discuss them, making it a priority to bring it up will keep you on the prevention track.
Creating a supportive postpartum team:
A 2014 study published in BMC Pregnancy and Childbirth found that women who lack social support after the birth of a baby are at higher risk for postpartum depression. As with other elements of childbirth, having an engaged partner or support network is essential to warding off depression, especially during the COVID19-induced social isolation.
An attentive partner and network will help care for you and notice changes in you may not be attuned to, especially if you are caring for a newborn. Engaging with the chosen support network and asking them to check in with you at regular intervals, in person or through calls and video chat during quarantine, will help you identify whether you may be experiencing symptoms of baby blues, PPD, or something more serious.
Looking for a qualified mental health professional:
If you know that you have a history of mood disorders or a past / family history of postpartum depression, it is important to engage a mental health professional before you experience the symptoms. One new parent whom Demi surveyed had a hard time finding a therapist after she started experiencing symptoms of postpartum depression: “Many offices are overwhelmed and don’t even return your call,” never mind accepting your insurance.
With long average wait times and high demand for services, especially for perinatal psychiatrists, it is prudent to plan ahead. Your provider may have recommendations for therapists, psychologists, and psychiatrists with whom you can establish contact before your birth. Digital health tools addressing mental health,4 which have proliferated during COVID-19, also eliminate some barriers of accessing mental health professionals remotely.
Postpartum mood shifts are a normal part of pregnancy, birth, and postpartum. Being educated and proactive about the potential for normal mood shifts to slide into more serious issues can improve long term health outcomes for new parents and their babies.
Lakshmin, P. (2020). "Experts Fear Increase in Postpartum Mood and Anxiety Disorders". The New York Times. 27 May. Available at: https://www.nytimes.com/2020/05/27/parenting/coronavirus-postpartum-depression-anxiety.html↩
National Institute of Health. Perinatal Depression. Available at: https://www.nimh.nih.gov/health/publications/perinatal-depression/index.shtmlhttps://www.nimh.nih.gov/health/publications/perinatal-depression/index.shtml↩
Bauman, B. L., Ko, J.Y., Cox, S., et al. (2018) Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression — United States. MMWR Weekly Report 2020, 69(575–581). DOI: http://dx.doi.org/10.15585/mmwr.mm6919a2external↩
Blumenfield, S. and Levin-Scherz, J. (2020). "Digital Tools Are Revolutionizing Mental Health Care in the U.S.". Harvard Business Review. 03 Dec. Available at: https://hbr.org/2020/12/digital-tools-are-revolutionizing-mental-health-care-in-the-u-s↩