Pregnancy is a whirlwind of tons of emotions and sensations – our body is ever changing as well as our wishes, dreams, plans, hopes, and expectations that come at us both from every direction. It’s completely normal to feel overwhelmed by the idea of bringing a new life and person into the world, while strangers and loved ones alike bombard you with their experiences and ideas.
Most pregnant women feel their appetite increase, an eager anticipation of the new life to come, and sleep should be good (excepting getting comfortable, which is always a challenge during pregnancy). Normal worries and concerns will be sprinkled throughout the pregnancy experience, but they shouldn’t dominate our days or nights.
Ask yourself, “Do I emotionally feel like ‘me’ most of the day?” “Can I to sleep at night?” “Am I mostly excited about the baby coming?,” and “Am I eating enough?”
All of the above should be answered with a resounding “YES.”
If you’re not, it’s time to seek out a specialized health care practitioner who can help understand what’s happening with you
Depression and anxiety affect just as many pregnant women as new mothers, and can happen to the strongest, most intelligent, and loving moms. If you experience depression during your pregnancy, speak to your obstetrician – this is called antepartum depression, and it affects a great many men and women during pregnancy. There are a number of ways you can get help, and not all of them involve medications.
Every trimester you should either be given a formal screening or simply asked a few key questions to determine how you’re doing emotionally. Receiving the right help during pregnancy will not only be best for you and your entire family, it will help you minimize the risk of postpartum depression.
Several days to weeks after giving birth, some mothers and fathers notice that they’re experiencing some strange symptoms, (most commonly) sadness, and/or anxiety after the birth of their child.
An estimated 1 out of every 6 women and 1 out of every 10 men experiences troubling depression or anxiety after the birth or adoption of a child, and in most people, these feelings are generally transient in nature. Given the tremendously stressful period of learning to live life with a newborn or new child is tremendously stressful to all involved, which is why we now recognize then men can also have postpartum mood disorders.
During the postpartum period, about 85% of women experience some type of mood disturbance. Generally, these symptoms are mild and short-lived; however, 10 to 15% of women and men go on to develop more significant symptoms of depression or anxiety. Postpartum psychiatric illnesses are typically divided into categories:
Postpartum Baby Blues
Postpartum Anxiety Disorders
It may be useful to conceptualize these disorders as existing along a continuum, where postpartum blues is the mildest and postpartum psychosis the most severe form of postpartum mood disorders.
Postpartum mood disorders are often characterized by despondency, emotional instability, anger, guilt, tearfulness, worrying, anxious thoughts or images, feelings of inadequacy and the inability to cope. It may occur shortly after the arrival of a new baby or many months later. For some, symptoms may begin in pregnancy; which is called or Antenatal Depression. The types of postpartum mood disorders generally lay on a spectrum.
Risk Factors for Developing Postpartum Mood Disorders:
Some things can make you more likely than others to develop postpartum mood disorders, including PPD. These are called risk factor. and having a risk factor or a few doesn’t mean for sure that you’ll have any problems with your mental health during or after pregnancy, but these risk factors, may increase your chances. Talk to your health care provider to see if you’re at risk for a postpartum mood disorder.
Your health care provider should assess you for PPD at your postpartum care checkups, including questions about your risks, feelings, stress level, as well as your moods.
Risk factors for postpartum mood disorders include:
Depression during pregnancy (Antenatal depression) or you’ve had major depression or another mental illness before
Family history of depression or mental health disorders.
You’ve been physically or sexually abused in your life
Problems with your partner, including domestic violence (also called intimate partner violence or IPV).
Extra stress in your life, such being separated from your partner, the death of a loved one, or an illness that affects you or a loved one.
Unemployed or have low income, little education, or little support from family or friends.
Pregnancy is unplanned or unwanted, or you’re younger than 19.
You have diabetes. Diabetes can be pre-existing diabetes (also called pre-gestational diabetes) or it can be gestational diabetes.
Pregnancy complications such as premature birth, birth before 37 weeks of pregnant
Multiples (twins, triplets) pregnancy
Pregnant with a child who has been diagnosed birth defects
You have trouble breastfeeding or caring for your baby.
Infant is sick or has ongoing health conditions.
Negative thoughts about being a mom and/or having trouble adjusting to being a parent.
Negative thoughts and feelings about being a mom may include:
Doubts that you can be a good mom
Pressure to be a perfect mom
Feeling that you’re no longer the person you were before you had your baby
Feeling that you’re less attractive after having your baby
Having no free time for yourself
Feeling tired and moody because you aren’t sleeping well or getting enough sleep
What is Antenatal Depression?
Depression during pregnancy, or antepartum depression, is a mood disorder just like clinical depression as far as symptoms are concerned. Mood disorders are biological illnesses that involve changes in brain chemistry and men and women who suffer from major depression are at a higher risk for developing antenatal depression.
During pregnancy, as I’m sure you’re aware, hormone changes affects the chemicals in your brain, including those that tell you to eat, sleep, and rest. Some of the other hormone changes are directly related to Antenatal Depression and Antenatal Anxiety. Unfortunately, these hormones can be exacerbated by difficult life situations, stress, and other factors which can result in depression during pregnancy.
Women with Antepartum Depression tend experience some of the following symptoms for at least two weeks:
Sleeping too little or too much
Loss of interest in activities that you usually enjoy
Recurring thoughts of death, suicide, or hopelessness
Anxiety without a trigger
Feelings of guilt or worthlessness
Change in eating habits
What Are The Postpartum Baby Blues?
Specialists believe that approximately 50 to 85% of women and men experience postpartum blues during the first few weeks after delivery; part of it is related to wildly changing hormone levels, the stress of having a new person to care for, and not feeling as though they’ll be able to manage. As this type of mood disorder is common – even expected, it can be more accurate to consider The Baby Blues as a normal experience following childbirth rather than a psychiatric illness.
Rather than feelings of sadness, men and women with The Baby Blues more commonly report mood lability, tearfulness, anxiety, and/or irritability. These symptoms typically peak on the fourth or fifth day after delivery and may last for a few hours or a few days, remitting spontaneously within two weeks of delivery.
While these symptoms are unpredictable and often unsettling, they do not interfere with a woman’s ability to function. No specific treatment is required; however, it should be noted that sometimes The Baby Blues heralds the development of a more significant mood disorder, particularly in women who have a history of depression.
If symptoms of depression persist for longer than two weeks, you should be evaluated to rule out a more serious postpartum mood disorder.
What Is Postpartum Depression (PPD)?
PPD tends to emerge over the first two to three months postpartum but can occur at any point after delivery. Some men and women actually note the onset of milder depressive symptoms during pregnancy. Postpartum depression is clinically indistinguishable from depression occurring at other times during a woman’s life.
In women and men who have milder cases of PPD, it can be quite difficult to detect postpartum depression because many of the symptoms used to diagnose depression (such as sleep and appetite disturbance, fatigue) also occur in postpartum women in the absence of depression.
The Edinburgh Postnatal Depression Scale is a 10-item questionnaire that may be used to identify women who have PPD.
On this scale, a score of 12 or greater or an affirmative answer on question 10 (presence of suicidal thoughts) raise concern and indicate a need for more thorough evaluation.
Edinburgh Postnatal Depression Scale (EPDS)
The questionnaire below is called the Edinburgh Postnatal Depression Scale (EDPS) The EDPS was developed to identify women who may have postpartum depression. Each answer is given a score of 0 to 3 . The maximum score is 30.
