By Amber-lee Buendicho
@thepowerofbirth
Trigger warning as distressing content is discussed.
"I have this memory of finally putting the baby down asleep and noticing that it was raining, so I walked outside the front of my house and stood there, smelling and feeling the rain. At that moment my husband came home from work and asked, "what are you doing?" I replied tearfully, "I'm just smelling the rain". We both laughed together about how dramatic it seemed, but that was the reality of how intense my emotions were." - Amber-lee
Becoming a mother is often depicted as blissful, joyful, beautiful, effortless, all-loving and as the peak of happiness for women in popular media and societal narratives. However, it's important to acknowledge that the reality of motherhood is complex and diverse. While there are undoubtedly many joyful and fulfilling moments, motherhood also encompasses challenges, sacrifices, grief, loss, and a wide range of big, confusing, complex emotions - but we don't like to talk about that?! And if we do, the hard times are usually put down to baby blues, but how do you know if it's more than that?
Up to 80% of new mums experience a temporary period of mood swings and emotional vulnerability known as the baby blues. While the baby blues are a normal part of the postpartum experience, it's crucial to understand the difference between the baby blues and postnatal depression (PND) to ensure early identification, intervention and appropriate support as the risks and impacts are vastly different.
Baby Blues
Basically, baby blues is a transitory emotional rollercoaster and typically occurs within the first few days after childbirth up to 14 days postpartum and is characterised by temporary mood swings and emotional changes.
Key indicators include: (Harris et al., 1994; O'Hara & Swain, 1996)
Occurrence: Baby blues are very common, affecting up to 80% of new mothers.
Symptoms: New mothers may experience
- frequent mood swings
- feeling happy one moment and tearful or irritable the next
- emotional sensitivity or easily overwhelmed by even minor stressors or triggers
- crying spells: increased crying or bouts of unexplained weeping are commonly reported during the baby blues period
- fatigue and exhaustion
- anxiety and restlessness: some women may experience heightened anxiety, restlessness, or a sense of unease during the baby blues phase and difficulty sleeping
Duration: Symptoms usually peak around the third to fifth day after birth and subside within two weeks.
Causes: A combination of hormonal fluctuations, exhaustion, adjusting to motherhood, lack of sleep and other psychological and social factors.
Source: David R. Grattan, Sharon R. Ladyman, Chapter 2 – Neurophysiological and cognitive changes in pregnancy, Handbook of Clinical Neurology, Volume 171, 2020, Pages 25-55.
In the postpartum period, women undergo significant hormonal changes that can contribute to the occurrence of baby blues. As mentioned by Grattan and Ladyman (2020), these hormonal changes play a crucial role in shaping neurophysiological and cognitive adaptations during pregnancy. Following childbirth, there is a rapid decline in the levels of estrogen and progesterone, which can affect neurotransmitter systems and brain regions involved in mood regulation (as seen in the graph). Additionally, there is an increase in prolactin and oxytocin, hormones associated with breastfeeding and bonding. The complex interplay of these hormonal fluctuations can influence neurotransmitter activity, neuronal plasticity, and the functioning of brain circuits involved in emotions and cognition, potentially contributing to the transient emotional changes experienced during the baby blues period. However, it is important to note that the exact mechanisms underlying the relationship between hormonal changes and baby blues are still being studied, and other psychosocial factors also contribute to the emotional experiences of new mothers during this time (Gratton & Ladyman, 2020).
I remember bringing my first newborn baby home and being alone with him and feeling really intense sadness and happiness all at the same time. I remember thinking, "what now?" It was difficult to shower because he screamed the whole time, I couldn't put him down for 10 seconds without him screaming for me so I end up holding him all.day.long, breastfeeding hurt like hell and made me ravenous, I was nursing a birth injury, and rarely slept - cue the baby blues. I was up and down as much as my baby was up and down. I have this vivid memory of finally putting the baby down asleep and noticing that it was raining, so I walked outside the front of my house and stood there, smelling and feeling the rain. At that moment my husband came home and asked, "what are you doing?" I replied tearfully, "I'm just smelling the rain". We both laughed together about how dramatic it seemed, but that was my reality. By week 6, I was feeling like I was getting the hang of it all and could handle the day-to-day (for the most part anyway) and those feelings had subsided.
