You just had a baby. There’s smiles and congratulations. Balloons and flowers. Visitors at your door. Matching hospital bands and a little one snuggled into your arm.
But something is wrong. You don’t know what it is yet, so you smile and push through as best you can. You pull your hair up into a quick knot and smooth your gown, or the first shirt you’ve put on in days, and get ready to receive the next group of family and friends. When the well-wishers are gone, your spouse, and perhaps close family, sense there’s a change. But these early days are so crazy and your partner is adjusting too. There’s no time and no words to describe what’s going on inside you, meanwhile the storm just keeps building.
The days blur by sleeplessly and you realize: somewhere in your mind something just broke. You think you might be losing it. And you’re scared.
Most moms who have emotional struggles after birth are diagnosed as having Postpartum Depression. But Postpartum Mood Disorder is a many-headed hydra that includes postpartum depression, and also illnesses like postpartum anxiety. Treatments such as counselling and medication are similar in treating PPMDs in all their forms. But as long as ‘experts’ blanket-diagnose all mood disturbances after giving birth as Postpartum Depression, the screening tools and awareness among healthcare providers remains narrowed to a subset of symptoms – that of depression. A mom suffering from Postpartum OCD, for example, might not get help because her symptoms aren’t recognized, or even worse, misunderstood.
If a mom is not showing typical signs of depression, and saying that she “just can’t sleep” (or relax or stop cleaning and sterilizing or checking on the baby at night, or avoiding sharp objects in the house), she might be seen as just another ‘nervous’ or ‘first-time’ mom. The truth is, Postpartum Mood Disorders can manifest, not only as depression, but also anxiety, panic disorder, OCD, mania, or psychosis.
Insomnia is a VERY common early sign of a postpartum mood disorder. It is also horribly isolating. Reaching out to friends and family can be met with raised eyebrows. You might hear statements like, “You’re a new parent! How could you have trouble sleeping? When I was a new mom I fell asleep, blah blah blah.” or my favourite crappiest advice of all time, “Just put your feet up and sleep when the baby sleeps”. When helping hands come to offer to relieve you for naps or nighttime duty, the agony of ‘Momsomnia’ ramps up several gears. The chance of sleeping at night or even for naps during the day is made more impossible under the crippling weight of performance pressure, when someone finally offers you a break. And nothing fills you with more guilt than seeing the confusion (or worse, annoyance) on your helpers’ faces when they ask you if you got some rest, and you reply sadly “no” after coming out of a quiet room hours later.
Trying to get help for postpartum insomnia is very very hard, and clear information is sparse. Many people confuse insomnia with the interrupted sleep that comes with caring for a little baby. But there is one HUGE distinction: not being able to sleep EVEN WHEN THE BABY IS ASLEEP and you have time to sleep. That is insomnia, NOT sleep deprivation.
Insomnia can be accompanied by sleep panic (panic attacks while trying to get to sleep or upon waking up in the morning, for example) and sleep dread (watching the clock until nighttime and holding negative associations about your bed and bedroom). One of the most frustrating things you can encounter when looking for answers is the notion of ‘sleep hygiene’, as if problems with getting to sleep or nighttime waking are, by contrast, somehow dirty. Postpartum insomnia is a monster of its own – and limiting screen time at night and sticking to a regular bedtime (you wish you could) may not help.
Medication is much-needed in many cases of postpartum mood disorder, such as to help with anxiety and insomnia. Furthermore, moms already have enough guilt on their plate without the added stigma that medication carries – like the rhetoric that it is just a Western World Numbing Agent (and you can tough it out with exercise and positive thinking). Medication is a common treatment in combination with counselling, and it saves lives. Period. But it can be difficult to know when and if to start it.
Not all symptoms are visible on the outside, and have different degrees of impact on a mom’s ability to look after her baby. Some people with anxiety can be on hyperdrive, or fueled by hyperarousal. They may not have trouble getting out of bed in the morning. They may not forget to shower or get dressed when opportunity is provided. And sometimes they can even get a lot of stuff done – sterilizing bottles, folding the laundry, and cleaning the kitchen until it’s spotless – until 4:00 in the morning. And that’s when the rubber starts to come off the tires. More attention needs to be given to these moms who just can’t stop worrying. Who need to get up and check to see if the baby’s breathing just one more time. Who can’t stop counting and recounting how many times the baby has fed, pooped, spit up, cried. It is these moms who fear the sky falling, and then end up crumbling inside.
OCD is a common experience among new moms, but is severely underdiagnosed. Reaching out for help with this disorder is terrifying. A lot of moms with OCD are paralyzed with fear that they are experiencing postpartum psychosis. OCD is NOT psychosis. OCD is another expression of anxiety. A book that addresses this topic entirely is called Dropping the Baby & Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood, written by Karen Kleiman and Amy Wenzel. This Huffpost article describes very well what the agony of perinatal OCD is like.
The truth is, postpartum anxiety and insomnia are hell. Please, if you need help, reach out. No matter how hopeless you feel, you CAN and WILL get better. Tell someone – your doctor, your partner, your mom. These recommended resources below are a good start – you can print them to show others what experience you are going through.
And someday think about joining your nearest Climb Out of the Darkness walk to raise awareness for perinatal and postpartum mood disorders. Watch this video by the Postpartum Progress team and be inspired to connect with moms in your community and beyond.
I’m still wearing my climbing boots.