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
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
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
