“I imagined myself getting hit by a school bus and not caring, because at least that meant I could rest.”
–Erin Sarris, 40, content strategist and infertility children’s book author
“My thoughts ranged from wondering how I could break a leg just to ‘get a few days away’ to picturing myself pushing the stroller into the middle of an intersection.”
–Frenchie Ferenczi, 35, consultant
“I went into labor seven weeks early with my first. It's not surprising that when I did the postpartum ‘Are you at risk of postpartum depression’ survey, I was flagged as a risk.
–Kara Cox, mid-30s, software engineering senior manager
“The newborn period felt like one endless day. I was unable to complete super simple tasks. The simple felt daunting.”
–Jennifer* (name changed to protect the mother’s privacy)
These are the stories of motherhood. But they are also the stories of postpartum depression (PPD), which affects one in eight women who have recently experienced a live birth. In many cases — including my own — women don’t even realize they are battling something far more consequential than “baby blues.” This is because we’re so enmeshed in sleep deprivation, hormone fluctuations, and, you know, keeping a brand-new human alive. The last thing we’re capable of acknowledging is a mental health breakdown.
What we do need to acknowledge, however, is that PPD should be taken as seriously as anything else in the postpartum period, be it the six-week checkup or a colicky newborn. To help us better understand PPD, Rescripted turned to several experts, including perinatal mental health clinicians, as well as real-life moms who’ve offered to share their stories.
Defining Postpartum Depression
Although “postpartum depression” is a common phrase, it’s become “an umbrella term,” says Julia “Jill” Garrett, PsyD., PMH-C, the founding psychologist and program director of the Motherhood Space, the maternal mental health program at Baptist Behavioral Health in Jacksonville, Florida. “The best term to use when describing these emotional challenges in the perinatal period (pregnancy and a year or so after having a baby) is Perinatal Mood and Anxiety Disorders (PMADs).” Dr. Garrett explains that PMAD is a preferable term over PPD because depression isn’t the only emotional challenge that can arise following birth. New moms and dads (“1 in 10 dads will experience a PMAD” she says) might experience anxiety, panic, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar disorder, or psychosis.
PMADs vs. “Baby blues”
With “baby blues” being such a part of our vernacular – 85% of new moms will experience baby blues, says Dr. Garrett – it’s easy to assume that any type of mood change that follows after giving birth is just that. And if you’re not a mental health professional, it’s tough to differentiate between adjusting to a new baby and a PMAD.
The main difference between baby blues and PMADs is how long your symptoms last. “The baby blues are commonly experienced in the first two weeks after having a baby due to a significant drop in certain hormones, as well as the physiological changes a woman is experiencing following birth,” says Kara Kushnir, LCSW, PMH-C, the founder and clinical director of A Work of Heart Counseling in New Jersey and the education and training chair for Postpartum Support International, New Jersey Chapter.
Generally speaking, the baby blues are “less intense and “last for a short period of time,” explains Kushnir. “[PMADs] occur when symptoms persist beyond those first two weeks postpartum and impact mood to the point of disrupting daily functioning, bonding with baby, and sleep, appetite, and overall demeanor.”
If your symptoms are still present around two to three weeks postpartum, it’s time to seek professional help.
Why PMADs occur
“We all have biological, psychological, and social vulnerabilities that, when occurring at the same time, can make a perfect storm for experiencing things like PMADs,” says Dr. Garrett. She explains that postpartum moms are already physically vulnerable to mood/anxiety disorders. Compound that with a lack of sleep, a possible personal/family history of emotional challenges, no paycheck, increased fights with their partner as they adjust to their new baby, etc., and you have an ideal breeding ground for a PMAD.
Those who have pre-existing mental health conditions and/or have experienced traumatic births or medical complications are also at a higher risk for developing a PMAD, says Kushnir.
Of the four moms (not including Kushnir and Dr. Garrett) interviewed for this article, three of them shared traumatic birth stories:
After undergoing in-vitro fertilization (IVF), Sarris became pregnant with twins, only to lose “a ton of blood” during a delivery that required two blood transfusions. “I had to be rolled in a hospital bed to meet [my twins], and I felt very disassociated.” Following a brief NICU stay, Sarris found it difficult to bond with her babies.
