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This Isn't What I Expected...

During the past two weeks have you:

  1. Felt nervous, anxious, or worried? Felt so unhappy that you seem to be crying all the time? Felt like you were going crazy? Had recurrent thoughts that you are not a good mother?
  2. Felt scared that you will never feel happy again?

If you answered yes to any of the above questions, you may be suffering from a form of postpartum depression. The term "postpartum depression" actually describes a continuum of postpartum emotional and physical reactions ranging from the common and relatively mild "baby blues" that resolve in a few days to the rare and extreme cases of "postpartum psychosis". It can occur anytime during the first year postpartum. Affecting 10-20% of expectant and new mothers, postpartum depression is a common complication of pregnancy and is a treatable medical illness.Beverly had tried for years to become pregnant. Finally she had given birth to the twin girls she had dreamed about. Recovering from a c-section and figuring out how to nurse and care for two infants was overwhelming. Even with night help initially she was so exhausted. What was most difficult though were the bouts of anxiety. She couldn't stop her mind from racing, from feeling the need to check on the girls breathing, sometimes every few minutes. Sometimes she would see re-occurring pictures in her mind of bad things happening to her girls. She knew she would never let anything bad happen to them but why was she having these thoughts. She felt so ashamed she was unable to tell even her husband. Beverly was experiencing Postpartum OCD.Sandra was five months postpartum when she began waking up and dreading the day ahead. She was having unexplained bouts of crying and was beginning to feel frightened of being left alone with her son. Sometimes she had thoughts that her baby and husband would be better off without her. Everyone else made motherhood look so easy. She wondered what was wrong with her. Sandra was experiencing Postpartum Depression.Many women expect that having a baby will be the happiest, most fulfilling time in their lives. Instead, you may be wondering if you made a mistake, blaming yourself, feeling guilty, ashamed, inadequate, and alone, wondering if you'll ever get through this.The postpartum period is a time of great physical, emotional, and relational changes that can be overwhelming and confusing for many women. Risk factors contributing to a postpartum reaction may include experiencing depression during the pregnancy, having a personal or family history of postpartum depression, or having previous episodes of depression or anxiety. Situational stressors such as marital discord, financial difficulties, unresolved losses, traumatic births for either mother or baby, lack of support, and social or geographic isolation can also be contributors.Warning signs during pregnancy or postpartum include difficulties with sleeping, eating, or caring for yourself or the baby; thoughts about hurting yourself or the baby; or having intense feelings of energy, anxiety or sadness.Untreated, depression and anxiety can affect mother-infant interactions resulting in developmental, cognitive, and behavioral problems in the child. It can also affect the mother's relationship with others, particularly with her partner. Untreated, these symptoms can wax and wane for years, flaring up with the inevitable stressors and crises that life brings.The good news is that symptoms of postpartum depression are temporary and treatable with skilled professional care. Treatment begins with education and the support of family and friends. Psychotherapy, participation in support groups with others experiencing similar symptoms, and the use of medication when indicated are used to treat the continuum of postpartum emotional reactions. When a woman is identified as being at risk during her pregnancy and a treatment plan is put into action, symptoms of postpartum depression can be minimized or even averted.

The Continuum of Postpartum Emotional Reactions

The Baby Blues: This term is used to describe the tearfulness, irritability, insomnia and sense of vulnerability that commonly characterize the first few days postpartum. These symptoms generally resolve without intervention in the first two or three weeks.

Normal Adjustment: This can be a continuation of the baby blues with the addition of anxiety, mood swings, and anger. It may continue for up to two months and is generally " on again, off again" in nature.

Postpartum Depression: This may occur soon after birth or many months later. Weaning from breastfeeding can also trigger PPD. It can range from mild to severe and may affect appetite and sleep. It affects your ability to function and suicide becomes a real risk.

Postpartum Panic Disorder: Characterized by panic attacks with uncontrolled anxiety, symptoms may include dizziness, shaking, and chest pains.

Postpartum Stress Reaction: This may include anxiety, panic attacks, or emotional numbness triggered by specific situations such as a complicated or traumatic birth, having a history of trauma, either recent of long ago, flashbacks, nightmares, and emotional numbness.

Postpartum Obsessive Compulsive Disorder: Irrational and uncontrollable thoughts come to you without cause. ( Sometimes these are thoughts of harming the baby.)

Postpartum Mania: You have a decreased need for sleep, may feel "speeded up" , and are unable to relax or slow down.

Postpartum Psychosis: Experienced by 1-2% of new mothers, this is characterized by extreme confusion, delusions, auditory hallucinations, hyperactivity and rapid or irrational speech. It usually occurs in the first 1-2 weeks after delivery. This condition requires urgent medical care.

If you or someone you know struggles with these issues, please reach out for help. Postpartum depression responds to treatment! Motherhood doesn't have to be this difficult and you don't have to do it alone.

Elizabeth Greason, LCSW, is a licensed clinical social worker specializing in the treatment of Perinatal Mood Disorders, Trauma, and Attachment. She facilitates support groups for women struggling with postpartum adjustment, works with both individuals and with couples. For more information call (415) 454-2636.


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Elizabeth Greason, LCSW
| About My Work: Elizabeth GreasonEMDR and Trauma Work  | Resources and Trauma Healing
Working with Addiction: A Somatic Approach | What Is Trauma?
 | Somatic Experiencing & Sensorimotor Psychotherapy
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 |  PPD Self Assessment  |  Perinatal Resources

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