How To Improve Postpartum Mental Health

Increasing awareness of mental health concerns in the postpartum period and research-backed tips for improving postpartum mental health

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May is Maternal Mental Health Month. The purpose of this monthly designation is to focus on increasing awareness for mental health concerns experienced by mothers. Today’s newsletter will focus in particular on mental health concerns in the postpartum period. Despite a growing body of research that the postpartum period may be the most vulnerable time period for mental health during a woman’s life and knowledge that nearly all women experience at least some mood changes during this time, women are still stigmatized for expressing anything but bliss in the transition to motherhood. 

The goal of this newsletter is to spread awareness of the common mental health struggles during the postpartum period and will specifically cover:  

• Postpartum depression

• Postpartum anxiety

• Postpartum psychosis

• Other common postpartum symptoms (intrusive thoughts, postpartum rage)

• How to improve postpartum mental health

Postpartum Depression

Research estimates that postpartum depression occurs in about 17% of mothers across the world. For most mothers, symptoms of depression emerge 4 to 6 weeks after birth and gradually decrease in subsequent months. However, postpartum depression can occur at any time in the 3 years after a pregnancy or birth.

Symptoms of postpartum depression include:

• Feeling very sad or irritable

• Loss of interest or pleasure in activities you used to enjoy

• Feeling worthless or guilty

• Changes in appetite or sleep 

• No energy or feeling like you’re always tired

• Restlessness or being slower in your actions

• Difficulty thinking, paying attention, or making decisions

• Thinking you are a “bad parent”

• Thoughts of harming yourself or your baby

Untreated postpartum depression can have a negative impact on the mother, baby, and the functioning of the family. Postpartum depression is associated with many negative impacts for mothers including problems with physical health, a lower quality of life, increased stress, more relationship problems, and a higher risk for suicide. Postpartum depression may also negatively impact infants as it is associated with slower growth (both height and weight), increased childhood illnesses, increased behavioral problems, breastfeeding difficulties, and problems with mother-child bonding.This information is not intended to cause shame because no one chooses to suffer from postpartum depression, but rather to highlight the important and wide-reaching consequences of postpartum depression. 

Postpartum depression often co-occurs with anxiety. Research finds that two out of three women with postpartum depression may also have an anxiety disorder.

If the symptoms of postpartum depression cause significant distress or impair your day-to-day-functioning or if you are experiencing any thoughts related to harming yourself or others, you should contact a mental health professional immediately. 

Postpartum Anxiety

Although postpartum depression may be more commonly discussed, postpartum anxiety may actually be the most common postpartum mood disorder. During the postpartum period, about 18% of women experience anxiety in postpartum weeks 1 to 4, 15% in weeks 4 to 24, and 15% after week 24.

Symptoms of postpartum anxiety include:

• Worry that seems excessive, out of your control, and/or irrational

• Intrusive thoughts (repeated disturbing thoughts often related to the baby or yourself being harmed)

• Trouble sleeping

• Guilt or self-blame

• Difficulty concentrating

• Panic attacks

• Avoiding anything that makes you anxious or nervous

• Feeling tense, shaky, or nauseous

Postpartum anxiety can include postpartum generalized anxiety disorder (persistent worry that occurs more days than not), panic disorder (recurrent panic attacks), and OCD (unwanted, distressing thoughts and rituals that prevent the thoughts from becoming a reality). 

Postpartum anxiety often involves excessive worry about a variety of topics and this can even include excessive worrying about parenting or your infant. Women with postpartum anxiety also show more self-blame. Postpartum anxiety can negatively impact breastfeeding as mothers are more likely to stop breastfeeding early and less likely to exclusively breastfeed when they have postpartum anxiety. Postpartum anxiety is also linked to issues in the mother-infant relationship. 

Postpartum anxiety often occurs with postpartum depression (about 1 in 3 women with postpartum anxiety symptoms also report postpartum depression). In these cases, symptoms are often more severe.

Male partners also show increased rates of anxiety during the pregnancy and postpartum period.

Postpartum Psychosis

Postpartum psychosis is a very rare but very serious condition. Postpartum psychosis involves the experience of one or more of the following: strange beliefs or thoughts (delusions), hearing, seeing, feeling, or smelling things that are not there (hallucinations), a manic mood with a loss of touch with reality, and severe confusion. Other common symptoms include disorganization, hyperactivity, irritability, paranoia, rapid mood swings, and erratic behavior. 

Postpartum psychosis occurs in about 1 in every 1,000 births. This might seem rare, and relatively it is, but it is important to note women are 23 times more likely to have a first psychotic episode during the postpartum period than any other time in their lives. 

The onset of postpartum psychosis is typically very dramatic and sudden and often occurs in the first two weeks postpartum.  Early warning signs include insomnia, anxiety, irritability, and mood swings (although these are also symptoms of postpartum depression and anxiety). The strongest risk factor is a history of bipolar disorder. However, 2 out of 3 women with postpartum psychosis have no history of a psychiatric disorder. In addition, 40% of women  with postpartum psychosis do not experience an additional psychotic episode outside of the postpartum period . This finding suggests that postpartum psychosis may be a temporary psychological condition in some women.

Postpartum psychosis is an emergency and requires immediate treatment. If you suspect you may have postpartum psychosis, call your OB, doctor, or 911 immediately. You can also go to an emergency room to seek help. Postpartum Support International (PSI) also provides postpartum psychosis coordinators to give free assistance to mothers and families who are not in an emergency situation. Also, given the nature of postpartum psychosis, a lot of birthing people will not be fully aware of their limitations or symptoms. It is crucial that support people or partners are educated on warning signs and are part of the birthing person’s care team to ensure they are cared for and seek treatment appropriately.

