Beyond the First Year: Postpartum Depression and Motherhood

Did you know that there is a higher rate of depression in mothers of four year olds than in newborn mothers?

The latest numbers show doctors only screen 5% of women for postpartum mood disorders in the first six-weeks after having a baby, so many women slip through the cracks. Where do they go? Some of them power through the struggle by a miracle. Some of them find answers on their own. Some of them return to work and that helps. Some of them have a family member who gets them help. Some of them commit suicide. And some of them are still struggling and trying to “power through” after four years. Four years.

Doctors, midwives, and psychologists label postpartum depression/anxiety as a mental illness due to childbirth that occurs in the first twelve months of a baby’s life. But what happens when the majority of the 15-20% of women who experience this illness aren’t treated or given resources?  

The more women I talk with, the more research I do, I’m beginning to realize that postpartum depression and anxiety can and does go well beyond the first year for many, many women. And Irene’s essay is proof of this as well.

When I arrived at Irene’s house, she was teaching a little girl how to play Uno, but I assumed the toddler was just learning her colors from the cards. “No,” Irene said, “we’ve just continued to try again and again and now I no longer have to prompt her about picking a number or color. She’s got it. It’s amazing what we can learn if we don’t underestimate ourselves.” That’s a sentiment that Irene lives by now—not underestimating herself, but she didn’t always feel this way, not even close.


In the months before Irene’s first son’s birth, in 2006, she was consumed with taking care of her husband who had suffered a severe infection of the digestive tract. While caring for her husband and planning maternity-leave lessons for her sixth grade classroom, Irene surprisingly went into labor in late September, six weeks early.

“I don’t even remember how I really felt in my pregnancy other than taking care of my husband and feeling tired,” Irene said. Irene is a woman who puts her all into everything, and is a bit of a perfectionist, so she was very focused on her students’ and husband’s well-being. When Connor made his early entry into this world, Irene didn’t feel ready to let go of her duties to others.

By the time Irene accepted she was actually in labor and her husband got her to the hospital, she was ten centimeters. No time for the epidural she’d planned for. She arrived at the hospital by 6:10 and Connor was born at 6:24. “And then our birthing class at the hospital started at 7 PM,” so Irene’s husband popped in to tell the other participants labor wasn’t “so bad” and the baby was already here! They wouldn’t be needing birthing class anymore.

“It makes for a fun labor story, but when he was born, my first thought was I don’t have lesson plans, so the stress began immediately,” Irene said.  “I even requested to stay one extra night in the hospital because I was just so overwhelmed, and I remember walking out of the hospital, pushing the stroller and just crying. I got really overwhelmed.”

Here's Irene just minutes before leaving the hospital. Her smile doesn't show the absolute overwhelm and uncertainty she was feeling.

Here’s Irene just minutes before leaving the hospital. Her smile doesn’t show the absolute overwhelm and uncertainty she was feeling.

So there was immediate surprise and stress. Then nursing was a “nightmare” and Irene was at the pediatrician’s office “every other day” to try and get help for the constant crying and the difficult nursing and lack of sleep. And I think Irene’s journey as a sleep coach really begins in the depths of this despair. All she wanted was for a doctor or professional to problem solve with her. Instead, she was sent home with little to no guidance or support. And this mimics her cycle of depression and anxiety postpartum: worry about the issue, then ask for help, no helps comes, and sink into depression.  “I wasn’t given any resources,” Irene affirmed. In hindsight, Irene can see “all the red flags” for postpartum depression and anxiety, but no one around her was saying anything. Irene remembers feeling “like I didn’t want to do anything but I had to. It took a lot of energy. I remember thinking it shouldn’t be this hard to make a lunch for myself or to pump another bottle.”

Eventually, Irene’s husband encouraged her to speak with her doctor, and while her doctor took a lot of time and spoke with her openly, she left his office without any resources or a plan for her care. This is not an uncommon experience. Many doctors and midwives recognize postpartum mood issues in their patients, and they talk with them about these issues, but the doctors either don’t know specialized therapist, can’t get their patients in with these specialist due to a waitlist, or they don’t put much stock in alternative forms of help, like a postpartum doula, a sleep coach, a moms support group. Women are left in an in between place, not know where to go next for help.

Irene was sleep-deprived and without resources already, and then at a month old, Connor was in the hospital for a week with a staph infection. Then in December, her husband had another surgery. “I can’t even remember those first six months,” Irene said with sadness. “It was as nightmare for me.” Irene can’t remember any developmental milestones or moments from Connor’s first year. Her memory is etched with these traumas instead: the hospital visits, the pediatrician, the screaming baby at her breast. Irene had also been influenced by the message that so many moms are given in our society: “I’m a mom now and I should know what to do. Get it together.” This pull-yourself-up-by-the-boot-straps mentality is one that many women feel and are also told by family members and doctors. This message is maybe the least helpful when someone is fighting postpartum anxiety and depression. Believe me, every day a woman gets out of bed and cares for her child during this time, she is committing a courageous act. So Irene slogged through and eventually had another son, Bailey.

