Everyone wants to know, “Why me?” Why did I get this? What did I do wrong?
You didn’t do anything wrong. Lots of women get postpartum depression, postpartum anxiety, depression or anxiety during pregnancy, postpartum OCD, postpartum PTSD, postpartum psychosis, and related illnesses. And there’s very likely more than just one reason why they do.
What are the postpartum depression risk factors?
What causes postpartum anxiety and the like?
Perinatal mood and anxiety disorders may be caused by a combination of nature and nurture. Yes, there is likely something going on inside your body—with your brain processing or your DNA—that makes you more likely to get PPD, PPA, PPOCD, etc. than the girl standing next to you. For instance, you might have a family history of mental illness that makes you genetically susceptible. Or there’s something about how your body works that makes you more sensitive to hormonal changes, makes you more vulnerable. This is the “physical” part of what may be making you sick that you hear people talking about—actual things and processes that you could see in a microscope or test for; brain chemistry and all that.
Why is it, though, that you can have two women who both have family histories of mental illness and only one of them gets PPD and the other one doesn’t? Why doesn’t every mom who has the “wrong” gene or set of genes, or who is more vulnerable, get sick?
That’s where the nurture—what has happened or is happening to you in your life outside of the realm of your neurotransmitters and the confines of your skull—part comes in. What is or has happened in your life, believe it or not, can turn your possibility of getting PPD into actually getting PPD, turn your susceptibility into fact. These are the things that are going on outside your body that raise your risk as well.
First, a definition of the term risk factor: A risk factor is any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or illness.
If you have experienced a period of or been diagnosed with depression, anxiety, OCD, bipolar disorder, eating disorders, or other such illness in your life, then you clearly have a higher risk for getting a perinatal mood or anxiety disorder like PPD. But there are many risk factors for these illnesses besides having a family member that has a psychiatric disorder or episode or having a history of one yourself—things that most moms don’t know about.
These risk factors include:
A traumatic pregnancy or birth: Did you or do you have hyperemesis gravidarum? Were you or are you on bed rest? Did you have an emergency c-section or other complications during delivery? Was your baby in the NICU? Did something that you found very frightening happen to either you or your baby during pregnancy, during birth, or after the birth?
An experience with emotionally painful or stressful experiences around pregnancy, childbirth and/or early parenting: Did you struggle with and/or were you treated for infertility? Have you suffered a previous miscarriage or other pregnancy loss? Did you just deliver multiples? Do you have a special needs baby? Does your baby have colic or a difficult temperament? Have you had difficulty with feeding your baby?
A history of domestic violence, sexual or other abuse: Were you abused as a child, or have you been as an adult?
A traumatic childhood: Did you have a traumatic childhood? Did you lose a parent? Did you have a troubling relationship with your own mother? Trauma as a child can have a VERY big impact on your emotional health as an adult, even if you think you’re “over it” and it’s “in the past.”
Stress: This is such a big one, and it surprises people, because everyone has stress right? But there are major stressors that can tip your brain over the proverbial edge. These include the loss of someone close to you, a job loss, financial hardship, divorce or strain in your relationship with your partner, and even a house move. Big changes in your life can have a big impact on your emotional health.
Lack of social support: Do you feel alone and as though you have no one to help you? Do you live far from your family and close friends? Do you feel like when you need help there is absolutely no one to ask? Are you a military wife whose partner is deployed?
- Personality: Are you a perfectionist? Do you have a controlling personality? Do you have low self-esteem? This is not so much a risk factor but studies are showing there is, as Karen Kleiman calls it, a “clinically relevant” relationship between this type of personality and having PPD or anxiety.
Here were my risk factors, none of which I had any awareness of when I had my first child and ended up with postpartum OCD:
- family history of mental illness
- baby with colic
- traumatic delivery
- traumatic childhood/traumatic relationship with mother
- perfectionist personality and likely had always had OCD but just didn’t know it
Any of these things can mean you are more likely to get PPD or a related illness than the mom next to you. They’re not a guarantee, but they raise your risk. And someone should tell you that. You should know about that.
