Hormonal shifts are a natural part of pregnancy and postpartum, and they can significantly impact your emotional well-being. While everyone experiences these changes differently, it’s essential to be prepared for potential shifts in your mental health.
Prior anxiety and depression can influence postpartum mental health—but it’s not the only factor. Sleep, nutrition, level of support, relationships, health, and a host of other things are in flux—and may influence your mood more significantly than they may have in the past.
In a perfect world, anyone who is expecting would receive preventative mental health care, but until that becomes reality, there are measures you can take to be proactive before your baby arrives. As a therapist, here are my essential tips to be prepared for your postpartum mental health. Keep it mind your mental health is individualized to you, and there is no one-size-fits-all approach. You should feel free to explore what you feel curious about and what inspires you to take care of yourself. As always, please don’t hesitate to reach out to a mental health professional if you need support.
Create a Postpartum Self-Care Plan
Becoming a new mom is exciting and creates a whole other list of “to dos.” But, let’s be honest, most of these center around the baby: the nursery, washing tiny pajamas, picking out a stroller, and so on. But you deserve (and will need!) just as much care and concern.
If you’ve already had a child, you may have a better idea of what your needs may be during postpartum, including what you learned before that you’d like to implement this time. If this is your first rodeo, welcome! I recommend focusing on stabilizing three main areas: support system, sleep (or coping with sleep deprivation), and time to de-stress. Writing these things down into a self-care plan can serve as an essential reminder when you’re too exhausted to think anymore. Then share your plan in advance with others.
Rally Your Support System
Your support system is so critical in postpartum, but it’s often the most neglected in terms of setting boundaries and communicating your specific preferences. Think about how you appreciate support now. Does it help when people do tangible things for you? Or do you prefer a shoulder to cry on and an ear for deep listening? Think about your non-negotiables. What will absolutely drive you to your limit?
I often struggle with knowing when to be proactive about help. I usually ask for it when it’s dire circumstances—and that’s because I appreciate my independence and want to be able to “mom it out” on my own. It’s actually healthy for your matrescence (the process of becoming a mother) to learn how to do things your own way.
I have very helpful friends, neighbors, and my in-laws live with me. I received much more help than I think is typical because of my multigenerational home. However, many times I yielded to help that I wasn’t asking for and didn’t fulfill me as a parent. I’m a developmental expert—I really don’t need advice on how to curtail a tantrum and I don’t want my time to be wasted deciding what to do about that.
So, now I focus on getting help with tasks that drain my energy. I will text a friend if I need a recommendation for a new double stroller or an app that tracks my feeding schedule. I don’t care what the product is, I just need to know what works. Learning how to ask for “little” help along the way has added up to a great sum of help.
Informing people of your expectations for support especially if you’ve had postpartum anxiety or depression before—can instill a sense of empowerment. Accept that you will need help, and that it will be in constant flux. Yes, it’s nice to have someone do the dishes for you when they come to visit for the first few weeks, but when you’re experiencing postpartum depression or anxiety , easy, brainless tasks like that can make you feel accomplished or like a “normal person” again.
If it benefits your mental health, put it on your “to do” list, even if it’s commonly done by others. You may want to start cooking your own meals much sooner or cleaning the house while babywearing. And you may be perfectly content allowing your best friend to do that while you enjoy a glass of red wine on the couch with the baby monitor. To each their own!
Let’s normalize saying “What’s draining you right now?” What’s taking away from time with you, not only the baby. If you need to get back into your running routine once you’re medically cleared, make that the first priority. What about a new pair of running shoes on your registry?
Create a Very Tentative Game Plan for Sleep
Within the first six to eight weeks, it’ll be challenging to have any expectations for sleep. After that time, it’s helpful to work toward at least a four-hour stretch. Regardless of how baby’s sleep goes, coming up with some coping strategies can be really beneficial when you’re sleep deprived brain can barely function.
My first child was a great sleeper as an infant that then became a nightmare later when sleep regressions hit. Now as a 4-year old, his sleep needs continue to evolve. More importantly, so do mine. Repeat after me: a happy mom is a rested mom.
It may sound like a pipe dream, but it is possible to feel content about your level of rest. As a lifelong insomniac, I completely resonate with the doubt on this topic. Fortunately there are things that can give your body rest in addition to sleep, that can really stretch out your resiliency during the early years.
A nighttime playlist was a lifesaver for me in the first year. The playlist was for me and songs I enjoyed. I’m not sure why but I picked many “nostalgia” songs that were calming—and also reminded me of my pre-baby life. If I woke up miserable and turned on the playlist while feeding, I felt a little bit more like myself and it gave me the sense that I could push through the day, albeit, exhausted. .
Your version of the nighttime playlist could be a comfort TV show (hello to all ‘The Office’ fans out there!) or a movie playing in the background. It could be notecards with encouragement\from your loved ones or text messages from friends sent in the daytime. That’s a small ask—but with a big impact to tell a mom friend “Just send me something that will help me not feel unhinged.”
If you have the financial resources, you could consider a night doula, or have a family member sleep over to help out. Even one night of sleep or additional help can feel supportive. Again, your needs will change and if you want to champ it through the night on your own, feel free. But it’s also okay if you need a break—you’d be surprised how much a handful of solid sleep goes a long way.
