Postpartum Depression and Toxic 'Mom Guilt'
Postpartum depression is common and treatable, but a fear of failure keeps many women from accepting the diagnosis.
Dr. Corey Babb
My name is Corey Babb, and I’m an OB/GYN with OSU Physicians, as well as the Director of the Oklahoma State University Center for Women’s Sexual Health. Last week we answered some basic questions about women’s health, but this week we’re discussing physical, emotional, and hormonal changes in the postpartum period and beyond, specifically looking at postpartum depression (PPD). Motherhood is hard enough without wading through the milieu of misinformation out there, so let’s get to the heart of things!
First of all, let’s talk about “normal” during the postpartum period. Your definition of “normal,” and your provider’s definition of “normal” may be completely different, so keep that in mind when you’re having that all-important postpartum appointment. For example, while I can tell you that it’s fine to feel tired all the time during the first three months (or years…) of a child’s life, that statement may be a complete shock to you - especially if you’re the type of woman who had energy in excess. Likewise, saying that you’re “clear” for sexual activity doesn’t mean anything if you’re not mentally prepared to engage in sex. Having a baby changes a woman to her core - emotionally, physically, even how she interacts with the world around her - and while most of those changes are beneficial, some can lead down the road towards isolation, resentment, and eventually, depression.
At this point, I’d like to discuss some misconceptions about what postpartum depression is, and what it’s not. The TV/movie/stereotypical PPD mom is frazzled, tearful, doesn’t interact with others, and, in severe cases, can harm herself or her baby. She obviously doesn’t have a good support network, and probably had some terrible experience with pregnancy or childbirth. The fact of the matter, however, is that most women with PPD seem just fine on the outside - they go to mom’s outings, have dinner with their friends, and live an apparently normal life. This is what makes postpartum depression so challenging to detect, and treat.
Now, we know that statistically 15% of women will develop postpartum depression (although my thought is that it’s actually much higher), and that up to 85% will develop “baby blues,” a short-lived form of PPD that resolves within six weeks following delivery. And we know that PPD as a condition responds very well to counseling, medication, or lifestyle modification (increased sleep, better nutrition, etc.). Treating the condition is not necessarily the problem. Diagnosing it, and having women come to terms with that diagnosis, is. In our collective consciousness, depression of any sorts equates to failure, and no woman wants to fail at being a mother. I have personally seen women who meet criteria for PPD dismiss it, saying that their symptoms are just “normal motherhood.” I mean, shouldn’t you have debilitatingly low energy if you’re only getting two-three hours of sleep a night? What about not wanting to be around people? Shouldn’t you have less desire to go out with friends because “bringing the baby along is a hassle?” What about sex life? You’re being touched all the time - should you really want to be intimate with your partner?
I’m going to stop right now, and address something. All too often I hear new moms say things like “I’m supposed to love my baby more, but I’m just angry at it,” or “I don’t understand why I’m not as close to my baby as I should be.” These are mom guilt statements. What’s mom guilt you ask? Well, it’s basically the accumulation of “shoulds, coulds, and woulds” that result from comparing oneself to other mothers. One look at social media, or maternity/childbirth websites will show you a plethora of perfect pregnancies, with baby showers, deliveries, and postpartum pictures filled with unicorns and rainbows. For the vast majority of women, this is not realistic. Childbirth is messy, painful, and can cause all sorts of problems that you have no control over. Likewise, childrearing is a minefield of insecurity, with many parents having no idea what they’re doing, yet trying to maintain an image of calm to the outside world.
In short, mom guilt is toxic, and unfortunately, contagious. It’s passed from one well-meaning woman to another as a means of trying to maintain some semblance of order in a completely chaotic situation. Does mom guilt lead to postpartum depression? There’s not a double-blind, placebo controlled study that says it does, although I doubt you can ignore the role it can play in the condition as a whole.
So what do we do? While it’s easy to say “stop comparing yourself,” the truth of the matter is that our culture is one of comparison. We might as well get rid of every mirror in the country, because I’m willing to bet there isn’t one mother out there who hasn’t looked at herself in the morning after a long night and asked “Am I doing this right? Why does it come so easy for everyone else?” Well moms, I’m here to tell you that it’s hard for everyone. Even moms who seem to have everything figured out.
Mom guilt aside, why does this happen? What actually leads to the development of postpartum depression? The answer lies with pregnancy as a whole, and to really understand it, we need to, as Julie Andrews would say, “start at the very beginning, a very good place to start.”
It may be the understatement of the century, but pregnancy causes an insane change in your hormones. Estrogens (estriol, specifically) and progestins skyrocket, causing not only the physical symptoms of pregnancy, but emotional changes as well. Luckily, hormones do level out - around five months, or so, into pregnancy - which leads to a little more emotional stability. As delivery approaches, certain hormones start to increase in number, leading to the “maternal nesting instinct.” With labor, oxytocin is produced to yield powerful uterine contractions, and is released in extra large amounts immediately after delivery, prompting a feeling of “bonding” between mother and newborn. In moms who breastfeed, this is augmented even more. During the first six weeks following delivery, hormones initially drop, then remain at an overall low level, which can potentiate feelings of fatigue, stress, and may even lead to decreased bonding with baby. It’s during this time that mothers may start to feel the beginnings of postpartum depression, manifested as any number of symptoms, including irritability, lack of interest in previously enjoyable activities, dietary changes, sleep changes, or feelings of distance between themselves and others. In summary, it’s the change from very high to very low levels of hormones that tend to lead to PPD.
Is there anything we can do about this? Is there a way to prevent PPD? Eh, not so much. We know that women who already have depression, or who have dealt with postpartum depression in the past are at greater risk for developing the condition, so careful observation and early management of symptoms is prudent. Likewise, women who develop anxiety during or after their pregnancies are also at risk for PPD, so those feelings shouldn’t be ignored, either. As I stated above, postpartum depression responds well to conventional therapies, and typically resolves with treatment. Honestly, the most important part of treating postpartum depression is recognition. Recognition that you are human, and that your body is changing; your life is changing. Recognition that it’s perfectly normal to feel imperfect, and that you are a great mom despite your pregnancy, delivery, or whatever may have happened that was out of your control. Recognition that motherhood is hard, and that it’s OK to feel overwhelmed. It’s OK to feel alone. It’s OK to wonder if you’re doing it right. Because in the end, being a good parent is hard.
Repeat after me - being a good parent is hard, and that’s OK.
Well, that about wraps it up for the blog this week. Next week I’ll be addressing sexual issues, including different types of problems mothers commonly encounter, and what to do about them. Thanks for reading! I have additional resources online at my Facebook page, @DrCoreyBabb, where I do Facebook Live videos, answer questions, and post links to relevant women’s health issues. Remember you are your best advocate, so take charge of your own health!
Dr. Corey Babb is a graduate of the Oklahoma State University College of Osteopathic Medicine, and completed his postgraduate training in Obstetrics and Gynecology at the University of Oklahoma-Tulsa, as well as Oklahoma State University Medical Center. He is board-certified in Obstetrics and Gynecology, and is a fellow of the American College of Osteopathic Obstetricians and Gynecologists, the International Society for the Study of Women’s Sexual Health, and is a North American Menopause Society Certified Menopause Practitioner. His practice is devoted to the evaluation and treatment of female sexual dysfunction, and he is the only physician in the state of Oklahoma that specializes in women’s sexual health. He is currently an assistant professor of Obstetrics and Gynecology at the Oklahoma State University Center for Health Sciences, and is the director for the Oklahoma State University Center for Women’s Sexual Health.