Cox delivered her first child four and a half weeks early. Her 18-day labor led to “severe sleep deprivation, and trauma/guilt around premature labor and a NICU stay.”
“I felt very helpless during the experience,” says Jennifer of her emergency C-section. Even though her daughter was a “much wanted baby,” Jennifer admits feeling like “I was looking at a complete stranger. I did not fall in love at first sight.”
But PMADs can manifest regardless of your birth experience. “Societal factors play a huge role in perinatal mental health,” says Kushnir. “So many women think something is wrong with them and struggle with their mood due to unrealistic expectations and pressures.”
Even though she “struggled to bond,” with her first child, had “excessive anxiety,” and “an underlying feeling [her baby] would be in better hands with anyone but me,” Ferenczi chalked her difficulties up to the COVID pandemic: “My PPD went undiagnosed for the first 14 months. It was 2020, work was crazy, and I just assumed that everyone was having a hard time.”
How to address intrusive thoughts
One pervasive symptom of PMADs is intrusive thoughts. These can range from harm to the baby, harm to yourself, or just wishing you could disappear. “I had intrusive thoughts about running away from everybody and moving someplace where I could never be found,” says Sarris. “I planned out how I could avoid seeing everybody in my life ever again to avoid feeling that shame that I (in my mind) deserved.”
“I imagined myself doing things that were really out of character for me,” says Ferenczi, “and it was terrifying. Not only was I struggling, but suddenly I was imagining myself harming myself and my son.”
The first thing to remember is that intrusive thoughts are quite common. “We know that this occurs for the vast majority of parents,” says Dr. Garrett. “I wish I had known that intrusive thoughts feel distressing but rarely reflect the actual desires we have,” observes Ferenczi.
Both Kushnir and Dr. Garrett recommend recognizing that these are just thoughts. “Thoughts are not facts, truths, or real unless we have acted on them,” says Kushnir. “I get moms to practice the three As – awareness, acknowledgment, acceptance,” says Dr. Garrett. “Awareness that scary thoughts are popping in, acknowledgment that they do not feel good, and acceptance that we all have thoughts pop in our mind and it doesn’t mean we are a bad person, it just means we are human.”
Treatment for PMADs
If you believe you’re suffering from a PMAD, psychotherapy with a trained professional is an excellent first step. Specifically, you’ll want to look for a therapist with a perinatal mental health certification (PMH-C); Kushnir and Dr. Garrett hold these credentials. Postpartum.net is a good place to start your search.
Kushnir recommends asking potential practitioners about “what kinds of approaches/practices they use,” if they’re in-person vs. telehealth, and if you can “bring baby with you in the office/have them in the room.” And since you’ll already be knee-deep in stress once the baby arrives, Dr. Garrett suggests “seeking out the support resources ahead of having a baby so you can have some ideas on standby.”
Since everyone has different needs, a trained professional will help you with a treatment plan. Some people just need evidence-based psychotherapy (like cognitive behavioral therapy), and others a combination of therapy and medication. “Additionally, peer support is invaluable,” says Kushnir. “Postpartum Support International hosts a plethora of free groups online.” Even if you’re not based in New Jersey, check out A Work of Heart Counseling’s website and Instagram. Kushnir and her team regularly host postpartum support groups and share perinatal health resources.
Although perinatal day programs like Jacksonville, Florida’s Motherhood Space (where Dr. Garrett works) are still “a rarity,” it’s worth researching if there’s one in your area. These are comprehensive treatment centers for new parents who need an extra level of care for both themselves and their babies. For example, Ferenczi availed herself of the Motherhood Center’s support groups and clinicians in New York City. “That connection [with other moms] is so healing,” she says.
You are not alone
No matter what kind of intrusive thoughts you may be experiencing, remember what the professionals say: These are just thoughts, and they do not make you a bad parent.
You may feel alone in this, but the truth is, you’re anything but: “Many of us are in this club,” assures Jennifer. “All the terrifying, terrible, awful thoughts and feelings you're experiencing are not your fault, and you're not the only one to feel this way,” echoes Ferenczi. Adds Sarris: “Don’t be ashamed of asking for help from a spouse, trusted friends, reliable family, community programs, or wherever you can. It’s okay to spend time away from your baby, and they need you to be in good shape for all the fun that’s to come.”
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Twitter.