We probably all know someone who’s struggled with depression or anxiety during pregnancy or in the months after childbirth. Many of us have been there ourselves. Or we might know someone right now who we’re worried about.
After all, perinatal mood disorders are hugely common, affecting as many as one in five women during and after pregnancy.
That’s why the U.S. Preventive Services Task Force recently recommended that all expecting and new moms be screened for depression.
But here’s the sad reality: Routine screening, alone, isn’t enough. For one thing, the recommended screening tool, the Edinburgh Postnatal Depression Scale (EPDS) is just a 10-question self-quiz—and far too many women feel self-imposed pressure to report that everything’s “fine” or even “perfect.”
What’s needed is for you and me—partners, friends, family, all of us—to watch for signs of trouble and step in with support, says Jane Honikman, the founder of Postpartum Support International and co-founder of Postpartum Action Institute, a training center for professionals and parent advocates in Santa Barbara, California.
“I like to assume that everyone is at risk,” Honikman told me. She had postpartum depression herself and knows first-hand how hard it can be for a woman going through it to get help on her own—or even recognize that she needs help.
Honikan has some simple suggestions for all of us:
Invite open conversations.
Most of us expect pregnancy to be pretty great, even joyful. And it often is. But there’s usually a lot of stress, too. Honikman, who’s also the author of I’m Listening: A Guide to Supporting Postpartum Families, says there are three main kinds of conversations we shouldn’t shy from—and most pregnant women actually long to have:
1) About decisions and challenges (everything from what kind of diapers they’ll use to making sure they’ll still have a job when their maternity leave is over)
2) About the changes taking place (like how weird it is to wake up every day in a new body or how her childless friends act around her)
3) About her fears (no end to the possibilities in this category).
Don’t worry about “scaring” anybody. The more honest we are about the less-than-sunny parts of pregnancy and postpartum with one another, the more helpful we are, Honikman says.
Share family history.
If you know a new or expectant mom with a mother, grandmother, or aunt who struggled with depression or a rough postpartum, don’t keep it a family “secret”—tell her. Women with a family history of depression or psychiatric issues are at higher risk of PPD. It seems to be a combination of genes and individual responses to hormones and stressors that set the stage for these mood disorders.
Encourage just-in-case help.
Honikman urges pregnant women to get in touch with a current or former therapist just to say, “I’m pregnant” as an FYI if they’ve had any history of depression or other mental-health issues. A past serious trauma (not just sexual abuse but even a car accident) is also important to mention. “Pregnancy and birth are traumatic, and things can get re-triggered,” she says. There can also be a grief response if the birth doesn’t go the way the mom expected, so having someone on stand-by during pregnancy can make it easier to get timely help.
Know what to look for.
The symptoms of depression in pregnancy are the same as at any time: significant changes in eating or sleeping patterns, anxiety or a ruminating mind that won’t “shut off,” irritability or anger, loss of interest in previously enjoyed activities, and talk of feeling ashamed, inadequate, or hopeless.
If you’re concerned…
Don’t assume a prenatal screening will pick up on what you’re seeing. Say something: “You just don’t seem like yourself. If you’re feeling like your mood is a little off, you really ought to bring it up with your doctor. It’s just not worth taking any chances.” If that doesn’t work, don’t be shy about calling her doctor or midwife yourself. (Reporting information isn’t a violation of HIPPAA.)
After the baby is born
Pace out the help.
We all want to see the baby! But it’s much more helpful to focus on the needs of the new mom (whether she has a history of depression or not). That’s why it’s usually a great idea for family members and friends to help right away with the menial stuff, like laundry and meals, leaving the partner to focus on the mom and baby, Honikman says. (A postpartum doula can also fill this role.)
Then, for the next few months, other visitors should come on a staggered schedule, so the new mom isn’t overwhelmed. If you’re the partner, control the flow and be ready with to-do lists in case anyone asks (pick up groceries, make a diaper run). If you’re a visitor, respect the parents’ need for rest and come ready to offer practical help, like dropping off meals or watching older siblings for a few hours.
Know what to look for.