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Irene knew what depression and anxiety felt like as she’d struggled with these symptoms for several years pre-pregnancy, but she never learned any tools to help her; she’d only been given medication as a tool. While many women want and need medication to recover from postpartum mood disorders, Irene wanted an alternative plan this time. She had accepted anxiety and depression as “a way of life” and a way of mothering, and it wasn’t until she began her own sleep coach training, at five years postpartum, that she recognized what she’d experienced and put a name to it. Irene was taking a workshop with Shoshana Bennett, a clinical psychologist and pioneer of advocating for women’s mental health, when she had her “ah-ha moment.” Bennett was discussing postpartum depression as it would pertain to Irene’s sleep coach experience, and Bennett’s words hit to directly to what Irene had experienced but could never fully verbalize. That was the beginning of Irene’s healing process. As Irene told me about the moment she realized what Bennett’s description of postpartum depression “was me,” she began to cry. It was a cry that held both sadness and relief. I compare this feeling to someone who has been suffering from chronic physical pain, and after searching and going from one doctor to another, the pain is finally diagnosed. It doesn’t take away the pain, but now the person has a direction to follow and resources to seek out.

New research from Australia points out “mothers are more likely to suffer depression when their child is four years old than when they are babies,” which means the medical field needs to change its approach to maternal mental health. A common statistic is one in seven women will experience postpartum depression in the first year, but this study found that “Almost one in three first-time mothers reported suffering depressive symptoms at least once between pregnancy and four years after birth.” This means we could be missing half of the women who experience depression or anxiety in the first few years of motherhood, because many women no longer have regular check-ups with their OBGYN after six-weeks postpartum. They found that “the strongest predictor of depressive symptoms at four years post birth were having previously reported depressive symptoms either in early pregnancy or in the first 12 months after childbirth.” This statistic is directly linked to Irene’s story and so many woman’s stories based on the evidence. If we don’t diagnose women early on and we don’t give them resources, postpartum mood disorders will not just go away, but continue to affect mothers for years and years.

Irene Gouge Loving Lessons GetSleep 250x250

“We’re not stuck.” This was one of the main mantras I walked away with after speaking with Irene. She believes we have to face our shame when it comes to postpartum mood disorders, and then we can begin to move forward. But the shame leads to silence and denial, which is a recipe for sinking deeper into mental illness. “I was supposed to be supermom,” Irene said, “but you can’t be your best self when you’re just going through the motions. When I began equipping myself with strategies and not just medication, I began to feel unstuck.”

Irene’s journey continues as she helps guide parents through sleep coaching, using a very gentle method. The main service she provides is sitting down and problem-solving with parents; this is exactly what Irene wish she’d had during those first years with her sons: “My own depression and anxiety kicked off my passion and love for understanding family dynamics and problem solving with families. We’re not stuck.”

Irene is adamant that moms must know that resources, like Postpartum Education and Support, are available:  “I needed to know that there were others who were going through this. My other mommy friends didn’t talk about this. That’s why I felt like I really just needed to get it together that first year. Just get it together, make it happen, I would think to myself.” This type of thinking, which isn’t abnormal at all, caused Irene to suffer for five years. I think her experience speaks to the need for doctors, pediatricians, nurses, and friends to speak up and get educated. We know that postpartum mood disorders are the number one complication due to childbirth, and we need to start treating it that way, right from the start. We need follow-up care much sooner than a six-week visit with our OBGYN, and much longer than just one year, and we need pediatricians to treat mothers like they are just as important as babies.

If you’re reading this and going through a postpartum depression, whether it’s at four months or four years after your birth, remember you are not stuck. This is treatable. Reach out and ask for help.

More Than Anyone Could Handle

At 17, Stacey married. After being married for six years, and at the age of 23, Stacey and Charlie chose to have a child. During her freshman year of college, she carried a baby boy. They were excited and acknowledged that they were “idiots” about this parenting thing, and did what many of us do—“read every parenting book and took every available class.” They were as prepared as they could be.

After only four hours of labor, Jones was born, but a there was a drastic change in the mood of the room—from calm to chaotic—as Stacey got to the final stages of labor. A nurse kept yelling with each one of Stacey’s pushes “There’s no heart beat.” This panic was how Jones entered the world and how Stacey entered motherhood. The cord had been wrapped around his neck.But then suddenly, Jones was healthy and fine, and the new family felt like they’d “dodged a bullet.”

