In surveys and interviews for my books, I was overwhelmed by the outpouring of passion surrounding the topics of depression, postpartum depression, and general anxiety after birth. While feelings about the postpartum period have been described to me in a multitude of ways (i.e., I was in a fog after my baby was born; I was a nervous wreck worrying about my newborn; my energy level and libido went to zero; I really lost my mojo, etc.) a common thread remains the same. The complexity and intensity of emotions–the highs, the lows, the guilt, and the extreme expectations– involved with motherhood is typically beyond anything most women have ever experienced.
So if you are feeling not quite like yourself after baby, you are not alone (Did I mention that you are not alone?) Motherhood is a complex transition for anyone.
And if any of your friends, family members, or co-workers are making you feel bad about struggling with these things? They are simply being mean, ill-informed, or both.
In my observations, the following compounding factors are making today’s mothers even more susceptible to anxiety and depression than previous generations:
Parents are older when they have their first child
Caring for a helpless human being after years of independence and self-discovery can be a major adjustment for anyone, but especially for Mom, who is culturally expected to pour herself into her offspring.
More “I” (Individualistic culture, behavior, and values are increasing)
In general, our society has become more individualistic. Life is about the “I” and “I-pursuits.” We are conditioned to think that way (grades reflect our identity in school, compensation is based on individual performance, and we are taught to be independent and self-reliant.) We take great pride in being a selfie DIY generation. However, when we put ourselves at the center of the universe and become focused on the extent of our own possibilities, any type of setback can be devastating (e.g., I was always a top performer at work, and now my boss thinks I’m distracted because I’m pregnant. I’m not going to get the top accounts anymore because I have a baby. How am I going to balance work and my life? I’m not good at anything anymore.) Parenting naturally draws the focus away from the self and self-pursuit, disrupting the “I” with anxiety and depression. We feel that we have failed relative to our own goals.52
Less “We” (Families are geographically dispersed with less social support)
When our grandparents struggled with life transitions, they generally had their spiritual faith, extended family nearby, a tighter-knit community, and a cohesive nation to provide comfort and support. This social safety net has all but eroded in the last few decades. 52
Intersection of career and motherhood
- Today, a record share of new moms are working and are college educated—66% of women with a child under age one have at least some college, compared to 18% in 1960.53
- Women are now 33% more likely than men to earn college degrees by age 27, and women are earning the majority of degrees awarded (The 1981-82 academic school year was the first time that women received more bachelor’s degrees than men.) 54
- Women are now half of the college-educated work force, marking a historic turning point in gender parity.
While this academic and professional success is terrific for women’s advancements and prosperity in general, a great deal of stress and anxiety can occur when one is confronted with choices between career and raising children.
What is depression?
Depression is a common, treatable mental condition that is more than feeling sad, blue, or down in the dumps for a few days. Depression is having despondent, empty, and anxious feelings that do not go away and affect your ability to function. Depression affects families, relationships, work performance, and day-to-day activities. One in ten Americans have depression at some point in life. The rate of depression for women is twice that of men, regardless of race or ethnicity.55
Depression typically results from a combination of factors rather than a single cause. Stressful life events such as the death of a loved one, loss of a significant relationship or job, abuse, neglect, or poverty can trigger depression. Areas of the brain involving mood, memory, and decision-making can be physically and chemically altered by a strong physiological response to a stressful event.
What is postpartum depression?
About 80% of postpartum women experience some form of the baby blues, while 15% have postpartum depression (PPD).56 Change is stressful, and the combination of biological, hormonal, and emotional changes after childbirth can pack a powerful punch.
- Biological/Physical Changes: Postpartum women have endured physical pain from childbirth and considerable changes to their bodies after months of pregnancy. Some women are disappointed that certain changes such as stretch marks, stretched skin, decreased breast uplift (from breastfeeding), and belly fat may never return to a pre-pregnancy normal. Postpartum women are also sleep-deprived, and the lack of rest affects the other body systems.
