Up to 75% of postpartum women have some degree of the baby blues, and 15% of women experience depression.
Although having a baby brings many positive things to one’s life, it also requires a lot of adjustments in the way we see the world, our priorities, how we spend our time, and the energy we can put into other areas of our lives. The postpartum period is a time of significant disruption in sleep, nutrition, and exercise.
- Risk Factors
- Treatment Options
- Obsessive-Compulsive Disorder (OCD)
- Bipolar Mood Disorders
- Post-traumatic Stress Disorder (PTSD)
The Baby Blues
Many new mothers experience mood swings, worry, and tearfulness in the first few weeks postpartum. This is often called the “baby blues”, and is likely related both to biological factors (hormonal shifts as the body changes from a pregnant to postpartum state) as well as psychological factors (adjustment to being a parent and the responsibilities of caring for a newborn, which is a major life event). It is a normal part of postpartum adjustment, resolves on its own, and does not require any intervention. Support and reassurance from family and friends is very helpful. Up to 75% of postpartum women have some degree of the baby blues. Although the baby blues is part of normal adjustment and resolves on its own, some women experience symptoms that are more severe and persistent.
What does perinatal mean?
The term perinatal means “all around birth”, and refers to the entire pregnancy as well as the postpartum period. There are different opinions about when the postpartum period ends, but most definitions list 6-12 months after the baby is born as the end of the postpartum period. Mental illness is the most common complication of pregnancy and childbirth. It does not discriminate: women of every age, culture, relationship status, and income level can develop perinatal mental health issues.
What puts me at risk of developing a perinatal mental illness?
- A previous episode of mental illness (e.g., anxiety, depression, bipolar disorder, OCD)
- A family member with a history of mental illness (especially if it was a perinatal mental illness)
- A lack of support in caring for your baby
- Marital or relationship stress
- Financial stress
- Health stress (whether concerning your health, your baby’s health or the health of a loved one)
- Giving birth to multiples (twins, triplets, etc.)
- A recent big life change (e.g., a move, a break-up, a job loss, death of a loved one)
- Having a baby who is seriously ill
- Having a high needs or colicky baby
- Having a thyroid disease
- Having a type A or perfectionist personality
- Hormonal changes including premenstrual dysphoric disorder (PMDD)
- Unmet expectations
- Unplanned/unwanted pregnancy
- Complications of labour
- Previous pregnancy/infancy loss
What kinds of perinatal mental illness exist?
Although the term postpartum depression is most commonly used to refer to mental health issues during pregnancy and the postpartum period, there are a variety of mental illnesses that can affect women during this time in their lives, including:
- Obsessive-Compulsive Disorder (OCD)
- Bipolar Mood Disorders
- Post-Traumatic Stress Disorder (PTSD)
The good news is that help is available. It is important for those affected by perinatal mental illness to know that they do not need to continue suffering, and it is not their fault that they feel this way. All perinatal mental illnesses are treatable, and with proper care you can fully recover. Treatment can include:
- increasing social and practical supports
- attending support groups
- counselling/talk therapy
- improving self-care (e.g., sleep, nutrition, exercise)
The treatment(s) you choose depends on the type of illness, how severe the symptoms are, and each individual’s beliefs and preferences. Speak with your healthcare provider to find a treatment that works for you. Often, a combination of treatment options is needed and recovery times will vary from individual to individual.
It is estimated that more than 10% of women experience depression during pregnancy, and more than 15% of women experience depression during the postpartum period. If symptoms start during the pregnancy, it is called antenatal or antepartum depression. If symptoms start after the baby is born, it is called postnatal or postpartum depression. Together, these illnesses are referred to as perinatal depression.
Symptoms of perinatal depression can include:
- persistent sadness, anger, or worry
- loss of enjoyment or interest in things
- lack of interest in your baby
- changes in eating habits and sleeping patterns (increased or decreased)
- intense guilt
- frequent crying
- trouble concentrating or making simple decisions
- feelings of hopelessness
- possible thoughts of harming yourself or your baby
In many women who are diagnosed with postpartum depression, symptoms actually began in pregnancy, but these symptoms may have been attributed to normal changes in emotions and energy due to being pregnant. It is important to note that Depression and Anxiety often go hand in hand.
In addition to biological mothers, fathers/partners and adoptive parents can also experience depression or other perinatal mental illnesses. While this is an emerging area of research, it is estimated that at least 10% of fathers experience postpartum depression or PPND (paternal postnatal depression). The true statistics are thought to be even higher because men’s postpartum depression is underreported. Maternal postpartum depression is a significant predictor of paternal postpartum depression. While some of men’s symptoms are closely linked to women’s symptoms, there are some differences which can include:
- withdrawal from social situations
- indecisiveness and irritability
- increased use of drugs and/or alcohol
- increased risk-taking behaviours and impulsiveness
- violent behaviour
- physical symptoms including digestion issues, pain, and/or headaches
Perinatal anxiety often involves excessive worries or fears about something terrible happening to your baby, yourself, or someone else you care about. Increased anxiety during the perinatal period is as common as perinatal depression. Although women often realize their fears are exaggerated or unrealistic, it can be hard to stop thinking about them. If excessive worry or fear is taking up a lot of a mother’s time and energy, and interfering with her quality of life, she might have an anxiety disorder.
