Postpartum mental health: Understanding, preparing and navigating the journey

Life after a new baby is filled with emotional, physical and psychological changes that may take new parents by surprise. While the joy of welcoming a baby is undeniable, mental health challenges may also arise after childbirth.

Many new mothers experience a range of emotions—from the expected "baby blues" to more serious concerns like postpartum depression and postpartum psychosis in rare cases.

“I feel like a lot of people are not prepared for the changes they may experience after giving birth” says Traydacia Pendleton, certified nurse midwife with Sentara Midwifery Specialists in Hampton, Va. “We’re so focused on the baby’s arrival but also need to talk about how this will impact the new mother, father and family unit.”

Preparing for life after baby begins during pregnancy

Before childbirth, education and preparation can help set expectations for postpartum mental health.

“While many expecting parents focus on the baby, it’s equally important to focus on how the experience will impact them,” explains Pendleton.

She adds that postpartum mental health begins with evaluating and talking about mental health during pregnancy.

Pendleton recommends talking about the following topics at prenatal appointments:

• Education and support: Expectant parents benefit greatly from understanding the changes that will occur after childbirth. Fatigue, mood swings and new roles as caregivers are often underestimated.
• Mental health focus during pregnancy: Pregnancy is a time to prioritize mental health. Mental health concerns may occur both during pregnancy as well as within the first postpartum year.
  
  Pendleton stresses the importance of depression and anxiety screenings at prenatal appointments. These screenings take place at the first visit, again in the second or third trimester and at postpartum visits. If needed, treatment can be started proactively during the pregnancy to help improve mental health and well-being and to work toward alleviating symptoms after the baby is born.

Childbirth education and doulas: Valuable resources

As part of her approach to mental health, Pendleton recommends childbirth classes. These classes discuss the birth process and caring for a newborn. Some classes may also discuss the changes you may experience during pregnancy and after birth, including talking about mental health obstacles.

Birth is a significant life event, and the postpartum period is a tremendous transition. Pendleton also recommends working with a postpartum doula. While we may associate doulas only with childbirth, these days there are a lot of different types of doulas, such as specialties in grief/loss and those who specialize in postpartum assistance.

“Postpartum doulas help new moms with healing and recovery as well as helping parents integrate the baby into their lives,” says Pendleton.

A postpartum doula may help with:

Hands-on help around the home

• Emotional support
• Lactation concerns
• Childcare so the parents can take a break, nap or rest.

For parents interested in working with a postpartum doula, Pendleton recommends looking at doulas in your area and checking online to find those who offer this service. You should set this up before delivery to ensure you’ll have help when the time comes.

Baby blues vs. postpartum depression: Know the difference

The range of postpartum emotions spans from the “baby blues” to postpartum depression and, in rare cases, postpartum psychosis.

Baby blues impact up to four in five new parents and can affect new parents of any race, age, income, culture or education level. Some partners may also experience these feelings. The baby blues may last from a few minutes to a few hours daily. But typically, these feelings will dissipate after about two weeks.

“It may surprise some new moms to hear this, but we expect to see the baby blues when they come in for their first appointment after giving birth,” says Pendleton. “It’s common and normal to feel this way. But we want new moms to report symptoms to your provider so we can offer support and follow up with you.”

While most new moms may experience the baby blues as they adjust to their new role, if these feelings extend past the first couple of weeks, then “more than likely, they’re heading into postpartum depression,” says Pendleton.

Here is the difference between the baby blues, postpartum depression and a more severe condition known as postpartum psychosis:

• Baby blues: This is a common, temporary condition that includes mood swings, sadness, irritability, and difficulty sleeping. These feelings often stem from the emotional transition into motherhood and are generally short-lived, lasting around two weeks after giving birth.
• Postpartum depression: If these symptoms persist beyond two weeks, postpartum depression is a possibility. Mothers may feel overwhelmed, anxious, or emotionally disconnected from their baby. This requires intervention from healthcare professionals to prevent long-term effects on both mother and child.
• Postpartum psychosis: This condition is rare but severely impacts the new mom’s decision-making, often causing delusions or hallucinations. New moms experiencing postpartum psychosis may have thoughts of self-harm or be afraid they may harm their babies.

