Baby Blues, and Then Some

Many moms struggle with postpartum woes

I  n a perfect world  , motherhood would be all about teddy bears, binkies and cuddle time with baby. Upon the emergence of wrinkly and miraculous newborn, however, reality sinks in pretty quickly. Mothers expect a new baby to change life drastically, and know it will be rough-going at some times. Still, the emeotions that accompany adjustments to a new baby can be more complex than we anticipate, and sometimes the new addition to the family rocks mom's world a little too hard.

Feeling overwhelmed, unsure and moody is normal in the early days after giving birth, experts say. "We expect in the first wo to three weeks after birth that the majority of moms are going to have some of what we called baby blues," says Alison Palmer, APRN, WHNP-BC, a nurse practitioner at Manchester OB/GYN Associates, New Hampshire state coordinator for Postpartum Support International, and Postpartum Emotional Support program coordinator at Elliot Hospital in Manchester.

Baby blues can gain a foothold during the significant hormonal shifts that occur in a woman’s body following childbirth. When you add meager sleep to the mix, along with caring for the new baby, possibly trying to breastfeed, and the sudden change in family dynamics, motherhood becomes a heavy emotional load, even for women who are not first-time mothers. The circumstances create “the perfect storm for feeling overwhelmed,” Palmer says.

So, it’s not surprising that the time might be marked by some increased anxiety and mixed emotions. “But as you get beyond the first few weeks, if you’re starting to have more bad days than good days,” find that your appetite is being affected, that you can’t sleep when presented with an opportunity to do so or want to sleep too much, you might be seeing signs of postpartum depression, Palmer says.

Postpartum depression, the number-one complication of childbirth that affects about 20 percent of mothers, according to Palmer, is an umbrella term that refers to an array of different disorders, including postpartum anxiety and postpartum obsessive-compulsive disorder (OCD). While both of those conditions involve excessive worry, moms suffering from postpartum OCD also experience intrusive thoughts about something bad happening to themselves or the baby. For example, a mother might think: What if I’m giving the baby a bath and he slips under the water and drowns? Other moms report being so fearful of Sudden Infant Death Syndrome, very much publicized through healthcare providers to expectant parents, that they stay up and watch their baby sleep all night because they’re afraid that the baby might stop breathing, Palmer says.

Much of the trouble is rooted in mothers’ high expectations, says Gerry Mitchell, MSW, Postpartum Support coordinator at Concord Hospital. “They want to do everything right, so they’re really anxious about not doing things right,” she says. Knowing that society expects a joyous, glowing mother makes it “hard for moms to admit that they’re … not so happy with how things are going,” she says, and the stigma attached to mental troubles can make individuals reluctant to ask for help.

Not to be confused with postpartum psychosis, which Palmer says is rare and can lead to hallucinations and delusions, postpartum depression can include excessive crying, general anxiety, irritability and anger. Distinguishing between normal adjustment to motherhood and postpartum depression comes down to the intensity, duration and frequency of the symptoms. If symptoms occur multiple times a day and keep coming each day for more than a week or two, “that’s certainly when you want to call and ask for some help,” Palmer says.

Anxiety-related trouble can flare up at any time during pregnancy and baby’s first year, and can occur regardless of whether the new baby is a woman’s first or fourth child, and regardless of the mother’s prior postpartum experience, since many factors that can influence a mother’s emotional outcome as she has children can change over the years, including her financial and social situation and her relationship with her partner. For sure, although shifting hormones play a role in postpartum troubles, “it isn’t all biology and chemistry,” Mitchell says. And as times with co-workers and friends become distant memories, motherhood can start to feel pretty lonely.

That’s where mom-and-baby groups, offered at many Granite State hospitals, can help. Palmer cautions, however, that for mothers who are filled with self-doubt and worry, baby-and-me-type groups can sometimes do more harm than good as they magnify the struggling mom’s insecurities. Mothers who are wrestling with anxiety or depression “can have a really distorted way of looking at themselves and others, and so they see those other moms as having it all pulled together,” Palmer says. “They feel like …‘They make this look so easy. Why am I having such a hard time?’” In such cases, a postpartum depression support group is a better choice because it provides a safe forum where moms can talk about the negative feelings that they’re experiencing. Online options exist for moms who don’t have transportation or can’t get to groups easily, Palmer adds.

One-on-one therapy can also be very helpful in addressing distorted thinking, and can offer techniques for handling anxiety and intrusive thoughts, Palmer says. In addition, doctors can offer advice on the variety of medications that are considered safe for women who are pregnant or breastfeeding. “Taking a pill isn’t going to magically make everything better,” Palmer says. “But for some people it is a piece of the puzzle,” and does not need to be considered a long-term commitment.

Self-care can help boost emotional health, too. Creating a sleep plan, with shifts worked out for mom and her partner, using a breastfeeding pump if necessary so that partners can share the responsibility of feeding the baby, eating healthfully, and getting some exercise can all make a difference, Palmer says. And don’t forget to give yourself a break and get out by yourself. “I always tell moms, ‘The best gift you can give your baby is taking care of yourself. It’s not selfish. You need to do it. Because at the end of the day you’re going to burn yourself out if you continue on like this.’”

Getting Help

“Many, many moms experience postpartum depression and anxiety,” says Gerry Mitchell, MSW, Postpartum Support coordinator at Concord Hospital. But they don’t have to go it alone. The following support groups offer a place where moms can connect with other moms and postpartum emotional health experts. All are free of charge.

Postpartum Emotional Support Group at Concord Hospital
(603) 227-7000

Postpartum Emotional Support Group at Elliot Hospital
(603) 663-8927

Postpartum Support Group at Families First Health Center in Portsmouth
(603) 422-8208

Postpartum Support International
postpartum.net