Please select the answer that comes closest to how you have felt in the past 7 days:
A score of more than 10 suggests minor or major depression may be present. Further evaluation is recommended.
Postpartum Depression (Postnatal Depression)
Postpartum depression is major depression that occurs after giving birth. Symptoms are present for most of the day and last for at least 2 weeks.
As many as 1 in every 7 women (14%) suffers postpartum depression .In a study of 209 women referred for major depression during or after pregnancy 11.5% reported start of depression during pregnancy, 66.5 % reported start of depression within 6 weeks after childbirth (early postpartum), and 22% reported onset 6 weeks after childbirth (late postpartum), One woman reported onset of depression at more than 27 weeks after childbirth.
Racing thoughts, psychotic symptoms (such as hallucinations or delusions), or a family history of bipolar disorder (BPD) may indicate bipolar disorder is present.
Treatment of depression during pregnancy and after childbirth is based on expert opinion. “Within the limits of expert opinion and with the expectation that future research data will take precedence, these guidelines provide some direction”. The following are some treatment options that have been suggested .
Psychotherapy such as cognitive-behavioral therapy (CBT) OR interpersonal therapy
Mild Depression postpartum while breast-feeding
Psychotherapy with or without antidepressant (sertraline or paroxetine)
Psychotherapy AND fluoxetine
Alternative medications: sertraline or tricyclic antidepressant
Severe Depression postpartum while breast-feeding
Supportive services AND sertraline
Alternative medication: Paroxetine
Some of the symptoms of postpartum depression include:
Depressed or sad mood
Persistent sadness not otherwise explained
Loss of interest in usual activities
Feelings of guilt
Feelings of worthlessness or incompetence
Change in appetite
What Causes Postpartum Depression?
The postpartum period is characterized by a rapid shift in the hormonal environment. Within the first 48 hours after delivery, estrogen and progesterone concentrations fall dramatically. As these gonadal steroids modulate neurotransmitter systems involved in the regulation of mood, many investigators have proposed a role for these hormonal shirts in the emergence of postpartum affective illness.
While seems as if there is no consistent correlation between serum levels of estrogen, progesterone, cortisol, or thyroid hormones and the occurrence of postpartum mood disturbance, some investigators hypothesize that there is a subgroup of women who are particularly sensitive to the hormonal changes that take place after delivery. This population of women may be more vulnerable to PPD and to other hormonally driven mood disturbances, such as those occurring during the premenstrual phase of the menstrual cycle or during the perimenopause.
Other factors may play a role in the development of PPD. One of the most consistent findings is that among women and men who report marital dissatisfaction and/or inadequate social supports, postpartum depressive mental illnesses is more common. Several investigators have also demonstrated that stressful life events occurring either during pregnancy or near the time of delivery appear to increase the likelihood of postpartum depression.
While all of these factors may act together to cause PPD, the emergence of this disorder probably reflects an underlying vulnerability to affective illness. Women with histories of major depression or bipolar disorder are more vulnerable to PPD, and women who develop PPD will often go on to have recurrent episodes of depression unrelated to pregnancy or childbirth.
Who is at Risk for Postpartum Depression?
All women are vulnerable to postpartum depression, regardless of age, marital status, education level, or socioeconomic status. While it is impossible to predict who will develop PPD, certain risk factors for PPD have been identified, including:
Previous episode of PPD
Depression during pregnancy (antenatal depression)
History of depression or bipolar disorder
Recent stressful life events
Inadequate social supports
Marital or family issues
What Is Postpartum Anxiety?
Recent research suggests that 6% of pregnant women and 10% of postpartum women develop significant anxiety disorders. Sometimes these men and women experience anxiety alone, and sometimes they experience it in addition to postpartum depression. You do not have to be diagnosed with OCD to experience these common symptoms of perinatal anxiety
Generalized anxiety is common in both the general population and the postpartum period, however some women may also develop more challenging types of anxiety, such as panic disorder, and/or hypochondriasis in the postpartum period. Postpartum obsessive-compulsive disorder has also been reported, in which women report disturbing and intrusive thoughts of harming their infant.
The symptoms of anxiety during pregnancy or postpartum might include:
Feeling that something bad is going to happen
Disturbances of sleep and appetite
Inability to sit still
Physical symptoms like dizziness, hot flashes, and nausea
Risk factors for perinatal anxiety and/or panic disorder may include a personal or family history of anxiety, previous perinatal depression or anxiety, or thyroid imbalance; however, many men and women develop Postpartum Anxiety without any risk factors.
Postpartum Panic Disorder is a form of anxiety with which the sufferer feels very nervous and has recurring panic attacks after the birth or adoption of a baby or child. During a panic attack, he or she may experience any or all of the following:
Shortness of breath
Feeling of someone sitting on his or her chest
Numbness and tingling in the extremities.
Panic attacks seem to go in waves, but it is important to know that they will pass and will not hurt you.
What Is Postpartum Obsessive-Compulsive Disorder?
Postpartum Obsessive-Compulsive Disorder (OCD) is probably most misunderstood and misdiagnosed of the perinatal mood disorders. It is estimated that as many as 3-5% of new mothers and some new fathers will experience some of these symptoms. The repetitive, intrusive images and thoughts are very frightening and can feel like they come “out of the blue.” Fortunately, postpartum OCD is temporary and treatable with professional help. If you feel you may be suffering from one of this illness, know that it is not your fault and you are not to blame.
Research has shown that these images are anxious in nature, not delusional, and have very low risk of being acted upon. It is far more likely that the parent with this symptom takes steps to avoid triggers and avoid what they fear is potential harm to the baby.
Some women and men do not have OCD but are bothered by obsessive-compulsive symptoms.
Symptoms of Postpartum Obsessive-Compulsive symptoms can include:
Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images related to the baby. These thoughts are very upsetting and not something the woman has ever experienced before.
Compulsions, where the mom may do certain things over and over again to reduce her fears and obsessions. This may include things like needing to clean constantly, check things many times, count or reorder things.
A sense of horror about the obsessions
Overly occupied with keeping your baby safe
Compelled to do certain things over and over again to help relieve her anxiety and fears–This can include counting things, ordering things, listing things, checking and rechecking actions already performed, and cleaning repeatedly. This may manifest itself in cleaning, feeding, or taking care of the baby.
May recognize these obsessions but feels horror and shame associated with them
Obsessions or thoughts that are persistent, are repetitive and can include mental images of the baby that are disturbing
Fear of being alone with the baby
Women who suffer from PPOCD often know that these thoughts, actions, and feelings are not normal and do not act on them. But the obsession can get in the way of a mom taking care of her baby properly or being able to enjoy her baby. With the right treatment, women with PPOCD can experience freedom from being controlled by these obsessions and compulsions
Fear of being left alone with the infant
Hypervigilance in protecting the infant
Moms with postpartum OCD know that their thoughts are bizarre and are very unlikely to ever act on them.
Risk factors for postpartum OCD include a personal or family history of anxiety or OCD.
Given the potential adverse effects of untreated mood and anxiety symptoms in either the mother, father, careful screening and early recognition of anxiety symptoms during the postpartum period is recommended. Antepartum anxiety are temporary and treatable with professional help. If you feel you may be suffering from one of these illnesses, know that it is not your fault and you are not to blame.
