Once you become pregnant, the preparation begins. You begin to read books about pregnancy. You begin to think of names and plan the nursery. Expectant mothers read every book about what it means to be pregnant, follow the growth of their unborn baby, and try and learn the changes their body is going through while their baby grows.
Mothers talk to friends and search social media for answers: what can help my morning sickness? What pillow can I buy to help me sleep better? Social media and the Internet are not only sources of information but also provide support for women in all stages of pregnancy and postpartum.
But while all of this is going on, many mamas-to-be are not always prepared for what happens after the baby arrives. While there is intense focus on the first three trimesters of this journey, there is very little, if any, focus on the fourth trimester. As a mom and pediatrician, I have seen moms feeling lost and bewildered. While they are overjoyed at having their precious baby, many moms have told me that this is not what they expected. While it is one of the most joyful times of our lives, it can also be the most challenging.
For many mothers, the birth of their baby significantly affects their mood and mental health. Postpartum depression and anxiety (PPD/PPA) are the most common complications of childbirth and pregnancy. PPD/PPA can affect up to 1 in 5 women during pregnancy or the first year after giving birth. If left untreated, PPD can worsen, adversely affecting the mother, her child(ren), and the family.
While caring for their infants, many mothers begin to feel unhappy or disconnected from their babies. The feelings of guilt can become overwhelming since women have often been told that this is supposed to be the happiest time of their lives. Though there is less stigma around maternal mental health than there was a few years ago, many mothers are hesitant to share their feelings of inadequacy, for fear of being judged. No woman wants to feel like she is a bad mother.
The adverse effects of postpartum depression are far-reaching. It can cause family dysfunction, prevent effective mother-baby bonding, cause early cessation of breastfeeding, and can adversely affect infant growth and brain development.
Luckily, PPD/PPA can be addressed and treated. While postpartum blues are secondary to hormonal changes in the first 10-14 days, postpartum depression and anxiety can have more severe symptoms that continue throughout the postpartum period. It does not matter if you are a first-time or seasoned mother, the emotional and hormonal changes we experience after pregnancy are different for every mom and with every pregnancy. Feeling anxious or sad is not your fault and nothing to be ashamed of. In fact, as a pediatrician, I tell my mothers that I need them to be happy and healthy so their baby can be happy and healthy.
If you are experiencing symptoms of depression or anxiety, first, please tell your partner, family member, or friend. Call your obstetrician so you can be evaluated prior to your 6-week postpartum check. You can also reach out to your pediatrician.
At CHKD, we screen all mothers for postpartum depression starting at the 1-month well baby check. Measures such as maximizing sleep, peer support, and therapy are all important in addressing PPD/PPA.
However, some mothers will require medication. And this includes mothers who are breastfeeding. I am here to tell you that you do not have to choose between breastfeeding and getting medication for your PPD/PPA. There are medications that are safe and effective for PPD/PPA while you are breastfeeding.
Talking with other women who have survived postpartum depression can be extremely helpful. Support groups offer the opportunity to validate experiences, share coping strategies, and gain support and encouragement. Postpartum Support Virginia (www.postpartumva.org) has a list of free support groups as well as a list of mental health professionals.
Medical professionals also play an important role in assisting women with postpartum depression. New mothers should talk to their OB, family practitioner, or primary care doctor. These doctors can help rule out underlying medical conditions, such as thyroid changes and anemia, which can occur following pregnancy.
Speaking with your midwife or doula is also important. Mental health professionals can assist with counseling and medication when necessary. Pediatricians can also provide information about postpartum depression, including medications that are safe with breastfeeding.
Remember, Mama, you are not alone and you are not to blame. And most importantly, with help, you will be well.
Natasha K. Sriraman, MD, MPH, FAAP, FABM is an Associate Professor of Pediatrics at Eastern Virginia Medical School/Children’s Hospital of the King’s Daughters, where she has written clinical protocols for postpartum depression screening in pediatrics and the NICU. A lactation consultant, expert on postpartum depression and mother of 3, she speaks internationally and publishes about the #4thTrimester. She prides herself on combining her medical expertise with maternal experiences to empower mothers. Learn more at www.NatashaMomMD.com.