Some women experience a lot of physical symptoms of anxiety such as:
- shortness of breath
- chest pain or tightness
- feeling their heart pounding
- sweating or chills
- numbness or tingling
If these physical symptoms come on suddenly and are accompanied by an overwhelming sense of fear, it’s called a panic attack. If a woman experiences a panic attack for the first time during pregnancy or in the postpartum period, she may be afraid that she is having a heart attack or a stroke, because the physical symptoms can be so overwhelming. It is important to note that Depression and Anxiety often go hand in hand.
Obsessive-Compulsive Disorder (OCD)
Obsessive-Compulsive Disorder involves having repeated unwanted, upsetting, intrusive thoughts (obsessions), which cause significant anxiety. Sometimes people feel they need to repeat certain behaviours over and over again (compulsions) to deal with the anxiety caused by the obsessions.
When OCD symptoms start during pregnancy or the postpartum period, the obsessions often involve thoughts about the baby, and can include:
- Thoughts or images of horrible things happening to the baby (e.g., SIDS)
- Thoughts or images of hurting the baby (without having any desire to do so)
- Obsessions and compulsions about cleanliness/germs due to fear of the baby getting sick (e.g., excessive handwashing)
- Obsessions and compulsions about safety (e.g., repeatedly checking the baby’s breathing, door locks, baby monitor)
- Mental rehearsal of how to respond if something bad happens to the baby (e.g., repeatedly imagining what to do if the baby stops breathing)
Mothers with postpartum OCD are very upset by the obsessive thoughts or images and try to avoid thinking about them. When they have thoughts or images of hurting the baby, they often do not realize how unlikely they are to act on them, so they may be afraid of being left alone with their babies. Postpartum OCD is the most poorly understood of all perinatal mental illnesses.
Bipolar Mood Disorders
Bipolar mood disorders are characterized by cycling between 2 phases: a low phase (depression) and a high phase (mania or hypomania). At times, these phases occur at nearly the same time. Bipolar 1 tends to have more severe symptoms and extremes in mood compared to Bipolar 2.
Bipolar mood disorder symptoms can include:
- severe depression
- elevated mood
- reduced need for sleep
- quick speech
- a sense of overconfidence or self-importance
- racing thoughts
- sustained high energy
- possible psychotic symptoms including delusions or hallucinations
Bipolar mood disorders can present during pregnancy or the postpartum period but women are often misdiagnosed. The most significant predictor for bipolar mood disorders is personal or family history of bipolar mood disorders. As such, it is important to talk to your health care provider to review your symptoms and family/mood history.
Postpartum psychosis is a rare but severe illness that occurs in 1 to 2 per 1000 women after birth. Psychosis is a term used to describe different types of symptoms that involve losing touch with reality.
Psychotic symptoms can include:
- Hallucinations – seeing, hearing, smelling, feeling, or tasting things that are not really there. The most common types of hallucinations in psychosis are auditory (hearing things such as voices) and visual (seeing images)
- Delusions – beliefs that are not based in reality. For example, some women with postpartum psychosis believe that others are trying to steal or harm their baby when this is not actually the case (a paranoid delusion)
- Disorganized thinking – periods of confusion, trouble putting thoughts together or making sense to others, trouble with memory
- Thoughts of harming the baby or suicide
Postpartum psychosis usually comes on rapidly within the first four weeks postpartum and is a very serious condition that requires immediate medical attention.
Post-Traumatic Stress Disorder (PTSD)
Women who have a very difficult or traumatic childbirth sometimes experience post-traumatic stress symptoms during the postpartum period. Post-traumatic stress symptoms can include:
- having nightmares about the event or daytime re-experiencing (flashbacks)
- avoiding anything that reminds you of the event
- feeling anxious and keyed up most of the time
- Wisner KL, Parry BL, Piontek CM, Postpartum Depression N Engl J Med vol. 347, No 3, July 18, 2002, 194-199 .
- Wisner KL, Chambers C, Postpartum Depression: A Major Public Health Problem, JAMA, vol 296, No 21, December 6, 2006, 2616-2618.
- Letourneau N, Tryphonopoulos PD, Duffett-Leger L, et al, Support Intervention Needs and Preferences of Fathers Affected by Postpartum Depression, The Journal of Perinatal & Neonatal Nursing, vol 26, No 1, 2012, 69-80.
- Pacific Post Partum Support Society (2019). Signs of Postpartum Depression and Anxiety in Men. Retrieved June 23, 2019 from http://postpartum.org/services/dads/signs-of-ppd-anxiety-in-men/
- Postpartum Support International (2019). Bipolar Mood Disorders. Retrieved June 23, 2019 from https://www.postpartum.net/learn-more/bipolar-mood-disorders/
- Pope CJ, Sharma V, Mazmanian D, Bipolar Disorder in the Postpartum Period: Management Strategies and Future Directions, Women’s Health, vol. 10, No 4, July 1, 2014, 359-371