What Is Postpartum Post-Traumatic Stress Disorder (PPTSD)?
Postpartum post-traumatic stress disorder (P-PTSD) often affects women who experienced a real or perceived trauma during childbirth or immediately after the baby was born.
P-PTSD is not a well-researched postpartum mood disorder, but for the estimated 3 to 16 percent of new moms and dads who suffer from it, this postpartum mood disorder is very real and incredibly frightening. P-PTSD can greatly impact the way they experience parenthood and care for their new baby.
For most women, the safe delivery of a healthy baby is moment remembered with great happiness. But not every new mom’s birth experience is a joyful one. In fact, more than a third of recently delivered moms describe their birth as traumatic, and the American College of Obstetricians and Gynecologists estimate that 3 to 16 percent display severe traumatic stress responses in the postpartum period. Like war veterans who suffer from PTSD – intrusive memories and flashbacks after suffering traumatic experiences on the battlefield – moms with P-PTSD look at their childbirth experience as a source of pain and anxiety and suffer from very similar post-traumatic symptoms.
P-PTSD is triggered by a traumatic event or events – real or perceived –– during pregnancy, labor, delivery, or during the postpartum period.
A mom-to-be may experience a traumatic event, such as severe morning sickness, fertility treatments, or serious pregnancy complications. Some women might experience trauma during childbirth if their labor was long and painful, if there was a cord prolapse, shoulder dystocia, a severe tear, previously undiscovered birth defects, hemorrhage, or an emergency C-section.
Trauma may result from a home birth that resulted in a transfer to a hospital due to complications; it could be from a planned hospital delivery that ended up unexpectedly at home. Trauma may develop if someone who’d wanted an intervention-free birth ends up requiring life-saving interventions.
Postpartum traumas may include having a premature baby, a baby who needs to be in the NICU, breastfeeding difficulties, or worse, a stillbirth or loss of a child early on.
Often the trauma is an emotional one: feelings of being powerless, of not being listened to, of not having adequate support during childbirth.
It’s important to remember that postpartum PTSD can develop after a real or perceived threat of death of the mother, father, or baby.
Traumas that may cause postpartum post-traumatic stress (P-PTSD) disorder include:
Unplanned or emergency C-section
Emergency complication such as prolapsed umbilical cord
Birth that requires invasive interventions such as vacuum extractor or forceps
Baby requiring a NICU stay
Lack of support and assurance during the delivery
Lack of communication from the birth and support team
Feelings of powerlessness
Symptoms of P-PTSD may include:
Nightmares and flashbacks to the birth or trauma
Anxiety and panic attacks
Feeling a detachment from reality and life
Irritability, sleeplessness, hyper-vigilance, startles more easily
Avoidance of anything that brings reminders of the event such as people, places, smells, noises, feelings
May begin re-experiencing past traumatic events, including the event that triggered the disorder
Women who are experiencing PPTSD need to talk with a health care provider about what they are feeling. With the correct treatment, these symptoms will lessen and eventually go away.
What Is Postpartum Psychosis?
Postpartum Psychosis (PP) is a severe, but treatable, form of mental illness that occurs after having a baby. It can happen ‘out of the blue’ to women without previous experience of mental illness. There are some groups of women, women with a history of bipolar disorder for example, who are at much higher risk. PP normally begins in the first few days to weeks after childbirth. It can get worse very quickly and should always be treated as a medical emergency. Most women need to be treated with medication and admitted to hospital.
Postpartum psychosis is the most severe form of postpartum mood disorders and is extremely – extremely dangerous. Postpartum Psychosis is a medical emergency. If you believe a friend or loved one is suffering from Postpartum Psychosis, don’t wait: call 911. This is an emergency.
Fortunately, postpartum psychosis It is a rare postpartum mood disorder that occurs in approximately 1 to 2 per 1000 women after childbirth.
The presentation is often dramatic, with onset of symptoms as early as the first 48 to 72 hours after delivery. The majority of women with puerperal psychosis develop symptoms within the first two postpartum weeks.
With the right treatment, women with PP do make a full recovery. Recovery takes time and the journey may be tough. The illness can be frightening and shocking for both the woman experiencing it and her family. Women do return to their normal selves, and are able to regain the mothering role they expected. There is no evidence that the baby’s long term development is affected by Postpartum Psychosis.
There are a large variety of symptoms that women with PP can experience. Women may be:
Excited, elated, or ‘high’.
Depressed, anxious, or confused.
Excessively irritable or changeable in mood.
Postpartum Psychosis includes one or more of the following:
Strange beliefs that could not be true (delusions).
Hearing, seeing, feeling or smelling things that are not there (hallucinations).
High mood with loss of touch with reality (mania).
Attempts to harm the child or herself
These are also common symptoms:
Being more talkative, sociable, on the phone an excessive amount.
Having a very busy mind or racing thoughts.
Feeling very energetic and like ‘super-mum’ or agitated and restless.
Having trouble sleeping, or not feeling the need to sleep.
Behaving in a way that is out of character or out of control.
Feeling paranoid or suspicious of people’s motives.
Feeling that things are connected in special ways or that stories on the TV or radio have special personal meaning.
Feeling that the baby is connected to God or the Devil in some way.
It appears that in most cases, postpartum psychosis represents an episode of bipolar illness; the symptoms of puerperal psychosis most closely resemble those of a rapidly evolving manic (or mixed) episode. The earliest signs are restlessness, irritability, and insomnia. Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behavior. Delusional beliefs are common and often center on the infant.
Auditory hallucinations that instruct the mother to harm herself or her infant may also occur.
Risk for infanticide, as well as suicide, is significant in this population.
How Are Postpartum Mood Disorders Treated?
Postpartum depression presents along a continuum, and the type of treatment selected is based on the severity and type of symptoms present. However, before initiating psychiatric treatment, any medical causes for mood disturbances (including thyroid dysfunction and/or anemia) must be excluded. Initial evaluation of a man or woman for postpartum mood disorders should always include a thorough and complete history, a physical examination, as well as routine laboratory tests.
Non-pharmacological therapies are often useful in the treatment of postpartum depression. It has been wildly demonstrated that short-term cognitive-behavioral therapy (CBT) was as effective as treatment with fluoxetine in women who have postpartum depression. Interpersonal therapy (IPT) has also been shown to be effective for the treatment of women with mild-to-moderate postpartum depression. Not only is IPT effective for treating the symptoms of depression, women who receive IPT may also benefit from significant improvements in the quality of their interpersonal relationships.
These non-pharmacological interventions may be particularly attractive to those patients who are reluctant to use psychotropic medications (such as women who are breastfeeding) or for women who have milder forms of depressive illness. Women with more severe postpartum depression may choose to receive pharmacological treatment, either in addition to or instead of these non-pharmacological therapies.
Only a few studies have systematically assessed the pharmacological treatment of postpartum depression.
Conventional antidepressant medications (fluoxetine, sertraline, fluvoxamine, and venlafaxine) have shown efficacy in the treatment of postpartum depression, standard antidepressant doses were both effective and well tolerated. The choice of an antidepressant should be guided by the woman’s prior response to antidepressant medication and side effect profile. Specific serotonin reuptake inhibitors (SSRIs) are ideal first-line agents, as they are anxiolytic, non-sedating, and well-tolerated.