I created resources for preparing and supporting your psychological health as a new mother and prioritising your health and wellbeing after baby. https://www.thepowerofbirth.net/printable-pdfs and you can also download free motherhood and birth affirmations when you subscribe https://www.thepowerofbirth.net/
Image from Helsana.ch
Postnatal Depression (PND/PPD)
A serious mental health condition, also known as postpartum depression, is a more severe and persistent condition that requires professional intervention. The effects of postnatal depression are known to go beyond the mother in that it can also affect the partner and the child. Evidence demonstrates that all countries are faced with the challenge of postnatal depression, but low- to middle-income countries (or rather mothers) face the greatest burden.
Here are some important aspects to consider:
Occurrence: PND affects approximately 10-15% of new mothers and can develop anytime within the first year after childbirth (however a recent study has shown the prevalence of depression is more common at 4 years postpartum than at any time in the first 12 months postpartum [Woolhouse et al., 2014]) The emerging picture is that postnatal depression is indeed a public health problem, particularly as the incidence is much higher than the quoted rate of 10%—15% (Almond P., 2009). If we aren't screening new mothers for mental health challenges, if we aren't providing adequate postnatal care through a midwife, doula, or child health nurse, how will we ever truly know the number of women affected?
Symptoms: It's important to note that the experience of postnatal depression can vary in intensity and duration. Symptoms can include;
- prolonged sadness or low mood (Field, 2010)
- feelings of hopelessness, worthlessness (Milgrom et al., 2008)
- loss of interest in activities or pleasure (Leigh & Milgrom, 2008)
- social withdraw and isolation (Cohen et al., 2006)
- changes in appetite and hygiene (Heron et al., 2004)
- sleep disturbances other than baby (Tsai et al., 2012)
- intrusive thoughts (Fairbrother & Woody, 2007)
- excessive guilt, worry self blame (Beck, 2001; Boyce et al., 2007)
- difficulty bonding with the baby (Murray et al., 2010)
- fatigue and low energy (Goyal et al., 2019)
- in more severe cases thoughts of self-harm or harming the baby (O'Hara & Wisner, 2014)
"You are not alone, you are not to blame, and with help, you will be well."
- Postpartum Support International
Duration: Symptoms persist for more than two weeks and can significantly interfere with daily functioning and the ability to care for oneself and the baby.
Causes / Risk Factors: Understanding the risk factors or potential causes can help identify women who may be more susceptible. These include: a complex interplay of hormonal changes, psychological factors, sleep deprivation, history of mental health issues, previous sexual abuse, lack of social and emotional support, pelvic birth injuries, temperament of baby, life stressors or recent adverse events, perfect mothering ideologies, adverse birth and breastfeeding experiences.
There are other Perinatal Mood and Anxiety Disorders including Pospartum OCD, Perinatal Psychosis, Postpartum Anxiety, Postpartum PTSD, Perinatal Bipolar disorders, Perinatal Panic disorder.
It's important to note that these are only some of the symptoms and the presence of these risk factors does not necessarily mean a woman will develop postnatal depression. Each individual's experience is unique, and multiple factors interact to contribute to the development of the condition. Identifying and addressing these risk factors can help in implementing preventive measures and providing appropriate support to women during the perinatal period.
I personally have not experienced postnatal depression, however, I completely understand how darkness looms in motherhood and how easily it can consume you. Many women have confessed to me their desire to end their life, disappear, run away and never come back, and even thoughts of familicide. They've spoken about the chains of guilt, extreme negative self talk and toxic comparisons - assuming everyone else is excelling and they are not. They have shared with me scary thoughts, deep shame, loneliness and numbness, even the regret of having children. If this is you right now, please seek help! I remember thinking, how is this happening to so many amazing mothers and we aren't talking about it!? Mental health does not discriminate, it has crept into the lives of so many competent, loving women and families. The hardest part is that because no one talks about it, there is deep shame in struggling with your mental health when it is suppose to be the happiest time of your life and this culture does not help mothers, it forces them to fall between the cracks where the most darkness looms. Maybe some of us live in denial that we are struggling, or maybe we don't know what's happening to us...
I often wonder that if there was more awareness around perinatal mental health if things would be different. We certainly have a long way to go. This is one of the reasons I created a platform for talking about these taboos in motherhood: Can We Talk About This Podcast by The Power of Birth. I value the lived experiences of others because this is how we learn and do better!
Click the photo to go to podcast
If you suspect you may be experiencing postnatal depression, it's essential to seek help without delay. Talk to your healthcare provider, who can provide a proper diagnosis and guide you toward appropriate treatment options, which may include therapy, support groups, mental health and parenting programs, medication, inpatient or outpatient admissions, or a combination of approaches. There are so many incredible perinatal organisations that are here to support you, they provide a wide range of FREE services and resources and personally, I highly recommend you reach out, even if you are a concerned family member and you are not sure what to do. The bottom line is, there is no rule about when you should seek help, if you are struggling in any capacity, please reach out to your support networks and professionals that can help you.
