We have this picture-perfect image of having a baby. If you are ever asked to describe how having a baby might feel, you would say magical, heavenly, deeply emotional and loving, right?

But it’s not the case always. Sometimes instead of feeling overjoyed and extremely happy, mothers feel weepy, sad, anxious and vulnerable. Some feel like that for short periods of time, whereas some mothers report feeling like that ALL THE TIME.

Some new moms report feeling irritated and angry, some withdraw from their partner or struggle to bond well with their baby. Some suffer from feelings of guilt or worthlessness, some even think of harming themselves.

The added stress resulting from the anxiety and social isolation of the COVID-19 pandemic, is creating further challenges for new mothers. These challenges contribute to increased rates of postpartum mood disorder during the COVID-19 pandemic.

Often, mothers suffering from such feelings, are misunderstood and mishandled. In better cases all of these symptoms are clubbed together and termed as “Baby blues” and mothers are told that it is normal for new moms to feel this way and this phase will pass.

But the fact is, though some symptoms usually disappear on their own, some do not.

It is of great importance that we, as new moms and also as someone who knows a new mom, learn to differentiate between what is normal and what are the red flags so that right actions can be taken to handle these situations.

Different Types of Postpartum Depression

Clinically, postpartum depression is defined as depression or a serious mood disorder after the delivery of a child.

Sadness, worry, melancholy, and tiredness are all symptoms of postpartum depression, which can make it difficult for mothers to care for their newborn baby and interfere with their normal activities.

Postpartum mood disorder affects each person differently and to a different degree. The “baby blues” are a milder and more short-term kind of depression that affects most of the mothers.

On the other side, a condition known as "postpartum psychosis" affects a very small number of mothers in extreme situations.

Baby Blues

First let’s talk about the more common and less severe “Baby Blues”.

Most new mothers will experience some negative feelings after giving birth, believed to be brought on by sudden change in hormone levels, sleep deprivation, stress and fatigue. This is known as the baby blues.

The most common symptoms of baby blues are:

• Weepiness/crying for no apparent reason
• Mood swings with irritability and anxiousness
• Feeling overwhelmed and emotionally fragile
• Poor appetite and sleep disturbance
• Feeling of loneliness

Baby blues usually kicks in 2/3 days after childbirth, peaks around one week and resolves on its own within 2/3 weeks after delivery, without any intervention.

Moms you should know that you are not alone to feel this way, and this phase will actually pass soon. Almost 50% to 85% of new moms experience the "baby blues" after delivery and recover without much intervention.

Family members should also treat the new mom with patience and provide reassurance that this will pass and the mom is doing nothing wrong.

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Postpartum Depression (PPD)

Postpartum Depression (PPD) however, is a more serious problem. In the beginning, PPD can look like the normal baby blues as mothers suffering from PPD show all the symptoms of baby blues. The difference is that with postpartum depression, the symptoms are more severe, lasts longer and shows no signs of improvement over time.

Symptoms of PPD include:

• Excessive and uncontrollable crying
• Persistent feelings of sadness, hopelessness, numbness or emptiness
• Extreme mood swings
• Exhibiting angry behavior toward others
• Fatigue and loss of energy
• Trouble sleeping and eating
• Withdrawing from friends and social activities
• Doubting her ability to care for her baby
• Inability to form a bond with the new baby
• Thoughts of hurting yourself or your baby

Approximately 15% of new mothers will experience PPD. Symptoms may occur a few days after delivery or sometimes as late as a year later.

In most cases, moms suffering from PPD cannot feel better without intervention. Treatment may include counselling and/or medication.

Because postpartum depression can range in severity, it’s very important than you talk to a doctor if you feel you are suffering from these symptoms.
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Postpartum Anxiety (PPA)

Another condition that new moms suffer from is Postpartum Anxiety (PPA).

It’s quite normal to be concerned about your baby during pregnancy or after birth. But if your anxiety is uncontrollable and you can't get these worries out of your brain, you might be suffering from pregnancy or postpartum related anxiety.

Postpartum anxiety affects about 10% of postpartum women. Some moms may experience anxiety only while others experience depression with the anxiety.

Symptoms of anxiety often include constantly worrying about the baby - whether the baby is safe, is breathing, is getting enough to eat, is growing properly, or whether something bad will happen to the baby.

