Pregnancy Blues; What You Need to Know

I know we have all heard about postpartum depression and many have heard of baby blues, but pregnancy blues, what is that?  Honestly, I didn’t know it was a thing.  In my first pregnancy, I was so happy. It was something I really wanted and it took over a year of trying before I was pregnant and so once it happened I was grateful!  It wasn’t until the baby arrived when I experienced some baby blues that first night in the hospital.  I was feeling exhausted from a long labour, my boobs had swelled, I couldn’t hold my pee and I had this new human I had to take care of.   I also realized there was no turning back and I wanted out or at least I did for that one night.  The good news is my baby blues were gone by the next night, don’t get me wrong there were nights I wanted out of this mom gig, but those were the nights I was able to pass on the baby to my partner and with time alone and away from hearing baby cries I was able to recharge like I needed.

Fast forward two years later, I had a two year old, and a baby due a few weeks away.  While I absolutely wanted a second child and the pregnancy was planned, my terrible two year old (whom I love dearly) was kicking my butt emotionally, my pregnant body was not cooperating like it did the first time around because at 34 weeks I was having a hard time walking more than 5 mins. I very clearly remember lying on my couch, which I had a hard time getting up from due to severe pelvic pain (yeah!) and thinking about what is was going to be like to be back in the newborn phase.  We had a great sleeper at the point, thus nighttime wake ups felt like a thing of the past.  I was dreading the zombie state that I knew was pending with a newborn.  I was dreading the post birth body, I was nervous about what breastfeeding would bring (I had some trouble the first time around which you can read about here), I was scared about birth because we all know every single one is different and I was especially dreading the lack of breaks.  Two parents with one kid meant we got breaks, we could trade mornings, bedtimes and so on, but two kids didn’t allow for that luxury in the beginning and for how long I didn’t know.  All this thinking while I was stuck on the couch (because I couldn’t get up) got me, feeling anxiety and inevitably crying that there was no going back from here and why had we thought this was a good idea?    I shared my feelings with my partner because I wanted him to know what was driving my abnormal moody behaviour (beyond the pregnancy) and he was super supportive and understanding.  The best part was he remained the rock while I was a crumbling mess and reassured me that we would do it together. I didn’t know it at the time but there was a name for what I was experiencing; pregnancy blues and a google tells me that anywhere from 12-20% of pregnant women experience it during their pregnancy but us moms often brush it aside as we may attribute our feelings to hormones and we don’t want to admit that our pregnancy and upcoming baby isn’t anything but glorious!  I reached out to my mother-in-law, Cindy Goodman Stulberg, who also happens to be a psychologist and an expert in dealing with depression about the topic to offer insights to the League of Moms community.

Why do Pregnancy Blues happen?

Let’s begin with what is Pregnancy Blues? It is called perinatal or antenatal depression, it is a diagnosable disorder that is very similar to postpartum depression. The only difference is the timing. It happens during the pregnancy, not postpartum or after pregnancy. As you say it is not as well known as PPD and important to discuss. Why is a difficult question, as there is no definitive answer to why. There are many factors that are thought to contribute including biological, hormonal, hereditary predisposition, situational stresses from work or family.  As well previous depressive episodes, personality traits and coping mechanisms. All that really means is that it can happen to anyone, it is not your fault, but there are ways to deal with it and feel better.

If you are struggling with a partner, dealing with other stresses, which can include an ill or demanding parent, feeling overwhelmed at work these issues can trigger or contribute to developing pregnancy blues.

Some also see hormones as the exclusive contributing factor but every woman who is pregnant and delivers goes through the hormonal changes but not every woman develops antenatal or postpartum depression. Hormones likely contribute but are not the sole cause.

What are the signs of Pregnancy Blues?

Some of the common signs are:
– Changes in appetite, either eating too much or too little
– Changes in sleep, either having trouble sleeping or sleeping too much
– Fatigue or lack of energy
– Feelings of great sadness, hopelessness or worthlessness
– Crying for no reason
– Feeling little interest or pleasure in things you used to enjoy

Are some women more susceptible to it?

