For those of you who are not familiar with my writing, I am a 29 year old mother of two little boys (1.5 and 3). I worked full time (while pursuing my undergrad psychology degree) while I was pregnant with #1. After #2 was born, I stopped working (since it would have cost me more than I made to put the kids in daycare) and became a stay at home mom. I am now pursuing a Master’s Degree in Mental Health Counseling. From the incredible amount of research and reading I’ve done as a result of my schooling, I’ve become passionate about the challenges of becoming a mom, especially when it comes to postpartum depression (PPD).
During my first pregnancy, I lost my libido, and it has never fully recovered (more than 3 years later.) This (among a number of other things) contributed to serious relationship issues with my husband (though we have since been able to work through our struggles and have devoted ourselves to improving communication and understanding). What does any of this have to do with PPD? Well among the diagnostic criteria for PPD, a libido that has not returned after you have been cleared to have sex again by your doctor is included. Of course, everyone’s comfort level with postpartum sex is going to differ, especially if there was tearing that needed stitching. That being said, if your baby is now a few months old and you still have no interest whatsoever in sex, it could be a sign that something else is going on.
The following is a list of diagnostic criteria (symptoms) for PPD. The bold symptoms, even if they occur alone (but very frequently occur with other symptoms) are a major signal that a woman is experiencing some level of PPD. The symptoms that are not in bold are still important. I never had thoughts of harming myself or my children, nor did I have problems bonding with them; however, I did isolate myself and have excessive feelings of being tired, sad, and overly emotional about seemingly insignificant things even after my son was over a month old (and in general, your body’s hormones have leveled back out.)
- Difficulty caring for baby’s basic needs
- Difficulty bonding with baby
- Shame or guilt (even if there is “no reason”)
- Loss of interest in activities for pleasure
- Loss of libido (after being cleared by M.D. or O.B. for resuming sexual activity)
- Social isolation
- Exhaustion and fatigue (beyond the normal adjustment period)
- Thoughts of self harm, or harming the baby
Many of these symptoms are also symptoms of depression in people who are not postpartum, but have been modified according to research with women who are experiencing depressive symptoms and who are also postpartum. It is estimated that up to 85% of women will experience some sort of mood disturbance after delivery, but most of this is contributed to the physical, emotional, and social adjustment that comes with having a baby. Anywhere from 7% to 25% of women may develop PPD (these numbers are estimated because most researchers believe that PPD is underreported). Even if you have only two or 3 of the less severe symptoms, you may be suffering from PPD if you have been experiencing them within four weeks of giving birth and the severity of the symptoms is not declining as time passes.
I recently completed a project for my human development class on the potential impact of PPD on child development. While doing my research, I discovered a wonderful paper on PPD which attempted to analyze the current state of research and views of PPD. The author completed her own study and subsequently came up with a number of recommendations to enhance the way we diagnose, treat, an ultimately view mothers with PPD. The most important aspect of Mauthner’s research was that while it may be physiologically and emotionally “normal” to have a challenging adjustment period after giving birth, we must normalize and validate each woman’s experience without causing women to assume that it is normal to be depressed. Indeed the drastic hormone changes that come with labor and delivery can wreak havoc on one’s body and mind, but by saying that PPD should be seen as a “normal” experience leaves women feeling as though they are inherently damaged.
The shift in American society to small nuclear families means that instead of growing up with child bearing women around us, we often grow up seeing a mainstream, medicalized view of birth. Instead of navigating pregnancy with our mothers, sisters, grandmothers, aunts, and friends around to help, we are often left to our own devices while still working, going to school, tending to other children, and all of the other roles that often come with being a woman, and we often do so alone.
Mauthner sat down with 40 women and asked them to describe their experiences in an attempt to better understand and redefine PPD. The following bullet points are a “nutshell” version of the meaningful information from this paper.
- Mothers with PPD frequently experience a conflict between their idea about the mother they should be and the mother they actually are.
- The expectation of culture is that mother’s should be happy post partum. This often leads to mothers remaining silent about their struggles because when they do reveal their feelings, they are often invalidated or criticized. This may lead to increased feelings of social isolation and withdraw.
- Mothers who experience PPD may be facing the challenge of a difference in what they expected the experience of motherhood to be versus their subjective experience of new motherhood.
- A combination of factors may contribute to the development of PPD including: access to social support, quality of social support, partner support (quantity and quality), relationship strain with a partner who is present, predisposition and/or history of depression, differences between expectations and reality of motherhood, a challenging or not as expected pregnancy and/or birth experience, self esteem issues about one’s body after having a child, infant health, infant characteristics, breastfeeding challenges, and level of fatigue and exhaustion.
Inspired by Mauthner’s study, and in an an effort to better understand women’s subjective experience of PPD, I created a survey to supplement my research project. I created a brief (10 question) online survey an asked for volunteers to respond to the survey at their convenience. Respondents varied in locations across the world due to solicitation for volunteers through the internet (a big thanks to TBS for posting it on the wall!) Women were asked if they experienced PPD and what their experiences of the post partum period were. Respondents (N=74) reported on level and quality of support systems, whether or not they took medication and/or attended counseling, what helped, what did not help, and their history of family and mental health.
What women with PPD said about their support systems.
- Report less support (or significantly limited support) from friends, family and partners than women without PPD.
