In my last piece I spoke about the symptoms of and risk factors for Postpartum Depression and shared with you a checklist of questions that I bear in mind when a patient is referred to me with PPD. I hope you found that helpful. And I hope that if it triggered you, that you found someone to talk that over with. This is serious stuff and I’m thinking not talked about enough, so I want us all to tread gently.
I’ll go into a little more detail here about why I ask some of those questions and how answering them will help you work through your PPD and come out the other side.
Is there a family history of PPD or depression?
The reason I check about family history of depression and PPD is not because I believe that it’s hereditary, rather it’s because I know a lot of people hold that belief. And when we believe in something strongly we can experience the ‘nocebo’ effect. People say “Well.. my mom had it so I guess it’s likely / probable/ inevitable…..”. But in fact this is not a given! Our family history can have a profound effect on our views and attitudes in ways that have no genetic component whatsoever. Take, for example, a tendency to vote a certain way.
Similarly, if there is a solid history of PPD, the woman might expect a diagnosis herself, and (unconsciously) behave in a way that fits this.
We can ‘learn’ depression.
So think about your own family history. Is there is a history of dealing with difficult issues through alcohol, panic attacks, or depression? Have you worried or assumed that you too will succumb? (Have you already?) Did your parents withdraw when they feel sad rather than discuss to openly and seek help? Is it considered weak or abnormal to fall apart occasionally, to feel overwhelmed? Are there judgements around mental wellbeing in your family of origin? Becoming aware of these family ‘traditions’ can help us understand how we behave under stress, where we learned our emotional habits. And ultimately it creates space for us to unlearn them.
Did you want this baby?
Not all pregnancies are planned. Accidents happen, contraception fails, women are raped. So a woman who finds herself an unwilling mother will obviously have difficulty settling into motherhood. Despite that however, she will still likely judge herself for not suddenly feeling a glowing powerful bond when the baby is born. She’s probably been told that nothing beats motherhood, that when the baby is born she’ll fall in love etc etc. But what if she doesn’t?
Not many people are told how frequently new mothers feel little to nothing in the beginning. If this is you, please, give yourself compassion. Talk to a trusted person. You may even find they relate and are relieved to learn they aren’t alone!
And some pregnancies are planned – meticulously even. Women who plan their pregnancies seem utterly confused as to why they feel no bond or nothing but sad when their child is born. It seems to make no sense.
But ‘trying’ can be stressful, exhausting and sometimes costly. These emotions aren’t always dealt with during the pregnancy, there is a sense that there is too much else to do – making a baby being one of them! And often, there are miscarriages to deal with before a pregnancy occurs. The loss(es) may not be acknowledged and the or couple is often encouraged to just go again – have ‘another shot’.
I’ve heard couples talk about feeling like machines who aren’t allowed grieve their lost little ones. Sex becomes routine, functional. And so maybe, when the long awaited child arrives, the feelings that didn’t get a look in before (grief, anxiety about money, jealousy of other couples) explode to the surface. Naturally. This is normal. But when you don’t know it’s normal, you’ll likely feel guilty, despite the fact that you’ve done nothing wrong. And guilt is a heavy horrible feeling that is terribly difficult to wriggle away from. These feelings can be worked through successfully in therapy – my hope is that even reading this will help you realise how human and normal these feelings are.
Have you suffered a bereavement?
Similarly, other griefs can be triggered by birth. A bereavement that happened during the pregnancy can go undealt with and suddenly overwhelm once the baby is safely delivered. And no normal person can deal with two huge life events without feeling overwhelmed. If the bereavement was a spouse, a parent or close friend it’s particularly difficult for women who, when they look at their child, are reminded more of who is absent than of who is newly present. In that way the child can come to represent pain. And it is very hard to bond with what represents pain.
We can be confused that a new baby can make us feel sad – again, it doesn’t seem to make sense, especially if your lost person died years ago. But it does make sense. And making that connection is important and wonderfully healing. Learning that we can feel more than one feeling at a time is liberating and healing. Give yourself that chance.
What was the birth like?
Having a birth plan that didn’t work out is extraordinarily stressful for women. All sorts of awful things can go wrong. Generally speaking we all kinda know that birth ain’t pretty, but we also tend to dismiss the horror that some women experience during birth.
Birth trauma can shock a woman to her literal core. She can become alienated from her own body and feel betrayed by it and by whatever care system was in place. She will be at her most vulnerable and will need care, attention, time to heal. She will need good quality contact with caring people, professional and otherwise. She will need time to bond with the baby without whom she would not have experienced all this pain.
Now, that might sound harsh to come of you, but the truth of it is that some women will resent the pregnancy and the baby for causing pain – even though intent to cause pain was of course absent.
But since when are feelings logical right?
There is a great deal of shame around having these feelings (which I have come to view as perfectly normal), so many women dare not discuss them. Shame and PPD are great buddies. Acknowledging and talking about your birth trauma in a safe place is important and will help.
Sex and intimacy
I’ve read many articles advising women to start having sex as soon as possible after the birth to have fun for themselves and also help their partner understand that they are still loved. This advice can feel pressurising and unhelpful. Here’s my advice:
Have sex when you are sure it won’t hurt you and when you are sure you want to. Otherwise it’s fake fun and fake intimacy – both of which are incredibly stressful emotionally and physically.
Talk to you partner about it, tell them what you need, which might be hugs, massages or gentle oral sex. Or not!! Maybe what you need is a few hours’ peace and goddamn quiet!!
If he/she listens you will feel supported, loved and cherished – and all of this will help with all of your other feelings. And if he/she doesn’t understand or makes demands, the issue lies with them, with your relationship, but not solely with you. Being interested in and available for sex is not your responsibility as a woman, newly postpartum or not! Couples therapy can often be helpful here and often just one or two sessions will set you right, together. There is hope.
Giving birth is invariably an invasive procedure and many different hands will be literally inside you up to, during and after the birth (forgive my frankness). This is unavoidable. For some women, this is fine. For others it’s the ultimate nightmare and can send a woman spiralling back into old abuse trauma that can continue post-birth and present as PPD.
If you have been abused please speak with a trusted person or therapist as soon as you find out you’re pregnant. If you have already dealt with it in a therapeutic setting you will know what your triggers might be. If you have not, I want you to take care of yourself and make things as safe feeling as possible for you.
Your feelings are normal, not a medical problem.
Never underestimate the power of sleep. One of the things I see in women who don’t suffer from PPD is that they have partner who, in as much as is possible, shares the night feeds, and night pickups. Or they have a baby who sleeps.
It is absolutely essential to our mental health to get sleep. Remember: staying at hime with a new baby is work, and you need your sleep just as much as your partner if you have one. Perhaps your need is even greater as your body is in recovery from a birth, or worse, traumatic birth.
For women who don’t have partners it is a good idea to ask for family or friends’ help, even if that’s hard to do. It’s my experience women who let themselves ask for help do better during stressful times. And postpartum anything is stressful. That’s normal.
What can you do?
I have found that PPD responds incredibly well to gaining awareness of the answers to the questions I listed. These are things we might not automatically associate with birth, but they are so incredibly interconnected. I hope I’ve given even a glimpse of how easily that connection can happen.
And so you may be at risk. But risk is not certainty. You now have a better idea of how to prepare emotionally for the birth of your child. Think of it as an emotional spring clean! Often just knowing what your trigger may be is enough to feel more in control, more normal, more hopeful. My hope for you is that you will create more emotional space for the joy that you so deserve after making a person – an actual person!!