Postpartum Depression: Causes and Symptoms

Approximately 20% of new moms experience postpartum depression. However, this statistic is likely an underrepresentation, as research often overlooks certain demographics, including women of color, low-income women, LGBTQ+ individuals, immigrants, and their family members, who have higher rates of depression and anxiety during the postpartum period.

Unfortunately, the challenges posed by the COVID-19 pandemic have further increased the risk of postpartum depression for new parents. The pandemic has brought financial insecurity, childcare challenges, and varying levels of state and local assistance, making maternal mental health a pressing public health concern. Supporting women and their loved ones during this critical time is essential for the well-being of our society as a whole.

The postpartum period is often the most neglected phase of a woman’s healthcare journey. Typically, women receive only one postpartum visit with their healthcare provider at six weeks post-delivery, which is often too late for effective preventive care. This leaves women feeling isolated, uncertain, and overwhelmed during those crucial initial weeks.

Symptoms of Postpartum Depression

Initially, the symptoms of postpartum depression may resemble those of the “baby blues.” These common experiences include feeling sad, moody, overwhelmed, having trouble sleeping, frequent crying, and exhaustion. These symptoms typically manifest around the 2-3 day mark after delivery and can last for about two weeks as both the mother and baby adapt to their new routine.

It is worth noting that around 80% of women experience the baby blues to some degree. However, if severe mood swings persist beyond the first few weeks, it is essential to be vigilant for signs of postpartum depression or other mood disorders. Postpartum depression is just one type of mood or anxiety disorder that can occur during this period. Other conditions include:

• Postpartum Anxiety
• Postpartum OCD
• Postpartum PTSD
• Postpartum Psychosis
• Postpartum Rage

It is crucial to remember that postpartum depression can persist for up to a year or even 18-24 months after childbirth. 50% of women who experience postpartum depression have no identifiable risk factors. It is, therefore, crucial to incorporate early and frequent screening for perinatal mood and anxiety disorders as a standard part of prenatal and postpartum care.

Recognizing the Symptoms

In the first year postpartum, women and their partners should remain vigilant for the following symptoms that may indicate postpartum depression:

• Anger
• Irritability
• Loss of interest in the baby or self-care
• Decreased enjoyment of previously pleasurable activities,
• Appetite changes
• Sleep disturbances (either excessive sleep or insomnia)
• Frequent crying
• Feelings of guilt
• Shame
• Worthlessness
• Hopelessness
• New-onset bodily aches and pains
• Thoughts of self-harm
• Intrusive thoughts
• Suicidal ideation

Although these symptoms are common during the postpartum period, the fear and stigma associated with them often leave women feeling isolated and frightened. If you are experiencing thoughts of self-harm or harm to your baby, reach out for immediate support (call the National Suicide Prevention Hotline at 988).

Causes of Postpartum Depression

The causes of postpartum depression are multifaceted and vary from woman to woman. While there is no single cause, certain risk factors contribute to the development of postpartum depression or perinatal mood and anxiety disorders. These risk factors include:

• A family or personal history of depression or anxiety
• Inadequate social support
• Financial stress
• Marital stress
• Complications during pregnancy or previous pregnancies
• Major life events (such as a death, job loss, or relocation)
• Multiples births
• Infants requiring neonatal intensive care
• Infertility struggles
• Gestational diabetes
• Gestational hypertension
• Preeclampsia
• A history of abuse or assault
• Adverse childhood experiences
• Substance abuse
• Systemic racism
• A history of Premenstrual Dysphoric Disorder (PMDD)
• A history of Premenstrual Syndrome (PMS)

These risk factors highlight the need for a comprehensive and inclusive approach to postpartum care that considers the diverse needs and backgrounds of all women.

Supporting Women with Postpartum Depression

Various tools are available to identify and support women with postpartum mood and anxiety disorders. One such tool is the Edinburgh Postpartum Depression Scale, a 10-question screening tool available in over 65 languages, free of charge. Women should undergo screening during both the prenatal and postpartum periods, with a focus on early and frequent assessments. However, it is important to note that a screening tool is only effective when healthcare providers create a supportive and non-judgmental environment for women to be open and honest in their responses.

Currently, barriers exist that prevent some women from accessing proper screening, such as providers’ lack of familiarity with the tool, discomfort in handling positive results, limited community resources, and a failure to create a safe space for women to share their experiences. While screening is an important part of the diagnostic process and treatment of depression, it is just one piece of the puzzle.

Moving Forward

Understanding the challenges and complexities surrounding postpartum depression can be overwhelming. We need a consistent, inclusive, and non-judgmental system of care that celebrates women’s choices and empowers them with knowledge and resources to improve their health. Remember to call 988 if you feel like you are struggling. You are not alone.

About the Author

Samara Robertson, CNM, MSN, APRN, NP

Postpartum Expert and Mental Health Specialist

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