Supports Within Australia
Perinatal Anxiety and Depression Australia PANDA www.panda.org.au
The Centre of Perinatal Excellence COPE www.cope.org.au
Gidget Foundation www.gidgetfoundation.org.au
Your local GP and Child Health Nurse can provide you with other free support. GPs can also provide a mental health care plan so you are able to get up to 10 Medicare subsidised sessions with a licensed psychologist.
To look for a perinatal psychologist near you COPE have a wonderful directory to help you find the right fit: https://directory.cope.org.au/
Brisbane/Gold Coast:
Peach Tree Perinatal Wellness www.peachtree.org.au
Catherine's House www.mater.org.au
Perinatal Wellbeing Centre www.perinatalwellbeingcentre.org.au
Lavender Mother and Baby Unit Gold Coast https://www.goldcoast.health.qld.gov.au/our-services/lavender-mother-and-baby-unit
International Supports
Postpartum Support International www.postpartum.net
CANADA Pacific Postpartum Support Society www.postpartum.org
UK Mind www.mind.org.uk
Differentiating between baby blues and postnatal depression is essential for new mothers and their families. While the baby blues are a temporary and normal part of the postpartum experience, postnatal depression is a more serious condition that requires professional support. By understanding the signs and seeking help early on, new mothers can receive the necessary care and support to navigate this challenging period and experience learning, connection and growth in motherhood. In the words of the amazing international organisation Postpartum Support International, remember, "you are not alone, you are not to blame, and with help, you will be well."
References:
Almond P. Postnatal depression: A global public health perspective. Perspectives in Public Health. 2009;129(5):221-227
Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50(5), 275-285.
Boyce, P., Condon, J., Barton, J., & Corkindale, C. (2007). First-time mothers' experience of early parenthood: Links to maternal identity. Journal of Advanced Nursing, 59(3), 247-255.
Cohen, L. S., Wang, B., Nonacs, R., Viguera, A. C., Lemon, E. L., Freeman, M. P., & Faraone, S. V. (2006). Treatment of mood disorders during pregnancy and postpartum. Psychiatric Clinics, 29(1), 107-126.
David R. Grattan, Sharon R. Ladyman, Chapter 2 – Neurophysiological and cognitive changes in pregnancy, Handbook of Clinical Neurology, Volume 171, 2020, Pages 25-55.
Fairbrother, N., & Woody, S. R. (2007). New mothers' thoughts of harm related to the newborn. Archives of Women's Mental Health, 10(3), 77-91.
Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior and Development, 33(1), 1-6.
Goyal, D., Gay, C., & Lee, K. A. (2019). How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first-time mothers? Women's Health Issues, 29(6), 516-522.
Harris, B., Lovett, L., & Smith, J. (1994). Readjustment difficulties in the early postpartum period: A longitudinal study. Journal of Child Psychology and Psychiatry, 35(2), 365-379.
Heron, J., O'Connor, T. G., Evans, J., Golding, J., & Glover, V. (2004). The course of anxiety and depression through pregnancy and the postpartum in a community sample. Journal of Affective Disorders, 80(1), 65-73.
Leigh, B., & Milgrom, J. (2008). Risk factors for antenatal depression, postnatal depression, and parenting stress. BMC Psychiatry, 8(1), 24.
Milgrom, J., Gemmill, A. W., Bilszta, J. L., Hayes, B., Barnett, B., Brooks, J., ... & Buist, A. (2008). Antenatal risk factors for postnatal depression: A large prospective study. Journal of Affective Disorders, 108(1-2), 147-157.
Murray, L., Fiori-Cowley, A., Hooper, R., & Cooper, P. (2010). The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcome. Child Development, 81(1), 251-269.
O'Hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression: A meta-analysis. International Review of Psychiatry, 8(1), 37-54.
O'Hara, M. W., & Wisner, K. L. (2014). Perinatal mental illness: Definition, description and aetiology. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(1), 3-12.
Tsai, S. Y., Lee, P. L., Lin, J. W., Lee, Y. J., & Chang, Y. C. (2012). Sleep disturbances and quality of life in postpartum women: A longitudinal study. Journal of Nursing Scholarship, 44(4), 379-385.
Woolhouse, H., Gartland, D., Mensah, F., & Brown, S. J. (2014). Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: Implications for primary health care. BJOG: An International Journal of Obstetrics and Gynaecology, 121(13), 1615-1624. https://doi.org/10.1111/1471-0528.12837