For many mothers, the only picture that they can imagine is one of themselves holding their beautiful new sleeping baby in their arms, feeling a sense of calm and accomplishment with their new life as a parent. Yet, parenthood is filled with unexpected surprises. The most surprising is how quickly the joy of a baby’s birth can turn to fear, ambivalence, and dread. It becomes even more confusing to new mothers and their partners when these feelings persist or continue to intensify post-delivery, for months (up to 18 months), and/or at the conclusion of breastfeeding.

The reality is that pregnancy, delivery, and motherhood can cause even the most self-assured woman or man to feel incompetent and even regretful about having a baby. It is not uncommon to hear from new mothers such comments as: What was I thinking? This is so much harder than I imagined; I should be happy, but I just feel so sad; I wish I could send my baby back; and, How can I be so incompetent?

Even more damaging is the conclusion by many new mothers that these thoughts reveal they must lack what every woman has: “maternal instinct”, defined as that inborn “sixth sense” and tendency that “all” women possess to protect and nurture their babies. In addition, there is a belief that maternal instinct can’t be taught, but that only “real” mothers have it. According to S.B. Hardy in her book “Mother Nature: History of Mothers, Infants and Natural Selection” (1999), maternal responses exist, but they are not true instincts; instead, over time maternal responses are biologically conditioned and learned.

When a pregnancy and delivery come after years of fertility treatments or with the assistance of donation and surrogacy, there is even greater reluctance by these new mothers to admit to and talk about any feelings of sadness, anxiety, or regret. This reluctance to share these common emotions can often put these new mothers at even greater risk for postpartum issues. As one mother stated, “I have no right to talk about how hard it is to be a new mother because I wanted it.” A large study published in the Journal of Pediatrics Researchers found that women who were pregnant with twins
were 40% more likely to experience moderate to severe postpartum depressive symptoms compared with mothers of singletons.

In her book “Down Came the Rain”, actress Brooke Shields writes about her postpartum depression experience: “Postpartum depression is beyond your control. It is very real and more common than most people realize. It does not mean that you are not a good mother or that you are crazy. Above all, it does not mean you don’t love your child. There is no reason to feel embarrassed or guilty or to believe that it is something you should be able to shoulder through on your own. The most important thing is that you do not wait for it to pass. Most likely it will only get worse and cause more damage. I recovered because I got help.” One of the issues that most people have is the shame of these feelings that often block one from taking the next step and getting support.

Regrettably there is still this public perception, even by medical professionals, that these mood changes are temporary and common and due to rapid hormonal changes, lasting just a few weeks. The myth that in order to be a “good” mother one has to endure and power through these feelings is often what prevents new mothers from seeking the support and medical intervention that they need. It is now believed that postpartum depression (PPD) can have a much longer effect on the health and well-being of new mothers than was first known. It is this lack of education about PPD that frequently leads many new mothers to believe that dark thoughts and sad feelings are all in their heads and not the result of a real chemical imbalance that could be effectively resolved with psychological and medical interventions.

Experts estimate that between 70-80% of all women will experience some negative feelings and thoughts after the birth of their baby. Dr. Louann Brizendine, author of “The Female Brain”, states that hormonal shifts cause the brain chemicals such as serotonin, that help support mood and well- being, to run low after giving birth, causing mood changes. Feeling the “baby blues” is very common; it lasts only a brief time and tends to resolve on its own. For 15-20% of new mothers however, the severity and duration of these feelings can be intensified, resulting in a more serious form of perinatal mood disorder (Postpartum Support International, PPSI).

Factors that can cause an increased risk to new mothers for postpartum depression include the following:

• history of depression or psychiatric problems in the past or during pregnancy
• a previous history of postpartum depression
• a history of postpartum depression in your family
• a difficult pregnancy and/or delivery
• previous pregnancy losses or fertility issues
• infant’s health issues, such as prematurity
• difficulty with feeding
• having multiples
• lack of hands-on help in the home or other support systems
• demanding and critical family members
• other young children
• relationship or family conflicts
• increased work pressures
• financial problems
• prior history of adjustment to new experiences

For those women who have prior histories of anxiety and depression or have discontinued their antidepressant medications for their pregnancy, the risk is even higher. As Brizendine states, “Biology can hijack circuits in spite of our best intentions during pregnancy.” Add a history of fertility challenges and personal health problems and the risk continues to rise. In a recent study from the University of Michigan, researchers found that women reporting increased levels of depression and anxiety during pregnancy were frequently not given adequate treatment for their symptoms, placing them at higher risk for PPD.

Many new mothers feel the pressure to breastfeed. Conflicts over stopping can impinge on a woman seeking the best medical and psychological help, including taking SSRIs. Given that the long term benefits of breastfeeding are well-documented, and the long term effects of nursing while on SSRIs are less clear, many are reluctant to take medications until they stop breastfeeding. The belief is that the health and wellbeing of the newborn is more important than the mental health of the mother. What is less understood is the long-term impact of treatment delay on the mother and the newborn.

And what is happening to the new dad? For many new dads there is a feeling that having a baby has ruined their lives. Typical comments from some new dads include: I can’t do anything right; I thought this would make her happy; All she does is complain and cry; The work is unending; I can’t go without sleep; I was looking forward to getting my best friend back and now I fear she has been lost forever; and, She has all this help so what is her problem? Just buck-up!

Husbands and partners dread the worst when postpartum symptoms persist; fearing that their wait to rekindle their relationship has now been permanently put on hold. Studies have shown that the birth of a first child disrupts marital harmony and contributes to a decline in marital satisfaction. Increased family work at home, loss of personal freedom and flexibility, and loss of meaningful time alone as a couple are some of the reasons cited for this decline. New parenthood requires adjustments and compromises by both parents. The role of a parent is different from the role of a partner. It is important that both be nurtured.

So, what are some of the signs that you are experiencing postpartum depression?

Symptoms of PPD:

• feeling a sense of constant anxiety and fear for no apparent reason
• experiencing a rapid heart or a feeling of heaviness in your chest
• having uncontrollable crying bouts for no reason
• eating too much or too little; causing weight gain or loss
• inability to concentrate on anything for any length of time
• no interest in any activities, even pleasurable ones
• a feeling of experiencing no joy with any part of your life
• a growing disinterest or anger towards your baby
• inability to sleep or oversleeping
• needing to withdraw from others
• feeling sad all or most of the time
• dreading the day
• fearing that you might try to hurt yourself
• feeling hopeless and unmotivated, being unable to make decisions
• irritability that may quickly turn to anger that is more intense than the situation calls for, if at all

If you find yourself experiencing more than 3-4 of these symptoms with intensities greater than 7 on a scale of 1-10 (with 10 being the most intense), then contact your OB-GYN, midwife, physician’s assistant, OB nurse, or mental health provider and reach out for support. Talk with your partner and your family and reach out for guidance (PPSI).

The good news is that it will get better. Asking for help is not a dirty word, nor does it signify that one should feel inadequate or not up to the task at hand. Having a baby is a major life altering experience. Parenting is not for the faint of heart. Feeling confident as a new mom and dad is a combination of time, experience and education; the more you do something the more confident you will become. Getting help can change this negative period of your life into a positive one.

For many moms, medications with counseling can help return a brain to its balanced state (Brizendine). Often speaking with someone can make all the difference. It may help you through this uncertain period by giving you the extra support you need. It might even save your life and your new baby’s life if the depression grows in intensity and becomes uncontrollable.

The most important takeaway message is: Get support and help early. Don’t just wait for these feelings of postpartum depression to pass. You do not have to go on this journey alone!

Patricia Mendell, LCSW