For women who cannot tolerate SSRIs, bupropion (Wellbutrin) may be an alternative; although one pilot study suggests bupropion may not be as effective as SSRIs
Tricyclic antidepressants (TCAs) are frequently used and, because they tend to be more sedating, may be more appropriate for women who present with prominent sleep disturbance. Given the prevalence of anxiety symptoms, adjunctive use of a benzodiazepine (including clonazepam, lorazepam) may be very helpful to help ease anxiety and allow for relaxation.
While it’s difficult to reliably predict which women in the general population will experience postpartum mood disorders, it is possible to identify certain subgroups of women (such as men and women with a history of mood disorders) who are more vulnerable to postpartum affective illness.
Current research indicates that prophylactic interventions may be instituted near or at the time of delivery to decrease the risk of postpartum illness. Several studies demonstrate that women with histories of bipolar disorder or puerperal psychosis benefit from prophylactic treatment with lithium instituted either prior to delivery (at 36 weeks gestation) or no later than the first 48 hours postpartum.
Women and men with postpartum psychiatric illness are offered a variety of services by clinicians with particular expertise in these areas:
Clinical evaluation for postpartum mood and anxiety disorders
Consultation regarding breastfeeding and psychotropic medications
Puerperal psychosis is considered a psychiatric emergency that typically requires inpatient treatment.
Acute treatment with either typical or atypical anti-psychotic medications is indicated. Given the well-established relationship between puerperal psychosis and bipolar disorder, postpartum psychosis should be treated as an affective psychosis and a mood stabilizer is indicated.
Electroconvulsive therapy (ECT) is well-tolerated and rapidly effective for severe postpartum depression and psychosis.
Can I Take Medications While Breastfeeding?
The nutritional, immunologic and psychological benefits of breastfeeding have been well-documented. Women who plan to breastfeed must be informed that all psychotropic medications, including antidepressants, are secreted into the breast milk, though concentrations in the breast milk appear to vary widely throughout the day The amount of medication to which an infant is exposed depends on several factors including, dosage of medication, rate of maternal drug metabolism, and frequency and timing of feedings.
Over the past five years, we’ve learned more regarding the use of various antidepressants during breastfeeding. Available data on the tricyclic antidepressants, fluoxetine, paroxetine, and sertraline during breastfeeding have been encouraging and suggest that significant complications related to an infant’s exposure to these medications in breast milk appear to be rare. While less information is available on other antidepressants, there have been no reports of serious adverse events related to infant exposure to these medications.
Women who have bipolar disorder may discover breastfeeding may be much more problematic. The first concern is that on-demand, around-the-clock breastfeeding may significantly disrupt the mother’s sleep, which can increase her vulnerability to a relapse of bipolar disorder during the postpartum period. Second, there have been reports of toxicity in nursing infants who have been exposed to various mood stabilizers in the breast milk, including lithium and carbamazepine. Lithium, a gold standard in management of bipolar disorder, is excreted at high levels in the mother’s milk, so infant serum levels of Lithium are relatively high, which brings an increased risk of neonatal toxicity. Exposure to carbamazepine and valproic acid in the breast milk has also been associated with hepatotoxicity (liver toxicity) in a nursing infant.
If you’ve been diagnosed and treated for bipolar disorder, the very best thing that you can do for yourself and your infant is to develop a postpartum plan with your psychiatrist and your OB, based on the symptoms you experienced before you were pregnant. In this plan, you can address your postpartum concerns and ways to manage these concerns.
Additional Things You Can Do To Help Postpartum Mood Disorders:
With the controversy regarding the use of some antidepressants during pregnancy, many women are interested in other ways to help treat depression. As mentioned above, support groups, psychotherapy and light therapy are alternatives to using medication when treating mild to moderate depression.
In addition to these, you may want to talk with your health care providers about some of the other natural ways to help relieve the symptoms of depression.
If you do not feel comfortable talking with your health care provider about your feelings of depression, find someone else to talk with. It is important that someone knows what you are dealing with and can try to help you. Never try to face depression alone. Your baby needs you to seek help and get treatment.
Pay attention to the warning signs. Find out what triggers your mood disorder. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes. Ask friends or family to watch out for warning signs.
Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.
Make some time to have fun. This can help remind you that everything won’t remain this stressful
Don’t isolate yourself, but don’t overcommit yourself, either.
Set realistic expectations. Be kind to yourself. Don’t pressure yourself to do everything. Ask for help when you need it.
New studies report acupuncture may be a viable option in treating depression in pregnant women.
Many foods have been linked to mood changes, the ability to handle stress and mental clarity. Diets high in caffeine, sugar, processed carbohydrates, artificial additives and low protein can all lead to issues regarding your mental and physical health. Make a conscious decision to start fueling your body with the foods that can help you feel better.
Learn about postpartum mood disorders. Empowerment leads us to feel better and more in control of our feelings.
Get exercise. Physical activity may help reduce symptoms
Exercise naturally increases serotonin levels and decreases cortisol levels.
Take a daily walk with your baby, or get together with other new moms for regular exercise.
Maintain an adequate diet. The Canada Food Guide is a useful reference in helping you choose how to eat well. Choose more protein and Omega 3, and fewer simple carbohydrates.
Avoid alcohol and illicit drugs. It may seem like they lessen your problems, but in the long run, they generally worsen symptoms and make the depression harder to treat.
Get adequate sleep. Lack of sleep greatly affects the body and mind’s ability to handle stress and day to day challenges. Work on establishing a routine sleep schedule that has you going to sleep and getting up at the same time. Ask for support from friends and family in watching the baby so you can get some sleep.
Available 24 hours a day, you will be asked to leave a confidential message and a trained and caring volunteer will return your call or text. They will listen, answer questions, offer encouragement and connect you with local resources as needed.
Office on Women’s Health: Provide national leadership and coordination to improve the health of women and girls through policy, education, and innovative programs.
March of Dimes: March of Dimes leads the fight for the health of all moms and babies. We believe that every baby deserves the best possible start. Unfortunately, not all babies get one. We are changing that.
Postpartum psychosis should be considered a medical emergency requiring immediate medical attention. Call 911 if you or someone you love is experiencing postpartum psychosis.
What is Postpartum Depression?
If you’ve just had a baby, you understand the mood swings that go along with your postpartum hormones. No matter how you love your child, how long you’ve wanted a baby, a new baby is stressful. Period. Lack of sleep, new important responsibilities, and a distinct lack of personal space and time to yourself, both parents can experience the baby blues. It’s extremely normal, but once symptoms of the baby blues last for a few weeks or worsen, you may be coping with postpartum depression.
Approximately 15% of new mothers and fathers will experience what is classified as postpartum depression (PPD). Symptoms may occur a few days after delivery or sometimes as late as a year later. People who experience postpartum depression will have alternating good days and bad days. Symptoms can be mild or severe, usually lasting for over 2 weeks.
There are lots of ways to help women suffering from postpartum depression, and remember that this is common, and you are never alone, no matter how you feel.
Is This Postpartum Depression or Is This The Baby Blues?
We know that you’ve just had a baby, and you’re expecting to be basking in the glory of a new life into this world. You thought you’d be celebrating with loved ones and enjoying every single second. But you’re not. In fact, you feel like crying or hiding away.
