Becoming a mom is supposed to be magical, and most often it is. But for the estimated one in eight women who suffer from perinatal mood and anxiety disorders (PMADs), new motherhood can deliver disappointment and despair. What kind of mom can’t look at her baby without weeping? Why does someone who desperately wanted children wonder if she made a mistake?
Just about every woman going through PMADs believes she’s alone, and the pain can be excruciating. In 2016, the Journal of the American Medical Association published updated screening guidelines to increase awareness of maternal mental health disorders. Hopefully, this will lead to more quickly identifying mothers in distress and clear up some commonly held misconceptions.
Here are some of the most prevalent myths:
Myth #1: Postpartum depression (PPD) feels the same for everyone.
Perinatal mood and anxiety disorders include PPD but also anxiety, panic disorder, obsessive compulsive disorder, bipolar disorder, post-traumatic stress disorder and—the most rare—postpartum psychosis. Many women experience symptoms of more than one at the same time. Depression and anxiety are more prevalent during pregnancy than previously thought, and their occurrence puts a woman at higher risk for problems postpartum.
Myth #2: PPD begins right after the baby is born.
They’re known as the “baby blues:” feelings of tearfulness, anxiety and being overwhelmed that begin a day or two after delivery. According to Postpartum Support International, the baby blues are very common and caused primarily by roller-coaster hormone fluctuations. These uncomfortable but mild symptoms normally ease in the first two or three weeks.
True postpartum depression can begin any time during the first year after birth. Surprisingly, many women do fine for several months and then develop symptoms. These might be precipitated by returning to work, weaning the baby or other external factors, but experts believe they primarily result from a mix of genetics, stress and hormonal imbalances.
Myth #3: Moms who are excited to welcome their babies don’t experience PMADs.
Perinatal disorders can happen to any mother, but there are certain factors—a difficult pregnancy or delivery, previous history of depression or anxiety, social isolation, history of early loss or trauma and current stressors such as financial problems—that increase the risk. Having symptoms of anxiety or depression doesn’t mean the baby is unloved or unwanted. Even women who struggle with infertility can experience prenatal or postpartum depression.
Myth #4: Frightening, intrusive thoughts (thinking about death, wanting to hurt yourself or fears of hurting the baby) are proof of postpartum psychosis.
Intrusive, repetitive and unwanted thoughts are generally caused by anxiety or obsessive-compulsive disorders, rather than psychosis. Women are usually so horrified by these thoughts—which they have no intention of acting upon—that they do everything they can to ensure their infants’ safety, including having others care for the baby and putting anything dangerous out of sight. According to the American Psychiatric Association, postpartum psychosis occurs in just one to two mothers per 1,000 deliveries and is a true psychiatric emergency in which the woman loses touch with reality and suffers from extreme agitation, delusions or hallucinations.
Myth #5: Breastfeeding is so natural, every mom should easily succeed at it.
Some newborn babies latch onto the breast immediately, can suck well and can get all their nourishment from nursing. For others, the process doesn’t go smoothly, and it can take days or even weeks to establish a comfortable and effective breastfeeding routine. Mothers who can’t nurse successfully and those who choose not to breastfeed often experience feelings of failure and shame, especially because of how often they hear that “breast is best.” Whether they are breast- or bottle-feeding, moms should be supported as they help their babies grow and thrive.
Myth #6: Once the baby sleeps through the night, PMADs will resolve.
Sleep deprivation and exhaustion can clearly contribute to a new mom’s state of disequilibrium. But these are more often the result of a mental health disorder rather than the cause, since anxiety, depression and obsessive thinking can seriously interfere with restful sleep. It’s important to tell health care providers about all symptoms, not just sleep-related ones, to reach a proper diagnosis. Sleeping pills are not the solution, but they may be prescribed on a short-term basis.
Myth #7: If meds are recommended, you must stop breastfeeding.
Several antidepressant and antianxiety drugs are considered safe for breastfeeding mothers. Perinatal psychiatrists—MDs who specialize in working with women throughout the childbearing cycle—are skilled in evaluating each woman’s needs individually. Because untreated mental health disorders can sometimes affect infant development, recommendations for medication are based on an assessment of risks and benefits. LactMed, part of the Toxicology Data Network of the National Institute of Health’s online US National Library of Medicine, provides a comprehensive database on drugs and how they might affect a breastfeeding mom.
Myth #8: Moms who don’t bond with their babies right away may permanently damage the mother-child relationship.
Although it’s disappointing when pregnancy, birth or new motherhood doesn’t lead to the perfect “Hallmark moment,” bonding doesn’t always happen instantaneously. Yes, babies are innately adorable and wonderful, but it can take some time to experience that deep sense of connection and love, especially for women struggling with depression, anxiety or other unsettling feelings.
Perinatal mood and anxiety disorders usually respond well to treatment, which can include therapy/counseling, medication or a combination of both, as well as the care and support of spouses, partners, family and friends. Although it can be difficult to find time, basic self-care strategies such as getting adequate rest and exercise, eating healthfully and learning to relax are important steps to take in feeling more like your normal, pre-baby self. Support groups, both online and in-person, can provide camaraderie as you navigate the ups and downs of new motherhood, overcome challenges and emerge as a new mother: strong and unbroken, ready to fully embrace your new role.
Barbra Williams Cosentino, LCSW, RN, is a psychotherapist and has written for many national, regional and online publications.