How to Help a Mom Through Postpartum Depression
Know the difference between the 'baby blues' and a serious problem
As a psychotherapist who works with new mothers, when I ask a client how she's doing, I'm hoping to hear some version of, “I’m tired, but it’s an amazing experience” or “being a mom is awesome." But, sometimes instead I hear something like, "It's not how I thought it would be. I love my baby, but I made a terrible mistake. I’m just not cut out to be a mother.”
In those cases, I know the mom could have a common case of the “baby blues" or the less common, and more serious, postpartum depression.
Any mother is vulnerable to postpartum depression. Serena Williams and Gwyneth Paltrow had it; so did Lena Headey from Game of Thrones. When it’s happening to someone you care about, it can be scary, sad and surprising. Why would anyone with a beautiful new baby feel depressed? If you are a parent -- or another loved one or friend -- of a mom who is experiencing postpartum depression, how can you help make her transition to motherhood less difficult?
Just the 'Blues' or More Serious?
The baby blues (or postpartum blues), experienced by 50% to 80% of mothers, begins in the immediate postpartum period. Characterized by crying, worry and fatigue, it typically resolves on its own within about two weeks. On the other hand, prenatal and postpartum disorders, including depression and severe anxiety, affect 15% to 20% of mothers (about one of 7) and can begin anytime from pregnancy throughout the first year after delivery, according to Postpartum Support International.
"It wasn't like a broken leg or a rash. You could put on a happy face and coo at the baby and no one would know how much you were hurting inside."
Other perinatal mood and anxiety disorders (PMADs) include obsessive compulsive disorder, bipolar disorder, post-traumatic stress disorder and — the most rare — postpartum psychosis. PMAD symptoms can include depression, anxiety, irritability, panic attacks, difficulty bonding with the baby, upsetting or intrusive thoughts, problems eating or sleeping and feelings of helplessness.
“We know there are things that increase the odds of having a PMAD,” says Dr. Samantha Shaw, a clinical instructor in women and infant mental health in the Department of Psychiatry at the University of Michigan in Ann Arbor. “Sleep deprivation and/or poor sleep are huge contributors. We need to do whatever we can to ensure that mothers get adequate rest.”
Other risk factors for PMADs include a personal or family history of depression or anxiety, hormonal changes, socioeconomic factors, poor social supports, the baby’s temperament and difficulty breastfeeding, Shaw says.
“Having a child is an enormous life transition, and there are cultural pressures about how you should or shouldn’t feel and what life after delivery should look like. These expectations can be really damaging,” she says.
Alicia Schlesinger, a former pediatric nurse from Little Neck, N.Y., who struggled with postpartum depression more than 25 years ago, says one of the worst things about it was that it was an “invisible illness.” Says Schlesinger: “It wasn’t like a broken leg or a rash. You could put on a happy face and coo at the baby and no one would know how much you were hurting inside.”
In a world where the mantra is “breast is best,” women who bottle feed because their babies are struggling to latch or because breastfeeding just isn’t right for them, frequently feel guilty. For these women, it might be a good idea to suggest the website of the “Fed is Best” Foundation, which provides resources and support on infant feeding, whether that means breast milk, formula or a combination.
Being Aware and Helping the Mom
It's important to know when it's time for the mother to get professional help, if she's not seeking it herself.
When she's extremely sad and crying frequently (or, conversely, feeling numb); if her anxiety is making it difficult for her to care for her baby; if she's having difficulty sleeping or eating or if she's having thoughts or feelings that are worrisome to her or those who care about her, she should be encouraged to speak to her physician immediately.
Also, encourage her to talk to about what she is going through. Many women keep their feelings inside because they feel shame and anticipate being judged.
Instead of saying, “Tell me how I can help,” offer concrete suggestions. For example, “I can come and sit with the baby for two or three hours so you can nap or go out to dinner” is much more helpful.
Those of us who became parents 20 or 30 years ago or who never had children need to realize that a woman’s values or ideas about motherhood may not be the same as ours and that societal norms have changed.
If you’re a parent who has experienced similar struggles, you may want to share them with the new mom.
Linda Byszynski, of Glendale, N.Y., a stay-at-home mom and certified lactation consultant, experienced severe postpartum depression, anxiety and obsessive-compulsive disorder with intrusive thoughts after giving birth to her second daughter, who is now 9.
"I was lucky because my mother talked to me about her own difficult problems. It made it easier for me to understand what I was going through and I felt less alone."
“I was lucky because my mother talked to me about her own difficult postpartum problems,” Byszynski says. “It made it easier for me to understand what I was going through and I felt less alone. When you’re in the throes of it, it seems like you’re the only one who has ever had such an awful experience, and you feel like you’re weak or ‘going crazy.’”
Remind the mother that help is available. Individual counseling can lessen feelings of depression or anxiety. Encourage her to join a support group or, perhaps, a mom-baby yoga class at a local community center.
Byszinski attended a support group and says, “There was such relief in being with other moms and in seeing that none of us were bad mothers who didn’t love our children. We were just a bunch of women with a terrible, painful disorder.”
As a psychotherapist who has facilitated new-mom support groups for many years, I know they reduce isolation and promote bonding with others going through similar experiences. It’s also a great way to meet other women for baby play dates.
If medication is recommended, be supportive. Whatever helps the mom to feel better will help her baby.
There are medications that are safe to take even for nursing mothers. In addition, the new medication brexanolone (brand name Zulresso), the first drug specifically for postpartum depression, was introduced in 2019. While promising, it is expensive, must be given intravenously over 60 hours and requires hospitalization.
Fathers Also Experience Postpartum Issues
Check in with the new dad to see how he’s doing, too. According to a 2017 article in the American Journal of Men’s Health, more than 10% of fathers experience depression and anxiety during the perinatal period. About one in 10 fathers experience postpartum depression and anxiety.
When moms are having a hard time, dads usually have to pick up the slack, taking care of mother and the baby, making sure there’s food and doing what seems like mountains of laundry.
And here are some things not to do:
Don’t tell the struggling mother that her baby needs her so she has to pull herself together. She wants nothing more than to be there for her child. Schlesinger’s father told her she had to “snap out of it.”
“In those days, they didn’t understand that it was an illness,” she says. “People thought you had control and that you could talk yourself into feeling better. It made me feel like a failure when I couldn’t.”
Don’t panic if the mother is having intrusive thoughts, such as fears about intentionally or unintentionally hurting the baby. Shaw says, “We need to normalize these thoughts, which are very common in overwhelmed mothers and are a red flag that the woman is really struggling. The vast majority of women with these worries are at no risk of acting on them.”
Yes, being a new mom can be challenging. But even with a difficult start, motherhood can end up being a beautiful experience. If you can help make that experience a reality, then that, too, is a very special thing.