Did you know May is Mental Health Awareness Month? It is also Maternal Mental Health Awareness Month. This is a topic of the utmost importance, and one that up until recent years, may not have been getting the attention it deserves.
Often after a woman has given birth all of the excitement and attention seems to go to the newborn baby (or babies). It truly is a very exciting time and it's definitely understandable when relatives and friends want to dote on the adorable, squishy babe of cuteness that has just been brought into the world. But there's also another person who just underwent some very significant changes-the mother of the precious little one.
Moms may experience a number of changes-physically, emotionally, mentally. Their well-being is as important as the infants during this time-if not more so. This goes back to the whole idea of "you can't take care of others if you're not taking care of yourself", "secure your oxygen mask before assisting others", etc. Since mothers still do the majority of the care taking when it comes to newborns, it's super important they're doing well and feel supported during the postpartum period.
I want to provide a general overview of what maternal mental health difficulties mothers may face postpartum. In addition, I’d like to discuss some of the factors which can impact a mom's mental well-being postpartum and how those personally affected me after the births of my three children.
Maternal Mental Health disorders include (but are not limited to) depression, anxiety and psychosis that can occur during pregnancy or afterwards (postpartum period). According to The Blue Dot Project, an organization that aims to raise awareness of maternal mental health disorders, use the blue dot as symbol or support and unity, and combat the stigma and shame associated with mental health disorders-up to 80% of women may experience what is known as 'the baby blues". This period is marked by several days of feeling sad, crying, or shifting moods due to hormonal changes. The symptoms are temporary and typically do not last beyond a period of a couple weeks.
Respectively, up to 20% and 15% of women will experience clinical depression or anxiety during and/or after pregnancy. The Office on Women's Health through the U.S. Department of Health and Human Services states that the following symptoms warrant a call to your doctor, nurse, or midwife:
Feeling restless or moody
Feeling sad, hopeless, or overwhelmed
Crying a lot
Having thoughts of hurting the baby
Having thoughts of hurting yourself
Not having any interest in the baby, not feeling connected to the baby, or feeling as if your baby is someone else’s baby
Having no energy or motivation
Eating too little or too much
Sleeping too little or too much
Having trouble focusing or making decisions
Having memory problems
Feeling worthless, guilty, or like a bad mother
Losing interest or pleasure in activities you used to enjoy
Withdrawing from friends and family
Having headaches, aches and pains, or stomach problems that don’t go away
*Postpartum psychosis is a very rare but serious disorder typically beginning in the first two weeks after birth that requires immediate emergency assistance in order to prevent harm from befalling a mother or her infant. Women who have bipolar disorder or another mental health condition called schizoaffective disorder have a higher risk of postpartum psychosis.
Symptoms may include:
Seeing or hearing things that aren’t there
Feeling confused most of the time
Having rapid mood swings within several minutes (for example, crying hysterically, then laughing a lot, followed by extreme sadness)
Trying to hurt yourself or your baby
Paranoia (thinking that others are focused on harming you)
Restlessness or agitation
Behaving recklessly or in a way that is not normal for you
Another common occurrence during the postpartum period (which I did not know about prior to experiencing them) is intrusive thoughts. According to a study conducted in 2019 of 763 women discovered that 70-100% of new mothers reported intrusive thoughts of infant-related harm (baby having an accident or falling) and nearly 50% reported intrusive thoughts of harming their baby on purpose. Experts believe that these thoughts are fueled by anxiety and may be related to obsessive compulsive behaviors. Mothers recognize the thoughts as distressing, unwanted, and out of character. If they become debilitating or interfere with their ability to function, they should seek professional help. Even if they haven't reached that level of severity, it can always be beneficial to talk to a professional such as a therapist or medical professional, your spouse, or a friend.
I myself remember feeling very anxious about accidentally dropping my firstborn. We had a second story home and I kept having troubling thoughts about how I might trip and fall while holding my son. I did share my concerns with my doctor as well as my husband. Talking to them and distracting myself from the thoughts when they did happen provided relief. Thankfully, I didn't experience intrusive thoughts after I had my second or third, but I still remember how truly shocked I was when I started having those anxiety-provoking thoughts after my first child was born. I didn't know what they were, why I was having them, or if I was a big outlier in the population of new moms.