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After a brief sigh of relief, only a few weeks later Jones was losing weight due to projectile vomiting after each feeding. Stacey visited the pediatrician and talked with family members, and no one was able to figure out what was wrong with baby Jones. One family member even suggested Stacey was “probably making him sick by being too overprotective.” It’s amazing how one sentence can stick with us over a decade later. A new mother is in such a fragile, vulnerable state, and when you add a sick baby to that equation, she is totally exposed to her inability to control anything, and that is terrifying. I also had relatives ignite some of my anxieties or tell me to “buck up” during those darkest weeks. When you are trying to help a new mother, keep one word in mind—compassion—that is what she needs.

Due to all the vomiting, Jones became extremely dehydrated and was rushed to the ICU. He was diagnosed with pyloric stenosis, a rare condition that affects the opening between the stomach and small intestine, and had surgery the next morning. Stacey’s worries were not just a new mother’s anxieties. Something was wrong with Jones. And the truth is, if a mother thinks something is wrong, we should listen to her; she’s usually right. Again and again, I hear from women that no one listened to her concerns and no one helped her problem solve the issues during these newborn months. And even if a mother is worrying over a symptom that doesn’t result in a medical condition, that mother is still anxious and worried, and providers need to calm her fears, talk with her, and guide her to support.

Then the first year passed in a blur, as it usually does, but “something was always a little wrong” with Jones. He never hit a milestone on time, but no one was really concerned besides Stacey, so she felt anxious and paranoid. At twelve months, Jones had an hour-long seizure, and “the doctors told us that he would probably have severe brain damage and might not live at all.” Stacey lived in this limbo for a year and then at around two-years-old, Jones was diagnosed with autism and the doctors said “he would probably never speak, never walk, and never go to school.”

Stacey found out the same week that she was pregnant with her second child.

During this time, all of these traumatic events, Stacey never realized she was depressed: “I loved my child.  I loved my husband.  I simply felt ill.  I withdrew from the world around me and remember feeling terrible because I would place my son in front of the television for an hour so I could lie down.  I didn’t actually sleep, because I couldn’t sleep (severe anxiety plagued me when I tried to rest), but I lay there because I felt paralyzed, as though I couldn’t get up.  Slowly, I began to lose contact with friends and loved ones.  I changed my courses so I could go to school solely online.”

And so with each child, all three, Stacey felt like she “wanted to crawl out of her own skin…I woke up every day thinking that I just wanted to go back to sleep and wake up as someone else.” And also with each child, the feelings of dread began to “ebb after a year,” but Stacey experienced so much drastic change, from children’s illnesses to the loss of her first husband, that those feelings collided some with other situational stressors. Yet Stacey does “feel a physical difference between sadness/depression and postpartum depression.”

With Jones and Elliot, Stacey had a very supportive partner, who encouraged her to join the world again, taking her on walks and helping care for the children. While Stacey still did grapple with PPDA after her first two births, she was able to recover due to her partner’s support. With Marshall, her youngest child, Stacey was in a new marriage and without that same support. This third time, she was “isolated from friends and family and had nothing to do but stew over how bad I felt.” The lack of support from her partner and distance from family made Stacey’s third bout with postpartum depression the most difficult. Because Stacey has had multiple children amidst different scenarios and varying levels of stress, she’s a good example of the way in which outside stressors can affect postpartum mood disorders, but they don’t determine it. Lack of support and isolation are triggers for PPDA, and in Stacey’s case, lack of support wasn’t the sole cause of her PPDA (as evident in her first two pregnancies), but lack of support intensified her PPDA or made it more difficult for her to recover that third time. I’m always asking questions about triggers, and while I’m always learning new information about causes for PPDA, I’m also always reminded that PPDA doesn’t discriminate—black, white, rick, poor, married, single, healthy babies, sick babies, breastfeeding, bottle-feeding. So there are some triggers that may intensify PPDA, but it’s an illness that won’t be pinned down.

PPDA is a moving target.

At about three months postpartum with her third child, Stacey “hit rock bottom.” She was up early packing lunches for the two older children, Jones and Elliot, and Marshall, the baby, began to cry. Stacey also began to weep as she “didn’t feel she had it in her to walk upstairs and pick him up and comfort him.” Stacey made herself see a therapist twice a week, attend a Bible study, and begin working again. And then one day, all of this obligations became things she looked forward to. She woke up and wanted to “open the blinds and make her bed.” She felt a desire to “get going” again.

So now Stacey is a single mom and “things aren’t perfect,” but she no longer suffers from the “physical pain” of PPDA. She’s reaching out to others for support and help, so while she’s “doing it alone, she doesn’t feel alone anymore.” I think one of the main signals of recovery is what Stacey said last in our interview—“I enjoy my children again.”

