Baby-Blues, Postpartum Depression, and Anxiety: are we talking about the same thing?

When we started talking about mental health, some of the most common words were "depression" and "anxiety". They were often related to some, very sad moments of one's life, like the loss of someone, redundancy, or divorce. In many cases, very difficult like conditions were playing an important role, like extreme poverty, homelessness, or situation of neglect.

Then, I came across "Postpartum Depression", "Perinatal Anxiety" and Baby-Blues.

Of course, the generalization for which people get anxious or depressed because of the very bad things they have been through did not apply anymore. I was left a bit confused: How could be possible that someone gets struggling with their mood in coincidence (or actually because) of something usually full of happiness, such as pregnancy? It did not make any sense to me, at that time.

So, I have read about it a bit in the last few weeks. And yes, now, it makes a lot of sense.

So, are we actually talking about the same thing?

No, they are 3 different things but, like the Nina, the Pinta, and the Santa Maria of Colombo, they often go together. The Baby-Blues coincide with a short period after birth in which a mother can feel particularly depressed, tearful, or easily irritable; It can often resolve itself naturally with no medication. Postpartum Depression and Perinatal Anxiety, on the other hand, are more complex mode difficulties that may show similar symptoms of the Baby-Blues but, differently from it, they will not pass naturally and may actually get worse.

In all cases, however, the attention of a specialist is essential.

In terms of numbers:

• Baby-Blues seem to affect more than 50% of women;

• About 3/10 of women will experience Postpartum depression and anxiety;

• Mental Health difficulties during pregnancy have been reported since 1850.

It doesn't sound encouraging, right?!

Even so, you can always fight your enemy if know them.

But why during pregnancy?!?!

You got it: this is "The Question". The point is that, despite the joy, happiness, sense of fulfillment, and richness of great expectations that came with expecting a baby, some other things are also coming within. And they are all making us more likely to develop one of the grey monsters in the title. To be a bit more specific:

• Hormone fluctuations: this is a normal, physiological consequence of pregnancy. Actually, our new "hormones alchemy" is one of the things that makes our pregnancy go on as it should. Then, our hormone level changes again, drastically, after giving birth. All this "up and down" makes our mode less stable and may increase the biological risk of developing mood difficulties during pregnancy and after birth.

• Big changes: everything, from our working schedule to our body, from our relationship with our partner to our economic priorities changes. And they change a lot. Now, changes often trigger fear and loneliness and, with them, anxiety and depression. Looking at all those things that seem, and are, so different than they used to be can be a tough aspect of expecting a baby.

• Previous experiences and expectations: Previous negative experiences (eg. abortion, stillbirth, or difficulties to get pregnant) may make a woman more likely to develop anxiety or depression as she fears the same traumatizing ending. Also, if a woman suffered from Mental Health difficulties in the past, she is more likely to experience them during pregnancy and after delivering the baby. This is unfair.

Practically, we struggle to put this plethora of things in order, our brain is on a 9-month-long rollercoaster trip, and our mind broadcasts the most terrifying "what-if" movie that can be humanely conceived. Nad we are told to stay calm and breathe... SURE!

And, in the meantime, there are a lot of things to do, and we feel we can do none of them.

Will we survive?!

Yes, we will. But we should breathe (yes!). There are, of course, other things we can do to help us cope with this not-so-easy situation (alongside breathing!). Here are some suggestions:

• Be kind to ourselves: this is something we should do anyway, always, let alone during tough moments. Being kind to ourselves means basically 2 things: stop considering ourselves guilty, weak, or not "good-enough"; and give ourselves what we love and make us happy. So, it may mean stop telling ourselves that we will mess up with the baby because we did not attend 1 of the antenatal classes, or because we are always terrible at important things, and give ourselves good things, such as a nice bath, a god book, a class that we enjoy, or calling our best friend. Doing what we like and talking kindly to ourselves are really the first, most important steps.

• Reflect on it: Now, this may sound strange, but I am actually telling you to stop, after a moment of anxiety or depressive mood, and have a thought about it. How do you feel your body? Are your heart, your breath, your skin, and your tummy anyway different? For example, is your heart working faster, or is your head dizzy? It may actually be because our mode impacts our physical body functions. And what were your thoughts when you started feeling anxious or depressed? where did you worry, or felt unhappy about something? Now, this is like a chain: we start thinking something that doesn't make us happy; we react to this thought with an emotion, like being sad, or fearful; our body changes getting ready to save us in a potentially dangerous situation. We feel unwell, and we get worried again, starting the chain from the very beginning. But we can stop the chain, for example, by relaxing our body (mindfulness, music, and physical exercise are some ideas) and by reconsidering our fears in a more realistic way (for example talking about them to someone we trust to put them in perspective). If you want to know more, look for Cognitive Behavioural Approach.

• Be strategic: anxiety and depression during pregnancy and after birth may be connected with all the many changes that we experience and the impression that we have lost control of our life. A strategy that may help us is to be organized with what is up to us so that we do not need to worry about it. This means we may find relief in having the bag ready quite in advance or setting up an agenda specifically for all the pregnancy-and-baby engagements. Last tip: put in the to-do list also the me-time we have talked about in the previous point, so you are sure you find time for yourselves.

• Seek help: lastly, talking about our worries, our expectations, and our feelings is just as important as talking about physical concerns we may experience during pregnancy. Just ask for help, if you see that the situation is simply too much to come with on your own.

And we survived!

Yes, we can survive this! But the key to winning this battle is playing it with kindness, self-compassion, and the support of the people we love.

References

Green, S. M. (2019) Cognitive behavioral therapy for anxiety and depression during pregnancy and beyond : how to manage symptoms and maximize well-being. New York: London.

Kennerley, H. et al. (2016) An introduction to cognitive behaviour therapy : skills and applications. Third edition. Los Angeles: SAGE.

Winnicott, D. W. (Donald W. (2005) Playing and reality. [New ed.] / with a new preface by F. Robert Rodman. London: Routledge.