As I mentioned earlier, there are several factors which can contribute to the quality of a woman's maternal mental health, especially after birth. Such factors include
a sudden hormonal shift in the first 24 hours after birth where estrogen and progesterone levels shift from very high to pre-pregnancy levels. This is theorized to be a possible cause of postpartum depression.
the kind of support system available
the amount of sleep a mother is getting
how she is experiencing the shift in her identity as a new mom
if she feels regret or sadness about her baby's delivery
her thyroid functioning
There are many other factors that surely impact a woman's maternal mental health,
I am just highlighting some that I have had personal experience with.
The Support System
I think the quality of a woman's support system is one of the most important factors when it comes to their mental well-being after having a baby. If a woman feels isolated, unsupported, or invisible-it can definitely take a toll on her mental health and exacerbate struggles she's already facing. It's been over six years since I had my first son, and I'm certain I will never forget the kindnesses shown to myself and my family after we brought our son home. We had friends who were experienced parents who dropped off meals knowing my husband and I would have very little energy or time to devote to cooking, loved ones who sent gift cards to purchase meals and gift baskets of treats to enjoy, and multiple friends who reached out to me to let me know they were there for me day or night if I wanted to talk, vent, whatever.
In my opinion, being a pillar of support for a mother during postpartum is one of the most impactful things you can do to support her mental health. It could be sending over meals so she doesn't have to worry about cooking, sending gift cards to a favorite restaurant, offering to watch her other kids so she can focus on the baby, cleaning up her kitchen, vacuuming, or running a load of laundry-pretty much anything that takes somethings off her plate.
I know I personally don't like asking for help and sometimes feel as though I should just be able to do it all. So, I really wasn't apt to actually ask people to help or support me. Sometimes moms feel guilty or they might not even know what would be helpful. I think that's why asking a mom what you can do to help AND providing some different choices would be a great way to support her.
Sleep Deprivation
Having those supportive people in my life really made a difference because of the extremely difficult time I was having with the next factor (which was certainly affecting my mental state)-sleep deprivation. When I was pregnant I remember people telling me the newborn phase was ROUGH because of the lack of sleep new parents experienced. To say I was naive to what rough really meant would be an understatement.
I labored for nearly 17 hours before delivering my first son via c-section past midnight. Counting that day when I was laboring and the following 3 days I spent in the hospital to recover before being released, I slept for maybe a total of 6 hours. Unfortunately, it didn't get much better when we brought our son home and discovered he would only sleep while being held, or in the care, or on a walk in the stroller. This was the case for the first 4 months of his life. My husband and I took turns or shifts throughout the night just to survive on what little sleep we could get, and I recall it taking it's toll on both of us. I also remember thinking to myself, "Ah, now I understand why sleep deprivation is used as a form of torture. This is the worst!"
I know there's the advice frequently given to moms that they should "sleep when the baby sleeps". Well, as I mentioned above, my son only slept during times where it really wasn't conducive to both of us sleeping. After reading articles and accounts from other moms on message boards about the hell that is sleep deprivation, I knew I wasn't alone in this predicament. I think that's why the next strategy I have for helping moms who are sleep deprived is pretty straight forward-hold her baby so she can get some sleep. If she's breastfeeding make a plan to either feed baby some milk that has been pumped (I know this might not always work due to baby not taking a bottle, etc.) or have her feed baby and then allow her to get a chunk of time to sleep. This will not necessarily cure her of the lack of sleep she's experiencing day in and night out, but it couldn't hurt.
Identity Shift
This was a big deal for me. I remember my first son was about a week old and I was speaking to a co-worker about how new mom life was treating me. I told them, "I know how to be a school psychologist. I don't think I know how to be a mom. This is really scary for me." I don't think of myself as a perfectionist, but I do like predictability and I like knowing that I'm doing a good job. I knew I was a competent and capable school psychologist. I just didn't know if I was or would be a competent and capable mother. I wondered if I had what it took. My co-worker assured me I did and I was still adjusting to a major life change and I would find my balance and a new normalcy would soon develop. Thankfully, they were right. If you're on the other end of a conversation like this with a new mom, I think it's important to be sympathetic and supportive. Sometimes just having someone to vent to and hear them out, is just what a new mom going through an identity shift needs. If you're the mom in this situation, just know that change can be really hard and in time you will find your way. It may not be as soon as you are hoping for, but it will happen and it's okay to feel all the feelings while you're adjusting to your new role.
Baby's Delivery
I may have mentioned this in another post I wrote years ago, but my husband and I took a childbirth education class for first time parents offered by our hospital, and we were in denial that I would be one of the 3 out of 10 women who would deliver via c-section. For whatever reason, as naive first time parents, we just didn't think I would be bringing our son into the world through having major abdominal surgery. Yeah, go us, we were completely wrong about that.
