What Causes Postpartum Depression? A Guide to Prepare & Prevent

What is Postpartum Depression?

The ‘postpartum’ period is defined as the first 6 weeks after a baby is born in the medical world. Generally a diagnosis of depression does not occur at this time with all the changes adjusting to a new baby. ‘Postnatal’ is a term that is used to describe the 12 months after a baby is born.

‘Postpartum’ and ‘postnatal’ are both terms commonly used to describe the first year after birth. In this blog, we’ll use both words interchangeably. It is more likely that a diagnosis is made, during this time.

Postpartum or postnatal Depression, is a mood disorder diagnosed after childbirth, affecting one in five Australian mothers. Diagnosis can be challenging due to matrescence, which is a word that describes the significant physical, emotional, and social changes women experience after having a baby.

Healthcare providers typically identify postpartum depression during visits after the baby is born, considering health history, post-delivery emotions, and sometimes lab tests to rule out other conditions. While there’s no specific test for postpartum depression, the Edinburgh Postnatal Depression Scale (EPDS) is used to screen parents because early recognition and treatment are important for both a parent’s and baby’s wellbeing.

Types of Postpartum Depression

There are several types of postpartum depression, each with its own characteristics and severity:

• Postpartum Blues: Often referred to as “baby blues”, symptoms include mood swings, crying spells, anxiety, and difficulty sleeping that occur a few days after giving birth. These feelings typically resolve on their own within a few days.
• Postpartum or Postnatal Depression: If the symptoms of depression continue for more than 2 weeks this may have become a clinical depression, this can occur at any time during the first year after childbirth. Symptoms include persistent feelings of sadness, hopelessness, and a lack of interest in activities that were once enjoyable. It can also affect a parent’s ability to care for their baby and themself.
• Postpartum Psychosis: This is a rare but severe form of mental illness that affects 1-2 out of 1000 new mothers. It develops within the first two days to up to 12 weeks postnatally. Symptoms include not needing to sleep, having lots of energy, hearing or seeing things that others don’t, strange thinking and reduced ability to care for yourself or your baby safely. This requires immediate treatment.

What’s the Difference Between Postnatal Depression, Postnatal anxiety and Perinatal Depression?

You may have heard of postnatal depression, postnatal anxiety and perinatal depression and wondered what the differences are. While these terms are often used interchangeably, they have slightly different meanings.

Postpartum or postnatal depression refers to a depression that occurs after childbirth, typically within the first year. It’s a mood disorder that can significantly impact a new mother’s ability to care for herself and her baby.

Postnatal anxiety refers to feelings of tension, worried thoughts and physical changes like rapid breathing, fast heart rate and sweating, occurring after the birth of the baby. Anxiety and depression can be felt at the same time and can be hard to separate. Sometimes anxiety is the biggest problem and can have a big impact on how you cope. Prolonged anxiety can lead to depression.

Perinatal depression refers to the period from becoming pregnant until the end of the baby’s first year. Depression can be diagnosed during this whole antenatal and postnatal period of pregnancy.

Understanding these differences can help you better recognise and get help to address the mental health challenges that may arise during this time.

It’s an Illness, Not a Failure

Postnatal depression is just like any other depression that can occur at any time during your life. Depression is a mental illness, and like other illnesses, it is not a choice, a failure, or a sign of weakness to experience postpartum depression.

Postpartum depression does not make you a bad mother or parent; you are a new parent going through a significant life event and experiencing a mental illness that can get better with the right treatment and support.

Building an Understanding of Postnatal Depression

Is it Matrescence or Postnatal depression?

Matrescence is the word that has come to describe the usual physical, emotional, and social changes the birthing parent experiences after having a baby. It is normal to experience changes for short periods in the postpartum period while adjusting to parenting. Matrescence can look a lot like early symptoms of postpartum depression.

If the emotions are overwhelming, last more than 2 weeks or getting in the way of your ability to do daily tasks, it may be time to get support. So, how do you tell the difference between baby blues and postpartum depression?