Postpartum checkups: Screening for mental health concerns

Routine follow-up appointments are one key to helping new mothers cope well with the changes after birth.

Healthcare providers, including OB-GYNs and some pediatricians, check on mental health during the first few postpartum visits. They often use the Edinburgh Postnatal Depression Scale, a series of questions about how the new mom is feeling, to help identify women who may have postpartum depression. This screening helps detect early signs of mental health struggles and ensures timely intervention.

Some factors increase the likelihood of developing depression after birth:

• Depression or bipolar disorder or a family health history that includes these conditions
• Lack of support from family or friends
• Multiple birth (twins, triplets, or more)
• Teenage pregnancy
• Health problems during pregnancy
• Preterm labor or other birth problems
• A baby with special needs

How self-care and a support system can help

Pendleton recommends self-care for all new moms.

“Self-care isn’t selfish; it’s about grounding yourself when you may feel disconnected,” says Pendleton. “It helps new moms move through the baby blues.”

Even small acts of self-care make a difference, such as:

• Allowing yourself to rest
• Enjoying a hobby
• Going for a walk
• Taking a bath

Receiving help from a support system is also a form of self-love, and it’s often difficult for new moms.

“We default to trying to do it all ourselves,” says Pendleton. “But accepting help not only helps us, it can make our support system feel loved and involved.”

Pendleton understands that not all parents have a large support system. The Hampton Roads area, in particular, has many military families who may not have as much in-person support. For those moms, Pendleton recommends keeping an open line of communication with their primary source of support whether that support is local or not.

“Talk about how you’re feeling with a trusted partner, family member or friend so they are also aware of what you’re experiencing,” she says. “They’ll have the most access to you even if they’re not local and can be observant to changes.”

Lack of social support has been shown to increase the risk of developing postpartum depression. Support groups—whether online or in person—connect new moms with each other and can be a great source of camaraderie.

Trauma and postpartum mental health

New moms may not recognize how a difficult delivery or another trauma, such as NICU stay, is impacts their mental health.

“We don’t talk enough about birth trauma,” says Pendleton. “We need more language and recognition of how it impacts new moms.”

She describes trauma as “your body keeping score” and says these instances impact how you navigate the postpartum experience.

Ways trauma may manifest during the postpartum period include:

• Anger
• Difficulty bonding with the baby
• Fear of being touched
• Feelings of guilt or disappointment
• Negative thoughts

“Birth trauma that’s not addressed can linger in your body as tension, worry and other negative mental health impacts,” explains Pendleton. “This is why it’s important to process your experiences and feelings.”

Pendleton recommends the book How to Heal a Bad Birth: Making Sense, Making Peace and Moving On to moms who struggle with a difficult birth. Working through these feelings helps keep them from impacting new moms long-term and even from these emotions affecting subsequent births.

Postpartum depression and the baby

Pendleton emphasizes the importance of understanding the broader implications of postpartum depression.

“I don’t want to insight fear, but I do want new moms to know that postpartum depression can impact more than just their mental health,” she emphasizes. “It can also affect their bond with the baby.”

When moms don’t connect with their new baby, their babies may not get the attention they need. For example, less physical touch can affect the baby’s sense of attachment.

Early intervention helps mother and baby

Intervening early is an important step for the well-being of both mother and baby. Getting help right away, whether through therapy, medication, or support groups and addressing postpartum depression leads to better outcomes for everyone involved.

Recognizing the signs and seeking support

Postpartum mental health concerns, such as depression and anxiety are serious, but with the proper education, preparation, and support, they can be managed effectively. Remember:

• The baby blues are common, but if you feel overwhelmed or disconnected for more than two weeks, it’s important to seek help.
• Whether it’s family, friends or professional help, having a support system helps navigate postpartum challenges.
• If symptoms persist or worsen, get help as early as possible is important. Postpartum depression is a treatable condition and prompt intervention makes all the difference.