Feeling like a hot mess after having your baby?
Are you blitzed out in love but also feel like you want to crawl into a hole and disappear? Or are you awake at night worrying even though you need sleep more than anything? Are you having trouble wanting to hold your baby and then feeling guilty about it?
You’re not a bad mom. Your hormones are just scrambled.
While a few days of hormone crash or baby blues is common, anything beyond that is a sign of postpartum depression or anxiety. Having a baby should be one of the happiest times of your life, right?
Sadly, though, many of us feel unhappy after our baby is born and suffer from postpartum depression. The Centers for Disease Control (CDC) says one in eight new mothers have this condition.
In my experience, it’s more like one in three.
Motherhood turns our worlds upside down and there’s no getting around that. But postpartum depression or anxiety makes it so much harder. Keep reading to learn why you’re feeling blue and how to get back to normal as soon as possible after birth. It’s a wild ride and you deserve to feel good while you bond with your new baby and adjust to your new life.
What is Postpartum Depression?
Postpartum depression is a feeling of sadness that new mothers experience after giving birth. Symptoms of postpartum depression include:
- Feeling angry
- Crying more often
- Postpartum mood swings
- Not communicating, or withdrawing from others
- Feeling numb
- Worrying about harm coming to the baby
- Worrying you’ll harm the baby*
- Preoccupied with the sense that you’re not a good mom
- Feeling like you won’t do a good enough job caring for your baby
Sound familiar? Anyone? If so, raise your hand.
* If you feel concerned you might actually harm your baby, please speak with a professional. Generally, your OBGYN office is a really supportive place to start.
Is It Postpartum Depression or Baby Blues?
Postpartum depression isn’t the same as baby blues. Postpartum depression lasts longer than two weeks and can hang around for four years or longer.
Baby blues, on the other hand, usually appear soon after delivery and last only up to ten days after birth. Baby blues are related to the exhaustion from labor and giving birth, as well as the effects of the heroic hormonal shift that occurs during this time.
Baby blues are a normal part of giving birth. They happen in up to 85% of new mothers. Symptoms of this emotional condition may include crying for no reason, irritability, restlessness, and anxiety. These symptoms last a week or two and generally resolve on their own without treatment. Postpartum depression, on the other hand, can be a lot more severe.
Postpartum depression tends to show up within the first month after delivery—usually after the first ten days. Sometimes it can start as baby blues, which turns into a second wave of postpartum depression. You might even be able to tell when baby blues turns into something more.
When You Worry Too Much About Your Baby
Postpartum anxiety is also a real thing. In this condition, new mothers obsessively worry about the health and well-being about their child. Symptoms can include:
- Constant or near-constant worry
- Feelings of dread and fear about things that could happen
- Insomnia even when your baby is sleeping
- Thoughts that won’t calm down
You can also have physical symptoms of postpartum anxiety. These include fatigue, heart palpitations, sweating, nausea, shaking, and hyperventilating.
In modern times, we have so many apps and methods to track a baby’s health and progress. Postpartum anxiety might show up as excessively tracking baby’s metrics like feedings, liquid, wet or dirty diapers, etc. If it feels like you are over-focused on this and it is not medically necessary, or if it is adding to your anxiety, consider if tracking your baby’s metrics is best for you. If you are Googling about your baby’s well-being much more than what seems appropriate, it may be a sign of postpartum anxiety.
The Heroic Hormonal Shift
Can’t relate with those magazine-ad mommies who are wearing their new baby while going for hikes in the beautiful outdoors, gorgeous hair whipping in the wind? How about those well dressed and fully makeup’d Instagram influencers?
It’s easy to compare. We’re all guilty to some extent. And while I won’t tell you to stop (easier said than done), I do want to encourage you to try and stay true to yourself and the things you love about you.
This is NOT a moment of weakness. Hormonal changes, depression, and anxiety make this so much easier said than done. It’s cloudy. It’s dark. It’s confusing. It’s a roller coaster. Remember that every single journey is different. Everybody is different and every healing journey looks different, even from someone you may know really well.
When you’re giving birth, your progesterone levels take a nosedive. At the same time, estrogen levels increase. This hormonal shift is what causes the uterine contractions that lead to delivery of the baby.
