What is postpartum depression?

Clinically, postpartum depression is characterized by low mood and energy, change in appetite, feelings of worthlessness and guilt, as well as trouble concentrating that lasts more than two weeks. As with Sara, PPD commonly coexists with anxiety, presenting as irritability, need for control, intrusive thoughts, or persistent worries about the baby.

PPD affects one out of seven women who give birth. When you include postpartum anxiety, the incidence becomes one in five women. The statistic is even higher for Black women. Overall, perinatal mental health disorders are the most common medical complication in the perinatal period. They are also some of the most serious. 

Depression affects not only the mother, but also her partner and baby. Children born to mothers with untreated PPD are more likely to have attachment and long-term behavioral issues. PPD increases the risk of divorce, as well as rates of depression in the partner. Yes, fathers can get postpartum depression too. The most serious complication of PPD is maternal suicide. Mental health issues are the number one cause of mortality in the year after giving birth. 

Today’s parents are under tremendous stress. The Surgeon General, Dr. Vivek Murthy, recently sounded an alarm “calling for a fundamental shift in how we value and prioritize the mental health and well-being of parents.” There are deep cultural pressures on mothers in particular – that they will foster a strong bond, exclusively breastfeed, and be there for every emotional need of their baby. These pressures are in intense conflict with the simultaneous expectation that she rapidly returns to work. Studies show that maternity leave shorter than 12 weeks increases rates of postpartum depression, yet the U.S. is the only developed nation to not have a national paid maternity leave policy.

Three years later Sara returned to my office pregnant with her third baby. She was terrified that she was going to have PPD again. Fortunately, there is a growing body of evidence showing that PPD can often be prevented — even for women at high risk. 

There are four key areas parents can focus on to reduce their risk. These are: increasing hands-on support, physical activity, emotional connection, and sleep. I say parents, rather than mothers, because partners can play key roles in prevention. Sara and her husband needed tools to make her third baby’s beginning different. 

While Sara was in her second trimester, together we created her “Survival Plan” to address these four domains. First, we explored what she and her husband could take off their plates and what outside support was available. Family and friends could help watch the baby so Sara could have some time to herself. She and her husband worked out a plan to divide up the care for the baby and household. While Sara was going to do all the breastfeeding, her husband would be in charge of washing the breast pump parts. Her husband also agreed to get up and watch the baby each morning so that Sara could take a shower.

We also created a plan for physical activity. Exercise has been repeatedly shown to be beneficial in preventing and fighting depression. While physical activity can be limited initially postpartum, most moms are able to take walks or do gentle yoga. (Talk to your doctor to clear you to do more intense activity.) Exercise and muscle contractions release myokines. These are small proteins, sometimes called “hope molecules”, that can improve one’s sense of wellness and mood. They also help the brain recover from stress. 

Physical activity can also be a great way to increase connections to other moms to reduce social isolation. Sara decided to join a local chapter of the Mom Walk Collective and took a mother & baby yoga class. There she met with other moms with kids the same age, which was deeply validating for their common struggles. Sara also set up a plan to connect regularly with friends and family to reduce her loneliness.

Getting good sleep is one of the most difficult challenges for parents of babies. We discussed a variety of sleep strategies, including initiating dream feeds and utilizing her baby’s 5-6 week sleep window. Finding effective ways for Sara to get better sleep made an enormous difference in her wellbeing. 

Despite having PPD twice before, Sara did not get it a third time. Addressing these four essential areas meant she had the support she needed. She was also less overwhelmed, less isolated, and better rested. Sara and her husband communicated better because they were on the same plan. They each felt like the other had their back. 

Prioritize New Parents

As a perinatal mental health physician, I work with lots of women like Sara. Teaching survival skills to parents before their baby arrives makes an enormous difference. Beyond these four survival skills, there are many more tools that trained perinatal psychotherapists and psychiatrists can offer families to both prevent PPD and recover from it. Sometimes this includes taking antidepressant medications. There is a preponderance of evidence demonstrating the benefit to both mom and baby outweighs the risks. 

As a society, we need to focus our attention on perinatal mental health, particularly on greater efforts for prevention. There is so much that can be done to ease the burden of motherhood and early parenting. Change needs to occur at the family level, in the doctor’s office, as part of prenatal classes, and by establishing a national policy for paid parental leave. It’s time we make this fundamental shift. 

If you or someone you know is struggling with their mental health, call or text the National Maternal Mental Health Line at 1-833-TLC-MAMA (1-833-852-6262). It is a free, confidential, 24/7 hotline with English and Spanish-speaking counselors who can provide support to parents before, during and after pregnancy. Translator service available in over 60 languages. 

How families and friends can help:

• Provide meals
• Watch the baby
• Join her for walks
• Help with laundry
• Listen to her

Dr. Jill Zechowy, M.D., M.S. is a perinatal mental health physician. She has a private practice in Santa Rosa, CA and offers tele-health to residents of California. She is a public speaker on maternal mental health and author of the Motherhood Survival Manual: Your Prenatal Guide to Prevent Postpartum Depression & Anxiety. www.womensmentalhealthmd.com 

¹ Sara (not her real name)