Monica*, a mom of four, has a brand new baby who is beautiful and healthy, after having a delivery that went off without a hitch. So now that Monica is home and trying to establish some semblance of a routine, why does she feel like something is not quite right?
“After the baby was born, I felt a physical heaviness, a blanket of sadness mixed with anxiety that I couldn’t get off me,” she explains. “I couldn’t shake this feeling that my spirit was clouded down. What made it worse was that it was supposed to be the happiest time of my life, so I felt bad admitting something was wrong.”
Though undiagnosed, Monica, like many new moms, was most likely suffering from a mild case of postpartum depression, or PPD.
According to the American Psychological Association, one in seven women (around 14 percent) may experience some type of depression during and after pregnancy. Most new moms experience mild “baby blues” after delivery, which may include feeling tired, sad, exhausted and just generally overwhelmed. These depressive symptoms tend to subside in a few weeks.
PPD symptoms, which are more extreme, may occur within the first several days of delivery or even weeks after a child is born, persist for several weeks or months and require some form of treatment. In extremely rare cases (1 in 1,000), women may experience a disorder called post-partum psychosis, in which they are unable to care for themselves or their child, and they may harbor thoughts of harming themselves or their baby.
For women suffering from post-partum depression, the symptoms aren’t always so obvious. “Some women experiencing PPD may feel down, depressed, isolated and lonely, while others may feel agitated, have no appetite, be overwhelmed with worry and unable to relax,” explains Helen Coons, a clinical health psychologist who specializes in women’s health and the clinical director at Women's Mental Health Associates in Philadelphia.
If you’re a new mom who has felt any of these symptoms at any time, don’t brush it off. Let your OB-GYN, primary care doctor or midwife know immediately. Many women suffer for months without getting help because they feel guilty for acknowledging that things are not going well.
In the meantime, here’s a primer of different triggers that may leave you feeling “off” or blue—and how to get back on track.
Trigger: Hormonal shifts
Your body goes through a major chemical shift after you have a baby. Doctors believe that the disturbance of feel-good neurotransmitters (serotonin, norepinephrine, epinephrine and dopamine) is responsible for PPD, but there are other hormonal changes going on as well, including a plunge in estrogen levels. “You have high levels of estrogen in your body from the placenta until you deliver,” explains Mary Jane Minkin, M.D., clinical professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine in New Haven, CT. When estrogen levels plummet, this can severely affect your mood, making you feel sad, irritable and depressed. Progesterone, known as a calming hormone, and cortisol levels, which control energy, are also elevated during pregnancy and dip way down after delivery. “The combined affect of all this hormonal activity and the physical exhaustion of giving birth would make anyone feel poorly,” Dr. Minkin explains.
How to get back on track: Time, rest and a healthy diet are what can help you begin to get back on your feet, explains Debra Wickman, an OB-GYN and medical director at SHE (Sexual Health Experts) in Gilbert, AZ. Dr. Wickman recommends taking a daily Omega-3 fatty acid supplement, which has been shown to help boost mood and may combat post-delivery inflammation and fluid retention in the body.
Trigger: Continued lack of sleep
Anyone who has stayed out too late, pulled an all-nighter before a test or has a new baby can attest that a lack of sleep impairs your reasoning, mental functioning, problem solving abilities and makes you feel impatient, irritable and even physically ill. “If someone is deprived of sleep for an extended time and runs herself ragged as many women do after having a baby, some symptoms of depression will be there,” explains Michael O’Hara, Ph.D., professor of psychology and director of clinical training in the department of psychology at the University of Iowa in Iowa City.
How to get back on track: Do whatever you can to get some much-needed rest. “If you can’t sleep for a large block of time during the night, force yourself to nap during the day,” suggests Dr. O’Hara. He adds, “This is where your social network comes into play.” In other words: Get some help. Recruit a relative, friend or sitter to take care of your baby or watch your older children for a short time so you can get some shut-eye, even if it’s a power nap. Sleep, as much as you may wish it to be, isn’t optional—it’s a necessity that keeps you well and mentally sound. “When treating women with PPD, our first step is to make sure they get rest and stabilize their sleep,” says Coons.
