Postpartum Blues

Dr. Greene's Answer

As magical as the journey of parenthood is, it often begins with a period of feeling blue. These are the postpartum blues. Women’s bodies are the scene of a powerful changing tide of hormones in the days and weeks after a baby is born. The rising hormone levels that gradually affected the incredible changes in your wife’s body during the time she was carrying your daughter have now precipitously dropped.

Most new mothers (perhaps as many as 90%) will have periods of weepiness, mood swings, anxiety, unhappiness, and regret. Usually this lasts for a few days or less and is quickly forgotten. It’s not unusual, however, for the blue period to come and go for six weeks. For some moms, the blues don’t begin until the baby stops nursing (another time of major hormonal shifts). Hormones, however, are not the entire story…

Moms who have adopted their babies also commonly go through a blue period. And now that investigators have begun to look into it, we know that most dads (though less weepy) go through a blue period of feeling unhappy, insecure, left out, and moody. One day I expect we’ll discover that even dads and adoptive moms have sudden hormonal and chemical changes in response to a new baby — but this has not been proven. We do know, though, that even at this exciting time of having a newborn, there are good reasons to be blue.

Every new beginning is also an ending of what was before. Every ending is a beginning. Whenever a baby is born, the world will never be the same. This is wonderful. It’s also okay to grieve for the loss of the way life was before.

Your wife no longer has the control of her own time the way she once did. Perhaps she also misses the challenges and rewards of her work. Hobbies may have been put on hold for a while. Her romance with you is also now different — it’s no longer just the two of you.

Whether her pregnancy was comfortable or not, she may be mourning the special intimacy of feeling her daughter inside her. Many new moms describe feeling empty inside. Pregnancy is a time of looking forward to an eagerly awaited moment. Now that looking forward is gone as well. Also, pregnancy breaks down barriers in society. Complete strangers would beam at her, want to pat her tummy, and tell her she was glowing. They would leap up to give her a hand. Now your daughter is the focus of attention, and your wife — who would probably benefit more now from encouragement and practical aid — is less likely to get it.

She may also be mourning the loss of her ideal appearance — she may still look pregnant. When my youngest child was one month old, a door-to-door saleswoman greeted Mom and asked when the baby was due! (Needless to say — no sale!) Wearing maternity clothes when pregnancy is over just isn’t fun, but usually nothing else is comfortable yet.

Now add to all this — SLEEP DEPRIVATION!. Your wife is probably more exhausted than she has ever been. Whenever people are sleep deprived they are more subject to swings of emotion and to feelings of inadequacy. This, by itself, is enough to cause a blue period (ask any pediatrician). I couldn’t tell for certain from your question whether it is your wife or your daughter who is crying all the time. Probably both! Research has shown that women with the postpartum blues tend to have babies who cry significantly more than those of their counterparts. It hasn’t been proven whether the fussy, crying babies make moms sadder, or whether the sad moms make the babies less happy — but it seems to me that both are true, and that the crying is a vicious cycle.

A true grief reaction, at a time of great stress (and insistent noise), in a person who is chronically sleep deprived, all built on a shifting foundation of tremendous hormonal surges — it’s a wonder that postpartum blues aren’t more of a problem. Most of the time, though, the powerful positive feelings that also accompany this time of new beginnings soon displace the sadness.

There are several things you can do to help:

• Help your wife get as much sleep as possible. If she is breastfeeding, she will probably feel sleepy just after nursing. Encourage her to take a nap. “Sleep when the baby sleeps.” Once nursing is well established, begin giving your daughter some bottle feedings (ideally of pumped breast milk). This will give your wife a break, and be a special time for you.
• Get your wife out of the house. Even brief breaks (especially if it’s time the two of you can spend together) can be very restoring, especially if you get outside.
• Surprise your wife with your thoughtfulness. Whatever is special to your beloved, go out of your way to make it happen.
• Release your wife from as many of her usual roles and responsibilities as possible. Unless she genuinely wants to (and her doctor okays it), she shouldn’t have to cook, do dishes, write thank you notes, make love, take out the trash, feed the dog, deal with her in-laws, or anything else except baby care and self-care. If you are not fortunate enough to have paternity leave, it may be difficult for you to pick up all these extra household tasks. (Even if you do have paternity leave, you may be so sleep deprived yourself that you can’t do them all!) If that’s the case, get help from someone your wife trusts and finds relaxing to have around your home. At the same time, help your wife to realize that she is not marginal to the household. She is an incredibly important person!
• Your sending a question to HouseCalls shows that you are already taking action on behalf of your wife and daughter. Continue to follow that instinct. Get as involved as possible in caring for your baby. Specifically, ask your wife what she would find most helpful. Would she like you to change more diapers? Read baby care books? Call your pediatrician with questions? Rock the baby to sleep? Run out and buy supplies? There is almost nothing that most new mothers appreciate more than concrete, loving assistance from the father in caring for their baby.
• Shower your wife with praise and encouragement. Point out to her the things that she is doing well, the ways that she is becoming more adept at baby care, the magnificence of what her body has done in creating a new life. Let her know that you believe in her capacity to be a wonderful mother. Gently remind her that it’s normal and fine for motherhood to be an unfolding process. She doesn’t have to have all the answers. Over time she will be amazed at how skilled she will become in understanding and nurturing her child.

If your wife can’t sleep (because she can’t, not because the baby won’t), if she doesn’t want to eat, if she loses interest in life or feels hopeless, if she is having disturbing or suicidal thoughts, or if the blues are lasting more than a week or two, this might be more than postpartum blues — she might have true postpartum depression. Seek professional advice right away. Her obstetrician or family doctor is a good place to start. Don’t let anyone brush this off. True depression is much less common than the blues. Professional treatment is important and is usually quick and effective. Whether your wife’s situation is the blues or full-blown depression, don’t minimize it. The weeks following your child’s birth are different from any other time in your life. They are rich, complex, and often out of control. So take a deep breath. Relax. Pamper yourselves. Enjoy the little things. When life seems particularly hard, take comfort in knowing that this time will soon be over. Though life will never be the way it was before your daughter was born, soon things will settle down. In the meantime, remind yourself and your wife that this is a once in a lifetime experience that you don’t want to miss.