Postpartum Mood Disorders

There are three types of mood disorders that show in in the postpartum: postpartum depression, postpartum anxiety, and postpartum psychosis. Up to one in five women experience depression and/or anxiety in the postpartum. One in 1,000 will experience postpartum psychosis, a psychiatric emergency requiring immediate treatment. If you think you're experiencing a postpartum mood disorder, contact me so we can discuss the best ways to support you.

If you think you might be experiencing depression, use the Edinburgh Postpartum Depression scale as a self-screening tool.

What is postpartum depression?

Postpartum depression is a mood disorder that occurs within the first year postpartum, and typically within the second month postpartum. 

The symptoms include sadness and hopelessness, shame ("I'm the worst mother ever..." or "why is everyone so much better at this than me?"), irritability, anxiety, crying “for no reason,” oversleeping or difficulty sleeping, difficulty concentrating or remembering details, or making decisions, anger or rage, loss of interest in previously enjoyable activities, physical problems including headaches, stomach problems and muscle pain, eating too little or too much, withdrawing from friends and family, difficulty feeling an emotional attachment to the baby, doubting one’s ability to care for a baby (and feeling like your baby thinks you're a terrible parent), and thinking about harming the baby.

Risk factors for postpartum depression are biological, social, psychological: previous depression and depression in pregnancy, previous trauma, traumatic birth, relationship instability, lack of family and community support, poverty, financial instability and job insecurity, health problems with the baby, a stressful life event during pregnancy, and alcohol or drug abuse. It is compounded by loss of sleep, difficulties with breastfeeding, and other challenges around caring for a new baby. I would add that an additional risk factor is cultural. When there are expectations that we should just "bounce up" and take care of everything--new baby, partner, kids, home, maybe back at work within a few weeks, and so on--or that we should be grateful for just having a healthy baby and forgetting whatever else we might have been through, then these can make it harder to ask for help.

But it might not be postpartum depression...

Thyroid hormone imbalances are common in the postpartum, and commonly misdiagnosed as postpartum depression.  I recommend doing lab work to check your thyroid, including TSH, thyroid antibodies, free T4 and free T3. It is not enough to only check TSH, so insist that your provider run a full panel.

The "postpartum blues" is a transient period of emotional ups and downs, sensitivity, irritability, and fatigue that occurs with the hormonal transition postpartum, typically between days 2-4, and is finished by the time postpartum depression shows up.

What is postpartum anxiety?

Not everyone knows how to support you in a healthy way. Some people will say the wrong thing, usually with the intention of trying to take away your grief and make you feel better. Comments like "at least it happened early" or "at least you know you can get pregnant" and so on can contribute to feelings of isolation and depression. Check out the links I posted for support groups and online community, and send the below like to your friends and family to help them understand.

It might not be postpartum anxiety...

After a miscarriage, the recommendation is for Rh- mothers and gestational parents to receive Rhogam at or after 10 weeks, however, it should be offered regardless of how early you are in pregnancy and you have every right to request it. You can also opt not to receive Rhogam. The risk of sensitization is low for a first trimester miscarriage, but is thought to be higher if there is any form of medical evacuation of the uterus.

What is postpartum psychosis?

Emotionally, consider what you might need to process your experience. Is there a meaningful ritual? Is there a special place where you want to bury what came out of your body? There is a wide range of what might come up (including feeling totally okay and not needing to do any of this). For lots of ideas, check out this manual: Holistic Healing After Miscarriage.




What are my options for a first trimester miscarriage?

There are two main approaches to miscarriage: expectant management and active management. Expectant management would mean waiting for the miscarriage to complete itself, as in, waiting for your body to pass the pregnancy on its own. In active management, steps are taken to induce labor (using a medication such as Misoprostol) or to manually remove what is in your uterus (there are a couple of options). According to a BMJ study, most people who choose expectant management (81%) will complete the process on their own. If you want help, you have a choice of who can help assist you, including me or another midwife at home, or a nurse midwife or doctor in a medical setting. 

What does this mean for my fertility? How long should I wait before getting pregnant again?

After one miscarriage, the risk of another is the same as if you'd never had one. After two, however, the risk starts to increase. After two miscarriages it's a good idea to have a conversation with a knowledgable provider who can help to determine why it might be happening (hormone imbalance? thyroid issues? all sorts of reasons) and work with you to prepare for a pregnancy.

Typically, you'll hear that you should wait three months before getting pregnant again. Recent research has disproven this, and even suggests that the first three months is a favorable time to conceive and have a healthy pregnancy. That said, you might not be emotionally ready. Check in with yourself and feel out whether it's the right time.

What if I'm lactating after the miscarriage?

Beginning in the second trimester, people may have milk come in around three days after a miscarriage (the same hormonal mechanism is triggered as after a live birth). To stop making milk:

  • drink sage tea
  • homeopathic Bryonia Alba 9C 3 pellets 3x daily to help with engorgement
  • homeopathic Pulsatilla 9C, 3 pellets 3x daily for overabundant milk supply
  • put cabbage leaves in your bra, cold packs over your bra, and wrap a scarf around tightly
  • Vitamin B6 200 mg for 5 days
  • a more gradual option is to pump, then space out pumping while reducing the duration of pumping sessions (you can combine this with some of the above options)

Another option is to donate your milk. The milk that we produce after a miscarriage or still birth is valuable in the treatment of premature babies. 

I could really use some connection right now

I'm Muslim. What do I do after a miscarriage?

Check out the archives at Seekers Hub for responses to common questions about miscarriage.