Editor's note: This article originally ran on UNC Health Talk.
Women are told many stories about how they will or should feel after childbirth: overjoyed, blissful, totally in love with their new babies.
These expectations can cause pressure on new moms and ignore the reality that every woman will feel different, and not all emotions will be positive. In fact, many women feel sadness and anxiety, or even despair, in the wake of childbirth. These feelings may last for a moment, or they may spiral into postpartum depression, which can last up to a year or longer without treatment.
Postpartum depression, which occurs after having a baby, can happen to any woman, but some women are especially at risk. Often, stigma prevents women from seeking help.
“I want people to know that this is treatable. Even the most severe forms of postpartum depression are treatable,” says Dr. Mary Kimmel, co-director of UNC Health’s Perinatal Psychiatry Program. “And moms who have postpartum depression are still good moms.”
What Is Postpartum Depression?
Postpartum depression is not “the baby blues,” a term for a few days or a couple of weeks of emotional volatility and sadness that is common after childbirth.
Symptoms of baby blues include crying, trouble sleeping, and feeling anxious or overwhelmed. Between 50 and 80 percent of women might have the baby blues, Dr. Kimmel says.
Postpartum depression is a more intense depressive episode that can last for a year or more. It’s a type of depression that interferes with a woman’s ability to care for herself or her family. And it’s not rare: According to the Centers for Disease Control and Prevention, 1 in 8 women experience symptoms of postpartum depression.
“The difference between baby blues and postpartum depression is timing and intensity,” Dr. Kimmel says. “We typically say baby blues last about 72 hours after birth. Technically, depression is at least two weeks. Baby blues involves some ups and downs of mood, but the mom still can enjoy things. Losing hope or suicidal thinking is postpartum depression.”
Symptoms of Postpartum Depression
Women with postpartum depression may experience:
- Mood swings
- Frequent crying
- Intrusive thoughts about not being a good parent
- Worry about harming her baby or herself
A disconnect from the baby
“If people aren’t able to connect with moments of joy or are unable to feel present in that moment due to fear or worry, then that’s a time when that person needs greater support,” Dr. Kimmel says. “If it’s an anxiety that’s so paralyzing that she is convinced that she and her baby are at harm, that is also a signal that she needs help.”
Postpartum depression impairs a woman’s quality of life, and in severe cases it can lead to suicidal thoughts or behaviors. New moms with symptoms of postpartum depression are at a higher risk of substance abuse.
Risk Factors for Postpartum Depression
Childbearing women of any age, marital status, education level and socioeconomic situation experience postpartum depression, but certain risk factors increase a woman’s chances of developing it. They include:
- History of depression: Women with a history of depression or anxiety before or during pregnancy are at higher risk of postpartum depression.
- Family history of postpartum depression.
- Sensitivity to hormonal changes: After birth, there’s a “decrease in estrogen and progesterone and changes to the immune system,” Dr. Kimmel says. Some women are especially sensitive to those changes.
- Young maternal age: Very young mothers (ages 13 to 19) have high levels of postpartum depression. Adolescence itself is a risk factor for mood disorders, Dr. Kimmel says, and the addition of a pregnancy and early parenthood and its many challenges exacerbates that.
- Major stressors in daily life: Besides caring for her new baby, a woman might be dealing with challenges related to her partner, other family members, work, finances, discrimination or an unstable living environment.
“The current COVID-19 pandemic, job loss and family problems could all be contributing factors. These added events can worsen the symptoms,” Dr. Kimmel says.
Getting Help for Postpartum Depression
Unfortunately, there’s still a stigma surrounding postpartum depression. Despite its prevalence, too few women seek help.
“A lot of it has to do with the image of what a mom should be. Women are afraid of how they are going to be viewed as a mother,” Dr. Kimmel says. “They often question themselves: Am I capable of being a mother? How are people going to perceive me? There’s this fear that they are going to be judged.”
Dr. Kimmel wants moms with postpartum depression to know that they are not alone and that resources and support are available.
Treatment options include:
- Cognitive behavioral therapy: In CBT, a therapist can help a new mom learn how to assess helpful and unhelpful thoughts and problem-solve on how to react in response.
- Relationship therapy: A new mom and her partner can seek help together to improve the relationship and family life.
- Medication: Selective serotonin reuptake inhibitors, or SSRIs, are prescribed to help treat depression and anxiety.
Dr. Kimmel urges anyone who is experiencing symptoms of postpartum depression to reach out to her healthcare provider.
“You didn’t cause this. This is a treatable medical condition. It is going to get better. We are going to help you get better,” Dr. Kimmel says. “Also, be kind to yourself, too. Your health still matters, even while focusing on your child’s health.”