Hormones, Baby Blues and Postnatal Depression

After giving birth, oestrogen, progesterone, and thyroid hormones drop dramatically. This causes mood swings, teariness, anxiousness or feeling overwhelmed. These hormonal changes are referred to as “Baby Blues” and occurs in up to 80% of women.

Baby Blues typically occurs 3–5 days postpartum and lasts for less than a week. It resolves as your hormones rebalance.

In postnatal depression these feelings are more intense and last for more than 2 weeks. Symptoms can be ongoing feelings of low mood, excessive crying, feelings of hopelessness, irritability and a lack of motivation or loss of interest in activities that previously brought joy.

Treatment for postnatal depression can vary depending on your symptoms. This might include joining a support group, talking to a therapist and possibly taking medications. For severe cases of mood disorders like postpartum psychosis, it is important to seek medical help straight away. Always consult your healthcare providers about medication, especially for those who are breastfeeding.

Exhaustion or insomnia

New parents often struggle with sleep due to 24/7 newborn care and worrying about when the next wake up will be. Some fatigue is normal but postnatal depression can cause insomnia which results in being unable to sleep even when there is an opportunity to sleep. This is beyond new parent exhaustion and can have a long-term impact on your mood.

If you’re lying awake, even though you are exhausted, it may be time to get some help.

If you are struggling to get to sleep or waking early when you don’t have to, it is important to seek supports as soon as possible.

Remember early intervention is key to protecting your wellbeing and your baby’s health.

Suicidal thoughts

With feelings of worthlessness, overwhelm, loneliness and inadequacy, you may experience a range of thoughts from wanting to disappear to harming yourself or suicide. These can last only a short time and at other times, can be in your head for longer periods of time and more often.

While this may be difficult to talk about or even embarrassing to mention, it is really important to talk to someone and seek professional help. Calling Lifeline (13 11 14) or 13YARN (13 9276) for First Nations help is a great place to start.

Intrusive thoughts

These are thoughts that you might accidentally hurt your baby or harm may come to your baby. These thoughts are very common for both partners. They can be frightening and unwanted and feel like they don’t make sense. If you are experiencing intrusive thoughts, talk to your support people about them, or if you do not feel comfortable talking to someone close to you, seek professional help.

Feeling overwhelmed

As a parent of a newborn, life that had a certain structure and routine now needs to change significantly. Feeling overwhelmed by these changes can occur if you’re a first time parent or a second, third or fourth time parent, as we know each child is different and we all have a unique set of circumstances.

If you’re going on parental leave for the first time, the change from a ‘worker’ to a full-time parent can be unexpectedly challenging. The change in identity, social contact and knowledge of your ‘new job’ can take some getting used to. You are no longer in a job where you knew exactly what to do, you are finding your way in parenting where your orientation manual includes conflicting advice from well-meaning family, friends, health professionals and the internet.

Your regular social contact with work colleagues dramatically shifts. You may find yourself feeling isolated and needing to make new connections with other new parents to fit your new schedule. Your primary identity becomes being someone’s parent rather than your role title.

This is a period of adjustment for both parents. Even if one of you returns to work, it’s important to remember that home becomes the workplace for the parent caring for your baby. At the same time, getting up for work after a night of broken sleep can be really tough. Supporting each other and working as a team makes a big difference.

All these changes are normal and require adjustment. It’s good to acknowledge these changes to help you accept them and find a way through them. If you find yourself struggling to move past them, it might be time to get some help.

Risk Factors and Diagnosis of Postpartum Depression

What causes postnatal and what causes postpartum depression, is not really known, but we do know that a lot of things are happening at this time of life, with many internal and external factors influencing your mental wellbeing. However, there are common factors that have been identified to put you at an increased risk of developing postpartum depression.

Risk factors

Factors that increase the risk of developing postpartum depression include:

• Family history of depression
• Your own mental health history of anxiety, depression, bipolar disorder, border personality disorder, panic disorder or previous antenatal or postnatal depression
• Difficult childhood experiences
• Complex social situation
• Complex pregnancy & birth journey
• Breastfeeding challenges
• Baby’s sleep and settling issues
• Limited support network

Diagnostic Criteria

Diagnosing postnatal depression usually involves a full assessment by a mental health professional or your GP. They will often use a widely used screening tool like the Edinburgh Postnatal Depression Scale (EPDS). This 10 question questionnaire helps identify women at risk of postnatal depression and guides further assessment and treatment.

