The Realities of Postpartum

I just realized I was supposed to blog again in September (my Sept post was meant for Aug), as I’d promised I would blog at least once a month from October 2020-October 2021.  So, this blog post is to make up for September, and I will be posting again for World Mental Health Day 2021.

Today, I’m going to blog about the importance of ALL information relevant to a new mother’s well-being.  I was pleased to see Good Morning America’s piece titled “Moms get real about what it’s like postpartum: ‘I felt like I got hit by a bus.'”  dated September 30, 2021.  I love that there is “real” talk about the realities of postpartum.  That is essentially the motivation and focus of my book, which I’d published back in 2011 because not enough people were talking about the realities of postpartum.  While my book uses the terms “hit from left field with PPD” and “PPD hits you like a ton of bricks” in Chapter 3 (Knowledge is Power), the general idea is the same, and it wouldn’t be so bad if more people talk about the realities of postpartum.  The 2 mothers in the article (Maria Alcoke and Jenny Laroche) share my desire to help educate other women so they can avoid the kind of negative experiences we had.  I mean, with knowledge, we have the the power to minimize fears and anxieties that come with first-time motherhood, as well as to get help EARLY.

Just like my book, the article mentions that there is plenty of information out there about preparing to become a mother, about pregnancy, and about baby care, but there isn’t a whole lot about the realities of the postpartum period, like hair loss, recovery from childbirth, anxiety with caring for a baby for the first time, societal expectation that the postpartum period is just for physical recovery from childbirth, and difficulties with breastfeeding–just to name a few.  For Laroche, who experienced heavy hair loss (“I had no idea that you lose so much hair. No one warned me,” said Laroche, who said she felt “like a passenger in my own body” postpartum) and was concerned about even the most basic of body functions, like bowel movements, these completely normal experiences wouldn’t have been so traumatizing and isolating had she known what to expect by talking about it with other mothers or reading about it.  Why are people so afraid to talk about their real experiences?  Is it fear of being shamed?  Judged by others? Not living up to their dream of being a perfect mother?  Wanting to maintain the notion that pregnancy and motherhood are always blissful experiences?  What I want to know is why people insist on keeping up these false notions.

Alcoke shares:

When talking [in] women’s circles and just talking with your friends and sharing experiences, you never want to scare someone away, right? People don’t necessarily want to hear that, like, ‘Oh did you hear about the vaginal tear that I had?’ but it’s part of the process. It happens. It’s super common.

These are things I touch on in my book in my Chapter 6 (My Postpartum Period – An Exhausting and Uncertain Experience) where I talk about Interrupted Sleep/Sleep Deprivation, Startle/Moro Reflex, Colic, Nasty Eczema and Cradle Cap, My Hair Loss, and Returning to Work.  I also talk about the realities of pregnancy, childbirth and the fact that breastfeeding isn’t always instinctive in Chapter 8.  Here’s an excerpt from my Knowledge is Power chapter:

It’s only natural for you to not want to hear about anything that could go wrong during the postpartum period. You may have enough pregnancy-related concerns as it is, with things like nausea, difficulty sleeping, getting everything ready for the baby’s arrival, spotting, cramping, bloating, preeclampsia, etc. I mean, who wants to look forward to her baby’s birth with anything other than positive thoughts? And who wants to think about something you’re convinced won’t happen to you? It’s natural to deal with concerns as they arise rather than worry about something that more than likely would not happen anyway. But remember that a cross-that-bridge-when-you-get-to-it mentality won’t help you if, once you cross that bridge, PPD hits you like a ton of bricks—suddenly and quite mercilessly.

and

From seeing the happy moms around you to those on the television and in magazines, you look forward to your future with your baby with joyful anticipation, thinking that, with happy thoughts, there will only be happy days ahead. And just because you never hear anyone you know talk about having PPD, it doesn’t mean no one you know has ever suffered from it. A friend, relative, colleague, or neighbor may one day suffer—or at this moment could be suffering—from PPD, and you may never even know it because she doesn’t know what is wrong with her and is ashamed to let anyone know that she is unable to enjoy her baby as she’d dreamed she would. No woman is completely immune from PPD after having a baby. With the right combination of risk factors and stressors, any woman—even you—could end up suffering from it.