Other Postpartum Symptoms 

Intrusive, Unwanted Thoughts

Nearly all new mothers (70-100% of mothers) experience intrusive thoughts about harm to their infants. Most of these thoughts are related to accidentally harming their infant, but half of mothers experience thoughts of intentionally harming their infants. However, it is very important that mothers know that thoughts about harming the infant do not actually increase your risk for harming the infant even when you are having thoughts of intentionally harming your infant. When parents experience these thoughts, it is important to recognize that they can be a normal experience and they do not reflect any true intentions. In a way, many perinatal mental health professionals see the distress related to the intrusive thoughts as protective because they signal you’re not comfortable with the nature of the thoughts and will often go out of your way to ensure the thoughts aren’t acted upon. 

Do not shame or guilt yourself for experiencing these thoughts or do anything to try to avoid these thoughts. Simply acknowledge them as a normal postpartum experience and move on. However, if the thoughts are causing you significant distress, you cannot move on from the thought, and/or you are worried you might act on the thought, seek help from a mental health professional as soon as possible. 

Postpartum Rage

Postpartum rage (translation: increased anger and irritability during the postpartum period) is an incredibly common experience in the postpartum period (see here for a review). About 30% of mothers report experiencing postpartum rage. This rage may emerge due to the stress related to this time period, lack of sleep, feelings of powerlessness and/or expectations being violated. Research also finds that the mother’s sleep quality and anger related to infant sleep is related to overall anger during this time. It can help for parents to know what is “normal” when it comes to infant sleep and to have realistic expectations for this time period. 

Mothers who are experiencing postpartum rage are also more likely to have underlying postpartum depression or anxiety and should consider seeking help from a mental health professional. These symptoms should not be ignored or overlooked since feelings of anger may be associated with more severe or recurrent depression symptoms in the postpartum period.

How to Improve Postpartum Mental health

1. Seek help from a mental health professional, particularly if your symptoms do not improve after two weeks, you are finding it difficult to care for your baby or complete tasks of daily life, or if you have thoughts about harming yourself or your baby. Therapy, such as cognitive behavioral therapy (CBT), and medication may be very effective in treating postpartum mood disorders. It is important to know that you can take many medications while continuing to breastfeed (just talk to your medical provider first).

2. Identify a community of people to support you in both practical and emotional ways. Reach out to mom’s groups in your community, get to know your neighbors, find virtual support groups, or ask family members in advance for help. Higher social support is associated with a lower risk of postpartum depression (Xie et al., 2009) Lack of social support is related to an increased risk for postpartum anxiety and worse mental health overall.

3. Try relaxation therapy. A recent study found that teaching new mothers to relax resulted in lower stress scores for mothers and lower levels of the stress hormone cortisol in their breastmilk. Their infants also showed longer sleep duration (!!), greater milk intake, and greater weight gain. The relaxation therapy consisted of listening to recorded “guided imagery” while breastfeeding or expressing milk at least once per day from 2 to 14 weeks postpartum. I was able to find the relaxation therapy used in this study on Amazon music and the iTunes music store!  Just search for “Breastfeeding Meditation” by Sheri Menelli.

4. Practice mindfulness. Mindfulness doesn’t have to mean practicing an hour of meditation every day, but rather taking moments throughout the day to be present and focus on your breathing. Research finds that mindfulness practice is associated with fewer depressive symptoms during the postpartum period (Dimidjian et al., 2016)

5. Practice using self-compassion with yourself. Remind yourself that everyone struggles and that you are only trying your best. When you are giving yourself a hard time, imagine how you would treat a friend in the same position. Self-compassion is associated with improved mental health in the postpartum period 

6. Identify “experts” who can help you to build your confidence as a mother, such as a knowledgeable pediatrician, lactation consultant, or physical therapist specialized in treating postpartum concerns. Research finds that mothers with more confidence show improved mental health in the postpartum period. 

7. Practice skin-to-skin care. Skin-to-skin care has been associated with many important benefits for mothers and babies. Daily skin-to-skin care lowers anxiety in mothers  and mothers who practice skin-to-skin care show greater reduction in the stress hormone cortisol. You can use a skin-to-skin carrier (like these) so you can practice skin-to-skin throughout the day without having to lie around topless all day. It is also never too late to start skin-to-skin care if you haven’t started yet!

8. Try using infant massage. Infant massage has many benefits for babies but may also help to lower postpartum anxiety and depression in mothers. Here is a YouTube video to get you started with infant massage!

9. Continue educating yourself about postpartum mood disorders. Simply educating yourself about these conditions is also shown to provide some benefits, so you’re already on your way! 

Expert Reviewer

All Parenting Translator newsletters are reviewed by experts in the topic to make sure that they are as helpful and as accurate for parents as possible. Today’s newsletter was reviewed by Dr. Nichelle Haynes. She is a Perinatal Psychiatrist in Austin, TX and CEO of her clinic, Reproductive Psychiatry and Counseling. She and Dr. Kristin Lasseter are excited to announce the launch of their YouTube Channel, Medical Mamas! Check out their channel, even in its infancy, it is filled with evidence based information for your reproductive mental health! 

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Welcome to the Parenting Translator newsletter! I am Dr. Cara Goodwin, a licensed psychologist with a PhD in child psychology and mother to three children (currently an almost 3-year-old, 5-year-old, and 7-year-old). I specialize in taking all of the research that is out there related to parenting and child development and turning it into information that is accurate, relevant, and useful for parents! I recently turned these efforts into a non-profit organization since I believe that all parents deserve access to unbiased and free information. This means that I am only here to help YOU as a parent so please send along any feedback, topic suggestions, or questions that you have! You can also find me on Instagram @parentingtranslator, on TikTok @parentingtranslator, and my website (www.parentingtranslator.com).

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