There’s a lot of talk about postpartum depression, which is great progress when it comes to increased awareness of maternal mental health issues. That said, there are a variety of common postpartum mental health problems that are far less talked about. Moms who are struggling postpartum might Google “postpartum depression” only to find that what they're experiencing doesn’t match the symptoms listed.
So let’s start with a quick overview of the most common mental health challenges and what they look like.
PPD involves feeling down, depressed, or hopeless. You might notice yourself crying constantly and you may feel less interested in activities you used to enjoy. Alongside feeling down or depressed, you might have more trouble motivating yourself to do things, struggle to get out of bed, or have trouble taking care of basic tasks for yourself, your baby, or your home.
Learn more about PPD here.
PPD may be talked about most often, but PPA is actually more common! It’s normal to feel some anxiety about whether you’re doing things correctly or if the baby is healthy and happy, but if the worry feels excessive, uncontrollable, or makes it hard for you to be present and engaged, it might be postpartum anxiety.
Anxiety takes a few different forms, but postpartum, it’s most common to worry about your baby’s health (e.g. SIDS, Covid, and weight gain), your ability to manage everything, your own health, or judgment from others.
Learn more about PPA here.
Incredibly common but rarely talked about, postpartum rage is particularly prevalent for moms of multiple young children (although it can show up no matter how many children you have). Postpartum rage often presents as uncontrollable, explosive rage that results in yelling, snapping, or being physically aggressive towards loved ones.
Moms tend to describe overstimulation as a common triggering factor as well as sleep deprivation. These rage episodes are often followed by intense feelings of guilt.
Learn more about postpartum rage here.
Impacting more than 70% of new moms, intrusive thoughts are unwanted thoughts or images that pop into your head. They usually involve some kind of harm coming to the baby and can be gruesome, vivid, and terrifying.
Intrusive thoughts can often involve mom doing something accidentally or even intentionally to harm the baby. As a result, moms often don’t disclose that they are having these thoughts, or, when they do, may be met with unwarranted alarm from others. The important thing to know about them is that they are very common, very normal, and don’t mean that something is wrong with you or your mind.
Learn more about postpartum intrusive thoughts here.
Up to 45% of moms report experiencing birth trauma. But what exactly does it mean for a birth to be “traumatic”? The clinical definition of trauma is exposure to death, or actual or threatened serious injury. After experiencing a traumatic birth, moms may frequently hear, “well at least the baby is OK.” As a result, many moms may believe that if everyone was fine in the end, it wasn’t really traumatic.
But make note of the definition - “actual or THREATENED.” Which means that if a woman feared for her life or her baby’s life at any point in her labor, the birth is technically traumatic. And a traumatic birth can lead to a number of longer term symptoms like heightened anxiety about one’s own health or the baby's health, flashbacks, strong emotions with reminders of the birth experience, and worries about future pregnancies.
Learn more about birth trauma here.
Knowing when to ask for help can be tricky. Because the postpartum period is notoriously difficult, moms often hear from well meaning others - “things will get better, this is just a phase.”
This certainly could be true, but in many cases, symptoms can drag on, causing problems like relationships issues, substance use, bonding disruption, unnecessary suffering, and in severe cases, thoughts of hurting yourself or others.
One sign that it’s time to talk to someone is if your symptoms are interfering with your functioning - this could be your relationships, your ability to care for your baby, your work, or caring for yourself.
Another sign is if you are frequently feeling concerned or bothered by how you’re feeling. If you’re thinking daily about wanting to feel less anxious, constantly worried about how you don’t feel like yourself, or really bothered by your frequent anger or irritability episodes, that’s a good sign that you should talk to someone.
The two primary options for postpartum treatment are therapy and medication. In therapy, you meet with a mental health professional either in person or via video, talk about what you’re struggling with, and receive guidance on how to feel better. With medications, your provider usually will prescribe an SSRI - the most common medication for anxiety and depression - track how it’s working, and make adjustments as necessary.
The go-to treatment option among medical providers (think OBs and primary care providers) is medication. This is because perinatal-specific therapists are often difficult to find, expensive, and have long waitlists. It’s NOT because therapy is any less effective than medication.
In fact, therapy actually may be MORE effective than medication in some cases, and has longer lasting positive impacts. But not all therapies are created equal! Cognitive behavioral therapy (CBT) is the gold standard treatment approach for the majority of postpartum issues. Non-directive talk therapy is less likely to work or produce lasting results.
Although CBT is widely talked about, many therapists do not use CBT, and therapy can often default to a venting session. Talking through your problems with an empathic listener can definitely be helpful, but if you’re not getting specific tools and skills to help you manage your symptoms, you’re missing out.
If a provider is using CBT, they’ll explain how thoughts, behaviors, and emotions are connected. They’ll use examples from your experience to demonstrate that your thoughts and behaviors are strongly tied to how you feel.
They’ll help you spot patterns that are maintaining your symptoms, then give you specific ways to interrupt those patterns. Common CBT skills include reframing your thinking, scheduling enjoyable activities, or facing feared situations that you’re avoiding. Homework should be assigned between sessions, and reviewed at the next session. If therapy doesn’t include these elements, it’s not CBT.
The simplest place to start is with Prospera. Prospera provides perinatal-specific cognitive behavioral therapy via weekly video sessions and is available across the United States and Canada.
But if you want to explore your options, which is always a good idea, there are a number of databases available where you can search for therapists near you by inputting your zip code. You can also specify that you’re looking for a therapist with perinatal expertise.
Here are a few of our favorites:
You can also check out Prospera’s step-by-step guide to finding a postpartum therapist near me.
Too many moms suffer in silence during pregnancy and postpartum. They don’t realize that effective, affordable therapy options do exist, and that medication is not the only available treatment.
If you’re not feeling like yourself, don’t wait to reach out for support. Intervening early can prevent things from getting worse and help you feel more present, confident, and joyful in your role as a mother.
Written by Andrea Niles, PhD
November 21, 2023