The Good Morning America piece also touches on the fact that a woman’s body goes through huge changes that–besides the size of the belly–aren’t necessarily visible to an observer.  These changes are hormonal and even neurochemical.  And yet women are sent home from the hospital a couple days after childbirth to recover and with a newborn to take care of (in addition to possibly other kids)!  Everyone recovers in different ways, lengths of time, etc.  Most mothers experience postpartum blues (not the same thing as postpartum depression – which I talk about in Chapter 8 of my book) due to the huge hormonal changes that come with childbirth.  But a percentage (up to 20%) of new mothers experience postpartum depression (PPD), which is a general term for when there is a postpartum mood disorder.  What the article doesn’t mention is that there is also postpartum anxiety, postpartum obsessive compulsive disorder, and postpartum psychosis.

The piece also touches on the fact that new mothers are setting themselves up for huge disappointment if they assume that, when it comes to pregnancy, childbirth and postpartum, things will turn out the way they plan.  No amount of books/information and staying on top of details is going to fully prepare you for all the variables that include the way a woman’s body responds to childbirth, the huge hormonal swings from pregnancy and childbirth, and the baby’s personality and development…..just to name a few.  When it comes to having a baby, the more you want control of a situation, the greater your struggle will be if the results are not what you expect.

This is an excerpt from my book:

Being a first-time mother, you learn the ropes as you go. Practice makes perfect. But mothers with perfectionist or control-freak tendencies find it particularly hard to adapt to the fact that much of their motherhood experience is one in which mistakes will be made and it isn’t possible to have complete control of your life when you have an infant. Those who set high expectations and have specific thoughts of how their childbirth and motherhood experiences should be are setting themselves up for disappointment when their expectations are not met.

The article also touches on the fact that postpartum care in the U.S. is lacking.  Once the baby is born, all the attention turns to the baby, and it seems everyone forgets about the mother.  The article mentions that, in 2018, the American College of Obstetricians and Gynecologists (ACOG) released new guidelines to help encourage more postpartum care.  Six weeks used to be the standard for the first new mother visit with her OB-GYN.  ACOG now recommends that new mothers contact their OB-GYN within the first 3 weeks after delivery, and that care should continue on an ongoing basis, ending with a “comprehensive postpartum visit no later than 12 weeks after birth.”  I believe the reason for this is for OB-GYN’s to assess if the new mother has any symptoms of a postpartum mood disorder.

Postpartum care for the new mother has been completely lacking in the U.S.  I discuss this in detail in Chapter 9 of my book.  Chapter 9 sections include these sections:
  • First Few Days at Home … Now What?
  • New Moms Need Nurturing Too
  • What Is Social Support?

I’ve blogged about social support in great detail previously here and here.  Hugely ignored is the importance of emotional and practical support during the first four to six weeks postpartum to enable the new mother to get the rest she needs while she is recovering from childbirth and at her most vulnerable, thereby minimizing her risk for PPD. A support network should be set up before the baby arrives. Be prepared to have support with how to soothe a crying baby, how to cope with reflux and colic, how to identify and deal with eczema and cradle cap, and how to deal with food allergies, etc. Not being prepared for these challenges and having to figure out how to deal with them via pure trial and error can cause anxiety levels to skyrocket.

How Can I Help If I Can’t Tell If My Friend or Loved One Is Struggling with Postpartum Depression?

That’s a really good question, especially if the new mom doesn’t even know she has postpartum depression (PPD) and many new moms (I am guilty of this) want to hide the fact that they are struggling because they think that that would be a sign that they’re not as good of a mom as they’d imagined themselves to be.

You just have to trust your instincts, be proactive in looking for signs that the new mom is not herself/extra exhausted and/or just ask her how the new mom is feeling. It can also be tricky, as just because she doesn’t look depressed doesn’t mean she’s not depressed. I’d blogged about that previously here and here.

It can be particularly tricky now with COVID and people not seeing each other face to face, and people wanting to take extra precautions to protect a new mom and her baby from exposure to the virus.

