Transition to Motherhood: Postpartum Anxiety and Depression

This is the eighth post in a series on The Transition to Motherhood

The transition to motherhood which occurs during pregnancy and the postpartum period is accompanied by a multitude of hormonal changes as well as changes in brain size and plasticity. These are remarkable in that they facilitate the mother's ability to attune to and care for her baby, but they may also predispose her to certain psychological difficulties.

Of course, almost all mothers experience an initial period after delivery during which they feel overwhelmed by the newness of it all. And to some degree, they may feel anxious, sad, or irritable as well. They may cry when they least expect to and snap at others without meaning to. This is completely normal and is often referred to as the baby blues.

These mood changes can be attributed to the enormous shift in the new mother's life and the drastic decrease in the secretion of certain pregnancy hormones such as progesterone, estradiol, and cortisol (Suryawanshi, O., 2022).

Support from those in the new mother's vicinity—her partner, her friends, and or her family—is crucial during this time to scaffold her new role as a mother as well as in aiding her physical recovery from the immense experience that childbirth is.

But there are a variety of other psychological experiences that a new mother can have which go well beyond the common baby blues and present more difficulties for the new mother. The most common of these is postpartum depression.

About 11 to 20 percent of new mothers experience minor depression. This can be felt as a sense of sadness, a feeling of low energy, or frequent fluctuations in mood. But some new mothers feel even more depressed than this. Approximately 7 to 14 percent develop major depression, the symptoms of which are persistent low mood, lack of energy, fatigue, difficulty with concentration, loss of interest in activities she used to enjoy, difficulty bonding with the baby, withdrawal from family and friends, changes in appetite, irritability and anger. But, of particular importance, this sort of depression also includes feelings of intense shame and guilt, including the feeling of not being a good mother.

Postpartum anxiety is another common difficulty for new mothers. Following delivery, many women feel quite anxious. They may feel nervous, worried, irritable, or angry, and or they may develop symptoms of an obsessive or compulsive nature, or even episodes of panic.

For these mothers, life, moment-to-moment, is very hard. They may worry constantly over the well-being of their baby; they may obsess over what is right to do for their baby or over issues such as cleanliness or hygiene for themselves, other family members, or the baby. They may worry over whether the house is clean enough to prevent illness for the baby, whether the crib is safe enough, whether others are handling the baby appropriately as well as any of a multitude of other things.

This worry can rise to the level of panic, a state so painful that it is intolerable.

A smaller number of mothers experience postpartum PTSD. For those mothers who have had a traumatic delivery experience during which labor was prolonged, during which the mother or the baby's survival was threatened, or during which extensive medical intervention was necessary for the mother or the baby, there will often be a post-traumatic response. This can include anxiety, panic, the inability to sleep, a great deal of worry and distress, and nightmares—all the symptoms we would expect to see in someone with PTSD.

A smaller number of new mothers may develop postpartum psychosis during which they develop feelings of intense restlessness, agitation, insomnia, confusion, or even euphoria. They may seem irrational or they may develop odd ideas or delusions about things including ideas that their baby is possessed, or evil in some way. They may be paranoid, they may have hallucinations and they may behave in ways that seem unusual.

While family members - and the mother herself - may want to dismiss the kinds of symptoms I have listed for these psychological issues in the hopes that everything is OK, ALL of these mothers need enhanced support, understanding, and professional help. The indications of postpartum depression, anxiety, psychosis and PTSD simply cannot be brushed off as the baby blues. Mothers experiencing these issues need immediate help from professional mental health providers, preferably both a therapist and a psychiatrist - one to provide support and insight and the other to evaluate the need for medication or even hospitalization.

These serious mental health concerns affect the mother's well-being, her relationship with her baby AND the baby's well-being.

These difficulties can happen to any mother, but those who have poor social support, those who have experienced recent highly stressful events in their lives, those who live in abusive or very difficult relationships, those who have previously experienced anxiety or depression, or who have a family history of these may be more at risk for the development these issues.

Postpartum Depression Essential Reads

Maternal Minds Matter

Struggling Mentally Post-Baby? Create a Mental Health Plan

We know that these difficulties arise from a variety of sources - but progress in neurobiological research is leading to significant clues as to their origins. Animal models and neuroimaging studies in humans are starting to detect abnormalities in the structure, function, and connectivity of brain regions responsible for theory of mind, self-regulation, and emotion in mothers who experience these problems (Barba-Müller and colleagues, 2019).

There is hope for earlier diagnosis and better treatment for these difficulties based on these scientific advancements; but for the moment, we DO have the ability to help new mothers who experience psychological challenges.

If you are experiencing any of these difficulties and if you feel you cannot talk with your partner, friends, or family about this, tell your OB-GYN. Call him or her, and reach out. Or, when you go for your baby's first pediatric visit, tell the nurse or pediatrician. Don't hesitate to get the support you need. Not only will this help you, but it will also help your baby and your relationship with your baby.