Trigger: Poor diet and lack of exercise
Taking care of a baby is physically demanding and time consuming, so it’s no surprise that a healthy diet and exercise program often fall by the wayside. Reaching for unhealthy foods can cause big dips in your mood and energy levels and can actually impede physical healing after giving birth. Add to that the fact that new moms are often either too exhausted to work out or simply may not have the time, so they miss out on the feel-good flood of endorphins that come from exercising. Plus, for some, their self-esteem takes a hit thanks to the weight gained during pregnancy, coupled with the guilt from not working out to start chipping away at the baby weight.
How to get back on track: Eating small meals frequently throughout the day, with a focus on protein, is the way to go. Include a lot of fiber-rich vegetables, which will stave off the post-delivery constipation many women experience. “Eat organic meats and dairy products if possible,” suggests Wickman, explaining that eating anything with growth hormones can prevent you from losing your pregnancy weight and may negatively affect your thyroid, which in turn, can slow down your metabolism. She also advises that new moms keep taking their prenatal vitamins for a year after the child is born. “Studies show that deficiencies in some minerals and vitamins like B12 and folate may be linked to PPD,” says Wickman. Avoid caffeine and foods high in sugar, which will only make you more jumpy and tired and may make the baby fussy if you’re breastfeeding. Also, stay hydrated. “Hormonal changes cause many women to sweat a lot and if you’re breastfeeding, you’ll need to drink more water than you think,” explains Minkin. Finally, buy or make double portions of healthy foods and freeze some so you’ll have a meal in a hurry on the days you don’t have the time or energy to prepare it.
Most importantly, have realistic expectations: It’s going to take several months or even longer to get back to—or close to—normal, so don’t beat yourself up along the way. “If a woman wants to be back in her skinny jeans the week after giving birth that’s probably unrealistic,” explains O’Hara. Have a plan you can stick with that gets you back to your ideal weight over the course of several months—one that includes a healthy diet and exercise, such as yoga. “Yoga is one example of a great workout that improves flexibility and boosts self-esteem, and women can do it during and post-pregnancy,” adds O’Hara. Using a workout DVD at home is a cost-effective way to workout with your baby at arms’ reach, or if the weather is nice, take a long walk with your baby in a stroller. You can also offer to watch a friend’s baby while she works out, then switch with her and get some workout (and alone) time for yourself.
Trigger: Feeling emotionally overwhelmed
Having a baby is a huge life change and being in charge of a little one is the biggest responsibility you can have. Don’t expect to be the perfect mom or have the perfect baby. The strong message from the media in our culture is one that suggests the baby comes out and you’re immediately attached and blissful, but as Coons explains, the reality for moms who don’t feel attached to their babies right away can make them feel inadequate, like they’re not nurturing enough. “Attachment isn’t always instant,” she says. Women also have overwhelming expectations about what it’s like to have a newborn, about keeping a perfect home, about how they’ll be able to do everything they always did before the baby. The truth is, in a post-partum period, you can’t achieve all you did before in the same amount of time—and that’s okay.
How to get back on track: Take care of yourself and your baby first and foremost and don’t sweat the dirty dishes or mountain of laundry. “It’s important for new moms to realize that societal expectations of being perfect and keeping everything just as before are not realistic and not the thing that should be prioritized,” O’Hara explains. He adds that in certain societies around the world, there are entire cultural practices set up around people caring for the mother and establishing a support system for her right after birth. This idea reflects a recognition that women can’t be expected to keep up idealistic norms after birth, and that women are exempt from certain responsibilities for a time after a baby is born. “A woman’s body and mind need this period of relief in order to get back to functioning fully and taking on parenting responsibilities,” O’Hara says.
Coons agrees: “Women need to know that the notion of productivity changes when you have a baby, and this shift is hard for women who wrap their identity around how much they produce or accomplish each day.” Although easier said than done, engage your partner, family or friends to help you with basic housework and meals until you adjust to the new baby. Most importantly, “recognize that asking for help is a sign of strength and being a good mom doesn’t mean doing things alone,” says Coons. She adds, “If mom runs on empty, she’ll be less able to be so caring and loving towards others who are important to her.” Find a postpartum or lactation group, or go online for community support so you can share information and not feel so isolated. Make sure to protect time for yourself to exercise, have some time alone—even if it’s just 15 minutes—and connect with your friends and family.
* Names have been changed
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