That’s a good thing. The bad news, though, is that this puts you into a near-instant state of estrogen dominance.
This is a heroic amount of hormonal shift. And it happens in just this one moment of pregnancy.
This sudden dramatic drop off of both estrogen and progesterone essentially mimics menopause.
Interestingly, these changes depend as much on the hormones of the baby, as they do on the mother’s! This is why induced deliveries** are more likely to require hormonal interventions after to restore a mother’s good mood and well-being. When a birth is induced, the hormonal cascades that promote the stages of labor aren’t encouraged in the same way.
Induced labor triggers the release of higher levels of the stress hormone cortisol in the baby. This in turn leads to a drop in progesterone, just like you would experience before your period. Only it’s much more dramatic because progesterone levels are 20 times higher in pregnant women.
Whether labor is induced or occurs naturally, the resulting hormonal changes happen relatively quickly. But it can take a long time to restore them to a more balanced state.
The postpartum period is defined as six to twelve weeks after delivery. Yet, sometimes it takes up to four years for out-of-whack hormones to rebalance themselves. This usually depends upon the stage of your reproductive cycle when you give birth. By that I mean, are you 20-years-old when delivering your baby or 45-years-old and perimenopausal?
During and after birth, new mothers also produce high levels of a hormone known as oxytocin. This is sometimes called the bonding hormone or love molecule. This is because it leads to feelings of euphoria and connection. It makes you love and want to take care of this tiny, needy little animal you have created. Oxytocin is triggered at birth, by touch, and by breastfeeding. It helps take the sting out of the other hormones dropping so severely.
**Please note: Whether you chose or needed a certain intervention in your birth plan, there is no judgement or shaming intended here. We are just talking about the evidence related to these labor and delivery events. Many women dream of the “perfect birth,” and few of us get it.
Hormonal Causes of Postpartum Depression and Anxiety
One or more of four hormones tend to be out of whack in women who are depressed or anxious after giving birth.
The thyroid works extra hard in pregnancy. It generally returns to pre-pregnancy levels within six weeks after you’ve given birth. But if it’s not working properly this can create depression, anxiety, or fatigue. In this case, a women can have an overactive thyroid (hyperthyroid) or a sluggish thyroid (hypothyroid).
New mothers could also develop thyroid autoimmunity (Hashimoto’s or Graves’ disease). Or they can have a flare-up of a pre-existing thyroid autoimmune condition.
Women who have higher levels of antibodies known as thyroid peroxidase antibodies (TPO), which indicate Hashimoto’s disease, have higher risk for postpartum depression. The same is true for women with lower levels of the thyroid hormone known as free T4.
This is the stress response hormone. Your body produces it according to a circadian rhythm every day. During regular daily life, cortisol is high in the morning and lower at night before bed. That’s why you have energy in the morning and get tired at night. But throughout pregnancy it naturally increases in both mom and baby.
The placenta—an organ that grows in the uterus during pregnancy to provide oxygen and nutrients to your unborn child—is its own hormone manufacturing plant during pregnancy. It acts like this to ensure fetal development is happening like it’s supposed to do.
The placenta signals the baby and mom to make more cortisol. If cortisol levels don’t return to normal after delivery, there’s an increased risk of postpartum depression.
Ironically, though, the problem isn’t high cortisol after giving birth. It’s low cortisol.
Cortisol levels are high during pregnancy. After pregnancy, they drop. This can cause problems because for months the placenta has signaled the mother’s body to make cortisol. Sometimes, a new mom’s body has to relearn how to make cortisol. That’s why cortisol levels don’t always bounce back right away.
Serotonin is a hormone that makes you feel content, happy, calm, and ready for sleep. You need estrogen in order to convert amino acids into serotonin. When estrogen levels take a tumble after giving birth you may not have enough estrogen to encourage adequate serotonin production. This is especially true if you’re close to menopause.
Trauma early in life is associated with low oxytocin later. High stress also is not a friend to your oxytocin levels.
What’s more, women who are given synthetic oxytocin (Pitocin) during labor might not make enough oxytocin on their own. Research shows these women have a higher risk of postpartum depression. Sadly, women aren’t often told this when deciding whether to use this drug during labor and delivery.