Your healthcare provider will look for a combination of symptoms such as low mood that lasts for at least 2 weeks, loss of interest in activities and changes in appetite or sleep patterns.

Fostering a Support System

As humans, we are hardwired for connection, which is made through emotional and practical support. A strong support network has been proven to improve our sense of self, well-being, and resilience, connecting with mental well-being.

Remember, “It takes a village to raise a child.” As previously mentioned, isolation is a factor that can increase the risk of developing postpartum depression. It is not a weakness to ask for help. It is a strength.

Partner Support

Adjusting to parenting occurs for all parents providing care for a child, which can result in relationship stress. Both parents can experience changes in their role within the relationship.

Focusing on preparing and preventing postpartum depression can start with nurturing a solid relationship with your partner. Open conversations starters could be:

• What are your expectations of one another?
• What type of parents are you hoping to be?
• What things would you like to do that are similar to what you experienced in your own childhood, and what would you like to do differently?
• What strategies do you already use to support your mental well-being and how can you tweak these to make them work with your new parenting routines?

These conversations are not easy and can make you feel uncomfortable in the moment. Have these conversations early before they become an issue. It’s important to remember that you and your partner are not mind readers, that you are on the same side, and that communication is key to fostering an equal, caring relationship.

Family and friend support

Becoming a parent can also change your relationships with family, friends and colleagues.

Having early open conversations about expectations and boundaries can reduce tension and prevent intrusion and isolation during the perinatal period. Try to be flexible, not all expectations can be met but open communication creates a base for honest conversations when adjustments need to be made.

It can be helpful to talk to those closest to you when you’re struggling and what support you might need. Also share with trusted people what has helped you in the past.

This openness can lead others understanding that you need support, even if you might not know exactly what you need. By being open you create a support network that can adapt to your changing needs during this crazy time.

Group and community support

In what can be a very isolating time in life, connecting with other people who have cultural connections or similar experiences can provide a much-needed emotional support system. This could include either face-to-face or online support options.

While everyone’s experiences are different, a support group can provide a safe, friendly environment to discuss the challenges of adjusting to parenting. This could be found in playgroups, new parent’s groups or perinatal wellbeing groups. Maybe there’s one or two new parent’s you know, who can get together for coffee or a walk. These can really help with your emotional wellbeing.

Health professional support

Trusted health professionals, including a mental health provider, are an important part of your support system. This can include a general practitioner, midwives, child and family health nurses, and anyone else who provides healthcare for you.

Ensuring you have regular check-ups is a proactive step that allows your healthcare team to monitor your health and will enable you to make informed decisions about your healthcare. The healthcare team can develop an understanding of your baseline health.

Supporting the early detection of postpartum depression, putting you in control of your health and getting you connected with early intervention supports and treatment.

Self-Care Strategies

Finding ‘Me’ Time

‘Me’ time and other self care strategies are important for your mental health, even though it’s hard to get in the postpartum period. Remember, you can’t pour from an empty cup.

What is ‘Me’ Time?

• 5-10 minute breaks or up to 30 minutes
• Focus on yourself and your needs
• Things that bring you joy and calm

‘Me’ Time Ideas:

• Going for a walk
• Practicing mindfulness
• Journaling
• Having a bath or shower
• Dancing to music
• Reading a book
• Getting outside

‘Me’ Time Tips:

• What does ‘Me’ time mean to you during pregnancy
• Set realistic postpartum expectations
• Schedule in small chunks daily
• Use your support system
• Communicate your needs to loved ones
• Set boundaries around your ‘Me’ time

Rest and Sleep in the Postpartum Period

Newborns can wake every 2-3 hours for feeding and settling which can be a big adjustment for parents used to 6-8 hours of sleep. Rest is key to preventing postpartum depression but it’s also one of the biggest challenges new parents face.

Tips for Sleep:

Share the night: If you can, share feeding and nappy changing with your partner. This way both parents can get some rest and bond with the baby.

