What you need to know about post partum depression and baby blues

How could a woman feel overwhelming sadness when she ought to feel joy?  Trust me, that's the same question she's asking herself when it comes to postpartum depression, postpartum anxiety, or even the baby blues. Guilt is the  overarching emotion. If you are someone you love as a new mom or about to be, you're in the right place to learn more.

Whether you're a parent, a grandparent, an aunt, uncle, or a friend. There's always something to learn.  

You're listening to Healthy Looks Great On You, a lifestyle medicine podcast. I'm your host, Dr. Vickie Petz Kasper. This is episode 111, "When a bundle of joy makes you feel guilty about not feeling joy." You're going to step into the thoughts and emotions of new moms so you can better understand what they are going through. And how to help. 

 

Congratulations! You just gave birth to the most beautiful baby on the entire planet and now he snuggles up to you and smiles, the birds sing, and everyone is blissfully happy.  Or, at least that's the script you had in your head. But then there's the reality. And it's not the pretty picture you envisioned, is it?

Postpartum depression makes you feel guilty about not feeling happy. You want to be happy. You feel like you should be happy. But you're struggling. Struggling with juggling all the things that come with a newborn and now you're supposed to take care of yourself and the rest of your family.  On top of that, you're cramping, bleeding, trying to heal from stitches either in the most private area or on your belly, which still rolls over beside you in bed.

And your breasts are so engorged they feel like they'll explode. Meanwhile, your grandmother's pastor comes to visit along with the neighbor you've only met once to, uh, you know, celebrate with you. Good grief, it's no wonder 

postpartum depression overwhelms new moms. And that's just the physical stuff. We haven't even gotten to the effects of hormones yet.  One woman described it like this.  Postpartum depression is locking yourself in your house because you're afraid something bad will happen to you or your baby if you emerge.

It's being a mom because you're obligated to and not because you want to. You want to want to, but you feel so disconnected and you don't know why.  Postpartum depression is being in bed all day with debilitating fatigue and lack of interest. It's isolating yourself from everyone and everything. You're merely existing.

Surviving, but nothing beyond that. It's unexplainable, relentless sadness. It's not uttering a word to anyone all day because you have nothing to say. It robs you of what should be the best moments of your life.  Zero out of ten recommend.  Postpartum depression is serious and it affects 10 - 15 percent of women in the first year after giving birth. 

The baby blues are much more common and experienced by 65 - 85 percent of women. What's the difference between postpartum depression and the baby blues? Well, both occur after delivery, but the blues are usually mild and go away pretty quickly. The onset is typically about 2 3 days after delivery. Peaks over the next few days and resolves within two weeks.

During that period of time, it can look very similar to postpartum depression with regards to a down mood. As Elton John sang, I guess that's why they call it the blues. Also,  the inability to concentrate, and you can't stop crying. And insomnia, but I hate to even mention that because who sleeps with a newborn in the house anyway?

You just slug through the day and don't enjoy that bundle of joy.  Sounds scary, doesn't it? It's actually very common to have big mood swings in that first week or two. Some people feel anger. Others describe debilitating fatigue. The baby blues are heavy, but the cloud usually lifts in a couple of weeks. 

One woman described it like this. I cried every day in the shower at 4 p. m. when the sun went down. It was a terrible guilt I felt for being sad when I should have been rejoicing in the goodness of God. Lasted about a month.  And that's typical of the Baby Blues. They come, they go, and life moves on.  What can you do to get through the Baby Blues?

Well, first of all, give yourself some grace. Your body has been through a lot. As much as possible, don't neglect taking care of yourself. You may think, but I don't even have time to eat, much less take care of me. I know, I know, but try to rest when you can. If your baby is sleeping and you can rest, do that instead of trying to get everything done around the house.

Unless, of course, you're taking care of other kids, then encourage quiet play. And if someone offers to help, this isn't the time to be independent and tough. Let your church family bring meals, let grandparents take older kids places, and don't turn down offers to help from family or friends.  Try and have some protected time for yourself, even if it's just a long, hot shower.

And remember, alcohol makes mood swings worse, so that doesn't solve anything.  If breastfeeding is a struggle, talk to your health care provider about a lactation consultant. Most hospitals and doctor's offices can provide resources. And connect with other new moms, preferably before you deliver.  And I'd also like to mention that there is a medication called Reglan, or metoclopramide, that is sometimes used to help with milk production.

Just be cautious with it because it can worsen postpartum depression.  But most of all, don't beat yourself up. What you're feeling is common and will likely resolve if it's baby blues.  But what if it's more than that? 

