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By Ian Hammonds
“If you ask me what’s the most terrifying and difficult emotion we experience as humans, I would say joy.”—Brene Brown
It’s important to state from the outset that as a male, I obviously cannot fully empathize with postpartum depression. I write here from the point of view of a mental health practitioner, with the goal of helping others both in and out of the field recognize the signs of this all-too-common disorder, which has historically been unrecognized and misunderstood.
Until I became a therapist, in fact, I would only heard or read about the condition in a remote manner. I only once associated postpartum depression with such extreme and tragic cases as that of Andrea Yates. Fortunately, times have changed—both for myself, and for mental health on a macro level.
Postpartum depression (PPD) is a multifaceted phenomenon that cannot go unrecognized or untreated. Until relatively recently, PPD has been hideously underdiagnosed. The baby blues affects 80% of women and goes away within a 7 to 10 days. Today, an estimated 1 in 7 women are believed to suffer from some form of postpartum depression. And while, thankfully, most cases reach nowhere near the severity of Yates, PPD can still be debilitating for many new mothers, who are already under an extreme amount of physical and emotional pressure. It’s crucial to develop a deeper understanding of what postpartum depression entails, as well as how to look for its signs.
A Cultural Understanding:
Before delving into the specific criteria for recognizing PPD, it’s important to state that this illness is distinctly separate from more frequently diagnosed disorders as Generalized Anxiety Disorder or Major Depressive Disorder.
“It takes a village…”
According to Cheryl Tyler, LPC, “In most of the world’s cultures, when a woman becomes pregnant and bears a child, it is expected that her entire tribe of people help her through the process. If there is any kind of isolation or if the mother has moved away from her tribe, this could lead to feelings of depression once the baby is born.” It is fair to say that the act of having a child is reliant on a community. And if a new mother doesn’t have one, she may not have the support that can be so essential in the first weeks or months following a birth. A question every therapist should ask a mother who could be suffering from PPD is: “Who are your people?”
In transplant cities such as Austin, it can be isolating to have a child and raise a family when most people don’t have the same kind of intergenerational support they might otherwise have if they had stayed in the same town as their parents/extended family. Tyler goes on to explain, “To expect mothers to have to pay for their communities while pregnant, such as ‘mom groups,’ is classist, as these groups tend to be expensive. Support is huge and should not come at a huge cost!”
“But you love being a mother … right?”
Aside from the element of isolation, new mothers also have cultural pressures to contend with. Even today, most girls are raised with the expectation that they will one day have children, and love every second of it. Women throughout history have been treated as though it’s their “duty” to reproduce. And the message that a mother should be infatuated with having children has been mistakenly repeated over and over again throughout generations. A lot of mothers are essentially set up to meet a rigidly high expectation, and when they realize that being a mother is not a solely blissful and joyful experience, they’re at a high risk of depression.
It’s common for a woman to have a child and feel a shift in attention from her as a pregnant mother to the newborn baby. This sudden change can feel minimizing and further isolating. It is also common for mothers, as well as their partners, to feel exhausted and ashamed when the household goes through the change of bringing a child home—there is endless pressure on a new family to know how to seamlessly navigate such a drastic lifestyle shift in such a short amount of time.
Another myth for young mothers is that they are expected to love each child equally, which is not always a realistic standard. This can set some mothers up to feel as if they have failed at being parents, which can also contribute heavily to PPD.
How do you know if you have postpartum depression? Recognizing the Signs:
Unfortunately, there’s no defined diagnosis in the DSM-5 for postpartum depression. Many therapists, doctors, and psychiatrists have historically underestimated this condition. It’s also important to note that symptoms for PPD vary between women, making it harder even for seasoned clinicians to diagnose.
“I’m not depressed, I just have baby blues.”
Postpartum depression often starts out by being described by the mother as “baby blues”—the period of 7-10 days after birth when the mother is exhibiting such criteria as sadness she cannot shake, irritability, diminished interest in activities, too much or too little sleep, and other classic signs of depression. If more than 10 days pass and these symptoms haven’t lifted, this is when the mother should seek help from a therapist or doctor. The US Preventive Services Task Force (USPSTF) updated their protocols in 2019 to include more careful screening prior to childbirth and early interventions after childbirth to help identify those who are at greater risk for PPD.
It’s important to note that baby blues are NOT an automatic precursor to PPD. Baby blues can fade, but PPD can go undiagnosed for months if the signs are not caught. This is harmful not only to the mother, but the entire family.
Other signs to look for when assessing for PPD:
- Genetic predisposition of depression—If depression runs in the mother’s family
- History of depression—If the mother was depressed prior to becoming pregnant
- Isolation—If there is any kind of cut off from family, friends, or other necessary resources
- Feelings of shame—Lowered feelings of self-worth, heightened feelings of worthlessness, essentially frequent feelings of “I am not enough”
- Suicidal thoughts—feelings of wanting to harm oneself as well as potential suicide attempts
Other Postpartum Illnesses:
- Postpartum anxiety: Anxiety after birth is just as prevalent as PPD but much less recognized. Mothers with this illness typically look scared most of the time, can become hyper-focused on their newborn child, have difficulty breathing, or exhibit other signs of generalized anxiety disorder. It’s important to note, however, that after giving birth, mothers develop more gray matter in their brain, which increases feelings of hypervigilance and hyper-awareness.
- Postpartum psychosis: Though rarely diagnosed, this is a disorder in which mothers begin to hallucinate, feel rapid mood swings, have delusional thinking or beliefs, feel paranoid, and become easily irritated. An extreme case, as mentioned in the beginning of this article, is the tragedy of Andrea Yates, a Houston mother of five who drowned all of her children in 2001. For far too long, this was commonly misconstrued as a defining case of any kind of postpartum illness due to the story making national headlines—thus minimizing the realities of millions of new mothers who are in need of a clinical diagnosis of depression without stigma.
If you’re a new mother and feel that you’re suffering from postpartum depression, anxiety, or psychosis, we’re here to help. There is no reason that you should have to feel depressed for prolonged periods of time after giving birth. As therapists, we’re actively deconstructing toxic and negative ways of thinking that have been accepted in past generations. PPD, PPA, and PPP should no longer be swept under the rug and treated as an afterthought. Consult with a doctor after giving birth on whether you have any of the abovementioned symptoms. The earlier you get screened, the better.
If you’re a partner of a new mother, or you know a new mother who is experiencing these symptoms, we recommend checking in with them to make sure they know they’re not alone.
At Just Mind, we have several therapists who specialize in postpartum depression counseling. Contact us today to make a counseling appointment. Another great resource for postpartum depression is the University of Texas medical clinic that specializes in Women’s Mental Health, who Just Mind frequently works with.