- Those who felt somewhat supported often described a partner who worked and thus was not around to help as much, multiple children, and/or lack of local friends and family available to help with every day needs.
- Report greater frequency of relationship strain with partner, and higher levels of relationship strain with partner than women without PPD.
- Report lower frequency of partner support and involvement than women without PPD.
What women without PPD said about their support systems.
- Are more descriptive about positive support systems and report greater levels of family involvement such as their mothers coming to stay for a week or more, and friends frequently coming to help with household chores.
- Describe their partner as being “very supportive” more often than women with PPD.
- Those who do report relationship strain still describe their partners as being supportive and helpful, as well as being able to mediate relationship difficulties more easily than mothers with PPD.
Women with PPD were asked about what they think might have helped them manage their PPD and daily life.
- Someone to talk to
- Not being told “You’ll be fine, just be happy you have a baby”
- Validation and acknowledgement of their experiences and struggles
- Greater frequency and quality of social support
- Self care opportunities (such as showering, naps, or reading a book while someone else watched the baby)
- More preparation about what to expect life with a new baby would be like
- Talking to other women with PPD
- Many reported they would have liked to try counseling but were unable to due to cost and opportunity
What women with PPD who received counseling or other services said about what helped them manage their symptoms.
- women who saw a female counselor reported positive experiences while women who saw a male counselor reported negative experiences.
- Medication to manage extreme depressive symptoms
- Networking with other moms (play dates, moms-only groups)
- Self Care opportunities (and encouragement by others to engage in self care)
- Dietary changes towards better nutrition
- Breastfeeding success (and support from others to do so)
- Faith based activities such as attending church
So what does this all mean? Essentially, I believe that PPD should be considered as being on a spectrum: some women have more difficulties, while others have fewer difficulties. Women with fewer difficulties should not be overlooked as being “less important” than women suffering from severe PPD. Between the physical, emotional, and social changes that take place when we spend 9 months creating a life and then bringing that precious live into this world, it is a TON to handle, much less handle it without much help. Even mothers who have a great deal of help still get PPD, and there are mothers with no help who never develop PPD. There are so many things that contribute to any mental health challenge; thus there should not be a “one size fits all” idea about PPD or any other mental health disorder. It should not be assumed that PPD is normal, but that if it does occur, it is not necessarily abnormal.
Many women get through PPD without any outside help, but nobody should have to. If you have had depression before, or are depressed while you are pregnant, take a few moments to listen to yourself if you begin to feel overwhelmed after giving birth. Just because you experienced depression before doesn’t mean that you necessarily will after giving birth, but you may be at a higher risk than mothers who have never been depressed. Also, just because you have never been depressed does not mean that you have a significantly less chance to develop PPD than someone who had depression before.
If you are experiencing PPD, consider seeing a licensed mental health counselor. A good counselor will not think that you are a hypochondriac because you are concerned that you might have PPD. In fact, most counselors believe that everyone could benefit from counseling from time to time, regardless of whether or not they meet the criteria for a mental health diagnosis. Counseling is especially beneficial to people navigating a drastic life change, even if it is not causing extreme distress. The benefits of having someone listen to you talk about your feelings and struggles can make a world of difference; especially when that person does not tell you that “everything will be fine,” “you’re overreacting,” or try to fix you. Skilled counselors will refrain from trying to cheer you up and giving you advice; they will listen to you talk because they know that sometimes the best healing and change comes from acknowledging and accepting the emotional struggles we deal with on a daily basis.
The journey of motherhood is full of joys and wonders. If you are struggling, reach out to someone for help. It is a failing to mothers and children that society often sweeps the struggles of mothers under the rug as if our challenges are not worthy of meaning. There are lots of people who can help, and many will be happy to help if they know it is needed.
As I close I leave you with this task. Next time you are standing behind a new mom at the checkout line in the grocery store and want to tell her how lucky she is and how happy she must be, instead, say this to her: “Your baby is beautiful! How are you feeling? I’m a mom too and I know how it can be both wonderful and occasionally challenging.” Maybe she won’t open up to you (especially if she is a stranger) but instead of walking away feeling guilty about her sadness, she may have some hope that she isn’t alone in this journey. By doing this, you will be working to bring women one step closer to joining together for the greater good, rather than segregating us through the one thing we all have in common; our ability to create and nurture life.
A note to the reader: I am not yet a licensed counselor and I am in no way offering medical advice. If you are concerned, please contact your practitioner immediately. Also, please be aware that there is a difference in mental health licensing and titles. Counselors are trained to listen, cannot prescribe medications (but can consult with a psychiatrist who can) an provide an opportunity to “talk through” your struggles. Psychiatrists have a medical degree and the emphasis in their education is diagnosis and treatment. If you have had a negative experience with a mental health professional before (such as a psychiatrist who prescribed meds and “didn’t listen,” consider seeking a counselor instead. They can be identified by their title of LMHC. (I’m not trying to bash psychiatrists and I know of many who are great listeners, but many people are not aware that there is a difference between a counselor and a psychiatrist.)
Mauthner, N. S. (1999). Feeling low and feeling really bad about feeling low: Women’s experiences of motherhood and postpartum depression. Canadian Psychology, 40(2), 143-161. doi: http://psycnet.apa.org/doi/10.1037/h0086833