You thought you’d be joyous and excited, not weepy, exhausted, and anxiety-ridden. While you may not have intended this, you should know that mild depression, anxiety, and mood swings are totally normal. So normal that we can refer to them as the Baby Blues.
Approximately 50% to 75% of all new mothers will experience some negative feelings after giving birth. Normally these feelings occur suddenly four to five days after the birth of the baby.
Most women – to a greater or lesser extent – experience some symptoms of the baby blues after giving birth; the hormones that kept you pregnant are replaced by new hormones, lack of sleep, delivery, social isolation, major sleep loss, and stress, and it’s natural to notice them. Some women report that they feel emotionally fragile, sad, and overwhelmed. Generally the Baby Blues occur within a couple days of your delivery, last a week, and taper off by the second postpartum week.
What Are The Symptoms of Postpartum Depression?
In stark contrast from the baby blues, postpartum depression is a serious medical issue that should not be ignored. But how do you know the difference between postpartum depression and the Baby Blues?
PPD, as it’s often abbreviated, can look like the baby blues, so much so that they share many of the same symptoms, however the symptoms of postpartum depression last longer and are more severe. You may also feel hopeless and worthless, and lose interest in the baby. You may have thoughts of hurting yourself or the baby. Very rarely, new mothers develop something even more serious – postpartum psychosis – may have hallucinations or try to hurt themselves or the baby. They need to get treatment right away, often in the hospital.
The difference is that with postpartum depression, the symptoms are more severe (such as suicidal thoughts or an inability to care for your newborn) and longer lasting. Symptoms of postpartum depression begin either during pregnancy or within four weeks after having a baby.
The symptoms of postpartum mood disorders don’t differ from the non-postpartum mood disorders except that the feelings of guilt and inadequacy about being an incompetent mother feed a person’s worries about being less than an adequate parent.
You might find yourself withdrawing from your partner or being unable to bond well with your baby.
You might find your anxiety out of control, preventing you from sleeping—even when your baby is asleep—or eating appropriately.
You might find feelings of guilt or worthlessness overwhelming or begin to develop thoughts preoccupied with death or even wish you were not alive.
Feelings of profound sadness, emptiness, emotional numbness, irritability, or anger.
A tendency to withdraw from relationships with family, friends, or from activities that are usually pleasurable for the PPD sufferer
Constant fatigue or tiredness, difficulty sleeping, overeating, or loss of appetite
A strong sense of failure or inadequacy
Intense concern and anxiety about the baby or a lack of interest in the baby
Thoughts about suicide or fears of harming the baby
People with postpartum depression feel guilty about being depressed at a time when they are supposed to be happiest and may be reluctant to discuss their feelings.
People with postpartum depression often experience a loss of appetite, leading to extreme weight loss.
People with postpartum depression often report an increased yearning for sleep, sleeping heavily, but awakening (and unable to get back to sleep) the moment their baby makes a noise.
The distinguishing feature in postpartum depression is irritability. Episodes of irritability may be unprovoked or provoked by the slightest infraction. These episodes of irritability are often directed at the significant other or baby and may escalate to violent outbursts or uncontrollable sobbing.
People with severe postpartum depression often have terrible panic attacks, severe anxiety, and spontaneous crying, long after the duration of the “baby blues.”
These people with PPD may feel jealous of their infant and have difficulties bonding with their babies.
These are all red flags for postpartum depression.
The Edinburgh Postnatal Depression Scale is a screening tool designed to detect postpartum depression. Follow the instructions carefully. A score greater than 13 suggests the need for a more thorough assessment because you could have postpartum depression.
If you’re a new mother or father, please don’t hesitate to bring up these feelings with your doctor. Don’t let your doctor brush it off. If s/he does, find another doctor.
Signs And Symptoms of Postpartum Psychosis:
Postpartum psychosis is a rare, but extremely serious disorder that can develop after childbirth, characterized by loss of contact with reality. Because of the high risk for suicide or infanticide, hospitalization is usually required to keep the mother and the baby safe.
Postpartum psychosis (PPP) is the most severe form of postpartum depression, but fortunately it is the rarest form. It occurs in 1 to 2 out of every 1,000 pregnancies. The onset is very sudden and severe, normally within 2 to 3 weeks after giving birth. Postpartum psychosis develops suddenly, usually within the first two weeks after delivery, and sometimes within 48 hours.
Symptoms are characterized by a loss of touch with reality and can include:
Bizarre, erratic behavior
Thoughts of hurting the baby
Thoughts of hurting yourself
Rapid mood swings
Hallucinations (seeing things that aren’t real or hearing voices)
Delusions (paranoid and irrational beliefs)
Extreme agitation and anxiety
Suicidal thoughts or actions
Confusion and disorientation
Inability or refusal to eat or sleep
Thoughts of harming or killing your baby
Postpartum psychosis should be considered a medical emergency requiring immediate medical attention. Call 911 if you or someone you love is experiencing postpartum psychosis.
What Causes Postpartum Depression?
Just as in all types of depression, there is no single reason to point to as the definitive cause of postpartum depression. A variable combination of lifestyle, physical, and emotional factors can all play a part.
There’s no single reason why some new mothers develop postpartum depression and others don’t, but a number of interrelated causes and risk factors are believed to contribute to the problem.
Hormonal changes. After childbirth, women experience a big drop in estrogen and progesterone hormone levels. Thyroid levels can also drop, which leads to fatigue and depression. These rapid hormonal changes—along with the changes in blood pressure, immune system functioning, and metabolism that new mothers experience—may trigger postpartum depression.
Physical changes. Giving birth brings numerous physical and emotional changes. You may be dealing with physical pain from the delivery or the difficulty of losing the baby weight, leaving you insecure about your physical and sexual attractiveness.
Stress. The stress of caring for a newborn can also take a toll. New mothers are often sleep deprived. In addition, you may feel overwhelmed and anxious about your ability to properly care for your baby. These adjustments can be particularly difficult if you’re a first-time mother who must get used to an entirely new identity.
Risk Factors For Postpartum Depression:
Several factors can predispose you to postpartum depression:
The most significant is a history of postpartum depression, as a prior episode can increase your chances of a repeat episode to 30-50%.
Mood Disorders: A history of non-pregnancy related depression or a family history of mood disturbances is also a risk factor.
Addiction: People with any history of depression, anxiety, alcohol or another substance use disorder prior to the pregnancy are at risk for developing depression during the pregnancy or within a few weeks after delivery.
Prenatal depression – Depression during pregnancy may be the strongest predictor for later suffering from PPD.
History of previous depression – Although not as strong a predictor as a depressive episode during the pregnancy, it appears that women with histories of depression previous to conception are also at a higher risk of PPD than those without
Examples of specific illnesses that have been associated with being associated with the potential to develop postpartum depression include any form of major depression, such as premenstrual dysphoric disorder, bipolar disorder, and generalized anxiety disorder.
Maternity blues – Especially when severe, the blues may herald the onset of PPD.
Recent stressful life events
Inadequate social supports
Poor marital relationship – One of the most consistent findings is that among women who report marital dissatisfaction and/or inadequate social supports, postpartum depressive illness is more common.
Childcare stress – Difficult infant temperament
In addition, three factors are less definitively predictive, but still arise consistently as factors that increase a woman’s risk of PPD, especially in combination with one or more of the factors listed above:
Single marital status
Unplanned or unwanted pregnancy
Lower socioeconomic status
What Is The Treatment For Postpartum Depression?
