From feeling the baby kick for the first time to the accompanying morning sickness, many parents openly discuss the highs and lows of pregnancy. Yet, the highs and lows of postpartum life are rarely mentioned. Instead, parents are given a brief overview of postpartum depression, various breastfeeding positions and a sheet for tracking feedings and baby’s dirty diapers. It’s rare you’ll be told about the irritability, hopelessness or lack of appetite that can happen after birth. In turn, many new parents commonly dismiss those unpleasant feelings, attributing them to normal childbirth and parenting woes.
Some may not even realize their changing emotions nor are they given adequate information regarding possible red flags and triggers, says Nicole Woodcox Bolden, a licensed social worker specializing in perinatal mental health. “Most women don’t leave the hospital with adequate mental health information,” she notes, adding that doctors don’t encourage patients to track changing emotions.
“Most women don’t leave the hospital with adequate mental health information.”
— NICOLE WOODCOX BOLDEN, A LICENSED SOCIAL WORKER SPECIALIZING IN PERINATAL MENTAL HEALTH
What screenings measure postpartum mood and mental health?
Talking about how you feel after delivery as well as noting strengths and frustrations, can set you up for receiving support and treatment. It can also help you feel connected to others and forge a sense of community.
Yet, the Baby Dove #OneRealPressure campaign, a partnership with the University of North Carolina, Chapel Hill School of Medicine’s 4th Trimester Project, which encouraged moms to share the realities of early motherhood, revealed that 59% of mothers feel society doesn’t allow them to share how hard the first year of motherhood can be.
Without talking about the real pressures and feelings of motherhood, many are forced to sit with shame and ignore their mental health, jeopardizing their emotional well-being.
Mental health challenges are the most common pregnancy complication. A study published in the National Library of Medicine found that up to 20% of women suffer from mood or anxiety disorders six weeks postpartum. Unfortunately, stigma, lack of awareness, and intermittent follow-ups from health providers following delivery lead to many parents suffering alone, in silence, and untreated.
A review of medical history, self reported screens and/or provider observation can all be used for postpartum mental health concerns.
The Edinburgh Postnatal Depression scale
The Edinburgh Postnatal Depression scale, a ten question screening tool to identify PPD, is administered during the first six weeks of birth at one or more of the postpartum checkups.
However, six weeks is not enough, according to Woodcox Bolden. Frequent surveillance of moods, behaviors and routines in the postpartum period extending past six weeks by the patient and medical providers can assist in closing the gap between the recognition of potential mental health risks and treatment.
Pediatrician screenings
The American Academy of Pediatrics recommends that pediatricians ask parents about emotional well-being during regular well-child visits for infants through the first six months.
“Some pediatricians offer mental health screening for mothers,” says Dr. Mona Amin, Enfamil’s 360 Infant Development Expert and founder of the New Mom Survival Guide. “However, this is not always the standard of care.”
Why screening isn’t a diagnosis — and mood tracking is a must
Symptoms of depression commonly present themselves during pregnancy or within the first few weeks following delivery. Other mental health conditions including burnout, postpartum obsessive-compulsive disorder (OCD) or the less common postpartum psychosis can appear within the first year.
“There are so many mental health challenges that can arise throughout the first year of birth,” notes Woodcox Bolden. Yet, she explains that the Edinburgh scale is only used for recognizing signs of depression; it’s not a tool for recognizing other common disorders.
Furthermore, screening is not a diagnosis. It’s just a jumping off point for providers. And if providers carry implicit bias and false beliefs about specific demographics, especially Black parents, regarding their pain threshold, it can delay referral to treatment regardless of the testing results. A study found that traditional depression screeners were not always accurate for mothers identifying as “low-income and urban.”
Screening is also dependent on the patient’s ability to accurately answer the survey, which can be challenging, given a new parent’s focus on their baby, lack of sleep and erratic diet, points out Reena Patel, psychologist and parenting expert.
It’s why she suggests regular self-audits — or tracking your postpartum moods — in which you take note of the various emotions and outbursts you might experience. Then, present your findings to your provider or have open dialogue with family.
How to effectively track moods to monitor your mental health
While journaling or writing bulleted notes may seem like the obvious option, it can be daunting and unrealistic when you’re caring for a newborn. If you’re already following the common advice of tracking feeding frequency, ounces fed and diaper changes, adding mood tracking might feel overwhelming. Fortunately, it is possible to weave mood and behavior observations into your typical routine without it feeling like an additional burden.