It Takes a Village but You Likely Don’t Have One
It’s not just hormonal issues that are causing your depression. To make matters worse, you’re also exhausted. Caring for a baby is 24-hours a day, non-stop.
You’re not getting together with your friends. You’re losing sleep. You’re often not eating balanced meals or at regular intervals and you’re not exercising like you used to do.
You might also be feeling a loss of sense of self.
We used to live in villages where aunts, uncles, grandparents, siblings, and cousins all helped with the care of a child. Today’s women are feeling the lack of overall support networks. This leads to feeling isolated. New mothers and fathers often have to do the work of a whole village. These feelings of isolation and overwhelm are even worse in women with postpartum depression and anxiety.
Sure, some couples have the support of grandparents that live nearby. But in many cases, grandparents live in distant cities or states and are only visiting for a short while after the birth.
Don’t hesitate to build your support network. Ask for help. Call on friends and family. Use Facebook mother/parent groups in your local area. Check out postpartum support groups through your OBGYN’s office or lactation support organizations. For those who have a religious or spiritual leaning, there are many community resources provided by synagogues, mosques, or churches. Gyms sometimes have childcare rooms to give you a break while you do self-care. Hire help for childcare or housework. Motherhood isn’t something we can do alone.
Other postpartum resources are:
Postpartum Progress is the world’s most widely-read blog dedicated to maternal mental illness. It gives a list of providers who specialize in PPD in your state.
Postpartum International is a nonprofit dedicated to raising awareness “among public and professional communities about the emotional changes that women experience during pregnancy and postpartum.”
La Leche League is a nonprofit that provides breastfeeding information and support to those who want to breastfeed their infants. In addition to groups that offer support to pregnant women and new moms, breastfeeding is thought to have a protective effect against postpartum depression.
Postpartum depression screening tool (or Edinburgh Postnatal Depression Scale) helps identify women who may have postpartum depression.
Birth trauma resources Stress caused by a traumatic pregnancy and delivery can often override the ability to emotionally cope, leading to psychiatric complications such as post-traumatic stress disorder (PTSD) and post-partum depression.
Risk Factors for Postpartum Depression and Anxiety
You’re more likely to suffer from postpartum depression if you:
- Had major depression prior to pregnancy
- Experienced high levels of stress before or during pregnancy
- Have a history of trauma
- Had a traumatic birth.***
- Struggled with anxiety disorder prior to pregnancy
- Have a history of insomnia or other disruption in your circadian rhythm
- Have high testosterone, which occurs more often in women with polycystic ovarian syndrome
- Are low in oxytocin
- Have low thyroid hormone levels
- Have a history of severe premenstrual syndrome (PMS)
- Your natural drop in estrogen and progesterone is particularly severe
- Fall into the category of low socioeconomic status
***Traumatic births are not often acknowledged by medical professionals and good options for healing and recovery aren’t well publicized. Many people don’t know where to start or that they could get help with this. There are therapists, counselors, and support programs available for women who experienced birth trauma.
Racial Differences in Postpartum Depression
There’s an important fact to bring to light. It’s that women of color who suffer from postpartum depression often don’t receive the right treatment. Postpartum depression care and awareness in all women is lacking. However, there are definite racial and ethnic differences in postpartum treatment.
For example, in one study, 9% of white women began postpartum mental health care, compared with only 4% of Black women and 5% of Latinas. Blacks and Latinas were significantly less likely to begin treatment for postpartum depression compared with whites. Among those who did begin treatment, Blacks and Latinas were less likely to receive follow-up treatment or continued care compared with white women.
Of the new mothers who started taking antidepressant medication, Black women and Latinas weren’t as likely as white women to refill a prescription.
Research shows that BIPOC women experience postpartum depression at a rate of nearly 38%. Meanwhile, the rate is much lower—only 13% to 19%—when statistics include all women with postpartum depression.
Promote Equal Postpartum Care for Mothers of Color
There are certain action steps we can take to make sure mothers receive healthy, safe, fair pregnancy and postpartum care. We recommend you read this Center for American Progress article, which offers a number of great suggestions on what policy-makers, health care providers, and you, can do to support mothers in underserved communities. Here are other steps you can take to bring about social change for this serious problem affecting mothers of color.
