You're Not Alone: The Emotional Struggles of Pregnancy

Mom struggling, holding crying baby

Women go through a lot of emotional, physical and hormonal changes during pregnancy, birth and in the year following the baby’s arrival. These changes impact a woman’s brain, which in turn affects her moods, behaviors and how she feels. Maternal Child Education Coordinator for UnityPoint Health, Deb Oldakowski, RN, BSN, LBSW, explains the disorders, how to identify them, the treatments and resources that are available.

What are Perinatal Mood Disorders?

Perinatal mood disorders impact about 15 to 20 percent of all women who give birth. They include postpartum stress, postpartum depression, postpartum obsessive-compulsive disorder (OCD), postpartum post-traumatic stress disorder (PTSD) and postpartum psychosis. This spectrum of perinatal mood disorders is considered the most common complications of birth.

Perinatal mood disorders include symptoms that may begin anytime, even up to a year after birth. Symptoms include feeling irritable, tired, guilty, worthless or helpless, restless or out of control, hopeless, anxious, overwhelmed or worried that nothing will get any better.

About 15 percent of women experience significant depression following childbirth. There are certain risk factors including a family history of depression, anxiety or postpartum depression. It also might be spurred by financial stress, marital stress or complications in birth or breastfeeding.

“Mothers may describe having little appetite or overeating, feeling unable to care for the baby, crying for no reason, difficulty thinking, not caring, trouble remembering even simple things, unable to cope with daily tasks or have repeated thoughts, ideas or images that are uncontrollable or cause her to feel anxious, guilty or shameful,” Oldakowski says.

Perinatal mood disorders may make a woman feel disorganized, such as she can’t make simple decisions, or that she lacks energy and interest in things that she used to find joy. Oldakowski says it’s best to recognize the symptoms early to begin treatment. The sooner treatment begins the more effective it will be. The more severe the symptoms, the longer the treatment will take. Treatment options include increased practical and emotion support, talk therapy and/or medication, or a combination of these.

What is Baby Blues?

About 80 percent of women experience the “baby blues.” This is a much milder display of symptoms that go away after about two weeks. Oldakowski says this is not considered a mood disorder and is so common it’s considered normal for women to experience. Symptoms may include crying spells, mood swings, feeling sad, anxious or overwhelmed. These symptoms are lessened when mothers get more sleep, eat healthy and receive both emotional support and help with daily household tasks.

Pregnancy and Depression

Depression can begin during pregnancy. Some women who feel depressed during pregnancy may have a hard time caring for themselves and their unborn babies. This can lead to eating poorly, poor weight gain, missed prenatal visits and trouble sleeping. Depression during pregnancy can raise the risk of having a baby born too soon or a baby born too small.

“Some women may even use harmful substances, like tobacco, alcohol or illegal drugs, to try to feel better. These can be ‘blue flags’ to family members during pregnancy,” Oldakowski says.

What is Postpartum Psychosis?

Postpartum psychosis is a severe postpartum mood disorder. It is not the same as postpartum depression. Postpartum psychosis only occurs in one or two women per 1,000 and is, therefore, much more rare.

“It can start suddenly in the first few days or weeks following birth,” Oldakowski says. “Women may say things like ‘you would be better off without me.’ They may also be unable to sleep for a couple days at a time, do or say strange things, hear voices or see things that are not really there.”

Oldakowski says postpartum psychosis in an emergency. Call 911 or take her to the emergency room, immediately. Oldakowski stresses that she should never be left alone by herself or alone with the baby.

What about the Fathers?

Dads should be aware of the signs and symptoms of both “baby blues” and postpartum mood disorders. If Dad sees early signs of mood disorders during pregnancy or the weeks following birth, he needs to help Mom get to see her health care provider. He can also provide practical and emotional support, encourage her and listen to her.

However, women aren’t the only ones who may experience depression after the birth of a baby. Dad can suffer from depression, too.

“In fact, about 10 percent of men with a partner who is depressed will also be depressed. Lack of sleep, coping with a crying baby and coping with a crying partner can create feelings of guilt or worthlessness, lack of sleep or concentration and can lead to thoughts of death or suicide,” Oldakowski says.

Final Thoughts

“The one thing I could say to a new mother is ‘You are not alone. You are not to blame. We are here to help,” Oldakowski says.

There are several resources for perinatal mood disorders. The Postpartum Support International (PSI) Warmline is available at 1-800-944-4473. This toll-free number provides basic information, support and resource. The suicide prevention hotline is also available at 1-800-273-TALK. Remember, your UnityPoint Health primary care provider is always accessible if you have questions or are experiencing symptoms of mood disorder during pregnancy or postpartum.

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