Postpartum depression (PPD) sometimes goes away on its own within three months of giving birth. But if it interferes with your normal functioning at any time, or if “the blues” lasts longer than two weeks, you should seek treatment. About 90% of women who have postpartum depression can be treated successfully with medication or a combination of medication and psychotherapy. Participation in a support group may also be helpful. In cases of severe postpartum depression or postpartum psychosis, hospitalization may be necessary. Sometimes, if symptoms are especially severe, electroconvulsive (ECT) therapy may be used to treat severe depressions with hallucinations (false perceptions) or delusions (false beliefs) or overwhelming suicidal thoughts
Untreated postpartum depression can affect your ability to parent. You may:
Not have enough energy
Have trouble focusing on the baby’s needs and your own needs
Not be able to care for your baby
Have a higher risk of attempting suicide
Feeling like a bad mother can make depression worse. It is important to reach out for help if you feel depressed.
Researchers believe postpartum depression in a mother can affect her child throughout childhood, causing:
Delays in language development and problems learning
Problems with mother-child bonding
More crying or agitation
Shorter height and higher risk of obesity in pre-schoolers
Problems dealing with stress and adjusting to school and other social situations
Postpartum depression, like other mental illnesses, presents along a continuum, and the type of treatment selected is based on the severity of the depression and type of symptoms present. However, before beginning psychiatric treatment, medical causes for mood disturbance (such as, thyroid dysfunction, anemia) must be excluded. Initial evaluation should include a thorough history, physical examination, and routine laboratory tests.
Non-pharmacological therapies are useful in the treatment of postpartum depression, including CBT, ITP, and couples counseling.
In a randomized study, it was shown that short-term cognitive-behavioral therapy (CBT) was as effective as treatment with fluoxetine (Prozac) in women with postpartum depression.
Interpersonal therapy (IPT) has also been shown to be effective for the treatment of women with mild to moderate postpartum depression. Not only is IPT effective for treating the symptoms of depression, women who receive IPT also benefit from significant improvements in the quality of their interpersonal relationships
These non-pharmacological interventions may be particularly attractive to those reluctant to use psychotropic medications (such as women who are breast-feeding) or for people with milder forms of depressive illness. Women with more severe postpartum depression may choose to receive pharmacological treatment, either in addition to or instead of, these non-pharmacological therapies.
Only a few studies have systematically assessed the pharmacological treatment of postpartum depression. Conventional antidepressant medications have shown efficacy in the treatment of postpartum depression at standard antidepressant doses were effective and well tolerated.
The choice of an antidepressant should be guided by the person’s prior response to antidepressant medication and a given medication’s side effects.
Specific serotonin reuptake inhibitors (SSRIs) are ideal first-line agents, as they are anxiolytic, non-sedating, and well tolerated (examples include: fluoxetine, sertraline, fluvoxamine, and venlafaxine)
For women who cannot tolerate SSRIs, bupropion (Wellbutrin) may be an alternative; although one pilot study suggests bupropion may not be as effective as SSRIs.
Tricyclic antidepressants (TCAs) are frequently used and, because they tend to be more sedating, may be more appropriate for women who present with prominent sleep disturbance.
Given the prevalence of anxiety symptoms in this population, adjunctive use of a benzodiazepine (e.g., clonazepam, lorazepam) may be very helpful.
Can I Breastfeed My Child If I’m On Medication?
The nutritional, immunologic, and psychological benefits of breastfeeding have been well documented. Women who plan to breastfeed must be informed that all psychotropic medications, including antidepressants, are secreted into the breast milk. Concentrations in the breast milk appear to vary widely. The amount of medication to which an infant is exposed depends on several factors, including dosage of medication, rate of maternal drug metabolism, and frequency and timing of feedings (Llewelyn and Stowe).
Over the past five years, data have accumulated regarding the use of various antidepressants during breastfeeding (reviewed in Newport et al 2002). Available data on the tricyclic antidepressants, fluoxetine, paroxetine, and sertraline during breastfeeding have been encouraging and suggest that significant complications related to neonatal exposure to psychotropic drugs in breast milk appear to be rare. While less information is available on other antidepressants, there have been no reports of serious adverse events related to exposure to these medications.
For women with bipolar disorder, breastfeeding may be more problematic.
First is the concern that on-demand breastfeeding may significantly disrupt the mother’s sleep and thus may increase her vulnerability to relapse during the acute postpartum period. Second, there have been reports of toxicity in nursing infants related to exposure to various mood stabilizers, including lithium and carbamazepine, in breast milk. Lithium is excreted at high levels in the mother’s milk, and infant serum levels are relatively high, about one-third to one-half of the mother’s serum levels, increasing the risk of neonatal toxicity. Exposure to carbamazepine and valproic acid in the breast milk has been associated with liver damage in the nursing infant.
Can We Prevent PPD?
While it is difficult to reliably predict which women in the general population will experience postpartum mood disturbance, it is possible to identify certain subgroups of women (i.e., women with a history of mood disorder) who are more vulnerable to postpartum affective illness. Current research indicates that prophylactic interventions may be instituted near or at the time of delivery to decrease the risk of postpartum illness.
Several studies demonstrate that women with histories of bipolar disorder or puerperal psychosis benefit from prophylactic treatment with lithium either prior to delivery (at 36 weeks gestation) or no later than the first 48 hours postpartum.
For women with histories of postpartum depression, several studies have described a beneficial effect of prophylactic antidepressant (either TCAs or SSRIs) administered after delivery. Patients with postpartum psychiatric illness are offered a variety of services by clinicians with particular expertise in this area:
Clinical evaluation for postpartum mood and anxiety disorders
Consultation regarding breastfeeding and psychotropic medications
The most important task of infancy is the bonding process between the infant and parents, as the success of this wordless relationship enables a child to feel secure enough to develop fully, and affects how the child will interact, communicate, and form relationships throughout life.
A secure attachment between parent and child is formed when the parent responds warmly and consistently to your baby’s physical and emotional needs. When your baby cries, you quickly soothe him or her. If your baby laughs or smiles, you respond in kind. You and your child are in synch. You recognize and respond to each other’s emotional signals.
Postpartum depression can interrupt this bonding. Depressed parents may be loving and attentive sometimes, but others may react negatively or not respond at all. Sadly, parents with postpartum depression tend to interact less with their babies, and are less likely to breastfeed, play with, and read to their children. They may also be inconsistent caregivers.
However, learning to bond with your baby not only benefits your child, it also benefits you by releasing endorphins that make you feel happier and more confident as a parent.
Make yourself and your baby the priority. Give yourself permission to concentrate on yourself and your baby – there is more work involved in this 24/7 job then in a full-time job.
Try to remember that we, as human beings are naturally social. Positive, happy, and supportive social contact relieves stress faster and more efficiently than any other means of stress reduction. Historically and from an evolutionary perspective, new parents received help from those around them when caring for themselves and their infants after childbirth. In today’s world, new mothers often find themselves alone, exhausted, and lonely for supportive adult contact.
When you’re feeling depressed and vulnerable, it’s more important than ever to stay connected to family and friend – even if you’d rather be left alone. Isolating yourself will only make your situation feel even bleaker, so make your adult relationships a priority. Let your loved ones know what you need and how you’d like to be supported.