While the baby blues are pretty common, 1 to 2 out of 10 women experience postpartum depression. It's much more serious than the blues. 

It's characterized by difficulty concentrating and trouble making decisions along with bad mood.  One of the hallmark signs is loss of interest in things that should bring pleasure. The medical term for that is anhedonia. Women with postpartum depression often feel worthless or experience excessive guilt.

They may feel guilty about feeling depressed. Talk about a vicious cycle. 

At the extreme end of the spectrum, new moms may feel like their newborn and their family are better off without them.  That can lead to thoughts about ending their own life. One woman shared this story: "Drowning. That's what it feels like. The waters are constantly rising and you can't breathe and you don't know who you are or why you are feeling the way you are.

You're numb and also incredibly angry at the same time. I was just going through the motions of what I knew I was supposed to do, take care of my baby and family. But all I wanted to do was not exist anymore." If you or someone you know is experiencing thoughts of suicide, either go to the emergency room or call 9 8 8. 

You can even text the number to get help. Again, that's 988, and it's not just for postpartum women. It's for anyone contemplating suicide.  Now, I know that anyone with a crib in the house has limited energy and time, so I'm going to keep mini medical school pretty brief today. But, let's talk about the hormonal withdrawal that really does a number on a new mom's body and mind.

Just think about it. One day, you're carrying a little human inside your own body. It's uncomfortable during the day and  can significantly disrupt sleep at night.  Then one day, the little one makes her arrival and boom, you aren't pregnant anymore.  It's mind blowing to think about all that happens throughout pregnancy, delivery and the postpartum period.

 Hormone levels fluctuate during pregnancy. And when the little bundle of screaming, peeing, pooping, eating, I mean, I mean joy arrives, estrogen and progesterone levels plummet.  Other hormone levels change too, including cortisol, which is the stress hormone, melatonin, the sleep hormone, oxytocin, which is the love hormone, and thyroid hormone, which affects the metabolism at every level. 

Sleep is super important and those who struggle are more at risk for postpartum depression.  

 I have an episode about melatonin in sleep. I'll put a link in the show notes.   That big hormonal upheaval after delivery always happens. But  It doesn't always have the same effect on everyone.

Some women are just more sensitive to abrupt changes in female hormone levels in the bloodstream.  And then there's the placenta.

It releases placental corticotropin releasing hormone. And those levels have been correlated to postpartum depression too. And if that's not enough to start the downward slide, neurotransmitter levels can get out of whack too. The enzyme monoamine oxidase A in the brain metabolizes neurotransmitters like dopamine,  norepinephrine, and serotonin, all of which are associated with postpartum depression.

And we really don't know why some women are more affected than others, but there are some known risk factors. If you struggled with PMS before you got pregnant, or had anxiety and depression before your pregnancy, or with a previous pregnancy, you're definitely at increased risk.  

But even  if you've experienced postpartum depression before, it increases the risk, but it doesn't always happen, so that's the good news. There were times when I had patients who had really bad postpartum depression with one pregnancy. They didn't have it with the next, but they were so anxious that they were going to, that it almost looked the same. 

Big stressors open the door for postpartum anxiety and depression, like a rocky marriage, financial strain, poor social support, or other disruptions like, say, a pandemic.  The prevalence of postpartum depression appears to be increasing with an uptick to almost 20 percent during the pandemic. Yeah, that one threw us all for a loop.

It's not clear what other reasons are contributing to the rise, but we know that pre existing mental health issues are also on the rise, and they go hand in hand. 

One brave woman shared this experience. "Severe sadness, loneliness, angry, and just so exhausted. I lost myself. I let myself and my home go. No longer cared. My house was dirty. Laundry piled up. No one checked on my mental health. No one looked at my now ex husband and asked why he wasn't helping me. I feel like everyone looked at me for all the answers and it was my fault.

I felt alone."  It's heartbreaking to hear women tell their stories. Women with Seasonal Affective Disorder are more likely to develop postpartum depression too, as well as those with a pre existing anxiety disorder. As if there weren't enough already to worry about, now you're responsible for a fragile baby's life.

And by the way, they're not really as fragile as you think, but there are endless things you can worry about if you're so inclined. And we can't cover everything in this episode, but one woman described postpartum anxiety like this.  "I felt an insane connection to my babies and was loving postpartum life.

