Understanding Perinatal Depression

Casie Lukes had a hard time relating to other new moms. She could commiserate about the sleepless nights and feeding challenges, but when they talked about how it feels to be a mom, Lukes found herself wondering whether something was wrong with her.

“Everyone else seemed so happy,” she recalls. “Whereas I felt like I was drowning.”

Alongside pelvic-floor pain and weight gain, Lukes was experiencing acute anxiety, nightmares, intrusive thoughts, and crushing depression following the birth of her first child. She struggled to emotionally attach to her and often wanted nothing more than to stay in bed all day.

Compounding it all was the sense that she couldn’t be honest about what she was experiencing. “I was scared to tell anyone what was going on,” she says. “What if it meant I don’t love my kid?”

Jennifer Doeden, LMFT, a licensed therapist who specializes in perinatal mental health, has heard many similar stories. “There’s a pervasive idea that this should be the best time of your life,” she says. “And if it’s not, many women believe there’s something wrong with them.”

It’s hard to overemphasize just how misleading — and inadvertently shaming — media portrayals of new motherhood tend to be. We are bombarded with advertisements, images, and greeting-card messages about the joys of parenting and the (supposed) instant bond between a mother and her child, so it’s easy to believe every other parent is having the time of their life.

“Social media often portrays moms as relaxed and put together,” says Doeden. “This leads to unrealistic comparisons and guilt.”

Even when there’s some recognition that motherhood is hard, honest discussions about fear and despair remain taboo. “We joke and laugh and demystify the grotty parts of motherhood — smeared banana on our pants and credit cards stuck in our computer drives — but we do not talk about [the moments] . . . when our rage bubbles over and the thoughts running through our minds are compulsive and unrelentingly terrifying,” writes Jessica Friedmann in her book Things That Helped: On Postpartum Depression.

Lukes, who is now raising three children after enduring two more bouts of postpartum depression, has learned that her experience is much more common than she had realized. But at the time she didn’t understand what was happening and felt very much alone. She wasn’t.

Peripartum depression (often referred to as perinatal depression, which covers a longer timeframe) occurs during or after pregnancy and is extremely common. Estimates suggest it affects about one in seven people who give birth. Postpartum depression is a type of perinatal depression that develops after someone gives birth.

Yet up to half of perinatal depression cases go undiagnosed. “Many people aren’t educated about peripartum depression,” Doeden explains, “so they don’t recognize the signs.”

 

“Baby Blues” or Something Bigger?

Many new mothers experience mild depression during and after pregnancy. Between the lack of sleep and the dramatic flux of hormones, transient feelings of sadness, sluggishness, and stress can be unavoidable.

Peripartum depression is different.

It can include many of the same symptoms characteristic of general depression: sadness, anxiety, irritability, and low energy, as well as changes in sleeping patterns, lack of interest or pleasure in usually enjoyable activities, and shifts in appetite or eating habits. It can also include feelings of failure, hopelessness, or worthlessness.

As with depression in the general population, both duration and impact determine whether the symptoms qualify as a disorder. A therapist’s peripartum depression diagnosis requires that symptoms must be present for at least two weeks and make it difficult to keep up with daily responsibilities, like packing a diaper bag or taking your baby out for a walk. (Peripartum depression is not currently listed as such in the Diagnostic and Statistical Manual of Mental Disorders, though the term is commonly used in professional parlance.)

“There’s a pervasive idea that this should be the best time of your life. And if it’s not, many women believe there’s something wrong with them.”

Yet even if you don’t exactly meet the criteria for perinatal depression or you otherwise remain undiagnosed, what you’re dealing with is still real.

What makes peripartum depression different from other forms of depression — and so devastating — is its effect on the relationship between the mother and child, and how that can make the mother feel about herself.

While mothers may have difficulty bonding with or caring for their child, they also may feel intense hostility toward the baby. Intrusive, disturbing, and often violent thoughts are common, leaving a mom afraid of her own mind.

Friedmann recalls this vividly — and remembers feeling like she couldn’t trust herself around the knives in her kitchen: “As I begin to lose touch, violence feels ever closer. Everything feels dangerous.”

Lukes remembers being afraid to respond honestly to depression screeners, fearing her baby would be taken from her.

“If I can’t take care of myself,” she wondered, “how can I take care of my child?”