Symptoms of PPA include:

• Constant worry about the baby and/or other issues
• Impending fear that something bad is going to happen
• Racing thoughts that you have difficulty controlling
• Trouble with focusing or being present
• Physical symptoms such as dizziness, hot flashes, and nausea
  

Postpartum anxiety is very much treatable and will go away with counselling and/or medication.
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Postpartum OCD:

Symptoms may include:

• Overly occupied with keeping your baby safe
• Compelled to do certain things over and over again to help relieve her anxiety and fears
• May recognize these obsessions but feels horror and shame associated with them
• Obsessions or thoughts that are persistent, are repetitive and can include mental images of the baby that are disturbing
• Fear of being alone with the baby

Maternal Obsessive-Compulsive Disorder (OCD) affects 3 to 5% of women. About 50% of women with postpartum OCD have intrusive or unwanted thoughts about intentionally harming their infant (e.g., throwing the baby).

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Birth-Related PTSD

Postpartum post-traumatic stress disorder often affects women who experienced real or perceived trauma during childbirth or immediately after the baby was born. It is believed that approximately 1-6% of women experience postpartum post-traumatic stress disorder after giving birth.

Symptoms may include:

• Nightmares and flashbacks to the birth or trauma
• Anxiety and panic attacks
• Feeling a detachment from reality and life
• Irritability, sleeplessness, hyper-vigilance, startle more easily
• Avoidance of anything that brings reminders of the event such as people, places, smells, noises, feelings
• May begin re-experiencing past traumatic events, including the event that triggered the disorder

If you see any of these signs and symptoms of depression, please do not waste time. Seek professional help or contact your doctor as soon as possible.

Timeline of PPD

Everyone's PPD progresses at their own pace. PPD can develop throughout pregnancy and up to one year after delivery, so don't underestimate your feelings if they occur outside of the normal postpartum period.

Stages in which postpartum depression symptoms may begin include:

Prenatal

Many women begin to experience prenatal anxiety three to four months before giving birth. These signs and symptoms frequently persist after the baby is born. They can transition into symptoms of postpartum depression or postpartum anxiety disorders.

Immediate (48 hours to 4 weeks following Childbirth)

In some cases, women start to experience postpartum depression symptoms almost immediately. Symptoms might appear as soon as 48 hours after delivery and can last up to 4 weeks. These symptoms are frequently strong and acute.

1 to 6 Months Postpartum

Most cases of postpartum depression arise in the 1 to 6 months following childbirth. It is most common for postpartum depression to begin sometime within the first 3 months after giving birth.

6 Months to 1 Year Postpartum

Some women may not exhibit any symptoms until 6 months following childbirth. These delayed symptoms can be shocking for many women to cope with. Therefore, it is important to be aware of postpartum depression signs and symptoms.

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Causes & Risk Factors of Postpartum Depression

In some cases, it’s unclear as to why and how a woman developed postpartum depression. This can make it even more confusing and challenging for those suffering from this crippling condition.

Experts agree that there is not one thing that causes postpartum depression, but multiple factors taken together that can trigger it. Each woman who develops postpartum depression has her own set of risk factors that make her more susceptible to its development.

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Hormonal Causes

Your hormone levels change dramatically after giving birth. During pregnancy, your body’s levels of estrogen and progesterone are extremely high. Within the first few days after birth, they quickly drop. It’s similar to the hormone changes that happen during PMS, only more intense.

In addition to estrogen and progesterone, your levels of thyroid hormones may dip after birth. If the dip is sharp, you may end up experiencing symptoms of fatigue, sluggishness, and depressed mood.

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Sleep Deprivation and Physical changes

‍When you're sleep deprived and overloaded, even little issues may be difficult to handle. You might be worried about being able to care for a newborn. You could be less beautiful, have identity issues, or feel like you've lost control of your life. Postpartum depression can be caused by any of these factors.

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Stress and Anxiety

I know, having a baby is the most wonderful thing that has ever happened to you, but that doesn’t mean you don’t feel some stress. Or a great deal of anxiety.

You'll probably have to modify your job and home habits, as well as renegotiate your closest relationships, on top of feeling like you have no spare time. It's no surprise that your emotions are heightened.

You may also feel overwhelmed by the duty of caring for this little child at times. You could question your abilities to be a good mother or whether you're doing enough for your child.

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Lack of Support

‍It might be very difficult to bring new life into the world. If you’re a single parent (and that wasn’t your desire or plan) or have an unsupportive partner or you lack nearby family and friends to lean on, you may feel exhausted, tired and depressed.