And it's my anxiety and lack of trusting others and need for control over my child's safety that would prevent me from using childcare to get a moment outside the home without my kid. I took him everywhere and I needed a break. And I would see others freely living their lives and truly questioned Why they weren't concerned about the things I was in regards to safety, and at the same time, I would also feel frustrated that my anxiety held me hostage.

I know for some, postpartum depression and postpartum anxiety can both exist, but for others, it's predominantly anxiety. While we truly love being a mom and love spending time with our babies, and don't have the majority of our days with low energy, motivation, or lack of connection with our baby."  I think that's an important distinction, 

but speaking of things to worry about, fear of childbirth increases the risk of postpartum depression. I took care of about 5, 000 pregnant women during my career, and some of them were absolutely terrified of the delivery process. And of course, you know, people love to repeat horror stories about labor.

Why?  I don't know. But they do.  And younger moms and single moms are more likely to be overwhelmed with the responsibility of motherhood, no matter how mature they might be. And that bumps up the risk for postpartum depression. And so does having a house full of kids or having an unintended pregnancy. And the past matters too.

A family history of depression puts you at risk for postpartum depression. And of course, a history of abuse.  You're more likely to have postpartum depression if your baseline health is poor or if you have body image issues.  The postpartum body is not for the faint at heart.  And if you already struggle with what you see in the mirror, then it may throw you into a downward spiral.

Motherhood is tough, but for some it's brutal. Women who have trouble breastfeeding or have a fussy baby also have a higher chance of postpartum depression.  When does it go away?  

Even without treatment, postpartum depression may go away, or it may turn into persistent depression.  It lasts about 12 months for half of women who experience it. And man, a lot happens in a year, especially in the first year after having a baby, and it can have a big impact. Women with postpartum depression may not eat right, which can further interfere with breastfeeding, bonding with their baby, or even caring with their baby.

And in extreme cases, it can affect the baby's development.  The relationship with her other kids and her husband can suffer, too. Depressed moms are less likely to read to their kids or play peek a boo with their babies. Here's the deal. It's not your fault. Please don't be shy about mentioning it to your doctor.

You aren't the only one, and it's important to get the treatment you need. One woman shared this: "I was feeling so alone and just the deepest sadness, maybe even hopeless. And I remember my doctor telling me that I needed to call him if feelings of sadness lasted more than a few weeks. But I was afraid to call because I didn't want them to think I was crazy and take my baby away." 

Listen, that's not how this works. If you're experiencing what you think may be postpartum depression, please let your doctor know. And your OB doctor may ask you questions to determine if you have postpartum depression. Normally, when screening for depression, we ask about things like fatigue and changes in appetite and sleep.

But I don't recommend asking any new mom these Captain Obvious questions. Who wouldn't experience that with a newborn in the house?  But remember that term anhedonia? 

It's an important marker of depression. Your doctor may ask if you have lost interest in things that should bring you pleasure even your sweet newborn. Your health care provider may ask if you feel down, depressed, or hopeless. 

One of the tools used to screen for postpartum depression is the Edinburg. postnatal depression scale. Let's step into the classroom for a minute and let me explain the difference between a diagnostic test and a screening test. When developing a screening test you don't want to miss anyone. So, think of it like one of those old timey fishing nets that they used to throw over the side of the boat.

And if you don't want to miss any fish, then you make the holes really really small. Now, when you pull the net up, you're going to have to sort through what's in there to get to what you need. So screening tests are designed like this to capture everyone who might have the condition. Then the physician or provider has to drill down to the level of a diagnosis to see which ones are caught in the net with the small holes actually fit the criteria.

Does that make sense? The Edinburgh Postnatal Depression Scale is a screening tool, not diagnostic. It's 10 questions to see who needs further evaluation for postpartum depression. It takes about 5 minutes to complete and there are 30 possible points. There's a link in the show notes. 

And if you score more than 10 or 11, you may have postpartum depression. Please just talk to your healthcare provider. Help is available. And be persistent. Some clinics have this down better than others. Here's another comment. 

"At what time periods do OB doctors check in with women? I filled out a form for baby blues in the hospital when I was still riding the hive giving birth. For I saw my OB at six weeks postpartum when my days were full of snuggles and I was binge watching my favorite shows and people were bringing meals.

Life was great. My postpartum anxiety hit at month three or four when I transitioned back to work and had to rip the band aid off of , having my kids at daycare with strangers."  So,  This brings up another point. There's a role for pediatricians because they continue to see moms long after the OB doc has released them to come back for their yearly exam.