- Hormonal Changes: Changing hormone levels can trigger symptoms of postpartum depression, similar to hormone changes that affect a woman’s mood before she gets her period. Levels of thyroid hormones may also drop after giving birth, which can exacerbate symptoms of depression (the thyroid is a small gland in the neck that helps regulate how your body uses and stores energy from food).
- Emotional and Psychological Changes: As if there wasn’t enough going on in the recovery department, postpartum women must shift emotionally from a period of high anticipation with freedom in their schedule to a loss of anticipation and a more restricted schedule. Some women report a feeling of a “loss of control over their life.” Mom is also no longer the center of attention, and the effects of weight gain (without a baby) can make a new mom fell less attractive, affecting her self-esteem. Low self-esteem and social isolation can lead to disconnection from others. Disconnection from others leads to depression.
Disconnection, denial, and depression
Many women feel embarrassed and ashamed about feeling depressed after the birth of a child. A new mom with PPD may refuse to tell family or friends how she is feeling, worrying that she will be seen as ungrateful and self-absorbed, or worse, an unfit mother. Someone with PPD may also be concerned that an employer or co-worker might find out about her depression and view her as unstable. Family and friends with children may offer little empathy because they have forgotten about their own difficulties adjusting to life with a newborn.57
What are some differences between “baby blues” and postpartum depression?
The baby blues often go away within a few days or weeks. The symptoms are not severe and do not require a doctor’s treatment. If you have baby blues, you may…
- Feel sad, anxious, or overwhelmed with your new life
- Have rapid mood swings
- Cry very easily, or have crying fits
- Lose your appetite, or eat too much, for a few weeks
- Have trouble sleeping, even when others are encouraging or allowing you to rest
If you have the following symptoms of depression for more than two weeks without relief, you may have postpartum depression.
- Feeling sad, overwhelmed, and hopeless about your life
- Crying a lot, or not being able to stop crying
- Having no energy or motivation to accomplish life’s tasks
- Isolating yourself from family and friends
- Losing interest in activities that you used to enjoy
- Eating too little or too much
- Sleeping too little or too much (beyond normal sleep interruption with a newborn)
- Experiencing headaches, aches and pains, or stomach problems that don’t go away
Postpartum depression can include more severe symptoms, such as:
- Thoughts of hurting the baby
- Thoughts of hurting yourself
- Not having any interest in caring for the baby
Untreated depression can lead to the following risky behaviors that affect both Mom and baby: 58
- Out-of-control responses to stimuli, especially crying and noise
- Neglect of an infant
- Excessive alcohol use
- Drug addiction
The recovery period after birth can be substantially better for Mom with support from a partner, family, and friends. Although no one can predict postpartum outcomes, families can recognize signs. Early identification and preventative measures could alleviate months of suffering for a new mom and the whole family.59-61 Here is a list of markers collated from several studies on postpartum depression. Read each predictor and think about ways that you might ease potential burdens for yourself or your partner.
- Previous history of depression
- Prenatal depression and anxiety (during pregnancy)
- Recent stressful life events (death in the family, moving, etc.)
- Lack of relational support from a significant family member or friend
- Marital dissatisfaction/dysfunction
- Unplanned pregnancy
- Child care stress
- Financial strain
- Low self-esteem (includes body image dissatisfaction)
- Perfectionism (high concern over making mistakes)
- Breastfeeding challenges
- Difficult infant temperament
Changing our habits of thought
I would like to offer some food for thought for moms reading this who may be feeling sad or blue, even years after having their first child. There is little doubt that certain depressive conditions (e.g., manic, bipolar, etc.) have biomedical and hormonal components that are more difficult to treat and may require medication. However, the vast majority of standard depression and anxiety, especially for women, could be dramatically improved by changing our habits of thought.
The postpartum phase is really difficult, especially if you are struggling with “trying to do it all.” Hormones, expectations from family and work, sleepless nights, and concern about how you are caring for your baby are all good reasons to feel anxious and not like yourself.
