Lately I have received numerous calls from moms whose kiddos are past the one-year mark. A couple of recent calls have been from moms whose kiddos are as “old” as 3. These moms always start the same way: “My son/daughter is almost (1, 2, 3), and so I know that I don’t have postpartum depression. But I am really unhappy and think that I need help. I know that your specialty is PPD, so can I still come see you?”
While I can’t make a blanket statement about each and every woman who calls me, more time than not these women — 1, 2 or 3 years past the birth of their little ones — are struggling with a form of maternal distress that dates back, in one way or another, to their pregnancy, postpartum, or even before. While these moms wouldn’t technically have postpartum depression any longer, they are often struggling with what I will call here continued postpartum distress that was never adequately supported when they first noticed symptoms.
When we use the terms prenatal/antenatal and postpartum depression we are really simply talking about an episode of depression or anxiety that occurs sometime during pregnancy or the first year postpartum. We believe that early symptoms, whether mild or severe, are caused by hormonal shifts during pregnancy or following delivery, physiological stressors like sleep deprivation and nutrient depletion, psychological strain including thought patterns that are likely to cause distress (such as “should” statements, perfectionist thinking, black or white thinking, and catastrophic thoughts) and/or other environmental stressors such as trauma, relationship conflict or changes in finances, employment, or residence. A postpartum episode of depression or anxiety can be triggered by one or more of the above. While they aren’t aware of this when they first call, most of these moms can trace their initial symptoms back to the earliest moments of motherhood. On the phone before they come in for a full assessment session, these moms will say things like, “But I was fine after I had my baby, and I didn’t start feeling bad until later.” However any one or more of the following are usually what we discover when we are together in my office:
- This mom has a long personal or family history of diagnosed or undiagnosed depression, anxiety, or mental illness.
- The pregnancy wasn’t planned and this mom wasn’t certain that she wanted to be pregnant – although she never disclosed this with anyone.
- This mom had a difficult delivery that was never fully processed after her birth.
- This mom had significant breastfeeding challenges that she struggled with silently.
- This mom describes her early postpartum months as “foggy” and that she actually doesn’t remember enjoying them.
- This mom had always hoped for a boy/girl, but gave birth to the other. While she loves her kiddo fiercely, she has never quite managed the loss she feels around not giving birth to the gender that she had dreamed of. Or perhaps this mom has always worried about her attachment to her child.
- This mom experienced a move, death of a loved one, financial loss, or relationship conflict around the time of her birth and these environmental stressors were pushed aside because she felt she “should” be happy once her baby was born.
- This mom had an early childhood trauma or serious family of origin conflict and she notes that emotions around these issues resurfaced shortly after birth.
- This mom felt un-supported in the months following her birth and felt that she “had to do it all on her own.”
- This mom’s baby did not sleep through the night until many months or years after he/she was born.
- This mom has not wanted anyone other than herself or her partner to care for her baby, and so she has not taken more than a very short period of time away from her babe since he/she was born.
- This mom became pregnant after months or years of fertility treatments, she used donor eggs to become pregnant, she had her baby through a surrogate, or she adopted her baby, and once becoming a mom she pushed all of her emotions around her efforts to become a mama aside.
- This mom is tired. Unrelentingly, frustratingly, understandably, deeply tired.
While the beginning of motherhood can feel exciting (perhaps sometimes even euphoric?) for many women, symptoms of depression and anxiety can develop or increase over such a subtle period of time that moms do not necessarily acknowledge that they are depressed or anxious until well into or past that first postpartum year. Often, stress can be cumulative. Months of inadequate sleep, poor nutrition, relationship conflict, and hidden emotional strain can take their toll on a brain.
Think of a minor running injury. While on a jog you trip and feel a slight pinch in your knee. You keep running and barely notice it. But each time you get back out to go for a jog, your knee becomes more and more strained (yet not painful enough to keep you off your feet). Suddenly one day while running months later your knee gives in. It has had enough. Your brain can do the same.
Why is all of this important? Too often, women assume that they have found themselves in a life that is just characterized by suffering, and they assume that since they don’t have postpartum depression it is silly or unnecessary to reach out for support. And so they keep on trekking while each day feeling overwhelmed, anxious, and farther from the woman who they know themselves to be. We talk so much about postpartum mood and anxiety disorders and not enough about maternal distress and I fear that many women tell themselves that they have missed the window of diagnosis or validity for their struggle.
While being a mother is wonderful, it is also complicated. Let’s make room for both no matter how far into the journey of motherhood you are.
~ Kate Kripke, LCSW