Fortunately, there is a lot more awareness now, and I think that helps with those who feel embarrassed or uncomfortable bringing it up. So, if you do have postpartum depression, you probably need to talk to a mental health counselor. And don't let the term psychotherapy make you feel weird. It's literally just talking to someone who's an expert at helping you cope with your feelings, deal with your problems, set achievable goals, and learn to respond in a healthy manner.

Let's face it, everyone has difficult relationships and this is often magnified when a new baby joins the group. Talking to someone who is objective can be healing. Now before we move on to the lifestyle medicine recommendations, I want to mention something that will sound strange.  Unless, of course, you've experienced it.

And here's the deal, at least 70 percent of new moms do experience what's called intrusive thoughts.  And they're usually about infant harm. Half of moms have intrusive thoughts about intentionally harming their babies.  A leading psychiatrist attributes this to the mom's worst fears bubbling up uninvited to the surface. 

Hormones push them into consciousness and sometimes it's a struggle to push them back down. These are often disturbing visual images that make you feel like you're losing your mind. And if none of the 70 percent of new moms who've actually had it admit it, then you think you are broken. The most common examples are of the baby falling or getting dropped, flying out of their car seat, or suffocating.

But sometimes they're even violent, like throwing the baby against the wall and smashing their head.  That can trigger self doubt and make you think that you're an unfit mother. Insecurity already makes women doubt their ability to get this whole thing right.  But if these thoughts just pop into your mind and repulse you,  then definitely talk to someone, but don't think you have to have yourself committed.

While this may sound like an oversimplification, the recommendations are exactly what I said before about baby blues. Try and get enough sleep, ask for help around the house, take a little time for yourself to relax, reduce stress, and don't try to do it all alone. Sometimes you need to distract yourself. 

Play games on your phone, do brain teasers, puzzles, get out and walk, listen to music, , and again, talk to someone you trust. Here's the best advice I can give you. Remember this, it won't always be this way.  Women with postpartum depression may need to take medication, but sometimes they barely get through the day. It's a hard place to make decisions from, especially if you're worried about the effects of breastfeeding. Since this is a lifestyle medicine podcast, we are going to review how lifestyle interventions may help.

First, start with physical activity. I know, I know you're exhausted and you've got a baby on your hip, so do something that involves the baby and any other kids, like take a walk with a stroller. Get outside and move, even if you're just creeping along at first.  And if it's not your first baby, think about activities that involve your older kids.

When my second child was born, we watched Barney the Purple Dinosaur and marched and danced around to the songs. It was a way to involve my toddler while getting my heart rate up a bit, to avoid screen time for your newborn, put them facing you rather than the TV. 

To manage stress, you need time for yourself. It may not be much time, but grab moments when you can. Prioritize what you really need to do. The dishes and the laundry can wait. Let go of unrealistic expectations that you can do everything you're doing now and everything you were doing before. You aren't Superwoman. 

You have a deep need to feel human right now, not just a caretaker for a very needy baby. So, trust someone else to take care of your little one and get out of the house.  Read a book. Don't neglect a hobby you enjoy. Schedule a date night or an outing with friends. Go shopping, get coffee, see a movie.  Let me tell you about a movie not to see.

"Beaches." You're probably too young to remember it, but after I had my first baby, I couldn't stop crying. It wasn't postpartum depression, but it was serious baby blues.  I wanted to watch a funny movie. Now, this was way back in the day when you went to the grocery store and rented a VHS tape.

Okay, Google it if I just lost you. Well, he came home with the movie "Beaches" and swore it was in the comedy section. Listen, it's a movie about a mother who has a terminal illness  and she is handing her child over to her best friend, so no, it did not help me stop crying. The point is, be careful what you watch, or what book you choose.

This is a sensitive time, and you don't want to activate your triggers. And also remember, you're not alone. 

Admit your feelings to your spouse, mother, grandmother, or a trusted friend. Isolation only worsens your symptoms. They'll be more sympathetic and helpful if they know what you're going through. And they may have some advice about soothing a fussing and crying baby. So, listen, ask for help. Let me say it again, ask for and accept help. 

And you may not be eating for two anymore, but your diet has a huge impact on your mental health. So, eat a lot of fruits and vegetables, whole grains and olive oil, and avoid red meat and processed meat, as well as refined grains, anything that has the word enriched on it, sweets, high fat dairy, butter, potatoes, gravy, and fried foods.

Some say no eggs, meat, fish, or even low fat dairy. So, if you eat those, at least make it in small amounts. And fiber makes you feel full, so eat nuts and plenty of beans.  Time is premium with a newborn around, but Fast food does not make matters better, and in fact,  can make it worse. Mood can improve in as little as two weeks if you follow a strict vegetarian diet.