Use your support system:

• Ask for help with household jobs

• Sleep or rest when your baby sleeps

• Consider having a friend or family member stay over 1-2 nights a week to help with night duties

Be gentle with yourself: Parenting is a new job with a big learning curve. It’s okay to struggle and ask for help.

Seek professional help: If sleep and settling issues for your baby are ongoing, talk to your child and family health nurse. They can give you advice and refer you to other resources if needed.

Nutrition

In the postpartum period, it is important to prioritise your nutrition to support your body’s recovery from birth and production of breast milk. Good nutrition can also help improve your mood during the postpartum period.

It can be hard to find time to eat regular nutritional meals while adjusting to parenting demands with increased fatigue. Having healthy snacks in the house and asking family and friends to prepare and provide meals that can be frozen can be ways to reduce the extra burden of preparing meals to ensure you have something good to eat.

Mindfulness

Mindfulness can be a useful tool. Just taking time to pause and be in the present in the moment encourages you to observe your thoughts and feelings without labelling them as good or bad. All feelings even the difficult ones are part of the human experience. Mindfulness can be useful to prevent parental burnout.

By being mindful you can create space from unhelpful thoughts, not all perceived problems are real threats. It helps you by getting you to stop, breathe, then continue on with your day with a clearer head, building emotional resilience and reducing stress.

image caption – Being a new parent can sometimes feel like you’re exploring new worlds, but with the right mindset and support you’re ready for a bold new step!

When to Reach Out for Professional Help

It can be hard to identify what is adjustment to parenting and what is postnatal depression, and you don’t have to work it out on your own. If your emotions are becoming overwhelming, prolonged or disrupting your ability to do daily tasks, it is time to get support.

A plan that is right for you is based on the type and severity of symptoms, and can include support groups, talk therapy, therapies and medication.

Having a regular connection to health professionals throughout the perinatal period can be an important part of the early detection of postpartum depression.

Health professionals will conduct antenatal and postnatal screening for indicators of perinatal depression and anxiety; the most common screening tool is the Edinburgh Postnatal Depression Scale (EPDS).

Completing the EPDS with your health professional allows them to help you identify appropriate intervention pathways for treatment and support for your mental health, including connection to perinatal clinicians such as counsellors, psychologists, psychiatrists and support groups and monitoring if medication treatment is required.

Therapy & Counselling Options

Your history and current needs will influence what type of therapy or counselling is right for you. There are many options for therapy types, and accessing the right one for you can be overwhelming. Talk to your GP and/or ForWhen to support the stress and reduce the guesswork of what may be right for you.

When you call ForWhen, our clinical navigators will listen, discover your experiences, and help you connect with services that meet your needs.

Talk therapies are a fantastic resource for reflecting on your expectations, childhood, coping strategies, and relationship readiness for adjusting to parenting. As we looked at earlier, in fostering a support system, open communication does not always come naturally for all people. It is okay to consider couples or family therapy to support this.

Medication 

Therapy intervention in postpartum depression is important, but sometimes medications can be a helpful addition to your treatment. Your GP is the best person to talk to about what other antidepressant medications might be right for you.

Read our article on postpartum depression treatment options to get a better picture of the options available to you.

Postpartum is a Journey, You’ve Got This

Postpartum depression is tough but you don’t have to go through it alone. Remember it’s not a reflection of your worth as a parent or a person, it’s a health condition that can be managed with the right support and care.

From open communication with loved ones to self care and mindfulness you have the tools to support your mental health. Don’t be afraid to lean on your support network whether it’s your partner, family, friends or healthcare providers.

Every parent’s journey is different and there’s no one size fits all pathway to postpartum wellbeing. Be kind to yourself as you navigate this new chapter of life. Celebrate small wins, acknowledge your feelings without judgment and most importantly reach out for help when you need it.

Remember, you’re not just caring for your baby you’re caring for yourself too.

And that’s not selfish, it’s essential. Your wellbeing matters and with the right support and strategies you can thrive in your new role as a parent.

You’ve got this and ForWhen is here to support you every step of the way with free, nation-wide mental health support and navigation services.