Understanding Postpartum Depression and Anxiety: What I Wish I’d Known as a New Mom

Understanding Postpartum Depression and Anxiety: What I Wish I'd Known as a New Mom

I faced it three times before I recognized it. My erratic moods, my worries about every tiny little thing – I had assumed all of these were a normal part of my new life as a mother. Everyone had told me my whole life would change. Seeing danger everywhere, that must be a part of what they’d meant, right?

When my oldest was almost two, I commented to a friend, “I had no idea that after you have a baby, you can picture the most awful things happening to them in vivid detail.”

There was a slight pause. Half a moment. Then she said, “Isn’t that a symptom of postpartum depression?”

What? No, of course not. Postpartum depression was when you cried all the time and couldn’t get out of bed and didn’t want to bond with your baby. That wasn’t me. I loved my baby. I loved her so much that it kept me awake some nights, as I lay there counting her breaths, recounting the myriad ways she could face injury or worse. The scenarios played on a loop in my head, violent and absurd. So this was motherhood.

And to a certain extent it is. We all worry about our children’s well-being. We all consider the dangers of certain situations and we think about what could or would happen if. Think about it this way: before you had kids you would watch a movie or see on the news something terrible happening to a child. You would be heartbroken for the family, and it would make you sad but its nothing like considering what if that was your child. What if it was your child who was diagnosed with cancer? What if it was you that left your baby in a hot car after several nights with no sleep? What if, what would you do, how would you feel? What if, what if, what if.

I wish I could say that my friend’s response was a turning point, but it wasn’t. Instead, it was a few years later, when I was a certified childbirth educator serving on a local Perinatal Mood Disorder Taskforce, that I began to understand my postpartum experience. I read a description of postpartum anxiety, complete with a list of typical obsessive thoughts, and it felt like reading a biography.

My experience with these ever-daunting thoughts of terrible situations that could come to my child at any given moment weren’t just fleeting thoughts I could shake out of my head. They were obsessive. I couldn’t get rid of them. I found myself anxious many days, but I just thought that was part of caring for someone that became your heart and soul.

Serving on that Taskforce gave me insight into a topic that I thought I had already understood. I’d taken the classes, I’d read the books, I’d been to the mommies’ groups. Nevermind that, I’d become certified as a childbirth educator and even learned how to talk to families about this stuff. Yet it was on the Taskforce that I began to identify several pieces of information that, had I known earlier, could significantly have impacted my postpartum experience.

Now I know that what I experienced with my first daughter was postpartum anxiety. Postpartum anxiety occurs to about 10% of postpartum mothers and includes symptoms like:

  • Constant worry
  • Feeling like something terrible is going to happen
  • Racing thoughts
  • Trouble sleeping
  • Lack of appetite
  • Constant need to keep moving
  • Dizziness
  • Hot flashes
  • Nausea
  • Panic attacks

After being on the Perinatal Mood Disorder Taskforce helped me to learn what postpartum anxiety is and it helped me to see that I, like many women, was a victim of it. My lack of education on the subject, despite being a certified birthing instructor, presented me with an entirely different postpartum experience that the one I could have had knowing I might end up with postpartum anxiety or being able to recognize the symptoms of postpartum anxiety.

What I Wish I Had Known about Postpartum Anxiety

I wish I had known that postpartum “depression” is only one type of mood disorder. It falls under the umbrella categories of “perinatal mood disorders” (PMD) or “postpartum mental illness” (PPMI) which can include depression, anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar disorder and more. Any of these can manifest postpartum or even during pregnancy. Learn more about the wide range of possible mood changes here.

I wish I had known that I was at a higher risk than some moms. With a family history of mental illness, especially depression and anxiety, my chances of experiencing PPD/A were elevated. Had I realized this ahead of time, I wonder if I would have tuned into my symptoms earlier, rather than writing off the experience as normal. Other risk factors include a history of sensitivity to hormone shifts (during puberty or with PMS), a high needs baby, and perfectionist tendencies. In other words, I was essentially a sitting duck.

