Baby Shower, Baby Blues
Woof, I’ve been all over from NYC to the Mojave desert and the nip got away from me. But tonight I was lucky enough to attend my cousin’s baby shower for her sweet boy that will be here any day now. Between chicken salad croissants, baby books, and carrot cake there were stories shared and prayers spoken over mama-to-be and her darling boy. Many were for strength both physical and mental during delivery, a successful transition into parenthood for her and her husband, and an abundant, healthy life for her son. As I chased my one-year-old into the other room, a prayer from my cousin’s sister-in-law shook me.
She prayed to protect her from postpartum depression.
I thought, wow. What beautiful, bold statement. No one speaks about postpartum depression so openly, plainly.
Please protect her from postpartum depression.
Shattering the stigma, breaking the shame around mental health.
She’s being proactive. Speaking matter-of-fact to a room full of women who love her.
She called the women around her to action.
She’s saying, watch over her. Check on her, don’t make her ask.
It’s something I’m so passionate about, so why did it strike me that someone spoke so openly. It’s what every woman deserves. At their baby shower, while everyone is so happy, full of love and apprehension - showering this soon to be baby with gifts. It’s the time when the mother’s circle should speak words of affirmation, prayers over her - we are here to support you.
To banish shame and acknowledge that she will experience the dichotomy of motherhood - sheer joy, deepest of unconditional love, depths of despair and exhaustion. The reckoning of motherhood in all its beauty and anguish.
It’s so common. Perinatal mood disorders.
The Center for Disease Control (CDC), estimates 1 in 8 women report postpartum depression symptoms. Some estimates are as high as 1 in 5 women will experience depression during pregnancy or the first year postpartum. And 50% of women are not diagnosed - primarily due to stigma, lack of awareness, and an unrealistic expectation of motherhood.
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I also think we do women a disservice using a cute name like baby blues to describe a significant hormone shift and resulting mood changes. In some women it is temporary and mild, other women descend into postpartum depression or anxiety, while a rare number develop serious postpartum psychosis and suicidal ideation.
Here is a graph showing the drop in estrogen and progesterone after birth from an article in Smithsonian Magazine.
What are the baby blues?
Baby blues are the result of the dramatic drop in estrogen and progesterone after birth. We talked about the hormone shifts in depth in our hormone post. If you recall, after the placenta is delivered - progesterone, which prevents prolactin (the milk hormone) from being fully expressed, drops. Progesterone reaches its lowest levels around days 3-5 postpartum, which is when your milk volume increases dramatically. This is also when baby blue symptoms peak. They typically last less than 2 weeks and occur in 85% of women postpartum, according to the American College of Obstetricians and Gynecologists.
So almost every woman you know who has had a baby experienced some level of mood changes in the hours and days after delivery. These symptoms include being very happy, then very sad, and then crying without being able to identify why. There may be feelings of anxiety, sleeplessness, loss of appetite, irritability, crying, and mood swings may vary widely. Symptoms should resolve in less than 2 weeks on their own. Thoughts of suicide are never normal and are not a symptom of baby blues.
Support during this time include prioritizing sleep and nutrition, support groups, and communication with your care team.
If symptoms worsen, or last longer than 2 weeks then it is time to contact your healthcare provider about possible postpartum depression.
My favorite midwife would tell women - if your mood is down, and stays down for 2 days, then it’s time to give her a call.
What is postpartum depression?
Postpartum depression is a depressive episode that occurs during pregnancy or the first year postpartum. Most commonly it occurs in the first 3 months after birth, but can also begin in pregnancy, with weaning, or when your period returns.
Symptoms include feeling hopeless, helpless, or guilty. You may feel afraid of being alone, worrying a lot, lack energy or concentration. There may be difficulty falling asleep, excessive weight loss or gain, and appetite changes.
Thoughts of hurting yourself or your baby - which are never normal. If you experience these thoughts, you should call 911 or go to the nearest emergency room.
Postpartum depression affects your ability to care for yourself.
The good news is - postpartum depression is treatable. There is a wide range of treatment options from talk therapy and support groups to medication like anti-depressants.
If you experience any of these symptoms - you need to talk to your healthcare provider about possible depression. Perinatal mood disorders are exceedingly common and tragically under-diagnosed.
How can I talk to my healthcare provider about my mood?
Start prenatally - ask your healthcare provider about postpartum depression and support groups in your area.
There is a screening tool called the Edinburgh Postnatal Depression Scale (EPDS). It is the most common tool, but some providers may use the PHQ-9 which is a depression screening tool used for all adults. ACOG guidelines for when to screen women are abysmal given how common perinatal mood disorders are, with only 1 screening in the 12 weeks postpartum and 2 in pregnancy recommended.
Postpartum support is nonexistent in the United States - one quick 6-week check that okays return to intimacy and discuss birth control, lack of in-home nurse follow up, and no federally mandated parental leave. The World Health Organization (WHO) recommends at least four healthcare contacts in the 6-weeks postpartum. Many women, especially of low income, young, and minorities skip their one check. In 2018, ACOG updated their recommendation to see all women for a 3 week postpartum check, and another comprehensive visit by 12 weeks. Not all providers have adopted this guideline, and women with low resources and education are often disproportionately affected.
Pediatricians are left to help fill the gap with the American Academy of Pediatrics (APP), recommending a screening at 1, 2, 4, and 6 month infant well checks. These screenings are also not universally administered despite the recommendations and can be difficult for the pediatrician to follow up on.
If you fill out one of these screenings at an appointment - a good conversation starter is to ask about your score.
It can be hard to talk about feelings of being overwhelmed or sad during a time that is supposed to be so joyful. I am hopeful that more open, plain conversations about how common postpartum mood disorders are and the reassurance that they are treatable will hope release the stigma.
Thanks for reading the nip - let’s break the stigma of postpartum depression and share this with someone you know.
Below I’ve included resources from the March of Dimes.
Thank you for reading + I’ll see you soon,
Sasha Jarman, RN, APRN, FNP-C
Resources from the March of Dimes Website
Crisis Text Line, text HOME to 741741
Depression during and after pregnancy: A resource for women, their families and friends from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Maternal and Child Health
Mothertobaby.org, How mental illness and its treatment affect pregnancy and breastfeeding from the Organization of Teratology Information Specialists (OTIS)
National Alliance on Mental Illness, 800-950-NAMI (6264)
National Suicide Prevention Lifeline, 800-273-TALK (8255)
Postpartum Support International, 800-944-4PPD (4773)
