When I had my first baby, I felt that I was very unprepared for the tidal wave that would change life as I knew it. I could never have imagined the love, devotion and sacrifice that I would make to a person I had just met. But despite being an ob/gyn, I was unprepared for the sleeplessness, the insecurities of being a new mom, and the recognition of normal maternal blues & fatigue as opposed to postpartum depression, especially in myself. I tell my patients all the time, being a parent is much harder than even the most rigorous days of medical school and residency.
In the first week, I feel that I as well as many of my patients, are buoyed by the excitement and adrenaline of this new life that has entered our lives. However, the reality that being a mom is a physically and emotionally fatiguing job that does not relent quickly sets in. There are so many joyful moments, the feeling of a sleeping baby in your arms, first smile, the experience of watching your baby explore the world through innocent eyes. However, peppered in these special moments, there are many unglamorous aspects of the job. Endless diaper changes, the struggles of breastfeeding, long sleepless nights, and the pressure of the responsibility of being a parent. At this point, many of my patients will have guilt about the resent they may feel for the loss of their former life, especially when spending the last 9 months in excited anticipation being parents. I myself have a vivid memory of getting a rare shower about 6 weeks after delivery, coming to the realization that this cycle was not ending anytime soon, and breaking down in tears. Whenever I saw my postpartum patients after 6 weeks, most of the time, I heard, or perhaps assumed that they were doing fine. So, I too, made the assumption that everything would return to pre-baby normality at that time.
There are hormonal changes, sleep deprivation, the stress of being the sole caretaker of a baby, and at times lack of social support, with husband’s having to go back to work soon after a delivery, family members living far way, and the isolation that occurs, because, let’s be honest, it is not easy to leave the house anymore. The first thing I tell my patients is to not feel guilty about their feelings. It is important that you verbalize your frustrations, and that your feelings are validated without guilt or judgment. The second thing is that it is important not to isolate yourself. Surround yourself around other mothers who have walked in your same shoes. Tap into resources that are available to help you, support groups, lactation consultants, family and friends, church groups, and at times hired mother helpers. The assumption many women have is that motherhood comes naturally, but for most of us, it is a learning process. With anything new, we all need mentors, experienced people that can reassure us, support us, and answer our questions.
Baby blues is something talked about, however it can be difficult to distinguish from the normal fatigue and anxiety of motherhood versus depression. The two most important clues are duration and severity. The symptoms of postpartum blues and depression can mimic each other, including tearfulness, irritability, anxiety, fatigue. Postpartum blues usually will resolve within a couple of weeks after delivery. Postpartum depression last beyond the two weeks, and can include feelings of isolation, hopelessness, uncontrolled crying, over concern/anxiety for the newborn, or the opposite, a disconnect or lack of interest for the newborn. The fear of harming yourself or your newborn is the most concerning characteristic of depression, and is important for you and your doctor to recognize, so that appropriate treatments and interventions can be pursued.
Blues often can be treated with support, reassurance, and time. Depression however is more complicated and needs to be treated using multiple different resources. The first step is recognition, so it is important that you bring up your feelings and concerns to your doctor, and make sure you are heard. Having harvested a 9 month relationship with your obstetrician, this usually is the best place to start. Treatment can include psychological therapy, support from peer groups or educational classes, extra help whether from family or hired to allow time for sleep/exercise, and at times medications.
Motherhood, especially in the immediate postpartum period, is one of the most challenging jobs in a lifetime. However, it should also be one of the most rewarding. It is important to recognize the challenges you are facing, so that you may receive the support and help you need to be able to enjoy the novelties, love, and growth we undertake as mothers.