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At the same time, there are certain factors that may increase your risk of developing postpartum depression, including:

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Genetical and Medical factor

‍Those who have struggled with mood disorders like depression or anxiety or more significant mental illnesses like bipolar disorder are 30% to 35% more likely to face postpartum depression in their lifetime.

Women who have experienced postpartum depression in previous child births are also much more likely to experience it again.

Recent studies have shown that there is a possible genetic factor in developing postpartum depression.

Other Risk Factors:

‍There are a variety of other possible risk factors that play a role in whether a woman will develop postpartum depression

• Having an unplanned or unwanted pregnancy
• Being under the age of 20 when pregnant
• Current substance abuse such as drugs or alcohol
• Abruptly stopping taking medications during or after pregnancy
• Parenting a baby who is sick, has health issues, or other special needs
• Birthing multiples (twins, triplets, etc.)
• Particularly difficult breastfeeding challenges
• Increased stress about childcare and/or returning to work

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How to cope with PPD

Having PPD does not imply that you are a horrible mother or that you do not love your child. You might not always know how to deal with your emotions. If you're suffering from PPD and don't know what to do, here are some suggestions:

Tip 1: Create a secure attachment with your baby

A secure attachment is formed when you as the mother respond warmly and consistently to your baby’s physical and emotional needs. When your baby cries, you quickly soothe him or her. If your baby laughs or smiles, you respond in kind. In essence, you and your child are in sync. You recognize and respond to each other’s emotional signals.

However, learning to bond with your baby not only benefits your child, it also benefits you by releasing endorphins that make you feel happier and more confident as a mom.

Here are some ways that you can strengthen the bond with your baby.

Skin-to-skin contact

Whether you're breastfeeding or formula-feeding your infant, try doing so while their bare skin is against your own. Skin-to-skin contact soothes you and your kid while also strengthening your relationship.

Close physical touch with your baby releases oxytocin, sometimes known as the "love" or "cuddle hormone." Increased oxytocin levels help you feel better, more compassionate, more sensitive to others' feelings, as well as making it easier to understand nonverbal signs from your kid.

Smile

‍Research has found that when a mother sees her baby smiling, areas of her brain that are associated with reward light up. The areas that are stimulated relate to the neurotransmitter dopamine (‘Pleasure Hormone’)

Singing

‍Singing to your infant not only gives them the sensory stimulation they require to concentrate their attention, but it also serves as a distraction from the negative thoughts connected with depression, while also empowering you as a parent.

Tip 2: Take care of yourself

Taking care of yourself is one of the best ways to relieve or prevent postpartum depression. Simple lifestyle changes can go a long way towards helping you feel like yourself again

Make meals a priority

‍When you’re depressed, nutrition often suffers. What you eat has an impact on mood, as well as the quality of your breast milk, so do your best to establish healthy eating habits.

Consuming a diet rich in omega-3 fatty acids, which are found in oily fish such as salmon, sea- fish, nuts, seeds, eggs, spinach- etc during pregnancy may lower the risk of postpartum depression.

Get some Sleep

‍A full eight hours sleep may seem like an unthinkable luxury when you’re dealing with a newborn, but poor sleep makes your depression worse. Enlist the help of your partner or family members to look after the infant so that you may get at least a few hours of sleep.

Get out in the sunshine

‍Your mood will be significantly improved by exposure to sunlight and fresh air. Please don't think too much, even if your hair is a mess or your clothing isn't perfect. Simply go for a walk with the stroller and try to spend at least 10–15 minutes outside each day.

‍Ease back to exercise

Studies show that exercise may be just as effective as medication when it comes to treating depression, so the sooner you get back up and moving, the better.

No need to overdo it: a 20-30 minutes walk each day will work wonders. Stretching exercises such as those found in yoga have shown to be especially effective.

Tip 3: Lean on others for help and support

In today’s world, new mothers often find themselves alone, exhausted and lonely for supportive adult contact. Research has shown that loneliness leads to painful feelings of isolation, becoming disconnected from others, and feeling as though you do not belong.

Receiving social and emotional support from others can enable you to better cope with problems on your own, by boosting your self-esteem and sense of independence.

Make your relationships a priority

‍When you’re feeling depressed and vulnerable, it’s more important than ever to stay connected to family and friends. Isolating yourself will only make your situation feel even worse.