I wish I had known how common it is. One CDC survey reports that between 8 and 19 percent of women experience some form of a mood disorder after they had a baby. Even with the more conservative estimate, that’s one out of every 12 or 13 women. Using the higher number, it’s almost one in five. When you have PPD/A, it’s one thing to hear someone say you aren’t alone. It’s another thing entirely to realize you probably know a handful of women who have experienced the same, even among your own friends and family.

I wish I had known that even the subcategories of PPMI can manifest differently in each parent and after each child. I have four children in all, and my postpartum experience was different every time, but all four carried their own elements of PPA. With my first, the primary symptom was obsessive or scary thoughts; with my second, the symptoms were physical – night sweats, fevers, heart palpitations, insomnia. After my third, my primary manifestation of PPA was rage. This one scared me so badly that I finally, finally asked my midwife for a referral to a counselor.

With my fourth, the scary thoughts resurfaced, but most of them were worries about the older kids. This time, thankfully, I had worked through my anxiety tendencies with my counselor, so I was equipped to address it head-on. (You can read one account of that experience here, at my personal blog). In fact, it is common for women to develop postpartum anxiety or depression with subsequent children even if they didn’t have it with their first or their first few children. Mothers, care givers, and partners need to be aware of this because just because it hasn’t happened before does not mean that a subsequent pregnancy will not trigger it. Along the same lines, if you have had postpartum anxiety or depression previously, you are more likely to get it again.

There is one thing I did know, that I now realize many others don’t, and this is a big one: Postpartum” is not shorthand for a mood disorder. Nobody “has” postpartum, in the history of the world, ever. Postpartum is what you are after you have a baby, not something you have. Every woman who gives birth is postpartum immediately afterwards. That’s because postpartum, by definition, refers to the first few months after delivery. Postpartum = ‘after baby’ just like pregnant = ‘expecting a baby’.

I once had a doula a consult with a family and referred to the services I offer postpartum. The father frowned and asked, “Do you think she’s going to get depressed?” My friends, we have enough work to do removing the stigma of these disorders without worrying about inaccurate terminology. Don’t do it.

Finally, I wish I had known that I didn’t need to be brave to be honest. Inevitably, if I write or talk about my experience with PPA, someone tells me I am brave for sharing. But that simply isn’t the case. Did counseling to address some of the underlying causes for my anxiety require bravery? Yes. But telling you I dealt with this? Nope, no more than telling you I once had to get stitches after a cut on my head.

The suggestion that discussing PPD/A requires bravery implies that there’s some secret shame associated with it, and there’s not. After I had my babies, my hormones and my thought processes went a little out of whack, and I needed help to get them under control. I want you to know about that so that if it happens to you, you are able to recognize it for what it is and take action, no bravery required.

If you or someone you know might be suffering from postpartum depression or anxiety, tell your gynecologist, your child’s pediatrician, or your primary care physician to find out the right path for you. Some options to help you get through your postpartum anxiety include:

  • Therapy
  • Medication
  • Diet changes
  • Exercise

One more thing I wish I had known? That it can be surprisingly tricky to discuss PPD/A in an Attachment Parenting-oriented community. Many in this type of community place a stigma on mothers who experience postpartum depression and anxiety because it can be seen as not “loving” your baby enough or not being a good enough mother. Please check out this fantastic new social media campaign by Babywearing International, No Flaws Only Human.

Disclaimer: I am not a therapist. This is my perspective on perinatal mood disorders as a doula, childbirth educator, and PPA survivor. If you want to know more, get connected to local support, or contact a counselor, here are some of my favorite resources:

Overview of common PPD/A symptoms

Postpartum Progress

Postpartum Support International

Photo credit – Just a Minute: Moments in Motherhood

25 thoughts on “Understanding Postpartum Depression and Anxiety: What I Wish I’d Known as a New Mom”

  1. I have no first hand experience with this but I feel compelled to share a testimonial on PPD from my fellow NeurOptimal neurofeedback trainer in the Netherlands in the hopes that it will be helpful to you or your readers:

    “My first contact with this fantastic system [NeurOptimal] was when I was suffering from very severe postpartum depression 12 years ago. It took me only two sessions with one of the few Dutch trainers at the time for me to decide I needed this system for myself in order to ‘heal’. After 15 sessions I started enjoying life again.”

