The Unseen Mental Toll of Giving Birth

Childbirth inevitably takes a serious mental toll on those who experience it, yet these experiences often remain stigmatized and unacknowledged in society — leaving new mothers without the necessary support.

Katlyn Pratt had always dreamed of becoming a mother, and in 2020 that dream finally became a reality — though it wasn’t quite like she’d imagined.

After her son was born, Pratt began experiencing symptoms of heightened anxiety and depression. Outside of caring for her baby, she had little motivation to do anything but sleep, and she faced the overwhelming feeling that she simply wasn’t up to the task of motherhood.

“I was neglecting myself and all the things I loved in life such as family, friends, and hobbies that were very important to me,” Pratt tells Healthnews. “Not only was I raising my baby during a pandemic shut away from friends and activities, but I was also a single mom as well with little help overall.”

Jillian Amodio, LCSW, a social worker and the founder of Moms For Mental Health, an online support group dedicated to ending the stigma and culture of silence around women’s mental health, had a similar experience. Following the births of both of her children, Amodio tells Healthnews that she was consumed with guilt, self-loathing, and felt “like a complete failure.”

“I did not have the knowledge or support I needed, and I was left completely unprepared to handle the aftermath of their births,” Amodio says.

Both Pratt and Amodio eventually discovered that they had been suffering from postpartum depression (PPD) — a common and serious illness that impacts roughly one in eight women with a recent live birth in the United States.

Symptoms of PPD include extreme sadness, intense panic or anxiety, intense fear that something is going to happen to the baby, mood swings, feelings of depression, feeling like a failure, and feelings of inadequacy. These feelings might impact the person's ability to care for themselves or their baby, Amodio says. In some cases, those suffering from PPD may have thoughts of harming themself or their baby.

The wide-ranging impacts

PPD is just one of several mental health challenges new mothers may face, according to Jessica Rohr, Ph.D., the director of Houston Methodist’s women's mental health program.

“Even when there are no predisposing factors for mental health difficulties, in the context of giving birth, the pregnancy and birth process itself can be quite stressful,” Rohr tells Healthnews.

Maternal mortality rates in the U.S. are the highest of any developing country, with 32.9 deaths per 100,000 live births recorded in 2010. This, Rohr says, is an understandably significant concern for people who are giving birth.

The pregnancy process, even if it goes smoothly, can also be quite difficult. Sleep is often negatively impacted, there can be chronic pain and discomfort related to being pregnant, and the impending changes in life can also cause stress, she says.

“If someone is predisposed to depression, anxiety, or has had a traumatic history, events during the pregnancy process and during childbirth can exacerbate these concerns,” she adds.

One of the main reasons for this is that major hormonal changes occur during pregnancy. Reproductive hormones increase during pregnancy and drop drastically after childbirth, which can lead to major changes in mood and emotional health, she explains.

This is commonly referred to as "baby blues," Amodio says. Nearly 80% of people post-birth experience some form of sadness, anxiety, teariness, or mood swings. Caused by the flood of post-birth hormones, this may resolve on its own after a few days for some. For others, it may develop into something more severe, like PPD.

The childbirth process itself is also a potential source of trauma.

“Even when the childbirth is medically successful — that is, both mom and baby are healthy and alive — parts of the childbirth process may be experienced as traumatic by the mother,” Rohr says.

And while most people are at least aware of PDD, many don’t know that the symptoms associated with it may actually begin before giving birth. As a result, Rohr says the word “perinatal” (meaning before and after childbirth) is actually more appropriate to describe it.

Perinatal anxiety is actually more common than PPD, estimated to affect up to 20% of women. Other mental health conditions that are common yet little-known include postpartum OCD (characterized by intrusive thoughts, often related to harming the baby), postpartum PTSD (trauma caused by real or perceived trauma during delivery or postpartum), and more.

Stigmas persist

Although there have been improvements in the amount of stigma around perinatal mental health conditions, Rohr says we still have a long way to go.

One of the major reasons that stigmas persist, she says, is that there is still significant stigma around mental health conditions in general. Many people still believe that there is a choice involved in having mental health conditions — a belief that is simply untrue.

The stigma is also related to the way we think about motherhood in our society, Rohr adds.

“For some women, admitting to having difficulty with the transition to motherhood means worrying that others will see them as a bad mother or even developing a concern about the safety of their children,” she says.

As a result, some women will hide their struggles because they feel so much shame about the experience. This not only leads to their mental health conditions going untreated, Rohr says, but also to an underestimate of how many women are actually dealing with these issues.

How to seek support

Oftentimes, new mothers refrain from reaching out for help out of fear of repercussions, shame, guilt, stigma, barriers to care, lack of social support, lack of education on perinatal mental health, poor quality or lack of postnatal maternal care, impersonal postnatal care, lack of family leave, and societal views about women and motherhood, according to Amodio.

“Speaking up about how common post-birth mental health conditions are helps give people the courage and vocabulary they need to seek help,” she says.

Rohr says anyone who is pregnant should educate themselves on the different perinatal mental health conditions and ensure they have resources available so they know who to reach out to if needed. She says people with an increased risk for mental health conditions, such as those who have experienced depression or anxiety before, should discuss this history with their OB/GYN and ask for increased screenings for mental health conditions during the pregnancy.

“Better education for new parents and partners about what to expect and what to look out for is essential,” Amodio says.

Those who are struggling might find it helpful to attend a support group or talk with friends and family, she adds. Having the assistance of a postpartum doula, night nurse, or supportive family member to help with nighttime care, household maintenance, or child care may also ease anxiety and make room for rest.

Gentle exercises such as yoga and walking might also be helpful, Amodio says, while others might need more intensive treatment. Speaking with a counselor or therapist about mental health symptoms is often helpful, and some new parents might also benefit from pharmacological interventions such as SSRIs.

Pratt eventually reached out to her doctor and was prescribed regular antidepressants, though she didn’t experience much relief. So when she saw an ad for a clinical trial for Zurzuvae — the very first oral medication specifically meant to treat PDD, approved by the FDA in August — she was interested.

Pratt quickly discovered she was eligible for the trial and that she would only have to take a 14-day course of medicine to experience the benefits. She says the drug pulled her out of her depression and allowed her to feel like herself again within days.

“I definitely would encourage new moms to reach out to their doctors if they are having symptoms, and to know that it is completely normal to feel this way and absolutely okay to reach out for help,” Pratt says. “It will be the best thing for your babies — they need to see a happy mom more than anything.”

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