How To Prepare For Postpartum Depression

Written by Katie Hintz-Zambrano
11:00 am
10/12/17

Photographed by Maria Del Rio

For women who are prone to depression (and even those who are not), when the birth of a new baby is on the horizon, the thought of postpartum depression and other maternal mood disorders often looms heavily. Although awareness around and standard screening for postpartum depression is still very much lacking, the American Psychological Association reports that 1 in 7 women suffer from a serious bout of depression post childbirth. And that’s not even counting the more widespread “baby blues” (feeling stressed, sad, anxious, lonely, tired, or weepy in those early days and months after birth, most often due to hormonal shifts, lack of sleep, and undergoing a massive life change). Luckily, there are some things women can do to prepare for those dark post-baby days ahead (should they arrive, or not). Maternal mental health advocate Jennifer Silliman, who is also the producer of the enlightening documentary The Dark Side of the Full Moon, shares some preparation tips below.

1.) Get Your Meds/Medical Team In Order. If you are currently on meds, it’s vital that you check in with the psychiatrist who originally prescribed your meds, ideally even before you get pregnant, and create a plan. “What we find is a lot of moms go off their medication, assuming that they cant take it during pregnancy, and they need to go off of it cold turkey, and that can often cause problems,” explains Silliman. “But everyone’s case is different. Perhaps you can lower your dose or change something. You have to go back to the person who prescribed you the medication, and tell them that you’re pregnant or trying to get pregnant. You need to have that talk and come up with a plan. There’s no way around that first step.” While you and your psychiatrist decide to ween off of your current meds or change over to more pregnancy-safe meds, you should also develop a postpartum plan and get a prescription for when baby arrives. “You should go to the hospital with the prescription or have it filled before delivering, so you have it in hand if you need it,” says Silliman. Just having the prescription there and ready to go (even if you don’t end up using it) can be a tremendous source of comfort to brand-new mothers. Meanwhile, “if you’re not on meds and use more holistic ways to take care of your mental health issues, like meditation, exercise, or yoga, then you need to talk to your OB about your mental health concerns,” says Silliman. “Oftentimes an OB won’t even ask about your mental health, but we all need to be the responsible party that tells them. You need to become your own advocate. Insist that they screen you and that they are consistently checking in with you. Tell them directly—‘I want you to screen me, every time I’m here. I want you to check in with me emotionally, every time I’m here to make sure I’m doing okay.’ Ask your OB how comfortable they are treating a woman with emotional symptoms and problems. You don’t want an OB who is going to dismiss you and tell you to go shoe shopping and you’ll feel better. If your OB isn’t well equipped, get connected with another doctor in their practice who is.” Also key: making sure your doctors are talking to each other. “We have a lot of non-coordinated care in this realm and it doesn’t work,” says Silliman. “The therapist needs to be talking to the psychiatrist, who needs to be talking to the OB. And they need to get it all figured out.” Setting up this type of integrated care before birth can yield to stronger care in the postpartum days. “The thought is that during that 6 week postpartum checkup, you trust your doctor and you can be completely honest with how you are feeling and not feel like your baby is going to be taken from you. You can talk about intrusive thoughts, about sleep deprivation, or whatever it is and feel safe talking about it,” says Silliman. “If that trust isn’t established, you won’t say a word and you’ll suffer in isolation. And that’s a terrible thing.” Another health professional to get on your side is your child’s pediatrician. In the first days and weeks postpartum, this is the doctor that you actual end up seeing most. Be honest with them about your personal issues and ask them to check in on you (and not just your baby), as well.

2.) Create A (Clued-In) Village. While moms-to-be should educate themselves about the symptoms of both prenatal and postpartum depression, they should also insist that their trusted circle of partners, best friends, and close co-workers are also clued-in to the signs and symptoms. “Sometimes as moms we don’t see it once we’re in it, but our partners or friends or co-workers do see it,” says Silliman. “We want everyone to be prepared, not just mommy, but the entire village that we encourage moms create around themselves.” Ask your inner circle to read up on this list of symptoms, have them watch a documentary about postpartum, or listen to a podcast on the subject. Our video clip on motherhood and depression is also a nice starting place. Once you have your tight-knit team on board, ask them to be your life lines when needed. “Have a handful of people that can be ‘on call’ that you can text at any hour for support. Even in the middle of the night,” suggest Silliman. “Just knowing that someone will pick up at any hour—even if you don’t call them—and they will be there for you is super important.” If the search for an adequate medical provider before or after birth has become daunting, you might also have to tap one of these friends to help you out. “Sometimes the search for a great OB or other provider who understands your issues in itself can be really, really exhausting and women usually just give up. When you’re having a hard time getting out of bed or don’t have someone to watch your new baby, there’s just no way you’re going to navigate through the medical system to try to get the help you know you need,” says Silliman. “That’s the real sad part of it. Women give up and hope it eventually goes away and they feel better. But depression typically doesn’t go away without intervention.” So, task your friends to be your moral support, and to help you find the solid medical support you also need.