 

Risks, Unknowns, and Cracks in the System

Why are misdiagnoses and missed opportunities for treatment so prevalent?

There’s plenty of research on the risk factors for postpartum depression, which include young maternal age, first-time motherhood, or older motherhood; a personal history of depression or anxiety; a lack of social support; domestic violence in the home; smoking; and poor eating habits. In addition, Black women are more likely to experience postpartum depression than their white and Asian counterparts.

Many of these risk factors overlap with those of peripartum depression, which hasn’t been studied as extensively but likely has similar roots.

Still, it’s impossible to know for sure who will experience peripartum depression.

There is a genetic component to the disorder, for example, yet plenty of women experience peripartum depression even if it wasn’t apparent in their own family tree.

Since her own mom didn’t experience depression after childbirth, Lukes hadn’t expected to either. Not only did that leave her unprepared, but it also meant her mom wasn’t equipped to offer the recognition or normalization she needed: “She tried to be supportive, but she didn’t really understand what I was going through or why,” Lukes says.

Systemic gaps further compound the issue. Though studies suggest that most women discuss peripartum depression with a healthcare provider during pregnancy, it’s easy for new moms to fall through the cracks once the baby arrives.

“Healthcare providers are busy, and they don’t always follow up when patients score high on depression screeners,” explains Doeden.

As a result, new moms may be left to fend for themselves. Lukes recalls having to push for certain tests she’d learned might be important; she sometimes felt like she was more informed than the professionals treating her. “Even the midwives at the birth center I worked with weren’t very educated on peripartum depression,” she says.

When she did see a doctor, Lukes felt “poked and prodded” both physically and emotionally. No one seemed to care that she was still bleeding six weeks after delivery, that she couldn’t breastfeed without experiencing a cascade of sadness and anxiety, or that she didn’t have the time or energy to cook the healthy meals they kept telling her she needed.

“I know those appointments are meant to be helpful,” she says, “but it felt like they were created by someone who had never given birth.”

 

Coming Out on the Other Side

These information gaps matter, because knowledge may be the most powerful tool you can use to protect yourself from peripartum depression.

“Education is so important, especially on the front end of pregnancy,” says Doeden. “Parents need to know what to look for, particularly when it comes to risk factors in their own history.”

She advises women who may be more vulnerable to peripartum depression to discuss medication options with a perinatal-competent psychiatrist before giving birth. Many antidepressants are safe to use during and after pregnancy.

Sauna, lymphatic massage, and somatic workouts, which integrate mindfulness and movement, can also help relieve the tired-but-wired feelings associated with the condition. Lukes found these practices — as well as red-light, brainspotting, and tapping therapy — to be incredibly helpful, and she still makes time for them today, years later.

Alongside teaching her clients techniques for regulating the nervous system, such as deep breathing and muscle relaxation, Doeden urges them to find small pockets of time to practice these strategies. “If the baby’s crying is really putting you on edge, it’s OK to take a few minutes for a silence break,” she says.

Establishing an adequate baseline of rest and regulation makes a big difference, but healing can’t happen in isolation. Doeden encourages prospective parents to establish a comprehensive support system well before baby arrives.

“People have a birth plan but rarely a postpartum plan,” she explains. “It can be incredibly helpful to know in advance who you can count on for help with errands, pet care, or emotional support if you’re having a bad day.”

As she navigated successive bouts of peripartum depression, Lukes learned to be boldly honest about her needs. “I’d let people know if I needed them to stop by for a visit. If they offered to bring food, I’d ask for something I actually wanted to eat.”

Getting back on solid ground can also involve reconnecting to the parts of oneself that fall away during the fog of new motherhood. For Lukes, that meant spending time in nature. Friedmann, a lifelong art lover, found solace in weaving.

Navigating peripartum depression often involves trial and error, self-advocacy, and a lot of hard work, but it’s important to find a balance between effort and self-compassion. Otherwise, the recovery process can turn into another source of shame.

“I put a lot of work into healing,” recalls Lukes. “And at times, that turned into punishing myself. I’d get so mad that my body wasn’t bouncing back even though I was doing everything right.”

Eventually she realized that, while eating healthy food and making time for physical activity were important, being kind to her body rather than forcing it onto the treadmill was the key to re-establishing some equilibrium.

“For so long I felt like my body had betrayed me,” Lukes says. “It took years before I finally learned to trust it, my mind, and [my] whole self again.”