My experience with PPA and PPD (and what I’m doing differently to prepare for baby #2)
*This blog post shares details about postpartum mental health. If you or anybody you know is struggling, please reach out to Postpartum Support International.
I’ve shared a lot about this topic on and off on my Instagram stories, but I decided it was time for a dedicated blog post…. So here we go! I definitely feel some vulnerability sharing this level of detail, but if I help even one person feel less alone or reach out for help when they need it, then my goal has been met.
So let’s dive in….
Throughout my 20s, I struggled on and off with mild generalized anxiety disorder. I say “mild” (not a clinical term) because I was always able to function daily, was a high-achiever, able to complete many successful years of schooling for my occupational therapy degree, and maintain relationships with friends, family, and significant others, etc. However, it was definitely there on and off, and I did see therapists over the years, which always helped.
Fast forward to 2020. I found out I was pregnant with my son, Jack, on January 1, 2020. We had moved to Denver from NYC just 7 months prior and Jake, my husband, and I were still kind of getting our bearings in this new city. But overall, we were SO excited (and a little nervous!) and ready to take on this next chapter.
Throughout my pregnancy, things were generally healthy and “normal”, both physically and mentally. I did not experience symptoms of prenatal anxiety or depression, though looking back, I think we all were kind of in a state of shock with the global pandemic and daily unknowns/ups and downs.
Jack was born in August of 2020. As we all know, that was a generally uneasy time in the US (and across the world) - there was still so much unknown about COVID-19 and though cases were a bit lower that summer, they soon skyrocketed that fall. At the time, I didn’t realize the impact that severe social isolation, social distancing, and lack of access to in-person resources likely played in my postpartum experience.
I remember being home from the hospital the first few days and having thoughts like - “What have I done?” and “Is this my life now?” I had never had thoughts of that sort before and so they kind of shocked me.
In those first few weeks, I also began to have lots of intrusive thoughts. These can present many different ways, but mine were mostly thoughts of accidents happening to Jack and/or myself - things like me falling down the stairs while holding him, the overhead lamp falling onto him, etc. These came to me in visual flashes where I would suddenly “see” this happening in my mind.
Fast forward to months 2-3:
We were experiencing a lot of breastfeeding challenges that greatly impacted my mood and mental health - Jack had a tongue/lip tie that we got lasered at 7 weeks old, but he continued to struggle. We were seeing an infant chiropractor, physical therapist, follow-up visits at the pediatric dentist, doing all of the stretches and exercises, etc. and it felt like a LOT. I was also working with an extremely knowledgeable IBCLC who definitely knew her stuff when it came to breastfeeding, but in retrospect, made me feel like exclusive nursing (at the breast) was the only and best feeding option. I felt like a failure that it wasn’t “working” and even more frustrated at myself/Jack that we were doing what felt like ALL the things - spending so much time, energy, and money on these specialists, and it still wasn’t working. How come it “worked” for other moms but not for me?!
In retrospect, this strive for “perfection” in breastfeeding robbed me of the joy in those early months. That coupled with sleep deprivation and hormonal shifts caused me to feel weepy a lot of the time. I found myself wishing this time period away, which caused a tremendous amount of guilt. I also simply just didn’t feel like myself - as vague as that sounds.
I knew something wasn’t right and reached out to my midwife practice around month 3 postpartum. They referred me to the perinatal mental health therapists at the hospital where I delivered and I began seeing a weekly therapist from that point on.
It definitely helped, though was not a quick fix. I continued to struggle with my mental health throughout the first year and beyond. I did trial a medication when Jack was around 14 months old - ultimately, the side effects were bad for me and at that point in time I did not feel the urge to try another one, and so I stopped it after a few weeks. I am definitely open to medication in the future, though, and believe that it is such an important piece of the mental health puzzle for many. I do think people are sharing more openly about it and helping to decrease any stigma.
Looking back, I’ve tried to take the time to really think about what *my* personal triggers were in this time period. The huge hormonal fluctuations of course play a large role, and I think I am particularly sensitive to hormone changes in general. There is also a genetic/physiological component that exists. But what else made me susceptible to experiencing PPA and PPD, aside from those? This exercise is not so I can 100% prevent it from happening again, but rather so I can set myself up with support in place for the best chance of success when baby #2 comes this spring.
After talking thoroughly with my therapists about this and doing a lot of self-reflection, here is what I have come up with as the factors that contributed to my PPA/PPD:
Lack of consolidated sleep - Since I was determined to exclusively nurse (based on what I thought was “best”), we did not introduce a bottle until week 5 or 6. Even after that, we mainly gave Jack a bottle about once/day, and not overnight. This means that I was awake and managing every single night feed for weeks on end. Though Jack was a “good” sleeper (thanks to routines!) from the start, he still fed quite frequently in those early weeks and months. If you’ve ever cared for a baby overnight (and most of you probably have!), you know that the entire feeding/soothing back-to-sleep process takes at least 45 mins-1 hour, if not more. I was doing all of this at each feeding, causing me to not sleep more than 2-3 hours max in a row, often less, by the time I fell back asleep. For me, this crushed me. I have recently learned from my research that the brain does not get a full rest/flush without that 4-5 consolidated hours. Even though I was sleeping in TOTAL a decent amount of hours, and was able to nap some days thanks to help from Jake and my mom, the constant broken-up chunks caused my brain to suffer.
What we’re planning to do differently for baby #2:
My bare minimum is getting 4-5 uninterrupted/consolidated hours of sleep a majority of nights. At the very beginning, this will likely not be possible as I do want to attempt breastfeeding again. However, after the first couple weeks, I will allow myself to sleep for that long without waking to pump. This means I will prioritize my sleep over a potential milk supply drop.