Yes, those who have had previous depressive episodes or suffer from severe PMS are more susceptible. And there is a hereditary component to depression, so if one parent or both parents have experienced mood difficulties you are more likely to be susceptible to experiencing depression. Not really wanting to be pregnant and being quite young at the time of the pregnancy also contributes to depression. Women with little or no emotional support  can be more prone to problems.  Also those with additional stresses including financial stresses are faced with more challenges which can be difficult to deal with especially if one doesn’t have constructive coping mechanisms to employ.

When should you seek help? Where should I seek help?

Whenever you are feeling down. The first thing to do is to talk to someone, anyone about how you are feeling.  It may be difficult to do if you are not used to sharing your feelings, but believe me it is one of the best things you can do. The advantages of talking to someone else, your partner, a friend, sibling, parent, other mothers, your hairdresser, is that you find out you are not alone. You are likely to find out that the person you are talking to has experienced some mood difficulties or knows someone who has. It is also a relief to not carry heavy feelings by yourself. Allowing someone to get to really know you and having a meaningful conversation builds closeness in your relationships and an opportunity for you to get care, support and concern and good advice from others. You can also gather more information online, through books, join a chat group for pregnant women all while still sitting on your comfy couch. If you want some professional help, which is a wise thing to do,  or are finding your mood is interfering with functioning then you should seek help.   I would start with your family doctor, OBGYN or midwife or ask a friend or relative, to see if they recommend a therapist skilled in effective treatment for antenatal depression.

What are some treatment options?

One of the best research based, short term therapies, highly recommended in psychology and psychiatry treatment guidelines, is Interpersonal Psychotherapy IPT. Therapy is offered by private mental health clinicians, in hospitals, and community mental health treatment centres. IPT and other forms of treatment including Cognitive Behavioural Therapy CBT, supportive psychodynamic psychotherapy, group support, for pregnant women and their partners is highly recommended. Antidepressant medication can also be discussed with a medical practitioner.

Do Pregnancy Blues affect the baby?

Pregnant women with depression tend to receive less prenatal care, don’t eat as well and don’t get enough rest. Mood difficulties can lead to self medicating, meaning using drugs, tobacco and alcohol to feel better. It is well documented that these have a negative impact on a developing baby. There is also mixed opinions as whether depression contributes to pre-term delivery and low birth weight.

Being depressed during pregnancy can place you at greater risk for having an episode of depression after delivery, which interferes with an ability to bond with a newborn. There is also some concern that maternal depression might influence the brain development of babies (Dr. John Krystal, Editor of Biological Psychiatry).

Can women do anything to manage their feelings?

Absolutely, as suggested above the best thing is to talk to friends and family about your feelings. Do not underestimate how important and valuable this step can be.  Aside from psychotherapy, if your medical practitioner recommends medication, consider it. Studies on the effect of antidepressant medicines on your baby suggest they are safe for treating depression during pregnancy however there may be very small risks. Discuss the pros and cons.

Will Pregnancy Blues dissipate on their own?

There is inconclusive evidence regarding the course of antenatal depression. A distinction needs to be made between antenatal depressive symptoms which means an individual has some symptoms but not enough to meet the criteria to diagnose a major depressive disorder, MDD. According the national institute of health MDD is unlikely to remit or dissipate without treatment.

Cindy’s Final Thoughts

If you have read to this point, keep reading.  Depression is a highly treatable illness.  It is not your fault and there are highly effective ways to feel better. Remember there is nothing wrong with you, and that learning effective strategies that you can continue to use and share with your partner and children can be an extremely valuable learning opportunity. Be proud of yourself that you want to provide the best for yourself and your family and that I and the League of Moms are there for you.  Now that my kids are grown, I get to experience the joy that grandchildren bring. What I am saying is that I have been there and survived and remember the good stuff.

Cindy recently co-authored the book, Feeling Better; a self-help book for beating depression and improving your relationships which you can read about here

Cindy Goodman Stulberg, D.C.S.,C.Psych. Psychologist and Director, Institute for Interpersonal Psychotherapy. Co-author, Feeling Better Beat Depression and Improve Relationships with Interpersonal Psychotherapy.

League of Moms / 01/27/2019

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