As many as 8 in 10 new mothers get the “baby blues” within the first few days after birth. Yes, it’s that common. (Blame post-childbirth hormones.) You might notice weepiness or crying jags and some irritability or anxiety but mingled with moments of happiness. It’s not unlike what some women experience around their periods, and usually lifts within a week or two.
Postpartum depression symptoms, on the other hand, start similarly but grow more intense—and last much longer. Along with the depression signs for pregnancy, red flags after the first month or so postpartum include a lack of interest in the baby or much of anything (including older children or her partner), obsessions about being a “perfect” mother, panic or fear about the baby, and talk of hurting herself or the baby. You might notice things like her checking the baby constantly or being totally fixated on the baby’s health or whether she’s a good-enough mom.
Much less common but worth knowing about: A very rare (one in 1,000 births) condition called postpartum psychosis—the mother having a break with reality—can strike suddenly within the first two weeks of giving birth. Its symptoms tend to be dramatic and scary: hallucinations and delusions, extreme hyperactivity and inability to sleep, paranoia and suspiciousness, rapid mood swings. If you see any of those signs, call a doctor and get her some help RIGHT AWAY.
Be realistic—for all your sakes.
When you sense things “aren’t right,” it’s tempting to ignore it or to write off odd behaviors as “new mom stress” or “sleep deprivation flakiness.” Denial doesn’t help anybody here. If you have to, be annoyingly persistent.
Things to assure a new mom: “Hey, it isn’t anyone’s ‘fault.’ You can have PPD and still be a good mom. It’s just that you have a weird chemical reaction happening in your body right now.”
Whether you’re a friend, partner, or family member, you’re apt to feel confused or stressed out yourself watching this play out. Remember that a new mom with depression or anxiety is just as perplexed and surprised as you are, says psychologist Shoshana Bennett, co-author of Beyond the Blues: Understanding and Treating Prenatal and Postpartum Depression & Anxiety and a co-founder with Honikman of Postpartum Action Institute.
Having a lot of consistent, reliable support is one of the most important things any new mother—but especially one grappling with PPD or anxiety—needs, Honikman reminded me. Be prepared that you might not find her to be a whole lot of fun to be around. She may be sad, distant, detached. All the more reason to step up. Here’s where just sitting quietly together is a really helpful thing to do.
Tip to partners who are now back at work: Call during the day to check in. “You doing okay? Need me to stop on the way home for anything—or maybe bring some dinner?”
Be a nonjudgmental listener.
“New mothers really need a time and a place to talk about the experience,” Honikman told me. “Social media is great,” she says, “but it’s not the same as talking.”
Listening without jumping in with judgments and opinions is hugely important, she says, because it can be so hard for someone with a mood disorder to open up in the first place. Women often say that they’re “afraid” or “embarrassed” to be seen as less than glowing, perfect, and competent. Or they don’t want to upset or disappoint their partner. So a new mom might seem resistant or defensive. Be patient and encouraging.
Do everything you can to encourage rest.
Fatigue can hugely exacerbate mood disorders. That goes for partners, too. You can’t be supportive through the strains of PPD if you’re run down yourself. Sleep, good food, getting out for a run or walk once in a while, getting together with friends—ironically, those bedrocks of mental and physical health for anyone become really critical, just when they’re often in short supply for new parents.
Encourage seeking help.
Offer to go to check-ups and follow-up visits, for both practical and emotional support. But know there’s no need to wait for scheduled visits if you’re seeing concerning symptoms.
In addition to prescribed medications or other therapies (such as cognitive behavioral therapy, other talk therapy, and light therapy), look for postpartum support groups in your area and suggest a visit. It can be easier for a stressed new mom to agree to go with you than to find a group and get there on her own. Many areas have groups specifically about postpartum depression; ask a doctor or therapist you know for recommendations.
Or just pass along this number: 800-944-4773. It’s a non-emergency “warmline” founded by Honikman in 1977, after her own struggles with postpartum depression. It’s a less-threatening, more helpful name than hotline, she told me, staffed by volunteers offering basic information and support to anyone calling.
Since every case is different, there’s no set time frame for when perinatal mood disorders end. But here are two happy words to remember that describe nearly every case: temporary and treatable. With ongoing help and treatment, almost all moms go on to do great. Their babies do great. It just takes time—and a lot of support from all of us.