3.) Plan & Think Through The Logistics. While birth itself very rarely goes according to your “plan,” it doesn’t mean you shouldn’t do the prep work. Think about and map out the day of your birth and the days immediately following and all of the little logistical obstacles you might face and try to solve them in advance. Who is going to walk your dog? Watch your other child? What will be in your hospital bag? Who is coming to the hospital with you? Who will be supporting you at home? Who is setting up and monitoring the Meal Train to make sure you are fed? Who will help clean the house and do the dishes? Is a baby nurse something you want or can afford? Can a friend or family member stay over night a few times to do night feedings? Make sure you get your team of both paid and unpaid helpers in place and that everyone knows their expected role. “Those little things, while they don’t cure depression, they can certainly help to not make it worse,” explains Silliman. “If a mom is symptomatic, and on top of that she has absolutely no help, it is just horrible.” Also, establish and communicate your boundaries clearly. If you would rather friends and family simply drop off meals and not do a formal visit, it is important to communicate that or have a partner/friend communicate that.

4.) Have A Flexible Feeding Plan. Even if you’re planning on on-the-boob breastfeeding exclusively, prepare for an alternative incase it doesn’t go as planned. Have a pump and bottle handy so that other folks can do the feeding for you so you can rest. Know about your formula options and have some in your home. “Have a Plan B, just in case,” says Silliman. “You don’t want to find yourself in the middle of the night with a crying baby and no means of feeding them. You just want to be ready with a Plan B in place. If you’re not willing to have someone else feed your child, just know that you will be up every two hours for a while.”

5.) Seek Out Brutally Honest Takes On Motherhood. Whether it’s accounts of motherhood online or in-person conversations about the topic, don’t just seek out the filtered versions. Insist that you get the real, not-so-pretty stories, too. “Moms need to be really honest about what their experiences were with their mommy friends. It’s super important to bring up the stuff that is not like a Hallmark greeting card. Both the physical stuff and the emotional stuff,” says Silliman. “There’s a big identity shift that happens, especially when you are a first time mom. It is huge. And even for a second-time mom, there is a whole other thing that happens. You feel split and guilty for not spending enough time with either child. Being honest and not just sharing the good stuff with each other is so important. You need to know you’re not the only one feeling this way. As women, we filter so much stuff, and it can be dangerous.”

6.) Read Up On Baby Bonding. Baby bonding can be a point of anxiety for many women, whether prone to depression or not. While you’ll never know if that instant bond (or a delayed bond) will occur until you actually give birth, no mom should dwell in guilt over not instantly bonding. “You might not love your baby when you see it for the first time. And that is okay,” says Silliman. “It happens to so many moms for so many reasons, maybe it’s a result of a traumatic birth, or a long stay in the NICU, or maybe you weren’t able to bond during the pregnancy due to a mood disorder.” One thing you can do to increase bonding includes skin-to-skin contact after birth (for both mother and father). If your bonding does seem strained, tell your partner or trusted friend to help you navigate it and keep an eye on it. “It’s okay. It doesn’t mean there’s anything wrong,” insists Silliman. “It just means you might need to work a little bit harder to make that connection.”

For more resources on this topic, check out the American Psychological Association, this incredibly honest podcast on postpartum depression, and our Mother articles on prenatal depression, 20+ ways to help a new mom, and Laura Miller on motherhood and depression.

Leave a Reply to Megan (cancel)

3 comments

Megan

I am so appreciative of this well -informed and -thought-out post on such an important topic. After the birth of my daughter 4 years ago I suffered from crippling PPD. I was confused because I thought, “how could I possibly have uncontrolled PPD when I already have (relatively) well-controlled ante-natal depression?!” This time around I was determined not to let it blindside me again. I’m grateful that you titled this piece by giving power to the woman–“how to prepare”. It reminds me that no, I didn’t just get lucky this second time around and not suffer from PPD. Instead I acknowledge that I worked really hard to prepare myself and that hard work has paid off so far. Reminding women that we are powerful and strong, not in spite of, but living with mental illness will continue to break barriers and reduce stigmas. Thank you for contributing to this fight.

Liz Preciado Genell

One key strategy that I feel was left out of this piece is getting as much sleep as possible. When my midwife and I were creating a strategy to combat postpartum depression ( I had a history of depression but was currently fine), my midwife told me there were studies that showed a close correlation between sleep deprivation in a new mom and postpartum depression. I was able to create a sleep plan with my husband and extended family that would eek out as much sleep as I could possibly get. I believe that along with having open communication with my doctors, family and friends, the sleep plan kept me from having any severe depressive episodes.

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