- Amplify and support women of color-led organizations.
- Support policies that improve work-family balance for women in the workplace.
- Support the Shades of Blue Project, an organization focusing on maternal mental health in underserved communities, before, during, and after childbirth.
- Donate to the National Birth Equality Collaborative (NBEC), an organization that provides training, research, and other assistance for the issue of black maternal mortality.
- Support the National Association to Advance Black Birth, an organization founded to help provide training and access to midwives and doulas of color and lower pregnancy-related deaths.
- Support the Black Mamas Matter Alliance, an organization that educates and advocates for better legislation to reduce black maternal mortality. They highlight needed research, and spread information about the social determinants of health that influence outcomes like traumatic birth or maternal and infant mortality.
How to Get Rid of Postpartum Depression and Anxiety
If you have postpartum depression and/or anxiety, please know that you don’t have to suffer alone. Here is what I do with my patients who are feeling emotionally and physically debilitated after giving birth. I’ve had a great deal of success with each of these strategies.
Test hormone levels.
I test women’s sex hormones, adrenal, and thyroid markers. I usually use the dried urine test for comprehensive hormones (DUTCH) to look at adrenal hormones (cortisol and DHEA) and sex hormones. This involves collecting a small amount of urine on filtered paper four times per day. I also order blood tests to look at thyroid function.
Various types of therapy.
Here are some I recommend:
- In women who have suffered a trauma in the past or who had a traumatic birth, I recommend a type of therapy known as eye movement desensitization and reprocessing (EMDR).
- Hypnosis therapy and cognitive behavioral therapy also work really well.
- Meditation programs like Ziva can be a powerful tool.
- Apollo neuro wearable touch therapy is another interesting solution. You wear it on your ankle or wrist and it emits silent, soothing vibrations that work on your central nervous system.
- Body therapies like acupuncture and craniosacral therapy can help.
Hormonal Support and Dietary Supplements
It’s critical you work with a trained functional medicine healthcare practitioner when taking hormones or dietary supplements. He or she can help you use them appropriately for your specific health concerns. They will order testing to find out the root cause of your postpartum depression or anxiety in the first place. Everyone is unique. The problem could be imbalances in hormones like thyroid, cortisol, progesterone, and estrogen. Or the culprit could be nutrient deficiencies, problems with brain chemical imbalances, anemia, etc.
These are the areas I work on with my postpartum patients to kick anxiety and depression:
- Oral natural progesterone in appropriate cases
- Estrogen (estradiol) support in appropriate cases
- Serotonin support, when testing indicates it, and under supervision of a clinician. This involves supplementing with tryptophan or 5-HTP. If your serotonin levels are high, it can be a marker of inflammation and supplementing with tryptophan or 5-HTP can only make things worse.
- A prenatal supplement. The same one you used during pregnancy can work wonders on your mood and mental health outlook.
- Lactation-safe herbal formulas and nutraceuticals.
At the risk of repeating myself, it is best for you to work with a skilled practitioner on this journey. With that in mind, these products are safe across the board if you’re breastfeeding your baby:
- Herb Lore Anxiety Blend tincture. Reduces stress, calms anxiety, fear, and agitation.
- Herb Lore Happy Day tincture. For women feeling sorrow, sadness, or depression.
- Lavella. An oral lavender essential oil that reduces anxiety and helps with sleep.
- Rescue Remedy. For trauma, stress, anxiety, depression, panic attacks, accidents, or injuries. Safe for newborns, pets, siblings, spouses/partners, too!
We Can Help You Feel Happy Again
If you have postpartum depression or anxiety, you’re not alone. We can order the right testing to help you balance your hormones and other factors that can cause your sad mood. We’ll pinpoint the root causes, and design a customized protocol just for you.
Babe, you can get through this rough time. We’ll hold your hand every step of the way to show you exactly what you need to do to feel happiness and joy again.
Your path to a happier life begins with a free 15-minute troubleshooting call. During this chat, I’ll get to know more about what troubles you. If after the call you come on board as a patient, I’ll work with you to get rid of your postpartum depression and anxiety. Book your call today so you can start enjoying the precious moments of a new beginning- for you and your little one.