Many women have an idealized vision of what motherhood will be like: Bonding with their child from the very first moment and spending those first few weeks together basking in that “new mom” glow.
But sometimes, the baby arrives and that picture is replaced by the reality of late-night feedings, early-morning fussiness, breastfeeding difficulties and total exhaustion.
For some women, these abruptly shattered expectations can turn into postpartum depression, says C. Neill Epperson, MD, director of the Penn Center for Women’s Behavioral Wellness.
Here’s what Dr. Epperson wants women to know about postpartum depression—and why it’s okay to embrace the fact that motherhood isn’t always easy.
Identifying Postpartum Depression
Q: How does postpartum depression differ from the “baby blues”?
C. Neill Epperson, MD: The baby blues are usually mild in severity. Sometimes, these feelings are characterized by tearfulness or moodiness. But low mood is often not the primary symptom—even though we call them the baby blues.
These feelings usually peak around three to 10 days postpartum, and usually, the symptoms only last for a few days at most.
Postpartum depression is a bit more intense than the baby blues. A lot of times, women are very anxious. They might feel agitated and on edge. And they might feel doubtful about their ability to be a good parent.
Guilt is one of the core symptoms of major depression at any time in a woman’s life. And a lot of times, when women feel guilt in the postpartum period, it’s usually because they’re not feeling the way they thought they were going to feel.
A woman might not feel as happy about having the baby as she thought she would. She might question whether she did the right thing. She might feel that she’s not being a good mother or that her baby can tell that she isn’t feeling attached. And she might feel guilty about that.
Other women talk about having a low mood and not enjoying things that they thought they were going to enjoy about having the baby.
Q: How does postpartum depression differ from “regular” depression?
Dr. Epperson: Postpartum depression has some of the same symptoms as major depressive illness, but there’s a heightened focus around things that have to do with motherhood.
For instance, one of the signs of depression is having a decreased interest in things that would normally be pleasurable. But if you have that feeling toward your baby, that can lead to feelings of guilt.
A lot of times, women might not know that what they’re feeling is postpartum depression. They might just think that they’re anxious about being a new mom.
Q: Are there any postpartum depression signs that women might not think to watch for?
Dr. Epperson: As a new mother, it’s normal to be concerned about your baby—concerned about whether you’re doing things right or whether your baby is getting enough food, especially if you’re nursing. If your baby is cranky, you might wonder, “What am I doing wrong?”
It’s also normal to have some self-doubts and to feel like motherhood is a major adjustment. But when you get to the point where your predominant mood state is unhappy, stressed, anxious or overwhelmed—and your thoughts about being a parent are more worried and negative—that might be postpartum depression.
Sometimes, women will have intrusive or aggressive thoughts towards their child—particularly if they’re not enjoying the motherhood experience as much as they thought they would. When that happens, a lot of women get extraordinarily anxious.
They don’t want to harm the baby, but when they’re feeling depressed, these thoughts get more power and have a greater impact on their overall sense of well-being.
Having those types of thoughts isn’t the worst thing in the world, but some women will get really overwrought by even having the thought. That worry can take on a life of its own.
Part of what I do is try to help women understand there’s a difference between having that thought and acting on it. Everybody gets tired sometimes. And motherhood is hard.
But there are times in your life when you have difficult thoughts—and you don’t act on them because you know they’re just thoughts.
Dealing with Postpartum Depression
Q: What are some of the different coping strategies and treatment options for women who are struggling with postpartum depression?
Dr. Epperson: A lot of times, women can benefit from cognitive behavioral therapy strategies. That’s basically a form of talk therapy that helps you understand the connection between your thoughts, feelings and behaviors. By challenging some of your negative thoughts, you can improve your mood or make more positive choices.
For example, you might be feeling exhausted, and maybe you need to take a break from the baby. Some women might think, “I’m not being a good mother.” That’s a thought you can challenge. You’re actually being a good mother if you get the rest you need.
Cognitive behavioral therapy can help moms become more accepting of how they’re feeling. We want them to get into the “thinking” part of their brain and tease apart their thoughts.
Sometimes, they just need to admit that they’re unhappy before they can start to work through their emotions. Other times, women need medication to help cope with postpartum depression.
Postpartum support groups can be very helpful for some women. It can be helpful to just hear other women say, “This is hard.” Admitting this isn’t a weakness, but some women beat themselves up over it.
And don’t be afraid to reach out for help. Join a motherhood support group or talk to family members—especially ones who are also moms. If they’re honest, they’ll let you know that it isn’t always easy—and that’s okay.
Penn Medicine offers a variety of support services for women struggling with postpartum depression and other behavioral health issues. You can call us to speak with a specialist: 215-573-8886.