Understanding Postpartum Mental Health: From Baby Blues to Depression

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Photo: Courtesy of Jenna Norman

Speak to any mother and she will regale you with stories about the wonders of motherhood. Probe a little deeper and ask about the first few days, weeks, or months postpartum, however, and you might get insight into a very different story. Indeed, the period that follows the delivery of a baby can be one of the most difficult times in a woman’s life, yet very few women are willing to speak honestly about this, making it all the more important for us to start a conversation around postpartum mental health.

With that in mind, we spoke to Anne Buist an Australian researcher and practicing psychiatrist specializing in women’s mental health and, in particular, postpartum psychiatric illnesses.

Does every woman struggle after giving birth?
Having a baby is a major life change — for women, it means making sense of the changes to their body that have happened through pregnancy and then again after labor and then again while they breastfeed. From only considering themselves, they now have another human totally dependent on them. Women react and handle this differently according to their personality, childhood, parenting experience, and level of support. It’s without a doubt a challenge for all women.

An unwell mother postpartum is likely to be less available physically and emotionally to the child, which also represents a risk to their attachment and later mental health.

What are the differences between baby blues, postpartum anxiety (PPA), and postpartum depression (PPD)?
The blues affects 80 percent of women and are a transient change or lability in mood, most likely in response to a huge physiological change. Postnatal anxiety and depression, often intertwined, are common symptoms of the adjustment, but when the symptoms continue for more than two weeks and last throughout most or all of the day, this represents something potentially more serious, affecting one in five to one in seven women.

What are common symptoms of each?
The blues are usually an hour or two of being more emotional and perhaps crying for no reason. PPA often presents with anxiety about the infant’s wellbeing or the capacity to mother, but can include low mood, panic attacks, and obsessional symptoms such as excessive cleaning. Postnatal depression can include anxiety but has a significantly lowered mood as well as tearfulness and biological symptoms. These include not being able to sleep even when the baby is, poor appetite and loss of weight, low energy, and loss of interest.

What are signs to look out for that something is out of the ordinary or that a woman’s mental health might be affected?
The woman not being herself, worrying about the baby, being withdrawn, asking for more reassurance than usual, and going through long periods when she is not enjoying herself are all signs to look out for. It is also important to remember that there is a more serious and rare variant of this, postpartum psychosis, when women may behave oddly, may really believe that something is wrong with the baby and not be able to be reassured, or be frozen with indecision. 

At what point should a woman seek professional help?
If the woman is behaving oddly, get help straight away. Try to find a way for her to get a good night’s sleep (sleeping medication, someone else looking after the baby) and, if this doesn’t help or the symptoms go on for two weeks, seek advice from a medical professional.

In your experience, what are the most effective ways to treat postpartum mental health issues?
This usually requires a mixture of approaches; counseling, support, a break from the baby, and help sleeping are all critical. In the more severe cases, antidepressants are recommended.

Are there any factors or characteristics that can make a woman more likely to develop PPA or PPD? Are women with a history of depression more at risk than others?
Women with a past or family history of affective disorders are at high risk. Other risk factors include lack of support, domestic violence, a childhood history of abuse, and a perfectionistic personality style.

How can a woman with a history of mental health problems prepare for the postpartum period?
They need to make sure that they have support, which includes someone who can give them a break from childcare. Talking with other mothers, thinking through some of the practicalities, and keeping expectations of themselves realistic will also help.

Should medication (antidepressants, SSRIs, and so on) be stopped during pregnancy or while breastfeeding?
Medication use (or decision to cease) needs to be a balance of risk. Most antidepressants, at average or low doses, appear safe in pregnancy and breastfeeding, and the mother being unwell exposes the infant in utero to higher levels of cortisol, which may alter their stress response and put the child at risk of depression and anxiety in later life. An unwell mother postpartum is likely to be less available physically and emotionally to the child, which also represents a risk to their attachment and later mental health. Therefore, keeping the mother well is important. The only medication that must be stopped during pregnancy are mood stabilizers, sodium valproate, and lithium.

How can untreated PPD impact the mother?
With the perceived guilt of being a bad mother, the woman can experience a loss of enjoyment and it may impair attachment between her and the baby. There is also an increased risk of suicide.

I recommend talking and singing with the baby, spending time sitting and wondering what they are thinking and feeling.

How can untreated PPD in the mother affect a child’s development and her family as a whole?
When someone is depressed, they turn inwards, and thinking about others with their needs in mind is hard if not impossible. All relationships tend to be affected, but the critical one is with the infant. Attachment is the building block for all later relationships and occurs primarily in the first year of life. Women who are anxious may convey to the child that the world is a scary place; women who are depressed struggle to convey joy, depriving the child of a sense of delight in themselves. This can be worked on and improved, but women need to get help.

What role can the husband and family of the mother play in helping her through this time?
They can provide breaks for her to have her own time and sleep, support her in getting help, and offer both kindness and patience.

How can a woman reconnect with her child after or during treatment for PPA or PPD? What are tips, exercises, and so on to strengthen that connection?
There are a number of groups and programs that help support and promote attachment. A good online resource is www.circleofsecurity.org but there are many others. I recommend talking and singing with the baby or spending time sitting and wondering what they are thinking and feeling. Trying to see the world from their point of view — understanding that you as the parent are the centre of their world and they won’t give up on you — is all part of the journey of parenthood. 

Anne Buist is an Australian researcher and practicing psychiatrist specializing in women’s mental health and, in particular, postpartum psychiatric illnesses.

Meet Anne Buist at the Emirates Airline Festival of Literature from February 4 to 9, 2020.