Most moms say to me “I had one night of good sleep and now I feel like a human again.” Maybe it’s the one thing your overeager mother-in-law can do that helps you feel supported. (Of course she can hold the baby as long as she wants….at 3 a.m.)
Map Out Time to De-Stress
I can’t stress enough, when it comes to relieving stress: a short amount of time can drive significant impact. Fifteen minutes is enough to calm down any nervous system. When I’m in the office, I typically do a five to 10- minute meditation and have clients rate their stress levels before and after. I’ve had people go from an 8/10 to a 4/10 in five minutes. Guess what’s really cool about calm down time? It can be anything and it’s a great model to your children.
Changing small things in my environment at home to cater to my own needs for calm, less stimulation, and a sense of normalcy has been a game-changer in my personal motherhood journey. It reminds me of a meme I saw that said something like “Moms can handle anything —except too many things on the coffee table.”
I once laid on the ground of my bedroom with an eye mask on, headphones and a weighted blanket just to calm the f**k down. (And the door locked, of course,) To my surprise, it actually worked. Decreasing my sensory output has been a lifesaver and reduces my own “Big Feeling” outbursts.
Smell is very closely related to the amygdala response, making any pleasing scent a great tool for quick calming. It’s just as good for you as it is for baby to be in a warm, inviting environment. Aromatherapy, candles, the smell of cookies in the oven, all of these smells can help regulate your overstimulation. And if you can, have a family member come over and cook your favorite meal at your house, while leaving you alone so you can close your eyes for a moment and pretend you’re on a sidewalk cafe in Paris.
Anything that de-stresses you, plan to do it for five minutes per day. Make a list before the baby is born and share it with your partner or support system. If they are at a loss for how to support your mental health, point to the list and have them help you accomplish at least one for that week.
Talk to Your Current Providers About Postpartum Mental Health
Whether you are under the care of a physician, midwife, doula or other professional, they often are a one-stop shop for postpartum resources. They are your local experts and can help navigate what options are viable to hopefully prevent the wild goose chase.
I often hear moms share they had no clue virtual or local support services are available, or that many are free and/or covered by insurance. Understandably, it’s tough sifting through every option when you’re taking care of a baby and trying to find an ounce of time for yourself. Just the process to find a therapist alone is overwhelming, so planning before you give birth can give a better roadmap for who to call when baby blues hits or anxiety (not the baby!) is the one keeping you up at night.
Medical/Psychiatry
Many health systems offer free resources for managing PMADs, but these might not be widely known. You could benefit from free mom groups, access to PMAD specialists or dedicated helplines. Don’t hesitate to inquire about these valuable support options.
It is also possible to advocate for a sooner postpartum medical appointment if you are at risk for PMADs. You may request a two or three week follow up after birth rather than the standard six weeks. I’m doing this for my second pregnancy— and I can’t wait!
Even if there’s no psychiatrist on staff who does perinatal-specific care, you can extend your search to virtual providers in your state. If you are seeing a therapist currently, ask them to help research with you. Chances are they have connections and can help you figure out who’s in-network with your insurance. Psychiatric nurse practitioners are also becoming a popular option as they tend to have more frequent availability and take on new patients more often.
Also, remember there is no shame in needing to take medication to manage your symptoms if talk therapy isn’t enough. As of August 2023, there are two medications approved by the FDA to specifically treat postpartum depression in adults: Zurzuvae (zuranolone) and Zulresso (brexanolone). Talking with a physician about medications now can give you the clarity you need to determine whether or not they are right for you postpartum.
Holistic Treatments
Immune irregularities in the body have been recently linked to PMADs. Other physical impacts such as chronic pain, pelvic floor dysfunction, inflammation, and sleep/nutrition deficiency can affect mood and general wellbeing. I find by addressing physical and emotional health in tandem, recovery tends to be quicker and longer lasting.
There are many holistic treatment options for postpartum women but the most common tend to be: chiropractic, physical therapy, acupuncture, herbalism, naturopathy and massage. (And hey, many of these can be paid for through a health savings account and may even be covered by some insurances.)
When you are working with a holistic provider, choosing someone who specializes in postpartum can be worth their weight in gold. It’s okay to keep with a provider you trust, but don’t feel shy to ask more about their background and training with postpartum. You can also review with your doctor/midwife/doula any special considerations to keep in mind if you pursue holistic treatment.
Therapy
I would be remiss to not mention the critical importance of therapy when you’re struggling with postpartum anxiety or depression. Postpartum mental health concerns are much different than it is for the general population, and therefore require expertise. Though most therapeutic methods are still effective, it is much more efficient and supportive when a therapist covers additional aspects of wellbeing such as: relationships and communication, boundary setting, hormonal changes, physical recovery, sensory sensitivity and trauma.
Perinatal mental health is a specialization and you can find certified perinatal mental health specialists on the Postpartum Support International Directory. Don’t worry if there isn’t anyone listed there! Most therapy directories have a filter for postpartum.
I was seeing a therapist after the birth of my son who specialized in compassion fatigue. As a mental health professional, it was really enriching and beneficial—for work. At home, not much was changing. Even as a therapist myself, I was unaware that I could see someone with expertise in PMADs. It wasn’t that my previous therapist was not helpful, she certainly was! But once I saw a specialist, my improvement accelerated significantly. I didn’t have to explain as much, and I learned new ways to take care of myself that I wouldn’t have considered before.