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A Film to End Mommy Wars

If you find yourself judging other mothers, if you feel judged, if you are a man working with women who are mothers, you need to watch this short film. It does what I try to do with my essays–give us a sneak peek into the realities of motherhood–which contains so many different experiences. You will see what a real working mom does before she even steps foot into the office and hear the judgement a bottle-feeding mom hears from strangers. Take a few minutes to watch. It will make you gentler and kinder with the moms you encounter from now on.


What Not to Say to the Mother of a Newborn 

Whether you are experiencing baby blues, like the majority of new mothers, or postpartum depression/anxiety, like 15% of mothers, your loved ones will try to give you advice or pep talks, and they usually aren’t helpful. So here’s what not to say to a new mom or what not to listen to for new moms.

1. “Look at your beautiful baby. How could you not feel blessed?” 

Here’s how: I have slept for 3 hours in 30 minute increments over the past 24 hours. 

2. “I raised [insert large number] kids and made it.”

Well, I’m glad you survived raising four children. I have one child and I can barely eat a meal during the day. Your comparisons are so unhelpful. 

3. “Get your big girl panties on” or “buck up.” 

Ok, this is tough love, but guess what? The big girl panties are on. Getting out of bed, nursing the baby, bouncing her for hours…these were all impossible feats, and the fact that I can’t muster a smile about them doesn’t make me weak.

4. “Just wait until they are teenagers.”

Are you fucking kidding me? Do you see the desperation in my eyes? And you’re trying to tell me it gets worse? And here’s the thing, everybody thinks their stage is the best and the worst, so keep that shit to yourself.

5. “Cherish this time. It goes by so fast.”

That may be true, but you saying that isn’t going to make me cherish my baby anymore. My baby will do that work with her smiles and coos. But right now, I haven’t showered in four days and I just went grocery shopping with my boob still out, so I’m gonna pass on cherishing those moments. 

What should you say?

Not much. 

Just do. 

Bring food. Do laundry. Hold the baby. And listen. 

Tutus Win

I’ve totally given in to tutus. I didn’t want Mae to like them, and she doesn’t like them: she loooooves them. So today we are on our second tutu already, and we are wearing this one like a tube top while running around the house buzzing the timer from a board game. Buzzzzzzzzzzzzzzzzz (Arthur is hiding and not amused at all).

Happy Monday!

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To Hell and Back–Again?

Mae is twenty months old, and I am just beginning to dip my toe into the possibility of having another child. I go back and forth on a weekly basis. And while we have the normal considerations–work schedules, finances, Mae’s development–our main concern is my mental health. Part of me thinks I’m crazy just for considering another pregnancy. I can’t imagine handling postpartum anxiety with another child around. Then another part of me thinks my experience could be different this time and that that phase is temporary, no matter how bad. But is it?

I think for moms who experience postpartum depression or anxiety that is our deepest fear:

What if I get PPDA again and this time I never get better?

While PPDA is extremely treatable, it does cause some women to have continued trouble with anxiety and depression. It was very treatable for me last time. Once my 50 mg of Zoloft started working and I attended a support group, I was on my way to recovery. BUT, that but is always in my mind. because I really lost my mind for a while. I lost totally control of myself. Do I want to step into that unknown again? into that abyss? Would a loving mother take that risk with the child she already has?

If you haven’t experienced PPDA, it’s hard for you to understand :”the depths of despair that can descend upon the soul of a mother” (Kleiman 119). I was debilitated. While I’ve forgotten some of the difficulties of those first few months, I still vividly remember the panic attacks, weight on my chest, and insomnia. And just the dread, a heavy, heavy dread, every morning.

Jimmy holding us while I try to summon the courage for him to leave for work.

Jimmy holding us while I try to summon the courage for him to leave for work.

And then, there is the love I feel for Mae. An unconditional love that busts me open in the best way. There is the joy I get from watching her change and learn. There are the lessons I learn and the way she makes me a better person. Don’t I want to do all of that again? Does a second child mean twice the love and joy? That sounds wonderful. (I know it also means twice the tantrums and stress).

You always think you’ll be the exception. I didn’t think I’d suffer with PPDA the first time around, and I want to believe I have the awareness and tools not to suffer during a second time around, but the facts are my chances are higher of experiencing PPDA the next time.


The Climb Out of the Darkness Walk (proof of so many recoveries)

The Climb Out of the Darkness Walk (proof of so many recoveries)

So I’m left with a big question and a heavy consideration. I’ve seen myself and other women dig themselves, scratching and clawing, back up to sanity and recovery. But I also know women who are still struggling, years later, to get back to a baseline.

Right now, I have to sit with uncertainty, probably for quite some time, as we figure this out. And the good news is motherhood has made me much better at dealing with the unknown.