December 9, 2021

Supporting New Moms in the Fight Against Postpartum Depression

The following blog post captures takeaways from an interview between the Society for Women’s Health Research and Taiwo Ajao, MPH, RN, IBCLC CD (DONA) a maternal-newborn nurse, lactation consultant and doula, and Jenifer LaNore, MSW, LCSW-C, PMH-C, a trained full-spectrum doula (DTI) and owner of Gracefully Balanced Perinatal Counseling, LLC, on postpartum depression, including what women should know, warning signs and risk factors, resources available for women dealing with mental health challenges during and following pregnancy, its surrounding stigma, and more.

What is PPD?

Postpartum depression (PPD) is a common psychological condition following childbirth, affecting roughly one in eight women. According to LaNore, while PPD is often used as a catchall phrase for anything that seems to be out of the ordinary in the postpartum period, PPD is part of a broad spectrum of mood disturbances associated with pregnancy.

PPD usually occurs between the two weeks following childbirth and the first year postpartum—and it can look different for each person who experiences it. Symptoms can include feelings of hopelessness, difficulty bonding with the baby, difficulty with the transition and new roles, feelings of guilt or shame, a loss of interest in activities, isolation and withdrawing from friends and family, mood swings, irritability, and suicidal ideation.

“I think very commonly—whether from the media or stories we’ve heard—I think we all have some idea of how we imagine [postpartum depression] to look, and we sometimes use that image to measure ourselves against and to define whether we fit within those criteria or not.” – LaNore

PPD is often confused with the “baby blues.” The baby blues, according to the National Institute of Mental Health (NIMH), describe “mild mood changes and feelings of worry, unhappiness, and exhaustion that many women sometimes experience in the first two weeks after having a baby.” LaNore explained that the sleep deprivation, hormone changes, and process of learning both your baby and who you are as a new mom can lead to emotional highs and lows in the days following birth but should begin to stabilize into week 3 and beyond. Baby blues is sometimes used interchangeably—mistakenly—with PPD, which can result in a mom delaying or seeking treatment, or minimizing their symptoms by assuming they are part of a “normal adjustment.”

Are mothers expected to recognize their own PPD?

A mother may notice her symptoms, or someone within her sphere, whether a health care provider, family member, coworker, or someone else within her support community, may bring attention to them.

According to LaNore, doctors should be screening for childbearing-related depression by the 6-week post-delivery mark to help provide a picture of how mom is coping. Beyond the screenings, Ajao noted the importance of reminding a new mother’s loved ones to watch for signs of depression and to capture and track any behaviors that appear out of the ordinary. She called particular attention to the vulnerability of new mothers who have experienced traumatic births—such as emergency c-sections or instances when a baby is rushed to the NICU and is separated from the mother following birth—which can raise the risk factor for PPD.

LaNore also encouraged people to monitor their symptoms up to the first year after birth and to be mindful that screening tools do not always capture everything. LaNore, as one example, shared that because she was not having depressive symptoms, her severe postpartum anxiety was not diagnosed. Another example, Ajao shared that she experienced worsening PPD with her first child from late pregnancy through 10 months postpartum. “I remember talking to my provider about how I felt. Unfortunately, my symptoms were dismissed and just got worse and worse. Now, as a postpartum and lactation consultant, I screen for signs of perinatal mood disorders and risk factors for PPD early during the postpartum period but also on an ongoing basis in the support group that I lead.”

One possible symptom of PPD is the struggle to bond with baby. What do you recommend to women you work with on how to develop that bond?

In order to help her patients develop a bond with their baby, LaNore recommends being intentional about interactions. This includes having conversations with the baby—whether about fond memories, their pregnancy experience, or the things that they look forward to showing their baby one day—and establishing physical connections through making eye contact and touching/holding the baby. LaNore said new mothers need to get in the practice of getting to know their baby, just as she would treat any other relationship in her life.

Do you recommend sharing your experience with your child as they get older?

Both Ajao and LaNore agreed that there can be benefits to sharing your postpartum experience with your child.

“I think reminding your child of the growth that you’ve had together is really important,” Ajao said. “It’s important to remind them that they’re part of the victories that we’ve won during this journey.”

For LaNore, she revealed that her children have witnessed her journey of healing firsthand. She shared that throughout her process she has been open about therapy and allowed her 7-year-old son to accompany her to one of her sessions. “I think it’s beautiful how unintentionally he’s been exposed to my healing journey and how that’s prompted conversations about mental health… At seven I feel like he understands it at his level and he has an appreciation for how important it is to take care of yourself in that way.”