Jake and I are going to share overnight feeding duties. There are lots of different ways to do this, and it depends on how you feed your baby, of course. For us, we are planning to sleep separately - one of us in our own bed, the other on the futon couch in the basement with the baby in the bassinet nearby. The person on baby-duty handles all night feeds during their shift. We will introduce a bottle early-on so that Jake can bottle-feed. When it is my turn to sleep in my bed, I will set an alarm to wake up to pump at intervals I feel are necessary at that time. (I find that waking up to pump is a LOT easier/shorter/less stressful than handling the feeding/diaper change/soothing-back-to sleep of a real-life baby.) We are either going to alternate entire nights, or split the night and take shifts (ie. one of us sleeps from 8:00pm-1:00/2:00am and the other sleeps from 1:00/2:00am-7:00am).
We are hiring a postpartum doula to do overnight shifts 2 nights/week. This will allow both Jake and I to sleep through that night. I will set my alarm and wake up to pump at intervals I feel are necessary at that time, if any.
Ultimately, I will prioritize my own sleep over exclusive breastfeeding and a full milk supply. This one can feel controversial because you CAN often have both, but I need to remind myself of this priority in case that’s not the case for me.
2. Breastfeeding difficulties - As mentioned above, I had this goal of “perfection” when it came to breastfeeding. I’m not really sure where this came from because I know the research and truly believe that the most important thing is a fed baby AND a happy mother, but at the time, I was stuck in “black-and-white thinking” - I thought that nursing exclusively was “good” and that bottles, pumping, formula, etc were “bad”. I honestly didn’t realize that there could be a middle-ground or you could do a mix of both. I was just so laser-focused on “fixing” Jack’s latch so that I could exclusively breastfeed, and felt growing frustration week after week when it wasn’t working.
What we’re planning to do differently for baby #2:
I am working with a different IBCLC this time who will support me from a place of putting my mental health first. I had a phone call with her last week and she seems wonderful.
We will introduce a bottle early-on so that Jake and the postpartum doula can help with overnight feedings. I will work closely with my IBCLC to make sure that we are introducing it in a way that will best support breastfeeding (bottle type, nipple type, pace-feeding, positioning, etc.)
I am open to combo-feeding (feeding both breast milk and formula) early on and for a longer amount of time. Hopefully, if I find a middle-ground approach that works for us, it will feel sustainable for longer.
3. Lack of social interaction - This one is kind of obvious, since Jack was born in 2020. I truly don’t think I realized how different my postpartum experience was from the “norm”, since it just felt normal to me at the time and it was all I knew.. But, not being able to go to restaurants, walk around stores, meet friends for lunch, etc is anything but normal. Even though things were somewhat open by fall/winter, there was still an overarching sense of worry about whether or not it was safe to take a newborn into a public place. It also felt scary to know whether it was safe or not to have visitors come over to the house. There were no in-person baby meet-ups or opportunities to socialize with other new moms. Jake and I personally did not do many things out of the house just for us, even if it was to run an errand or grab lunch. All of these things combined contributed to feelings of isolation and boredom, which both negatively affect my mood and mental health.
What we’re planning to do differently for baby #2:
Though we will have the new difficulty of a germ-y toddler being around the new baby, this time around the general state of the world is in a much better place. Jake and I are both committed to prioritizing social interaction and getting out of the house. We also have made more social connections at this point so will have more people to make plans with this time.
The weather will (hopefully) also be much nicer as I am due in early May, so we will make sure to spend lots of time outside. Getting fresh air and sunshine is a HUGE contributor to my mindset and mood.
4. Tendency towards obsession/checking/worry - This is simply how my brain is wired, which is why I have experienced anxiety in the past, but a major contributor to my PPA. I found myself hyper-fixated on Jack’s feeding and sleep times, constantly checking the baby monitor, and micro-managing Jake when he was taking care of the baby (maternal gate-keeping). These behaviors were part of my slew of PPA symptoms, which I didn’t understand at the time.
What we’re planning to do differently for baby #2:
While I can’t change the way my brain is naturally wired, I have been working a lot in therapy sessions on identifying these tendencies in myself and talking through the underlying reasons why I feel/do these things. I think simply acknowledging them out loud with Jake helps. I also want him to hold me accountable and (gently) “call me out” on some of these things if he notices them happening again.
I am working on having a menu of mantras I can turn to when I find myself leaning towards the hyper-worrying/obsessing/checking behaviors: “My baby is safe.” “I trust Jake (or whoever) to care for our baby.” “Everything is a season. No stage lasts forever.”
This past week, Jake joined my therapy session so we could sit down and have a structured conversation about how we can plan to put these types of supports/systems in place. One thing we focused on (that became very emotional for me) was my request that he “look out for”, so to speak, symptoms of anxiety/depression in me during the postpartum period, and kindly communicate them to me ASAP. These are things like excessive worry, feelings of hopelessness, black-and-white or all-or-nothing thinking when it comes to breastfeeding, excessive irritability, racing thoughts, maternal gatekeeping, and more.
I also asked Jake what he needs most during this upcoming period and we discussed how to make sure he also gets his needs met, too. This is all a work in progress as we still have more to discuss, AND we know things will constantly change so we can’t plan for everything, but it definitely helps to have a head start!
I am hopeful that this time around will feel different. Will it be easy? No, of course not. But I find comfort in knowing that I am setting myself up for success as best I can and plan to take it one day at a time.
If you’ve made it to the end, THANK YOU for reading through this with me. This was longer than I thought it would be, but I just have so much to say about this topic : ) I sincerely hope you found some value in reading this. Please comment below or send me a DM on Instagram if any of this resonated with you!
If you are struggling, know that you are not alone. Here are some resources to help:
Postpartum Support International provider directory
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