In addition to the practical help your friends and family can provide, they can also serve as a much-needed emotional outlet. Share what you’re experiencing – all of it – with at least one other person, preferably face to face. It doesn’t matter who you talk to, so long as that person is willing to listen without judgment and offer reassurance and support.
Even if you have supportive loved ones, you may want to consider seeking out other women who are dealing with the same transition into motherhood. It’s very reassuring to hear that other mothers share your worries, insecurities, and feelings. Good places to meet new moms include support groups for new parents or organizations such as Mommy and Me. Ask your pediatrician for other resources in your neighborhood.
One of the best things you can do to relieve or avoid postpartum depression is to take care of yourself. The more you care for your mental and physical well-being, the better you’ll feel. Simple lifestyle changes can go a long way towards helping you feel like yourself again.
Studies show that exercise, for some people, may be just as effective as medication. But don’t to overdo it: a 30-minute walk each day can work wonders. Stretching exercises such as those found in yoga have shown to be especially effective. Make certain that you’re cleared by your OB/GYN before you begin to exercise.
A full eight hours may seem like an unattainable luxury when you’re dealing with a newborn, but poor sleep makes postpartum depression worse. Do what you can to get plenty of rest – enlist the help of your partner or family members to catching naps when you can.
Make some time to relax and take a break from your parental duties. Find small ways to pamper yourself, like taking a bubble bath, savoring a hot cup of tea, or lighting scented candles. Get a massage. Splurge on a pedicure.
When you’re depressed, nutrition often suffers, because you may not have any appetite. As you know, what you eat has an impact on mood, as well as the quality of your breast milk, so do your best to eat well.
Sunlight lifts your mood – and prevents vitamin D deficiency – so try to get at least 10 to 15 minutes of sun per day.
More than half of all divorces take place after the birth of a child. For many people, the relationship with their partner is their primary source of emotional expression and social connection. The demands and needs of a new baby can get in the way and fracture this relationship unless couples put some time, energy, and thought into preserving their bond.
The stress of sleepless nights and responsibilities can leave you feeling overwhelmed and exhausted. And since you can’t take it out on the baby, it’s all too easy to turn your frustrations on your partner. Instead of finger pointing, remember that you’re in this together. If you tackle parenting challenges as a team, you’ll become an even stronger unit.
Many things change following the birth of a baby, including roles and expectations. For many couples, a key source of strain is the post-baby division of household and childcare responsibilities. It’s important to talk about these issues, rather than letting them fester. Don’t assume your partner knows how you feel or what you need.
It’s essential to make time for just the two of you when you can reconnect. But don’t put pressure on yourself to be romantic or adventurous (unless you’re both up for it). You don’t need to go out on a fancy date to enjoy each other’s company. Even spending 15 or 20 minutes together—undistracted and focused on each other— can make a big difference in your feelings of closeness and togetherness.
Help! My Loved One Has Postpartum Depression!
If your loved one is experiencing postpartum depression, the best thing you can do is to offer support. Give her a break from her childcare duties, provide a listening ear, and be patient, and understanding.
If your partner has PPD, remember that you also need to take care of yourself. Dealing with the needs of a new baby is hard for all involved. If your significant other is depressed, you are dealing with two major stressors.
Don’t wait, just offer help around the house. Chip in with the housework and childcare responsibilities. The person may not feel it is appropriate to ask for any help from anyone.
Encourage talking about feelings, which can be awkward, but is necessary for your loved one. Listen to your loved one without judging or offering solutions. Instead of trying to fix things, simply be there for your loved one to lean on.
Make sure your loved one takes time for themselves. Rest and relaxation are important. Encourage the parent to take breaks, hire a babysitter, or schedule some date nights.
Go for a walk together. Getting exercise can make a big dent in depression, but it’s hard to get motivated when you’re feeling low.
Additional Resources For Postpartum Depression:
Postpartum Health Alliance is a non-profit organization dedicated to raising awareness about perinatal mood and anxiety symptoms and disorders and providing support and treatment referrals to women and their families.
If you are struggling or have questions, please call our warmline at 619-254-0023. Our trained volunteers can provide you with support and referrals.
If you need immediate support please call the San Diego Access and Crisis Line at 1-888-724-7240. The toll-free call is available 24-hours a day, 7-days a week
Postpartum Depression International: source of great information about all types of Postpartum Mood Disorders and also offers women resources for where to go for local help. Call or Text our HelpLine
Available 24 hours a day, you will be asked to leave a confidential message and a trained and caring volunteer will return your call or text. They will listen, answer questions, offer encouragement and connect you with local resources as needed.
I know I have a better life than a lot of people, and I try to be grateful for it.
I feel guilty when I dwell on my problems: other people have it so much worse: how can I complain? How can I mope around or be depressed?!
Oh how I wish I could talk to someone, to sit in a group and swap stories about burning the inside of our mouths, or panic attacks, or how much it sucks to have to lug all your belongings around in a garbage bag.
But I just can’t.
I have walked past the building where NA meetings are held probably a hundred times, looked at their website again and again, memorizing their schedule, but I can’t bring myself to go.
I’m afraid that people won’t like me because I’ve been clean now for four years, that because now I have a car and an apartment in a slightly decent area of the city, I’ll be told to get over it, to stop whining.
On the other hand, I think, what if I go to a regular counselor and I scare them? What if, when I admit to the time I smoked crack with my pregnant best friend, it’s too much and they kick me out?
What if I get the cops called on me when I admit to all the illegal things I’ve done?
Now I’m surrounded by people that, if they knew what I used to be and what I still am, would go running in the other direction.
I even tried to become an alcoholic for a few months; I drank myself into a stupor everyday, forced it into me until my brain chemistry was so out of whack and my kidneys hurt right through my back.
I still drink – get drunk – by myself, but I have to be careful because it makes my panic disorder worse. I drink just until I feel myself going crazy, stop for a few days, then back at it.
It’s funny, when my brother hanged himself, I was kind of mad that he took that option away from me: you can’t have two kids from the same family both kill themselves!
I’m okay with his suicide, though. I understand it was a planned out thing, so things were obviously pretty bad to get to that point. My brother didn’t speak, though; I was the only one he spoke to until he was about 17, and then he even shut me out.
After a while, I started getting paranoid that he was going to kill me, so I distanced myself from him even further.
I’m pretty alone now.
I lost most of my friends when I got clean, and I’ve moved to a different city since. I hate it here a lot, and most people here are way out of my league education and status wise. I have a few friends from work that I go for drinks with on the weekends, but I can’t really connect or open up with anyone.
I’m afraid to date again; my ex is still too fresh in my mind, and the thought of having to have sex again makes me uncomfortable. I don’t like being touched sexually.
It’s a shame because I would love to have children – they would give me something to focus on, to love and be loved back, without having to be in a relationship.
But I guess as of right now, it’s me, alcohol, and my two darling cats.
I have had 10 miscarriages – just saying that is hard for me
For so long I have tried to sweep it under the rug – once my number became larger then three I became numb to it all. I’m not really an emotional person, but this topic always brings up memories as if it all happened yesterday.
I have been through 10 miscarriages in 6 years.
I am 28 years old – I have been pregnant 13 times – and have 3 living children.