You should know about postpartum depression risk factors. You should know that bipolar episodes raise your risk of postpartum psychosis. You should know whether you might end up having postpartum OCD and intrusive thoughts.
Because if you and every other mom knows, then she can be prepared. She can be read to learn what the symptoms are and identify them in herself. She can know that she needs to reach out for help and figure out who might be able to help her in her town. She can make sure her family or friends or someone in the community who cares are at the ready.
I was not aware of my risk factors AT ALL. I had:
1 – a family history of depression (WHY did no one tell me?!)
2 – stress (lost my dad shortly before getting pregnant)
3 – lack of social support (just moved to a new town)
And then I got PPD a second time because I was misdiagnosed and untreated the first time around. Now it’s my mission to make sure no one goes through what I did. You’ve inspired me, Katherine!
Also, if breastfeeding troubles count as a risk factor, then add that in as well! So much pressure because “breast is best”. How about: “feed your baby any way you can because blood is all he’s getting from your breasts”? Ick. Never again.
My favorite saying about breastfeeding is “breast is best….except when it’s not.” There are a whole host of reasons why women choose not to breastfeed or can’t breastfeed. It’s all about finding what works best for each individual mom and her baby.
My risk factors were/are:
Depression in family
High needs baby
I was one of those who had risk factors, but circumstances tipped me to the brink.
I’ve always struggled with my hormones during my cycles. Changing my eating habits helped me a LOT with regulating my moods, so I wasn’t too concerned about my chemical make-up. I am used to those surges and am good at knowing when and what to do to get myself back in gear. I didn’t think about the effect of the huge changes in a REALLY short period of time would wreak on my mental health. Got pregnant, bought a house, moved, quit my job to be a stay at home parent, got married and had the baby at home. (The ONE thing that went without a hitch!:)) Although I am only 6 months in I see at this point just how crucial emotional support and community is for me. If I had it all to do over again I would have really kicked my husband’s ass into gear. I would have stopped trying so hard to get anything done and just enjoyed being home with my baby. Piles of laundry and take out boxes be damned! Thank you for giving a voice to all of us who are struggling towards the light.
I had several risk factors–the loss of my only grandfather right after I found out I was pregnant, the sudden loss of my father 2 months before DD was born, loss of one vehicle in our household/being housebound, early severe nausea & unable to stay active during 2nd & 3rd trimesters due to unknown heart condition, living away from family & friends/less social support–I knew my risk was high and I made sure to get a diagnosis at 9 wks pp when I knew it had gone beyond just “baby blues”. It helped to know what the signs were, what to look for, how I was feeling and knowing what was “ok” and what wasn’t. Make sure you know, and those who love you know what to look for so you can get help as soon as you realize something is not right.
My risk factors were:
1. History of depression
2. OCD / Perfectionist / Control Freak Personality
3. Lack of help – My choice as a result of controlling personality.
4. Stress from work and pressure to breast feed.
My risk factor was my needlephobia during pregnancy. Every time the issue came up, I’d basically have a panic attack (always did in the past too, but I was/am pretty deft at avoiding needles). The stresses of not knowing whether a needle would be involved in delivery was probably what pushed me over the edge. And the fact that no medical providers know how to deal with anyone who panics about needles. My midwives were great, but even they didn’t “get it” until they saw my reaction the first time they tried to draw blood.
PPD is something that a lot of women don’t ever want and maybe even think they don’t have it when they really do. Too many women suffer with it and I think that it not only hurts them, but their new baby also.