Don’t keep your feelings to yourself

‍Share what you’re experiencing- the good, the bad, and the ugly—with at least one other person, preferably face to face. Let your loved ones know what you need and how you’d like to be supported.

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Tip 4: Make time for your relationship

For many couples, the relationship with their partner is their primary source of emotional expression and social connection. The demands and needs of a new baby can get in the way and fracture this relationship unless couples put some time, energy, and thought into preserving their bond.

Don’t scapegoat

‍The stress of sleepless nights and caretaking responsibilities can leave you feeling overwhelmed and exhausted. Since you can’t take it out on the baby, it’s all too easy to turn your frustrations on your partner.

Instead of finger pointing, remember that you and your partner do not belong to separate teams. If you tackle parenting challenges as a team, you’ll become an even stronger unit.

Communicate!

‍Many things change once a child is born, including responsibilities and expectations. For many couples, the distribution of household and childcare responsibilities is a major source of stress. It's critical to address these concerns rather than allowing them to fester.

Please don't assume your partner understands how you're feeling or what you're looking for.

Reconnect with your husband!

It's essential to make time for just you and your partner to reconnect. But, don’t need to put too much pressure on yourself to be romantic or adventurous. To enjoy each other's company, even spending 15 or 20 minutes of quality time together is more than enough. It makes a significant impact on your emotions of intimacy.

Moms, you must always remember that experiencing postpartum depression is not your fault. So, never feel guilty or ashamed about how you feel.

How Families can Help a new mother with Postpartum Depression

Research has shown that one of the critical risk factors of women developing postpartum depression is a lack of support. Women are more likely to improve their symptoms and recover from postpartum depression if they have stability and support at home.

Many partners and family members really want to help but they clearly do not know how.

Encourage her to talk about her feelings

‍Listen to her without passing judgment or making suggestions. Rather than attempting to fix things, just simply be there for her.

Offer to Help around the house

‍Assist with household chores and childcare responsibilities. Don’t wait for her to ask! Encourage her to take breaks.

Go for a walk with her

Exercise can help her feel better, but it's difficult to stay motivated when she is depressed. Make walks a daily habit for the two of you to help her.

Validate the things She Does Well

‍Remind her of all the things she achieved that day while caring for and seeing her child to validate her efforts. Make a point of mentioning how healthy the baby is and how the infant just smiled at her. Recognize how tough it is to manage on little sleep when caring for a newborn.

Let Her Know She Is not Alone

Just letting her know you are right there with her and will give her whatever support she needs will be a huge comfort.

What Families Should not Do

In our country instead of providing enough support, family members sometimes unknowingly make things difficult for a new mom - why is she acting like this? Why isn’t she more excited with her newborn?

Sometimes they may actually cause further problems by being overbearing or insensitive. Here are some tips of what not to do when offering support:

• Don’t make this worse by making a lot of suggestions, like- mom should have exercised more during pregnancy or that her diet was lacking in some way.
• Never make her feel weak or that she is responsible for the depression.
• Don’t intrude unless it is obvious she needs urgent assistance or care. Offer to help in specific areas and if she declines, try something else or do something behind the scenes such as helping with household chores, cleaning, washing, cooking etc.
• Never comment negatively on a woman’s shape or behavior after childbirth. This is never helpful and can cause the depression to worsen.
• Don’t talk about her career and other future plans.
• Please try to give new moms some privacy while breastfeeding her child.
• Do not put a lot of pressure and responsibility on her.

Food for thought!

Baby Blues, Postpartum Depression (PPD) & Postpartum Anxiety (PPA) can affect any woman. These diagnoses do not discriminate based on race, religion, socioeconomic status, or culture. The impact of not treating these symptoms can be incredibly costly to the mother and equally to the baby.

It is time to lift the taboo from these conditions.

Moms, always remember that, suffering from any of these DOES NOT make you a bad mother. Do not feel guilty or ashamed. You are not at fault here. Treating these symptoms as you treat any other symptom is the first step. Be aware of these conditions and make sure you get help from a doctor or a counsellor if you think you are showing symptoms of PPD or PPA and its not getting better over time. Be assured, you can feel better with proper intervention.

Wishing a happy motherhood to all the moms out there!

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Disclaimer: This article should not be used as a diagnostic tool. Rather use it for awareness and seek appropriate help.