I went walking with another new mum the other day. It felt like a luxurious indulgence given the months of Stage 4 lockdown that we have experienced in Melbourne. Both of us had given birth during Covid. She’d had a gorgeous baby girl and I’d had two beautiful baby girl MCDA (monochorionic diamniotic) aka identical twins. When we saw each other we cooed over our littles and were exuberant to connect and share stories about our experiences as new mums in lockdown. We talked about the absolute joys of having our babies, how insanely adorable they were and their cute antics. In the same breath, we talked about the horrors of sleepless nights, the loneliness of Covid, the myriad projects we were both working on and how excruciatingly painful it was to have to wade through postpartum depression in the midst of all that we had on.
Yet, somehow we were coping. Was it because she was a psychologist and I was a neuroscientist that we were able to chat so openly and casually about our experiences managing postpartum mood swings? Perhaps it was because we each understood that the range of emotions we had been experiencing were so vastly different than us in a ‘normal’ state that it was if we were merely observing and assessing a set of symptoms as opposed to truly feeling them.
When I first called my GP to tell him I thought I might have some form of postpartum depression he said he wouldn’t be surprised if that was indeed the case. My mood was all over the shop.
In his mind I ticked all the boxes for someone who he would deem high risk. I’d had a fairly traumatic post birth experience. I hemorrhaged at birth losing more than 2 litres of blood, my doctor subsequently forgot to remove my stitches resulting in them growing into my skin. This, along with a drain tube that he accidentally left in me, meant that I found myself back in the operating room being cut open again six weeks after my birth to remove it all. I had also developed a gastric ulcer, likely as a result of the physical trauma experienced during the birth, and physically it was all a bit rough. Because the girls were born just as Covid hit, my partner and I were unable to get the support we had planned on.
It was us against the world with a four year old in tow and two new baby girls to juggle. I was running a startup and he was busy writing and preparing for a promotion. When my eldest daughter’s early learning centre sent an email to say they were shutting down because there had been Covid positive cases detected, we looked at each other and cracked up laughing. It was as if the universe was playing a joke on us. Separate from family in a country that was not my own it was all starting to feel like a bit much.
My GP took me through a questionnaire where he asked me to rate my responses to various statements on a scale from 1- 5 so he could get a sense of my overall mental state. “You are scoring fairly high” he said deadpan. Yup. No surprise there. It was all laughable really in that funny, not funny kind of way.
I share my experience because it is so important for women to talk about these things. To share stories with one another not so that we can feel as if what we are going through is normal - it isn’t - but it is common, and by sharing we can feel less alone.
The impact of our hormones on our physiology and mental state is powerful and real, but we don’t have to suffer in silence, feel shame, or be a victim of biology. There are resources available to help and sometimes it just takes connecting with another person.
So how do you know the difference between baby blues and depression?
Well first things first, I want everyone to know it’s common for a mother to feel depressed or moody after giving birth. This fact can come as a big surprise. The general going in expectation is that after you have created a baby human and brought them into the world you are meant to feel grateful, euphoric, exuberant. Well, that’s not the way hormones work. Sorry.
As a result of the myth of inflated happiness, many women are left with feelings of guilt when unsurprisingly things don’t actually feel that good. About 80% of mothers will experience baby blues in the first week to two weeks or so after giving birth. Usually these symptoms resolve on their own without requiring any medical intervention.
Symptoms of baby blues
For between 10 - 20% of women these symptoms linger and you may begin to experience postpartum depression (PPD). The tricky thing is that many women don’t identify with feeling “depressed” at all. This makes it fairly hard to diagnose. Most women with PPD will describe anxiety as one of their most notable symptoms, and in fact in about 50% of women postpartum anxiety (PPA) is comorbid with PPD.
Symptoms of PPA:
However, it can also manifest in other forms - such as postpartum panic disorder. This is “a form of anxiety with which the sufferer feels very nervous and has recurring panic attacks. During a panic attack, she may experience shortness of breath, chest pain, claustrophobia, dizziness, heart palpitations, and numbness and tingling in the extremities”. Another form of anxiety is postpartum obsessive compulsive disorder (OCD) which is now an official category of its own. Because having a new baby is hard work a lot of women will just assume that these fluctuations in mood come with the territory of new parenthood. However, if your symptoms continue for more than a few days and you find that even weeks after birth you are still feeling low or overwhelmed you may want to seek support.
So what does it feel like?
For some women it might feel like nothing at all.
Others describe feelings of depression, anxiety, anger, rage, or even OCD. After giving birth to my twins I was fascinated by the range of emotions that I would feel in a given day.
Some days it would just feel like not wanting to get out of bed in the morning, and I would have to remind myself that it was just the hormones making me feel this way and well, I would force myself to get out of bed.
On other days it was simmering rage at my partner. We both found this amusing as we are fairly relaxed individuals, not to mention he is the world’s most empathetic and nurturing partner. In my PPD state, he might as well have been the devil incarnate.
There were times where I would suddenly find myself with a bout of OCD. I would be overcome with the desire to clean - everything. I’m talking 4am wakeups walking through the house clearing surfaces and mopping floors.
The ways in which postpartum mood disorders can manifest are myriad.
From a neural perspective, I find it interesting that the systems implicated in postpartum anxiety and depression in particular appear to interact with and overlap with those that are involved in maternal caregiving. This makes a lot of sense to me. There are numerous research studies that show that postpartum depression can result in mothers feeling disconnected from their babies. In my case, I made an extra effort to practice skin to skin contact and also breastfed the twins exclusively to try and overcome the wiley impact of what I call “separation” hormones. I was also intentional about getting outside, taking a walk, reading, and meditating. Even a simple shower break can go a long way—anything that’s calming to the system.
So what to do if you think you may be experiencing a postpartum mood disorder?
Ultimately, know that you are not alone and there is help available. And remember, unfortunately, while postpartum depression is well researched there are not a lot of studies available on postpartum mood disorders more broadly. As such it may not show up in the way you might expect. If something doesn't feel right or if you find that you have persistent mental or physical symptoms:
And remember the next time you see a new mama holding a new baby recognise that the emotions she is experiencing might be myriad. If she tells you that she is “fine” look a little closer. A simple “how are you” stated in an open, curious and empathetic way may go a long way to getting her to open up and speak freely.