However, how are you talking to yourself about these things?
Why do women have depression rates twice that of men?
When I first explored this question, I naturally assumed “Well, there are probably some hormonal causes with a little bit of oppression and work-life conflict thrown in the mix.” Yet truthfully, study after study discounted my theories.
Work-life conflict? Women who work outside the home are statistically less depressed than stay-at-home moms.
Hormonal imbalances? It turns out hormones are a factor during critical periods, such as pregnancy and menopause, but on average, they do not account for a two-to-one difference over a lifetime.
Oppression due to gender roles, less money, and less appealing jobs? Well, that’s complex. However, rich women are twice as likely to be depressed as rich men, and unemployed women are twice as likely to be depressed as unemployed men. Also, men are more likely to be stressed from work than women, and time wise, work takes up a larger proportion of a woman’s day than anything else (other than sleeping).
So why do women suffer so much more?
Women and Rumination
The answer might be summed up in one word: rumination. Derived from the Latin for “chewing cud” (the process in which a cow chews, swallows, regurgitates, and then re-chews its own food), rumination implies that how women think about problems tends to amplify them. Ruminating, or immersing oneself in negative thoughts like a cow chewing cud and then linking those thoughts back to some unchangeable aspect of oneself, is a recipe for disaster, or at least the blues.
Susan Nolen-Hoeksema of Stanford University originated the rumination theory and has spent her life confirming that men do not typically ruminate as women do.
- In one study, men and women were offered a choice of two tasks when they were sad: make a list of ten words describing their mood (a task focusing on the depressive episode) or rank a list of countries in order of their wealth (a distracting task). Seventy percent of the women chose the ruminating task, describing their feelings and mood, while the reverse percentages were selected by the men.52
Millions of mental health dollars have supported the idea that if men and women could stop ruminating and explain challenges and bumps in the road to themselves in a different light, depression could be lifted for many.
Sources
52. Seligman, M.E.P., Learned optimism : how to change your mind and your life. 1st Vintage Books ed. 2006, New York: Vintage Books. 319 p.
53. Livingston, G. and D.V. Cohn. Record Share of New Mothers are College Educated. Pew Research Social & Demographic Trends 2013; Available from: http://www.pewsocialtrends.org/2013/05/10/record-share-of-new-mothers-are-college-educated/.
54. U.S. Department of Labor (Bureau of Labor Statistics). America’s Young Adults at 27: Labor Market Activity, Education, and Household Composition: Results From a Longitudinal Survey Summary. Available from: http://www.bls.gov/news.release/nlsyth.nr0.htm.
55. Noble, R.E., Depression in women. Metabolism, 2005. 54(5 Suppl 1): p. 49-52.
56. Dietz, P.M., et al., Clinically identified maternal depression before, during, and after pregnancies ending in live births. Am J Psychiatry, 2007. 164(10): p. 1515-20.
57. Heinrichs, M., et al., Selective amnesic effects of oxytocin on human memory. Physiol Behav, 2004. 83(1): p. 31-8.
58. Ko, J.Y., et al., Depression and treatment among U.S. pregnant and nonpregnant women of reproductive age, 2005-2009. J Womens Health 2012. 21(8): p. 830-6.
59. Beck, C.T., A meta-analysis of predictors of postpartum depression. Nurs Res, 1996. 45(5): p. 297-303.
60. Muscat, T., et al., Beliefs About Infant Regulation, Early Infant Behaviors and Maternal Postnatal Depressive Symptoms. Birth, 2014. 41(2): p. 206-213.
61. Oppo, A., et al., Risk factors for postpartum depression: the role of the Postpartum Depression Predictors Inventory-Revised (PDPI-R). Results from the Perinatal Depression-Research & Screening Unit (PNDReScU) study. Arch Womens Ment Health, 2009. 12(4): p. 239-49.