"Am I ever going to want to hold and nurture my baby?"
"Do these feelings mean that I'm a bad mother?"
Paradoxical emotions amalgamate as motherhood emerges. The convergence of biological changes, a shifting identity, and a lifestyle metamorphosis galvanizes a spectrum of previously foreign feelings. It's customary to traverse a continuum of emotions during the initial moments of this rite of passage.
"Is my partner disappointed that I'm not the mother he thought I would be when we decided to start a family?"
"Are these deadening feelings payback for my ambivalence about getting pregnant in the first place?"
Attachment and bonding are involved in the establishment of the burgeoning mother-infant intimacy- setting up the framework for future relationships and inaugurating baby's worldview on love. But what happens when complicated feelings serve as a blockade to the initiation of bonding and attachment or if initial parental enthusiasm recedes or is altogether absent? Postpartum adjustments come in all shapes and sizes. Uneasiness may perseverate, developing into intractable feelings that seem insurmountable.
"Why didn't anyone tell me how hard breastfeeding would be?"
"If my baby can't attach to my breast, can I cultivate a healthy attachment with her?"
A majority of postpartum women experience fluctuations in mood within the first few weeks after giving birth. Postpartum blues are considered an expectable result of new motherhood, lasting up to two weeks, estimated to impact as many as 80 percent of women. Postpartum depression affects approximately one in five mothers. Symptoms of postpartum depression can be relieved within one to six months when addressed promptly. If left unattended, postpartum depression may persist for up to one to two years.
"Is my apathy going to deleteriously impact my child, leaving little possibility for healthy attachment and deep connection?"
"Why do I feel so disengaged? I expected that when my partner placed our baby in my arms for the first time I would light up and my uncertainty about becoming a mother would instantaneously dissipate."
The juxtaposition of pregnant hopes and maternal reality is often quite shocking- resulting in an unearthing dizziness, leaving new mothers wondering who they are, if they have "gone crazy", and if they will ever feel "like themselves again".
"Why can't I sleep?"
"Why don't I eat?"
"Why do I ruminate?"
"Why am I somewhere in the background?"
Postpartum depression is a quiet epidemic. The glaring statistic that one in five women suffer during the postpartum period begs society to reflect on the need for preventive public health measures. Diagnosis of depression and anxiety in pregnancy are often overlooked, ambivalence around becoming a mother is frequently culturally muted, and unmet hopes or expectations may result in a roller coaster of regrettable feelings.
"When will I get a reprieve? I was exceedingly depressed after my first baby was born but I thought it would be different this time. We are more financially stable and I somehow made my way through the darkness without any help. But here I am again, drained. I feel colorless most of the day, the week, the month."
"Why do I feel this enormous chasm between us? My baby feels so far away. The labor and delivery process was so far from what I hoped for, so different than what I had planned--I expected a calm birth, no pain medication, no medical interventions. I ended up having a c-section. I don't feel connected."
Hormonal shifts, depression during pregnancy, history of mood disorders, previous episodes of postpartum depression, family history of depression or bipolar disorder, tendencies toward perfectionism, eating disordered behavior, lack of social support, marital discord, financial instability, unplanned or unwanted pregnancy, obstetrical complications, traumatic birth experience, and a history of early loss, trauma, or sexual abuse can be contributing factors associated with the development of postpartum depression. Risk factors are associated with creating an increased sense of vulnerability to the illness -- they are not directly causal.
"During childbirth I was flooded with haunting memories I had pushed away, thinking that I had resolved these issues and was free of the shame and rage. But during the delivery I was pocked and prodded and uncomfortable and at times felt helpless and out of control- this is when memories of being sexually abused during childhood emerged. Now I can't get these images out of my mind. Do I have the energy right now -- the stamina -- to manage the pressures of new motherhood?"
"Is it because of the losses? All of the miscarriages I had before this last pregnancy created a sense of dis-ease and lack of attachment to this pregnancy. I thought that once my baby arrived a feeling of permanence would envelop us. Will we bond?"
These clinical vignettes are a sampling of maternal concerns and internal excavations my patients have journeyed through as we work toward a gratifying and connective parenting experience.
The best thing a woman can do for her baby is to take care of herself. This will likely entail widening her community of wellness practitioners and other social support networks with the aim of helping her reach optimal health.
Harnessing helpful resources in a timely fashion can aid in the prognosis of this painful mood disorder. All too often, a new mother and her surrounding family and friendship circle hope that these precarious symptoms will diminish on their own. Early intervention promises to ease the course and severity of postpartum depression whereas denying the despair may yield a more complicated recovery.
Bonding is a process, not a finite event. A healthy attachment relationship can be procured over time, even when postpartum mood disorders infiltrate early motherhood. Elevation in maternal mood, lessening of overwhelming anxiety, and (re)finding pleasure will lead to a satisfying mother-baby relationship.
This Emotional Life is a two-year campaign to foster awareness, connections and solutions around emotional wellness. Join our community at www.pbs.org/thisemotionallife.
Follow Jessica Zucker, Ph.D. on Twitter: www.twitter.com/drzucker
Here is how I know...
Biology and hormones, etc. have NO influence on our behavior whatsoever.
I learned this from those who informed me that no matter how much a man's biology compels him to seek out a variety of women, we are human beings of morals, not animals.
Those men, I'm told, are simply immoral bad people who CHOOSE not to control themselves and that "biology" is just a handy excuse.
So...applying that logic to postpartum depression...one can clearly see that these women simply are looking for a convenient excuse.
They should receive the same message men receive about their biology...control it and be quiet about it and stop pretending it's real just for an excuse or else you are a bad person.
NOTE- I still disagree and think we are all creatures of our biology and that no one should be vilified for their natural state of being, but....fair is fair, I guess...
There are biological reasons behind rage and anger. This is not a defense for murder.
There are biological reasons behind hunger. This is not a defense for gluttony.
There are biological reasons behind alcoholism - also not a defense.
It seems like an elementary distinction to me.
Thanks for the information. However, I am a little saddened that this relatively common, albeit unexpected condition is not more widely understood after so many years.
Lawson Meadows
There are millions of women who have NEVER taken fish oil and NEVER had PPD.
I do have to thank you though, I got a bit of a chuckle myself from your "just stop it." So for making me giggle, you get fanned.
Have an uplifting life.
Lawson
It is partly hormonal, partly physical, and partly everything else thrown in. I went through a postpartum depression, and even as a medical professional, I could not get my doctor to listen. I also was having thyroid problems and couldn't get them to listen to that either. Finally, after slugging through a year, I went to a different doctor, told them my symptoms, had my thyroid tested, and I was so low thyroid.
If a medical professional can't get physicians to listen, how is the average patient going to be able to do it?
Not everyone with postpartum depression has a jerky husband or a difficult delivery.
We're not talking about the macho "pulling an all-nighter" every couple of weeks. We're talking day upon day upon day upon day for months and months of operating in a difficult environment with a sometimes difficult baby or babies with little to no sleep.
I don't know if sleep deprivation causes PPD or PPD causes sleep deprivation. I only know that it's hell and I was glad to get help and be able to afford care. For those women who can't....well, maybe we should stop wondering why we're dealing with so many damaged children who grow up into damaged people.
His father, however, swore that he never, ever heard the baby cry at night. Not once. He had no idea how lucky he was in that I never bashed him on the nights when he was supposed to get up and take care of that difficult baby, but who never, ever heard the baby cry, or responded to elbow jabs or almost being rolled out of bed.