  2. I’ve dealt with postpartum depression with both my pregnancies. Reading this made me feel like I wasn’t alone in this. Such a great read 🙂

  3. I had PPD with my first pregnancy and it was so alienating. I couldn’t talk to anyone, not even my husband, about the thoughts and feelings I was experiencing. I didn’t experience symptoms with my second and third children, but with my fourth I had it again. Luckily I knew what it was but it was stil very isolating. Great post with excellent information.

  4. This account sounds like could have wrote it about the first 5-6 months of my daughter’s life. The scary scenario visions, laying awake at night sobbing because I was convinced as soon as I fell asleep (i.e let my guard down), she would stop breathing and die. I thought this was all normal until I would try to casually mention those feelings at a baby class, and the other moms just looked at me blankly. The PPA did eventually go away on it’s own, but I wish I would have gone to talk to someone sooner about it. I felt like it wasn’t a thing that was a big enough deal to go talk to someone about, but in hindsight it really, really was.

  5. I had horrific post partum obsessive thoughts. me hurting the baby, others hurting the baby, all of that. I started to feel better around the time I got pregnant with my second one. I took Zoloft immediately postpartum with my second one. It helped. They are five and seven and I still deal with this sometimes. I had never experienced anxiety until I had children. the only way I can describe it is soul crushing

    1. I also experienced this after my 1st pregnancy almost 9 years ago. I had 2 more children after and not any where as bad as the first experience with PPD/A. I do also experience the symptoms still but when I look back at my childhood I can remember high anxiety and unrealistic thoughts even then. I just didn’t have the tools to identify what it was.

  6. Thanks for sharing this piece. I am especially looking forward to the next one because I want to hear more about your take on the conversation about ppmd and attachment parenting. I have found that my ppmd experiences are used against me as evidence that I ought not be attachment parenting. For example, my depression is exacerbated by my lack of sleep and I have been told that cosleeping and breastfeeding are the problem. The pro/anti attachment debate should not be part of the ppmd discussion. It isn’t supportive to a woman with ppmd to undermine her parenting values.

  7. I too experienced significant PPD, my symptoms were debilitating anxiety attacks and inability to sleep. I lost 35 pounds in 4 weeks. My OB GYN suggested Zoloft and I took it and am so relieved that I did. It wasn’t hard to come off of.

  8. I wish mine was this mild. I wish I could just turn to a friend and say “I didn’t know you think about bad things happening to them in such detail” and not REALIZE that’s PPD or PPA or whatever. Mine is so bad I’ve been hospitalized twice now. There’s no way I couldn’t have known I was thinking and feeling abnormally.

    1. Tori, I’m sorry you’ve had this experience. I’ll echo what Catherine says below, for many women, it’s not that the symptoms are mild so much as completely hidden. As you probably know, some mothers have managed to internalize PPA and allow it to become a part of our typical thought processes, rather than recognizing it for what it is. If something is a problem but someone doesn’t know what to do about it, they may suffer in silence. I hope someday we can all own our individual experiences and heal from them no matter the degree of severity.

