Baby blues, postpartum depression or postpartum anxiety?

Also, ways to cope.

No matter how much you’ve looked forward to it, having a baby is stressful. With the lack of sleep, the disruption in your daily routines and discomfort from labor and delivery, it’s no surprise that a lot of new moms feel like they’re on an emotional rollercoaster.

“It’s normal to feel overwhelmed for a little while. After you give birth, your life and hormone levels change, which impacts your mood,” said Paige Swales, certified nurse-midwife at Foothills Community Midwives. “But some new parents experience feelings of sadness or hopelessness that can stick around and can be a sign of postpartum depression.”

​These feelings may be difficult to talk about because of the stigma associated with postpartum depression (PPD). In fact, PPD affects around 1 in 5 women, yet many sufferers keep quiet about their symptoms and therefore remain untreated.

A combination of psychotherapy, support networks and medications, such as antidepressants, are the standard line of intervention, as Swales and her co-presenter, Anna Fernandez, certified nurse-midwife at The Birth Center of Boulder, explained in a recent free online health lecture.

Certified nurse-midwives Paige Swales, (left) and Anna Fernandez (right).​

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Watch Is It Baby Blues or Postpartum Depression?

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Symptoms of baby blues and PPD

Mild and transient depression is so common in new mothers that it has its own name: baby blues.

“About 85% of women experience baby blues. Baby blues symptoms don't affect your ability to carry on throughout the day, and don’t require treatment,” said Swales.

Symptoms of baby blues include:

• Crying
• Feeling overwhelmed
• Fatigue
• Irritability

“Baby blues usually start within the first couple of days after delivery, peak around one week, and taper off by the end of the second week after birth. Unlike baby blues, PPD is an illness, like diabetes or heart disease, and feelings of sadness or hopelessness don’t go away,” Swales noted.

Symptoms of PPD include:

• Feeling sad and crying for no reason
• Loss of interest or pleasure in activities
• Changes in appetite
• Sleeping issues (don't want to get out of bed or are excessive sleeping)
• Loss of energy
• Feeling worthless or guilty
• Difficulty thinking, concentrating or making decisions (e.g., difficulty deciding what to make for dinner)
• Lack of interest in the baby or not wanting to bond with the baby

According to Swales, “PPD can affect any new parent—any race, age, income, culture or education level and any time in the 12 months following birth.”

About postpartum anxiety

“Sometimes PPD and anxiety go hand-in-hand. But the symptoms of postpartum anxiety are slightly different. Postpartum anxiety manifests in the form of extreme worry, with racing thoughts and constant fear, that causes hypervigilance about the newborn and other aspects of a mother’s life,” Swales stated.

Symptoms of postpartum anxiety (PPA) include:

• Increase in purposeless physical activity (e.g., fidgety)
• Worry that does not go away with reassurance
• Scary thoughts of harm coming to one’s baby
• Feeling guilty much of the time
• Difficulty thinking, concentrating or making decisions
• Difficulty sleeping/insomnia
• Panic attacks possible

Preventing PPD and PPA

Fernandez reviewed several things you can do either prior to pregnancy or during pregnancy that help during the postpartum time:

• Set realistic expectations for the postpartum period. “I’m always recommending to really talk to your community,” said Fernandez. “Connect with other pregnant people who are in your childbirth education class or different weekly groups in the community. Ask them, ‘What were your expectations prior to giving birth and what were the real realities after you did give birth? What were the most surprising things to you?’ ”
• Chat with your partner. She said, “Chatting with your partner about how you’re going to be a team in this, how you’re going to do this together, and what will be your communication style if we find ourselves in x, y or z.”
• Create a resource list. Fernandez said to think about who you'll call if you find yourself in a situation where you’re struggling postpartum. Make of mental list of professional resources and then find those resources. She said knowing these things ahead of time can be a real benefit to you.

Ways to cope with PPD and PPA

Treatment is key. Do not wait to seek help. “The first line of defense if you find yourself in one of these situations, where you're feeling like you're having postpartum anxiety or depression, is to chat with your health care provider,” said Fernandez. Other ways to cope include:

• Know You’re Not Alone. “Knowing that you're not alone is a really big part of coping. Other moms can be your greatest source of strength,” Fernandez said. “Boulder is well resourced in the community. We have a lot of external resources that your health care provider can refer you to as needed.”

• Name it to tame it. By putting this simple tool to work, your emotions can inform you and not overwhelm you. Fernandez shared an example of how “name it to tame it” works. “If you have anxiety about something as small as walking up the stairs with your baby, you might have some of those fleeting intrusive thoughts—flashes of terrible things that could happen such as falling down the stairs.” The next step is to describe, or name it – whether to yourself or out loud. “For example, saying to yourself, ‘This is an intrusive thought. I'm going to just let you go, and let it be okay that I had that thought. What I can do is hold my baby a little closer, grab the handrail or whatever it is that makes me feel safe.”

• Nap often to stay rested. You’ve probably been told to sleep when your baby sleeps. This advice is absolutely important but maybe what's more important is finding a community around you that can help. Call on your friends and family. Fernandez recommended asking, “I am really needing some extra sleep, can you come over?”

• Self-care. You may find it helpful to schedule some dedicated “me time” once a week. Meditate, go for a short hike, work in the garden, read a book, journal – whatever it is that makes you feel strong and like yourself again.

• Get regular exercise. Walking with your baby in a stroller might be an easy way to get in some steps and breathe fresh air.

• Maintain a healthy diet. Eating nutritious foods can help you feel better and give your body the nutrients you need, especially if you’re breastfeeding. Think healthy sources of food such as proteins (cubed cheese, lean meats, poultry), fruits (apple slices), vegetables (chopped carrots), whole grains and healthy fats (avocados, nuts and seeds) that are easy to grab on the go.

If you wish to be screened or treated for PPD, schedule an appointment with Foothills Community Midwives at (303) 415-4045 or The Birth Center of Boulder at (303) 443-3993

Click here to view/download a PDF of slides shown during “Is it baby blues or postpartum depression.”