If you can't do without meat, at least increase your fruits and vegetables. There is statistical evidence that that makes a difference.  You may not be able to completely avoid the bad stuff, but it is dose dependent. So don't beat yourself up about that bowl of ice cream. Just try some mango next time.

 And here's why. Mango is high in that all important omega 3 fatty acids.  In pregnant women, there is a positive association between low omega 3 levels and a higher incidence of maternal depression.  Brain chemistry is regulated by levels of the neurotransmitters serotonin, norepinephrine, and dopamine.

Brain derived neurotropic factor, or BDNF, causes the membrane of every cell to be more or less fluid. which affects production of these chemicals, as well as reuptake.  Omega 3 fatty acids affect how the cell membrane allows for things to go in and out.  Besides mango, omega 3 fatty acids are also found in seeds, like flax seeds and chia seeds, lettuce, nuts, 

 especially walnuts and also beans. Kidney beans are the best. If you're eating fish, think salmon.  Studies have shown improvement in mood with intake of saffron, turmeric, probiotics, and carbohydrate rich evening meals., but think good carbs.  Among women of childbearing age, deficiencies of folate, vitamin B12, calcium, iron, selenium, zinc.

And Omega 3 fatty acids are more common among depressed versus non depressed women.  Vitamin B12 is not found naturally in plants. So if you're eating a plant based diet, you may want to add fortified whole wheat cereal or bread. And as far as supplements, just keep taking your prenatal vitamins.  Calcium is found in dairy products, but it's better to get it from fortified plant based milk like almond or soy.

But watch the sugar content because many are sweetened. Another good source is black beans. And did you know you can make black bean brownies and they're delicious?  Think green when it comes to veggies. Broccoli, bok choy, spinach, collard greens, and kale. Sesame seeds contain calcium too, so add those or use tahini, which is basically sesame butter. 

Zinc is found in pumpkin seeds and baker's yeast, and if I haven't convinced you to try black bean brownies, black beans contain zinc too. I'm going to put a link in the show notes to a recipe for them.  Selenium is found in Brazil nuts, and you don't need many. Oatmeal is good for breakfast. Add a little sorghum on your oatmeal for iron.

Lima beans contain iron too, but probably not on your oatmeal.  This mineral is also found in whole wheat pasta and brown rice, which is a good way to load up on those carbs at dinner, which may help you sleep better. Restorative sleep is so important in refreshing your mind. Try and keep your newborn on a schedule so you can get some rest, but realize  some level of sleep deprivation is inherent in motherhood.

This too shall pass.  Once you've arrived at the depression destination, you may need medication to fix the chemical imbalance inside your brain. Your doctor may prescribe it and listen, you don't want to miss this precious time. If you need it, take it. Don't try to gut it out. This is about chemistry, not about how strong you are. 

If you're prescribed a medication while breastfeeding, your doctor will take that into consideration when choosing the antidepressant. The bottom line is, do the benefits outweigh the potential risk?  And remember, folate or vitamin B9 can help in the production of serotonin and dopamine. And when used with antidepressant medications, it's been shown to improve the efficacy and shorten the response time. 

Food really high in folate includes legumes, asparagus, leafy green vegetables like spinach.  And if you don't like it, add a little to a smoothie. It turns it a very unappetizing color of green, but you can't really taste it.  Other sources include papaya, citrus fruits, and beets. And don't knock them if you haven't tried them.

But remember, they can turn your urine pink, and that can be alarming.  Broccoli, Brussel sprouts, nuts and seeds contain folate too. So does whole wheat, bananas, and avocados.  So pay attention to your diet, ask for and accept help, 

 That's a lot of information for a worn out new mother, so I created a download you can print that highlights the nutritional recommendations we've discussed. If you're taking a meal to a new mom, you could use this as well. 

 Feel free to pass this along so your friends and family don't bring you food that makes you worse. If you're fixing your own meals, remember, push the easy button. When you can, buy frozen, pre cut fruits and veggies, and give yourself a whole lot of grace during this time.

Restoring health may be slow going, but it's worth it. And healthy looks great on you, Mama. 

RESOURCES:
Download postpartum nutrition guide

Edinburgh Postnatal Depression Scale

Black Bean Brownie Recipe

Call 1-833-TLC-MAMA (1-833-852-6262) for 24/7 free confidential support for pregnant and new moms.

 

 The information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or health care provider and take medications as prescribed. Though the information in this podcast is evidence based, new research may develop  and recommendations