How to Improve Postpartum Mental Health

Despite a growing body of research that the postpartum period may be the most vulnerable time period for mental health during a woman’s life and knowledge that nearly all women experience at least some mood changes during this time, women are often still stigmatized for expressing anything but bliss in the transition to motherhood.

The goal of this post is to spread awareness of the common postpartum mental health struggles and cover how to improve postpartum mental health.

Postpartum Depression

Research estimates that postpartum depression occurs in about 17% of mothers across the world. For most mothers, symptoms of depression emerge four to six weeks after birth and gradually decrease in subsequent months. However, postpartum depression can occur at any time in the three years after a pregnancy or birth.

Postpartum depression often co-occurs with anxiety. Research finds that two out of three women with postpartum depression may also have an anxiety disorder.

Postpartum Anxiety

Although postpartum depression may be more commonly discussed, postpartum anxiety may actually be the most common postpartum mood disorder. During the postpartum period, about 18% of women experience anxiety in postpartum weeks one to four, 15% in weeks four to 24, and 15% after week 24.

Postpartum anxiety can include postpartum generalized anxiety disorder (persistent worry that occurs more days than not), panic disorder (recurrent panic attacks), and OCD (unwanted, distressing thoughts and rituals that "prevent" the thoughts from becoming a reality). Postpartum anxiety often involves excessive worry about a variety of topics and this can even include excessive worrying about parenting or your infant. Women with postpartum anxiety also show more self-blame.

Postpartum anxiety often occurs with postpartum depression (about one in three women with postpartum anxiety symptoms also report postpartum depression). In these cases, symptoms are often more severe.

Postpartum Psychosis

Postpartum psychosis is a very rare but very serious condition. Postpartum psychosis involves the experience of one or more of the following: strange beliefs or thoughts (delusions), hearing, seeing, feeling, or smelling things that are not there (hallucinations), a manic mood with a loss of touch with reality, and severe confusion. Other common symptoms include disorganization, hyperactivity, irritability, paranoia, rapid mood swings, and erratic behavior.

Other Postpartum Symptoms

Intrusive, Unwanted Thoughts: Nearly all new mothers (70-100% of mothers) experience intrusive thoughts about harm to their infants. Most of these thoughts are related to accidentally harming their infant, but half of mothers experience thoughts of intentionally harming their infants. However, it is very important that mothers know that thoughts about harming the infant do not actually increase their risk of harming the infant even when they are having thoughts of intentionally harming their infant.

Postpartum Rage: Postpartum rage (increased anger and irritability during the postpartum period) is an incredibly common experience in the postpartum period (see here for a review). About 30% of mothers report experiencing postpartum rage. This rage may emerge due to the stress related to this time period, lack of sleep, feelings of powerlessness and/or expectations being violated. Research also finds that the mother’s sleep quality and anger related to infant sleep are related to overall anger during this time. It can help parents to know what is “normal” when it comes to infant sleep and to have realistic expectations for this time period.

How to Improve Postpartum Mental Health

1. Seek help from a mental health professional, particularly if your symptoms do not improve after two weeks, you are finding it difficult to care for your baby or complete tasks of daily life, or if you have thoughts about harming yourself or your baby. Therapy, such as cognitive behavioral therapy (CBT), and medication may be very effective in treating postpartum mood disorders. It is important to know that you can take many medications while continuing to breastfeed (talk to your medical provider first).
2. Identify a community of people to support you in both practical and emotional ways. Reach out to parenting groups in your community, get to know your neighbors, find virtual support groups, or ask family members in advance for help. Higher social support is associated with a lower risk of postpartum depression. Lack of social support is related to an increased risk for postpartum anxiety and worse mental health overall.
3. Try relaxation therapy. A recent study found that teaching new mothers to relax resulted in lower stress scores for mothers and lower levels of the stress hormone cortisol in their breastmilk. Their infants also showed longer sleep duration, greater milk intake, and greater weight gain. The relaxation therapy consisted of listening to recorded “guided imagery” while breastfeeding or expressing milk at least once per day from two to 14 weeks postpartum.
4. Practice mindfulness. Research finds that mindfulness practice is associated with fewer depressive symptoms during the postpartum period.
5. Practice using self-compassion with yourself. Remind yourself that everyone struggles and that you are only trying your best. Self-compassion is associated with improved mental health in the postpartum period.
6. Identify “experts” who can help you to build your confidence as a mother, such as a knowledgeable pediatrician, lactation consultant, or physical therapist specialized in treating postpartum concerns. Research finds that mothers with more confidence show improved mental health in the postpartum period.
7. Practice skin-to-skin care. Skin-to-skin care has been associated with many important benefits for mothers and babies. Daily skin-to-skin care lowers anxiety in mothers and mothers who practice skin-to-skin care show greater reduction in the stress hormone cortisol. You can use a skin-to-skin carrier so you can practice skin-to-skin throughout the day without having to lie around topless all day.
8. Try using infant massage. Infant massage has many benefits for babies but may also help to lower postpartum anxiety and depression in mothers.
9. Continue educating yourself about postpartum mood disorders. Simply educating yourself about these conditions is also shown to provide some benefits.