What are some resources for identifying and managing PPD and mood disturbances?

LaNore shared that there are different treatment modalities that have been proven effective in treating PPD. The first modality is psychotherapy, with cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) being two frameworks under which therapists who specialize in perinatal mood and anxiety disorders may work. The second modality is medication management (there are reproductive psychiatrists who are trained in prescribing medications during pregnancy and the postpartum period), and the third is peer-support groups, many of which are now accessible via telehealth or webform.

Regardless of the treatment modality, LaNore noted the importance of delivering the message of hope to new moms:

“Just because you have [PPD], that doesn’t define you as a mom. This is treatable. You can and will feel better with the appropriate support.” – LaNore

Echoing the importance of seeking professional help, Ajao said that professionals, such as LaNore, can serve as a key intervention because they can make the connection for moms on what they are experiencing. “It’s liberating [for new mothers],” Ajao said, “to be able to put a name to [their symptoms] and realize that what happened to them is real, and they are not alone” … It’s nice sometimes to get on a website, but there is nothing like having a seat in the room of that professional who can normalize their experience and lead them to recovery.”

Are visits to mental health professionals covered by insurance?

Many providers accept insurance for mental health services, or they can offer a superbill, which is a form that can be submitted directly to the insurance company to see if that specific carrier will provide reimbursement for services. LaNore also shared that some providers offer therapy on a sliding scale. For those individuals who have found a therapist who they connect with but who does not accept their insurance, she recommended inquiring about whether they have a sliding scale payment option.

Additionally, she noted that Postpartum Support International offers peer-mentor programs where individuals can connect with other moms who can serve as one-on-one support; free support groups that can be accessed virtually (there are also dad and grandparent support groups); and specialized support coordinators who can help navigate issues, such as termination for medical reasons. There is also a provider directory on the website of providers who are trained in treating postpartum mood disturbances, infertility, grief and loss, and more. PSI also has a HelpLine (1-800-944-4773) that offers basic information, support, and resources.

How can we work to address stigma around PPD?

From the societal perspective, Ajao noted that stigma is generational and a challenge in certain communities. She revealed that even the term “postpartum” is automatically associated with stigma among some; “the reality is that PPD can completely paralyze a new mother, and there are real stories where some have lost their babies to the foster care system. The fear of this reality can often keep suffering women in silence,” she said.

When asked about what terms might be preferable, Ajao and LaNore said “perinatal distress” or “perinatal mood disturbances” could be used as substitutes, depending on the individual.

From the public health perspective, Ajao said that stigma can be addressed “one mom at a time.” She said moms can help break down stigma through actions, such as identifying key people in their lives whom they give permission to ask questions related to PPD and allowing a spouse permission to weigh in on anything that seems amiss (e.g., flagging if a new mom hasn’t eaten). These permissions can help create a reassuring community and remind new moms of the support system she has in place.

What are some things that can be done to support new moms and family units?

Ajao stressed the importance of enhanced training for clinical providers, noting that each interaction is a moment of opportunity where a provider can assess for mood disturbances and mental health wellness. She believes there are myriad opportunities to connect families with resources and support, but that each person must play their part.

LaNore encouraged focusing on psychoeducation for the entire family. She shared that while we do a decent job talking about signs and symptoms to new moms, it would be more helpful to share information with the mother’s community, who will be helping to care not only for the new baby, but also for her on a day-to-day basis.

She also noted the importance of emphasizing postpartum care planning in addition to preparing for the baby. This includes thinking about the day-to-day functional areas where help will be needed once the baby comes: who has permission to see how mom is coping, eating, and sleeping; who will organize the meal train; who will pick up the other children from day care; who can be called to hold the baby if mom needs to shower and nap, etc. “Let’s practice asking for the help we need and being specific about it,” said LaNore.

Finally, LaNore raised that while most of the focus is specific to moms for mood disturbances following childbirth, that dads are also at risk for mood changes. When one or both parents are experiencing changes in their mood, function, or coping, the whole family unit feels the impact. LaNore shared, “As we open up more conversations about perinatal mental health, I think the focus will broaden where we will look at it from a family health perspective.”

If you or someone you know might be experiencing postpartum depression or a related maternal mental health condition, you are not alone and not to blame. Text HOME to 741741 to text the National Crisis text line; call 1-800-273-8255 to reach the National Suicide Prevention Hotline or visit the website at; or contact Postpartum Support International at 1-800-944-4773 or via text at 503-894-9453.

SWHR’s blog series on maternal and infant health disparities is supported by a grant from Covis Pharma. SWHR maintains editorial control and independence over blog content.