I was asleep when my water broke and once we arrived at the hospital shortly after, I was hoping we would soon get to meet our first baby boy. Well, 17 hours later and coming to a standstill at 8 cm with a developing fever, we decided the best course of action would be a c-section in the midnight hour. I was so relieved to deliver a healthy baby boy, whose cord happened to be wrapped around his neck 4 times and may have been his reason for not descending further down the birth canal, I didn't really process the fact that the idea of what I thought my delivery would be like and what really happened didn't match up. It didn't hit me until later on that I just had major surgery and how it would affect my postpartum recovery. For a short period of time afterward, there was a side of me that felt I had failed somehow because my delivery experience was nothing like I thought it would be.
The best advice I can give to other mothers who have experienced such a stark contrast between what they thought their delivery would be like and what it was actually like, is to allow yourself to process what you went through. Know that it's okay to feel all sorts of emotions in response to how your delivery went. You may feel guilt, remorse, anger, confusion, etc. and it's okay. None of your feelings are wrong. I would strongly encourage speaking to other moms who have experienced similar feelings or a therapist who can help you process and navigate your emotions.
Thyroid Functioning
I have had 3 children within a span of 5.5 years and during that time I never saw a primary care doctor for a regular check-up. I know, not a good idea. I was so busy raising my children, that I put my own health on the back burner.
After the birth of my third child this past October, I decided to FINALLY go and get all my regular blood work done. Some of the results were pretty shocking. My blood test showed I had a very high level of thyroid antibodies-meaning my body was producing antibodies which were essentially attacking my thyroid. My TSH (Thyroid Stimulating Hormone) level was also really low which is indicative of Hyperthyroidism. I was referred to an endocrinologist who is a doctor that specializes in hormonal and endocrine disorders. The thyroid is a small butterfly-shaped gland located below your voice box at the base of your neck.
The thyroid is very important in terms of regulating metabolic functions, temperature, heart rate, cholesterol and even menstrual cycles. It also serves an important role in how your mental health. Too little thyroid (hypo) can result in feelings of sluggishness and even depression. It can also make you feel cold and result in a lowered heart rate, constipation, and weight gain. Too much (hyper) can make you feel on edge or anxious as well as experience excessive sweating, a high heart rate, palpitations, and restlessness. More information about what the thyroid does can be found here.
Through additional bloodwork and an ultrasound of my thyroid, we discovered that my thyroid gland had significant tissue damage from the antibodies and I was going into an even higher hyperthyroid state. My doctor believed what I was experiencing may be called postpartum thyroiditis and my thyroid levels would likely shift to a hypothyroid state. She said the high antibodies levels and obvious tissue damage pointed to a diagnosis of Hashimoto’s Disease-an autoimmune disorder.
My doctor’s prediction was correct and now my TSH levels show that my body is in a very Hypothyroid state. I am on medication and will need close monitoring to get my thyroid levels at an optimal level, but I am really glad that this was discovered and I’m getting the treatment I need.
I never thought about how my thyroid functioning could impact my mental wellness postpartum. Now looking back on some of the symptoms I was experiencing physically and emotionally after the birth of my first two children, it makes a lot of sense and I wish I had gone sooner to get my regular blood work done. If I hadn’t made it a priority to finally go this past February, I still would have no idea that my thyroid levels are so abnormal. I would just attribute all my feelings to being a mom and say things like “well I’m a busy mom. I think it’s normal to feel like this” to myself. Which is exactly what I did after I had my first two babies.
In conclusion, I want to convey that although it goes against our intuition as mothers to put our needs before our children’s, sometimes we need to do so in order to function at our best. I remember reading that taking care of yourself is part of taking care of your children and it really resonated with me.
There are so many things which can impact maternal mental health, and I know I only touched on a handful of them. However, I hope that by sharing my experiences with some of these factors that impacted my postpartum experience, other mommas will feel less alone if they’re struggling as well.
Did you experience some of the same things? If not, what are some things that affected your postpartum mental health?
Together in motherhood,
Jenn
References
Collardeau, F., Corbyn, B., Abramowitz, J. et al. Maternal unwanted and intrusive thoughts of infant-related harm, obsessive-compulsive disorder and depression in the perinatal period: study protocol. BMC Psychiatry19, 94 (2019).