Postnatal Mental Health
Having a baby brings so many changes all at once, even if you already have children. There can be joy and happiness, along with challenges. Some challenges can be unexpected, particularly if it is your mental health that suffers.
Most people have heard of postnatal depression, but many mental health conditions can occur after birth. Knowing the signs means you can seek help for your distress, rather than just persevering through and hoping it will get better.
The Baby Blues
The baby blues are common and not a mental health condition, but it is valuable to know about them. After birth, many women can feel teary, sad, and emotional, so it is called ‘the baby blues’. These feelings can come on quickly and leave you crying or unhappy, but they also tend to pass once they’ve been felt and expressed. Many women experience the baby blues in the days after birth, and it typically settles within two weeks after giving birth.
Postnatal Depression
Postnatal depression involves feeling either sad, flat, or lacking interest in things you used to enjoy. It is different to the baby blues as it can occur anytime in the year after birth, and involves having more bad days than good days, or feeling down or flat for most of the day. There are sleep changes, with insomnia (as in, you can’t sleep or get back to sleep when the baby is sleeping) or needing far more sleep than you used to. Your appetite changes too, with losing interest in food (even if you have the opportunity to eat) or eating more than you used to. You might gain or lose weight without trying for this. It can also be hard to think, concentrate, or make decisions. There may be thoughts about death, feeling agitated (or the opposite: feeling slowed down), having a lack of energy, or being tired most days. Sometimes, you can feel worthless (like your baby would be better off without you), or very guilty (like feeling bad for your family/baby/partner that they have you and you can’t do enough). Things can feel harder and more effortful, and you may have lost interest or motivation to push through.
Postnatal Anxiety
Postnatal anxiety is more common than postnatal depression. It can involve hard-to-control worries about your baby, for example, being worried about their feeding, sleeping, settling routines, their breathing overnight or a risk of SIDS, starting solids, or being apart from your baby. There can also be worry about other life areas too.
In addition to these worries, you can feel tired, have difficulty concentrating or a mind that goes blank, feel tense or restless, irritable or angry, have tense or sore muscles, and develop insomnia (difficulty going to sleep or staying asleep). When you get enough sleep, it may feel like it doesn’t help you catch up.
Sometimes, women can have panic attacks, which are intense, short-lived, but overwhelming anxiety episodes that feel out of control. Panic attacks have many physical symptoms such as a racing heart, difficulty breathing normally, and feeling shaky or faint (and other physical symptoms).
Perinatal Post-Traumatic Stress Disorder (P-PTSD)
P-PTSD can occur as a result of trauma experienced in pregnancy, birth, or postpartum. P-PTSD can occur from birth trauma, or from other traumas such as serious health conditions (e.g., Hyperemesis Gravidarum, or HG); unexpected or invasive medical intervention; your baby being admitted to intensive care; or anything else that causes fear and distress. P-PTSD involves reliving the trauma through intrusive thoughts, memories, nightmares, or flashbacks, and having distress or strong physical responses when you are reminded of the trauma. Because this is so overwhelming, you try to avoid thinking about, talking about, or being reminded of what you’ve experienced, for example, not wanting to hear or see any birth stories, visit any hospitals, or have another pregnancy. There is also an increase in negative thoughts and feelings, and there may be jumpiness, insomnia, irritability, or difficulty controlling your anger.
Postnatal Obsessive Compulsive Disorder (OCD)
After birth, many women experience worrying and intrusive thoughts about bad things happening to their babies. This can be normal, although distressing. However, when these intrusive thoughts occur daily, and repeatedly throughout the day, this is not normal and is classed as an obsessive thought. They can involve seeing, imagining, or thinking about bad things happening to your baby, for example, leaving them in a hot car, them being hurt or sick, or seeing yourself shake, drop, or throw baby. These thoughts are so distressing that they can trigger rituals or safety behaviours to keep your baby safe, for example, checking on them repeatedly overnight, avoiding being alone with your baby, avoiding holding your baby, and more. If you have obsessive thoughts or rituals that take up time most days, then you might be experiencing postnatal OCD.
Postpartum Rage
This involves episodes of intense anger that are difficult to control. It might be angry outbursts, like exploding at your baby, baby, or older children, or throwing things. Sometimes, you can feel this way but narrowly hold it in or walk away before you have an outburst; it is difficult to control.
It’s common to feel guilty, ashamed, awful, and remorseful afterwards. You love your family, and don’t want to feel or act this way.
You might dwell on the bad things that frustrate you (including your own actions), and then reach a peak where you end up exploding. And because you try so hard not to do it again, things can build up until the cycle repeats itself. Postpartum rage can be part of postnatal anxiety, depression, P-PTSD, or occur on its own.
Dysphoric- Milk Ejection Reflex (D-MER)
D-MER occurs during breastfeeding, and is when the let-down reflex triggers a flood of negative thoughts, feelings, or body sensations. Women can suddenly feel anxious and panicky, a sense of dread, tearful or low, irritated, or angry. You might suddenly have negative thoughts about yourself or baby (and anything, really), and thoughts of death. There may be physical sensations such as feeling restless, that your skin is crawling, your nerves are being grated, and more. These feelings typically fade away when baby stops feeding, and some women have relief after the let-down (and during the feed).
Postnatal Psychosis
Postpartum psychosis is a serious (but not common) condition, which involves hallucinations or delusions. Hallucinations are when you experience things that aren’t there for other people, such as hearing voices, seeing images, or unusual smells. Delusions are fixed, untrue beliefs that are unshakeable, for example, believing that other people are controlling your thoughts, or that your baby has been swapped out for a different baby. Postpartum psychosis benefits from medical intervention as the first-line treatment.
When you’re navigating life with your baby, sometimes with other children in tow, there is a lot to adjust to. Sometimes, you can miss the signs that something is not quite right.
If you don’t feel like yourself, tell someone about it.
If you don’t feel like yourself and relate to any of the above descriptions, please see your GP as a starting point. The good news is that many postnatal mental health conditions respond well to treatment – it’s just getting the ball rolling.
Seek help early. You don’t have to come last, just because you’re a mother. You matter too.
And, if the help you find doesn’t fit you (or isn’t actually helpful), please try again- because things can get better.