Megan Markle’s interview with Oprah and Huffpost article dated March 18, 2021 titled “How to Tell if a Friend is Struggling with Depression or Anxiety During Pregnancy motivated me to write this blog post. It reminded me how even I made it difficult for people to gauge that I needed help.  For those like me who don’t like to be the center of attention/make a big deal over something that causes embarrassment/want to inconvenience anyone and who want to appear a capable and strong woman and mother, we tend to try to shrug things off and shoulder on. Then there’s also the fact that PPD symptoms are different for different women, which makes it all the more tough to tell if something is wrong.  Heck, even medical/mental health practitioners find it challenging to diagnose a perinatal (during pregnancy and postpartum) mood disorder in many situations. 

Megan admitted she experienced suicidal ideation (thoughts of suicide).  According to a study published in 2020, there has been an increase in suicidal ideation among pregnant women in the United States in recent years.  Although I didn’t really experience suicidal ideation, I did get to the point that I felt the urge to disappear to escape the God-awful combination of feelings and fears that I found myself experiencing. That may have been one step shy of suicidal ideation, and I shiver to think of what could’ve happened had I not gotten medical help when I did! Because I was feeling at the end of my rope. It really was beyond awful.

New mothers struggling with a perinatal mood disorder should focus more on getting better and getting help than on feeling bad they even need help or are struggling.  It would help if everyone realized that depression and anxiety in expectant/new mothers is very common, and they should not feel any shortcomings if they do experience it.  They (and you) need to know that they need to get help if they experience any/combination of these symptoms, because it can go from bad to worse suddenly if they do not see a doctor and help:

  • Persistent and mostly inexplicable sadness/tearfulness and feeling empty inside
  • Loss of interest/pleasure in most of your usual activities; inability to laugh
  • Overall impaired functioning*
  • Sleep difficulties (either insomnia or sleeping too much)
  • Weight loss (usually fairly quick) associated with a decrease in appetite
  • Weight gain associated with an increase in appetite
  • Excessive worrying (e.g., about the baby’s well-being)
  • Difficulty thinking, concentrating or making decisions
  • Feelings of guilt/inadequacy/of being a bad mom
  • Urge to run away/disappear/vanish into thin air
  • Onset of panic attacks
  • Sense of despair and/or hopelessness leading to thoughts of death/suicide

The Huffpost article lists the National Institute of Mental Health website and of course Postpartum Support International (PSI) as helpful resources that list common and unfortunately under-recognized signs.  PSI can also help an expectant/new mother to local support groups/mental health professionals.

It is extremely common for a pregnant/new mom to feel (and look) fatigued.  After all, there are a lot of hormonal changes going on.  But if she is really struggling, seems not her usual self and/or seems much more anxious than they normally are–to the point of not being able to carry out their daily activities and/or are having trouble sleeping—then you should suggest she see someone who works with perinatal (during pregnancy and postpartum) mood disorders.

Here are some ways you can help:

  1. Being aware of perinatal mood disorders (refer to PSI link above).
  2. Frequently check in with her and ask how she is TRULY feeling.
  3. Realize that pregnancy/postpartum is NOT always smooth and happy, so if she is struggling, tell her it’s okay that she doesn’t feel happy and it is of utmost importance that she is doing okay.
  4. Ask her if she needs help (but I would just offer it—for example, just drop off food).  We all know it’s common for neighbors, friends and family to bring over meals for the first few weeks so the new parents don’t have to struggle to put meals together while they are busy caring for the new baby.  I’ve blogged about postpartum help here.  Less common is offering the expectant mom a prepared meal, but doing that especially if you know your loved one is struggling would be a particularly caring thing to do.  Bringing over food/groceries is another way to show you care and during COVID times, these moments of connection (albeit brief and socially distanced) can help stave off loneliness.
  5. Arrange to go on walks regularly with her.  Walking and getting out are extremely important during pregnancy and postpartum weeks.  I wrote about the importance of getting out here.
  6. Last and not least, just be there for her. Give her company so she feels less alone (especially important during COVID times). It doesn’t have to be a long visit. Nor do you have to have a long conversation or do much (which is hard during COVID times anyway). But dropping by a couple times a week (if you’re able), would mean so much. Check out my previous blog post here.

The Huffpost article does mention that “postpartum care in the United States is anemic” but I won’t go into this because this would take up an entire blog post on its own.  I have already written posts about this in the past, such as this one.