One of the most common questions I hear from parents with a perinatal mood disorder is “Why do I feel like this?” We don’t know why some parents struggle with their mood in the early years of parenthood and others don’t, but it remains a central question among mental health researchers and clinicians. Attempts to answer this question commonly involve two factors — human neurobiology and thinking patterns — but not everyone agrees about the relationship between these factors. As perinatal mental health clinician Karen Kleiman explains, “Some experts believe that the negative thoughts are symptoms of depression. Treat the depression, and you will think less negatively. Others say that negative thoughts cause the depressive thought process. Learn to reframe the thinking into positive channels and you will begin to feel better, these experts believe.”1
Although why is a worthy question to answer because it opens treatment possibilities, and examining the clinical symptoms of mood disorders gives us an entry point for understanding what is happening, I think it’s equally important for parents to be able to name what it’s like for them to experience depression or anxiety in plain language. Listening to parents’ personal experiences and creating the space for them to analyze and interpret their thoughts, feelings, and circumstances allowed me to develop the Perinatal Mood Framework. Over time, the individual stories of parents struggling with their mood started to merge into a collective narrative, not just because they were all expressing similar feelings, but also because they often shared internal and external expectations of what it means to be a “good” parent. The “rules” of parenting had become so narrow and confusing that they were starting to feel unattainable. I call this the culture of impossible parenting, and it is having a devastating impact on the mood of new parents. In this first part of the book, we’ll explore the framework and impossible-parenting culture in detail, to provide a basis for exploring the most painful parts of this culture — birth, sleep, relationships, and body — in part 2.
While we’re on the topic of naming, I’ll point out that Perinatal Mood and Adjustment Disorders (PMADs) is a catch-all term that encompasses mood disorders that occur during and after pregnancy, such as depression, anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, bipolar disorder, mania, and psychosis. This book focuses primarily on the experiences of postpartum depression, postpartum anxiety, and to some extent postpartum post-traumatic stress disorder related to birth and reproductive trauma, so I want to provide a common understanding of what is meant by those terms.
What is it? Temporary moodiness, weepiness, and overwhelm in the first few weeks after becoming a parent. Impacted by hormonal changes and adjusting to sleep deprivation.
How many parents are affected? Estimated 80 percent.
Symptoms: Mood swings, weepiness, irritability, restlessness, sadness, anxiety, loneliness, grief, feelings of loss or regret.
What is it? Clinical depression that develops after becoming a parent.
How many parents are affected? Estimated 12–20 percent.
Symptoms: Sleep changes, forgetfulness, appetite changes, crying spells, negative thinking, hopelessness, loss of interest in life, emotional withdrawal, uncommunicativeness, overwhelm, lower self-confidence.
What is it? Clinical anxiety that develops after becoming a parent.
How many parents are affected? Estimated 17 percent.
Symptoms: Intrusive thoughts, racing and/or fearful thoughts, heart palpitations, trouble taking deep breaths, insomnia, chest pain, panic attacks, fear of being alone with the baby.
An estimated 2–3 percent also develop Postpartum Obsessive-Compulsive Disorder, which is characterized by obsessive worries about health (own or baby’s), excessive concerns with cleanliness or germs, hyper-protectiveness of baby, repetitive/obsessive thoughts.
What is it? Trauma in response to difficult birth or reproductive experience, which could include sexual, emotional, physical, structural, nursing, or loss trauma.
How many parents are affected? Estimated 9–17 percent.
Symptoms: Flashbacks, nightmares, panic attacks, dissociation, hyper/hypoarousal leading to feelings of helplessness or panic.
Here’s my concern with defining perinatal mood disorders like this: While the medical definitions of PMADs are important for a clinical diagnosis, definitions like this are hard for parents to interpret for themselves because the experience of early parenthood is intense for just about everyone. I can’t count the number of parents who’ve said to me, when reflecting on their postpartum experiences, “I think I might have had a little bit of PPD.” And that’s because clinical definitions don’t capture the emotional nuances of grief and disappointment (of yourself, baby, partner, or community), confusing identity changes (you may not recognize yourself), and how deeply you want the very best for your baby/babies (Are they okay? Can I give them everything they need?). Even when you don’t meet the clinical criteria for a PMAD, you may still be experiencing a lot of strong scared or sad feelings. This is why naming matters — not the labels themselves, but the discussion about what you’re dealing with. Regardless of what you call it, you deserve support.