About a week after my oldest son was born and in the grips of a disorientating new landscape called parenthood, I remember calling my mother in tears demanding- “Why didn’t you tell me this was so hard!” I felt equal parts anger, betrayal, sadness and exhaustion. I was utterly confused- why was this happening to me and where were these feelings coming from? I wanted answers and yet I felt too scared to ask for help; too ashamed to admit openly that this was happening to me. I felt intensely alone despite having a wonderful support network; and I felt to blame even though I had done- ‘all the right things’. For months while pregnant I had imagined this fantastical version of motherhood that would come to sharply contradicted my reality. Perinatal mood and anxiety disorders (PMADs) are the most common complication of childbearing individuals. And according to Post-Partum Support International, an organization whose mission is to increase awareness among public and professional communities about the emotional changes that women experience during pregnancy and postpartum, suggests that 60-80% of new mothers/birthing parents experience normal “baby blues” within the first weeks of delivery and at least 1 in 7 mothers go on to experience more complicated depression or anxiety which can last several months. Other studies suggest that the rate of postpartum depression and anxiety is even higher –closer to 40%.
The Vermont Department of Health (VDH) describes PMADs as being a spectrum of emotional distress that can include depression, anxiety, obsessive compulsive disorder, bipolar affective disorder, PTSD, and rarely psychosis. Neurobiological changes during pregnancy and into parenthood are very dramatic and rapid. Some researchers have likened pregnancy as a developmental period as seminal as puberty. Pregnancy is a whole body disruptive event and yet the neurobiological discussion has historically been absent from perinatal care, taking a backseat to care that is centered on the physical and what can be seen while the emotional health piece and impact of these unseen brain changes are addressed usually when it becomes a problem.
Increasingly, more education and conversation between pregnant persons and doctors, mental health clinicians and support services are happening and this needs to continue. Screening early in pregnancy is an important and accessible way for providers to identify potential risks for postpartum mood disturbances. In addition to genetics and brain chemistry, there are variables in an individual’s history and current life circumstances that can place them at higher risk for postpartum mood disturbances including trauma, substance use, and persistent psychosocial stress. The VDH sites that due to the American history of structural racism, members of the Black, Indigenous, People of Color (BIPOC) community are disproportionately impacted by perinatal mental health conditions, experiencing them at rates 2-3 times higher than white individuals.
Given the universality of brain changes in pregnancy it is expected that most new birth parents will experience some variability in mood and functioning. It’s common to feel overwhelmed, tearful, fatigued and worried about your baby. These short-term changes or shifts in mood, the “baby blues”, generally resolve in 2 weeks. In contrast, postpartum anxiety or depression can linger for many months,
or longer, and can have more a pronounced impact on the mother and even impact the emotional relationship with baby.
While not all new birthing parents experience the “baby blues” or postpartum depression or anxiety, it is important to know your risks, seek to build a support network, and ask for help from a trusted provider, family member or friend as needed.
By the time my second son was born I had done some research, talked to a therapist, and generally felt more prepared for the road ahead. Many of those same feelings and fears returned but knowing how best to support my wellness made all the difference.
The National Maternal Mental Health Hotline is staffed by licensed clinicians and peer specialists is available 24/7/365 by phone or text: 1.800.944.4773. Text en Español: 971-203-7773
Amy Ripley has been employed as the clinical social worker with the Brattleboro Retreat, and is embedded at Brattleboro Memorial Hospital's Community Health Team and Four Seasons OBGYN practice for the past five years. Amy provides brief solution focused mental health care to clients throughout the hospital and community.