I can be a very private person, but I think miscarriage and infertility have enough secrecy surrounding it that I do not want to perpetuate it. The more it is talked about – the more women and families can feel supported and listened to and important – not embarrassed and ashamed like I am struggling to not feel. I am opening up the door to talk about it – so here is my long story:
My first two miscarriages were kind of a blur to me. We were not trying to get pregnant and basically found out we were expecting the same time we realized we were miscarrying. I had always heard that having one miscarriage was ‘normal’ and so I honestly didn’t put too much thought into it. They were still very painful and devastating to me but I thought once we were actively trying everything would be OK – that no one would have more then 2.
My husband and I decided to start trying for a family and we actively began trying to conceive using basal body temping as a guide. We became pregnant again in November 2004 after the first month of trying. I was about 6 weeks pregnant just around Christmas when I miscarried (#3). This time it hit me – hard. I mean I have never heard of someone who has had 3 miscarriages ever – let alone in a row.
Basal Body Temperature Chart using Fertility Friend
I began feverishly doing my research.
With my basal body charts I had noticed that my luteal phase was under 10 days (according to research the shortest it should be for a successful pregnancy) so I began to take vitamins B6 and B12 to lengthen it. I went to the doctor and his thought was that my progesterone was low and that is why I was not able to hold on to the pregnancy past 6 weeks. So a new plan evolved. I would stay on the vitamins and go on a progesterone supplement the moment I found out I was pregnant. This made the basal body temping so important – I needed to know the exact date.
We began another month of trying to conceive (TTC). Thermometer in hand and a plan in mind we became pregnant again in June and I was on the progesterone medication. The plan was to stay on until 12 weeks pregnant and then to slowly wean myself off. When 12 weeks came along we lowered the dose of progesterone but I began to bleed so we quickly went back onto the medication. The baby was doing fine and the new plan was to wean off at 20 weeks. 20 weeks came and I was successfully weaned off with no further complications. I had my first full term baby (Big P) in December 2005 – a healthy boy.
Big P – 8lbs 1oz
My husband and I had always wanted to have our kids close in age, so we starting TTC again relatively quickly. I began the basal body temping again and got pregnant pretty quickly. When I got the positive I went to the doctor to get a prescription for the progesterone and started taking it again. I miscarried #4 shortly after 7 weeks. My doctor and I both thought it was because the progesterone was not started soon enough so I was given a prescription for the next time to begin the day I had a positive test. I got pregnant again and started the progesterone but miscarried #5 at 6 weeks 5 days and I was starting to lose hope. I went back on the vitamins and we began TTC again. Thinking back it probably would have been better to give myself a few months to heal physically and emotionally but I was determined and had the okay from my doctor.
In July 2006 we got pregnant again and everything was going smoothly. I was on the progesterone and we had an ultrasound that showed the heartbeat and the baby was growing. I was on bed rest again for the first 20 weeks and was weaned off the progesterone at 20 weeks. Everything was going smoothly. At 8 months pregnant I awoke with vertigo – fell and cracked my wrist. I was taken to the hospital and without going into too much detail I was diagnosed with possible stroke and they ran a large amount of tests and I was hospitalized.
In one of those tests they discovered I had a blood disorder called Factor V Leiden. Everything was going relatively smoothly with the pregnancy. I was having some weight issues – having only gained 10lbs and was 8 months pregnant they were checking to see if the baby was growing -which she was. I was being induced just over 2 weeks early because of the vertigo and possible stroke. Our healthy baby girl (Princess R) was born in February 2007.
Princess R – 7lbs 14oz
This is where the story starts to get a bit crazy. I had 2 more miscarriages (#6 & 7) due to failed birth control. We were not trying to have an other baby yet – however these losses were still quite painful.
In May 2007 I was diagnosed with Celiac Disease and was on a strict gluten free diet. We had wondered if that was an underlying cause contributing to the miscarriages and we’re hopeful that was the answer. I still had the constant vertigo that started in January 2007 and was seeing a neurologist for possible causes. During one of our meetings she mentioned Factor V Leiden again. That was the first time I had heard of it since back when I was pregnant with Princess R. The neurologist thought that could be the cause of my possible stroke when I was pregnant. I was sent to other specialists for that.
My husband and I were ready to expand our family again. I went off birth control in the beginning December 2007 and we began TTC again. I became pregnant the first month but lost miscarriage # 8 at just over 5 weeks. We didn’t take any breaks between that loss and trying to conceive again and we became pregnant again the next cycle at the beginning of January.
I was back on the progesterone and everything was seemingly going okay – baby was perfect. We had made it past 8 weeks of pregnancy and thought everything was going to go smoothly. We had told extended family and friends and had begun taking daily photos of my growing belly – our kids were excited.
Big P and Princess R telling the family about the growing baby
A phone call came to me a few weeks later that shattered me. The baby (Triton) that had made it to 13 weeks was “no longer viable” and he had passed away (miscarriage # 9). I was confused – I had done everything ‘right’ – I was on the progesterone, was on bed rest – everything. I was scheduled for a D&C because I did not want to deliver at home.
The OB who was going to be doing the surgery turned out to be a lifesaver to me. Another miracle that Triton brought into my life. My OB had read over my chart, talked to me for a long time about my history and pegged that I had been diagnosed with Factor V Leiden, a blood disorder that predisposes me to making blood clots.
The surgery was scheduled for April 24, 2008 and I was able to get the answer I needed. When the pathology came back it showed blood clots caught in the umbilical cord cutting off the supply to Triton. He had given me the answer and we had a new plan and a concrete diagnoses for all my losses – Factor V Leiden.
Recovering from surgery, my husband and I were not trying to conceive yet. I did become pregnant (seriously it’s like he just has to look at me to get me pregnant) the next month but miscarried again (#10) likely because I was not healed up completely from the surgery. We were both ready to start the process of adding to our family and met up with my OB again.
The new plan – because Factor V Leiden predisposes me to throwing blood clots normally and any pregnant woman’s risk of blood clots increase anyway – my chances were pretty high. This is the reason for my miscarriages, my possible stroke at 8 months pregnant – but luckily there was something we could do. I was still going to be on the progesterone for 20 weeks because I did have an issue with low progesterone – it was just not the whole story.
I continued with the basal body temping and this time added low dose aspirin (it’s a blood thinner). Once I got that positive pregnancy test – I went on the progesterone and was put on another medication called Fragmin. This medication is a needle that I inject into my lower abdomen – it is a blood thinner that is safe to take while pregnant. This medication was designed to thin my blood enough to stop me from making clots and putting me and baby at risk for miscarriage or still birth.
I injected myself with this needle every day – I was covered in bruises but everything was working. It became second nature to me. Since it is not safe to go into labor while on blood thinners I was placed on bed rest at 36 weeks because I had begun to dilate. The plan was to induce me again just over 2 weeks early – I had to be off the blood thinner to deliver but could not go over 12 hours without the medication or I would risk another stroke. So, the safest thing to do was a planned early induction.
In February 2009 our third full term baby (Baby E) was born perfect and healthy. I was put back on the Fragmin blood thinners and had to continue giving myself the injections for 8 weeks postpartum.
Baby E – 7lbs 13oz
Now, if you are still with me – thank you. It is hard to condense this story into a few paragraphs. I don’t really have a ‘moral’ or ‘message’ to this story except this is my story. It has been a very difficult and extremely painful journey.
It has taken me a long time (and I am still working on it) to accept what has happened and to begin to digest it all.