  9. This is such a great wake up for me. I’m still deep in the abyss of postpartum anxiety and I still so often doubt the diagnosis, thinking that I’m a regular gal and that most women experience this. The grey area between no symptoms and extreme PPD/A is vast and I hold to a belief that the number of women who suffer is greater than is believed. I echo Tatiana’s comments on the “disorder” coupled with attachment parenting and I encourage conversation around ending shaming of our choices in parenting and our experience with PPD/A. This is a subtle form of oppression and I believe there are other, more compassionate, ways of supporting families who cope with challenges postpartum. I also want to reframe the experience for Tori… I’m sorry to read the severity of symptoms for you, and it isn’t that many of us don’t REALIZE there is a problem (ie. I argue that the symptoms are not necessarily mild) rather there are so many factors for us as individuals that would prevent us from thinking we might need extra support or help. What is relevant is that there needs to be waaaaay more conversation, acceptance, kindness and support for EVERY woman post birth.

  10. Talk to your Dr and have a full blood test done as well. I was having panic attacks and shaking six months after my first. My postpartum anxiety turned out to actually be Graves Disease which is a thyroid imbalance that can cause tremors and anxiety.

  11. thank you for sharing ….I am going threw some really bad PPA right now the scary thoughts the feeling that my son is going to get hurt every second of the day. I have had hard time focusing on other things other then my son because I feel like if I turn my attention away from my son then something will happen to him because I took my focus off of him . I some times don’t know what to do and I scare myself for how I think and then I feel like a bad mom for how I feel.my son is now 16 months and I cant seem to feel like I cant enjoy him like I want to because of my fears and thoughts. I feel so alone because my family and friends don’t understand.

    1. Lina, I’m so sorry you’re dealing with that. If you haven’t already, please consider visiting the links at the bottom of the post to find some help. When friends and family don’t understand, it’s so important to connect with other people who do. You are NOT a bad mom.

  12. Catherine and Tatiana, please feel free to contact me ([email protected]) if you’d like to share more about your experiences and thoughts regarding PPA and attachment parenting. It sounds similar to some of what I’ve seen and heard, and I’d love to explore it further.

  13. Thank you so much for this article. So many things make sense to me now. My son is 2 and I’m still having issues and I just thought it was ‘me’. My relationship has broken down because of my mood swings, negative thoughts, always thinking the worst, being so easily irritated and angry, pretty much all the symptoms listed. How I wish I’d stumbled across this article before my family broke up because my partner couldn’t deal with it anymore. Now I’m armed to go to my doctor and get some help, at least I can start to enjoy being a mommy more instead of spending the whole time worrying about everything. Thank you.

  14. Thank you for this beautiful and important post. This was my experience of PPA too – though I too didn’t realize it at the time. Now I work with moms and families who are experiencing PMADs and so I know firsthand, and from personal experience, that being able to speak our truth not only helps us recover faster but it also helps break down the shame and stigma that is inexplicably attached to postpartum depression and anxiety. My wish is for all mothers who are suffering in the darkness to be able to find postpartum support groups in their community, which is why posts like yours are so immensely valuable in helping de-stigmatize this horrible illness.
    [email protected]

  15. I am also a birth doula and had helped many women with their births, but was not prepared with my own postpartum experience. I had a wonderful, all natural birth, but lived in a postpartum fog for 18 months of my son’s life, trying to get by each day. In the early days I had hot flashes panic attacks, especially when he started crying in public. I started limiting leaving the house to times I knew he was fed and napped. He was a horrible napper and is still up at night 2-3 a night at 26 months.
    I had obsessive thoughts about his sleep, and would recount how many hours he or I slept. I did some mild sleep training with Elizabeth Pantley’s No Cry Sleep Solution, but was more than obsessed with his sleep or lack of my sleep. It got a bit better after 6 months, but it took me a year to comfortably leave my house at night to go out, because I was worried he would wake up an I wouldn’t be there to comfort him. I kept most of my anxiety hidden from my husband, because he suffered from postpartum depression, anxiety and had panic attacks to the point where he had to seek therapy. I tried to be the glue that held us all together. My husband was surprised to hear what I went through internally when I finally told him about how I felt. We as a couple have decided not to have any more children, because of our experiences. I do follow attachment parenting methods with cosleeping and breastfeeding mainly it helps with my sanity at night time, so will be very much interested in your article.

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