I have the risk factors and pretty sure of the dx…I just have no hope of getting better and I feel as though I am drowning at the shore. My family thinks and tells me to just get over it I have absolutely no one to talk to as I have no insurance and am living off of the last of my savings. I tried the ppd “warmline” but didn’t get help..the person was from another country and said they would email me some resources if they could find some but I guess they couldn’;t. . I have tried the #ppdchat on twitter but never got any response. I am ready to just give up
My risk factors 1. hyperemesis gravidarum during entire pregnancy 2. emergency c section 3. babies spent time in the nicu 4,two babies with colic 5.stress from multiple issues including being left by ex at 6 months pregnant 6. lack of social support 7. low self esteem
I don’t know how much one person is supposed to take
1. Emergency C section
2. Lack of doctor support at the end of my pregnancy
4. HX of sexual abuse
5. Family hx of depression/ mental illness
6. Perfectionist/ control issues
I struggle, but I’ve not sought treatment. I don’t know how bad is bad and what is actually within the range of “to be expected.” Life just completely changed and I imagine, it will be a long period of adjustment. Trying to give myself some grace every day, but some days it isn’t enough.
Angela, that’s a heavy list. I’m sorry. You are so right, it is a long period of adjustment. Please consider treatment if you continue to struggle. You should give yourself that grace rather than go on a long time in this struggle. I’m sending you peace.
This is all such good information, and I really admire what you are doing.
The problem is that I came upon this site only after I had postpartum psychosis — twice. I am finding it healing to read all of the information and it is definitely helping me learn how the psychosis connects to other mental illnesses I face.
I wonder though… how do women find this site before even having a baby? I obviously agree that the information is important, but I can’t say I would have given this site a second glance during pregnancy.
At this point, I would love to help and share my story, but I am curious about the audience of your blog.
Oh so slowly, society is beginning to understand the need for education about maternal mental health before the baby arrives. So more doctors and counseling clinics are covering this, but yes, there is still much work to be done in making sure mamas have that education. There are also many many clinics, hospitals, etc, that are doing more thorough education and checklists with moms right after they have the baby, to see if any symptoms have arisen, and to help moms understand what things are red flags should they arise in the first few months.
If you are interested in sharing your story, we occasionally accept guest posts but cannot accept them all. We consider each and every submission though. Thank you for asking! If you want to submit something, you could send it to email@example.com
Thank you so much for your response. I am on board with your mission.
I got postpartum depression with my first child. She is now two and I just found out I am pregnant . I’m very unhappy about this pregnancy . I am petrified I will get post partum again . It’s been a constant argument with my husband all week . He wants the child and I do not . I’m three weeks. Will my feelings change ?
I believe your feelings can change, yes. It’s a BIG adjustment and of course you are scared after experiencing PPD. The reality is that it could happen again, but it may not. Everyone is different. This time you know what could happen and you can prepare. It would be good to stay on top of it as you go, by talking with your doctor. Some people stay on a low dose of a safe medication during pregnancy. Others prepare by increasing therapy. I hope those are options for you. It may be hard for a while, but it will get better if you keep reaching out for help. I’m sending you peace!
I can relate, too, Olivia. I got pregnant after suffering from severe ppd after the previous baby. I was deathly afraid and not at all happy about the pregnancy. I took the time to prepare for what was coming. I started seeing a therapist and was open to the OB about my condition. I began taking meds shortly after birth as I learned that the longer I let it go, the harder it was to get away from ppd. I prepared meals, arranged rides for my kids to get to school and came up with a support system for after birth. I did anything I could to reduce the stress afterward and increase the amount of sleep I could get (fatigue and tiredness do NOT help ppd). While I can’t say I avoided ppd entirely… it was definitely better and at least managed. I felt like I had control of the ppd instead of the other way around.
Sexually assaulted at 9 by my step father, again at 13, 16, 20, 25 by my uncle.
Family history of depression. I was diagnosed with depression at 13.
Mother had a lot of health issues while I was growing up, grew up early.
Verbally abused by my mother
Growing up in a broken home
Lost my father in 2008, my mother in 2012, my grandpa in 2014 (I was 5 months pregnant).
No emotional or physical support.
No one spoke to me about PPD and I didn’t even knew Anxiety was a thing after giving birth until this article. My mother had PPD with me while being severely depressed. I didn’t get help for anything. I hated breastfeeding, couldn’t get close to my daughter for the longest time even if I tried…there was a barrier. I had thoughts going through my head. I stayed in bed when she cried, my brother would yell and cuss at me to get up to take care of her. All I did was cry. She’s almost two, Things are better, but I still have my moments.