Prior to delivery, make a schedule of how you plan to track your moods — whether weekly, daily or multiple times a day — and share the plan with a trusted loved one or friend, as that will keep you accountable, explains Patel. It’ll also lay the groundwork for you to have discussions that could boost your self-awareness.
Apps such as Moodtracker make it easy to document sleep, water intake and emotions throughout the day and notify a designated support person for various entries.
— NICOLE WOODCOX BOLDEN
Apps such as Moodtracker make it easy to document sleep, water intake and emotions throughout the day and notify a designated support person for various entries, notes Woodcox Bolden.
Other no-pressure tracking options for mental health purposes include:
- Notating recurrent thoughts in a planner during nursing sessions.
- Shouting your daily vent into a smart speaker.
- Record your feelings or routine for the day in the voice memo of your phone after making dinner.
- Hanging a calendar with space to write down frustrations near the TV. The visibility and easy access allow other household members to contribute to the log.
What exactly to track
Creating an easy method for mood tracking aside, it can be challenging to recognize your feelings in the first place. “We’re so used to crying as a child and immediately being told to stop crying,” says Patel. “So we’ve grown up in a society averse to validating and allowing for emotion.”
Identifying emotions and moods is one way to monitor mental health, but it’s not the only way. Behaviors and environmental changes can be just as helpful in better understanding emotional well-being while parenting.
You might also consider simply taking note of:
- How many people were at home with you.
- The number of times you mentioned missing your life prior to kids.
- Episodes of forgetfulness.
- Length of time expressing big feelings such as crying.
And when it comes to expressions of emotion, like crying, it may be best to focus on what triggered the emotional display and how long it lasted, suggests Woodcox Bolden. “Sometimes we’re just sensitive, and we want to cry,” she notes. “That doesn’t mean you’re depressed. I say take note of what happened before you felt the shift. How quickly were you able to recover from it?”
Crying with recovery in a few minutes versus crying for days while ruminating on distracting thoughts are drastically different and could be a sign of a problem, she adds.
Even the amount of times you’ve woken up in one night to check if the baby is breathing or refusing to give the baby a bath due to irrational fears can be a sign of things like anxiety or postpartum obsessive-compulsive disorder. Postpartum OCD varies from typical OCD in that it appears more rapidly and tends to be an excessive obsession with solely the newborn.
Noticing behaviors and patterns like these can make it easier to get targeted treatment.
What to do if you’re concerned about mood patterns
After two to four weeks, you should have enough information to share with someone trusted, says Patel.
When reviewing your tracked behaviors and emotions and notice that maybe you experienced an outburst more than you realized or you didn’t shower as often as you should, the first thing you should do is acknowledge that something could be amiss.
It’s normal to struggle with accepting that you could have postpartum depression. It could even be hard to admit that something could be wrong socially or emotionally because it’s unexpected, acknowledges Patel.
“Accepting that you could have postpartum depression or accepting that there is something wrong not even hormonally, but potentially socially and emotionally in reference to mental health, is hard, because you didn’t expect this,” she acknowledges.
But if you are paralyzed with fear and struggling over concerns of your mental health these are the simple first steps you can take:
1. Share one problem with someone
An entire log listing every problematic thing you’ve experienced can be overwhelming so start small. Pick one concerning item from the list and tell someone trusted whether it’s a parent, spouse, friend or support group. “It allows you to sit with the feeling and is a huge step towards practicing self-awareness you can be proud of,” notes Patel.
2. Let go of solutions
Patel advises pausing before jumping to solutions. You don’t have to find a fix right away, and you may not even be ready to accept help, she suggests. Allowing yourself to sit with the feeling for a bit even after sharing it with a loved one is part of self-awareness. It can also later lead you to the position of being able to accept help.
3. Bring it to the attention of a professional
Ultimately, you’ll want to share what you’ve tracked with your health care providers as it can help them help you with the right treatment, says Woodox-Bolden. It can give insight into whether the mental health concerns are environmentally-based — such as a loved one’s behavior triggering challenging emotions — or biologically-based, warranting a change of diet or vitamins.
4. Utilize other resources
Additionally, with the push to treat and recognize reproductive mental health concerns, there are more resources available.
Consider checking out any of the following:
- Just Birth Space text line
- Mental health chatbots through your hospital of delivery
- The Black Birth Equity Fund through Baby Dove for doula support
- Postpartum International helpline for non-emergency issues and questions
Ultimately, while it can be challenging, tracking moods throughout the postpartum period could lead to the best, most targeted form of mental health support.
