Postpartum Depression: Can You Have It More Than Once?

May is Maternal Mental Health Month, so HuffPost Parenting and Wellness are shining a light on postpartum well-being. From how new moms handle those early days as parents while struggling with their own mental health to how to be there for friends and family, we’ve created a space for moms and their loved ones to feel seen and heard in those first trying months of parenthood. See the full series here.

After Sara Ahmed’s first child was born in 2008, she was struggling emotionally. Sure, there were moments of joy during that first year, but she was also feeling lost, sad and hopeless.

“Compounded with the most exhausting sleep schedule and fatigue that really, nothing can prepare you for of my life, it really made for an isolating and confusing time for me,” Ahmed, a writer who covers motherhood, mental health and other subjects on her blog Sugar Land Sara, told HuffPost.

It took a year for Ahmed to realize that something wasn’t right with her. She finally made an appointment with a psychiatrist who diagnosed her with postpartum depression and started her on a low-dose antidepressant.

“That and therapy made all the difference in the world,” Ahmed said.

“Having an established relationship with a therapist felt like a security blanket because I knew if I started to drown, I wouldn’t be trying to find help in the midst of it all.”  – Sara Ahmed, mental health and motherhood writer

When she had her second child in 2013, Ahmed’s PPD did return — as it does for many moms — but this time, she felt much more prepared. She knew more about the condition, what causes it and how to manage it. She had already scheduled some appointments with a psychiatrist and a therapist during the first several months of her son’s life. And she was more open with loved ones about what she was going through.

Just knowing the upheaval my mind — and not just body — would go through postpartum really helped me set more reasonable expectations for life with a newborn again,” Ahmed said. “And honestly, having an established relationship with a therapist felt like a security blanket because I knew if I started to drown, I wouldn’t be trying to find help in the midst of it all.”

If you’ve been through postpartum depression before, you may worry about what this means for your future pregnancies. Below, experts explain the chances of it coming back and offer advice on how to prepare if it does.

Women who have had PPD before are at greater risk of having it again.

Postpartum depression is a mental health disorder that impacts 10 to 15% of mothers. Symptoms of PPD may include persistent feelings of sadness, irritability or worthlessness, trouble bonding with the baby, difficulty concentrating, loss of interest in activities or hobbies you once enjoyed and thoughts about harming yourself or your child, among others. These mood changes last longer than the “baby blues” that many women experience during the first couple weeks after giving birth.

Having a history of postpartum depression does, indeed, put women at an increased risk of recurrence. Studies have indicated that anywhere from 25% to 50% of moms will develop PPD again after a subsequent pregnancy.

Other factors that raise your risk of PPD, according to perinatal and reproductive psychiatrist Alison Reminick, include having prenatal depression or anxiety, a family history of depression or anxiety, dealing with a recent stressful life event (like the death of a loved one), a lack of social support, a poor relationship with your partner, child care stress and an infant with a difficult temperament. Having complications with pregnancy, birth or breastfeeding can also play a role.

But that doesn’t mean PPD is a certainty.

First-time moms often have no idea what to expect when it comes to childbirth and caring for a newborn. The unfamiliarity and uncertainty can be overwhelming and can lead to feelings of anxiety, helplessness and hopelessness. But by the time you have a second or third child, you have considerable experience under your belt — and that can make a big difference.

“You know that you may not have the birth experience you desire, you know that breastfeeding might be difficult, you know the first three months are the hardest and that sleep is a luxury,” said Paige Bellenbaum, founding director of The Motherhood Center mental health clinic in New York City.

“You have perspective,” she added. “This knowledge allows for mothers to be prepared in a different and better way.”

Plus, you’re able to make more informed decisions about birth, infant care and self-care the second time around, all of which can have a positive effect on your mental and emotional well-being.

Having some firsthand motherhood experience under your belt allows you to be prepared "in a different and better way," the next time, said Paige Bellenbaum, founding director of The Motherhood Center.
SelectStock via Getty Images/Having some firsthand motherhood experience under your belt allows you to be prepared “in a different and better way,” the next time, said Paige Bellenbaum, founding director of The Motherhood Center.

“You can choose to stay on your medication during pregnancy if your symptoms returned last time when you went off of it. You can decide that you want an epidural this time because your natural birth the first time felt traumatic physically and emotionally,” Bellenbaum said.

“You can decide to have a doula present during birth because last time you felt like nobody was taking you seriously or advocating for you during delivery. You know you can line up a postpartum doula or night nurse to help with night feeds so you can get more sleep or have your husband or another family member take some nights during the week.”

How moms can be better prepared the next time around:

Mothers who have dealt with PPD before are more equipped to deal with the condition if it does happen again. You may not be able to prevent PPD entirely, but you can at least reduce the severity and length of your symptoms.

Talk to a therapist while you’re pregnant — and preschedule some appointments for after the baby arrives.

Start building a relationship with a mental health professional during pregnancy so you have someone on speed dial during the postpartum period. They can help you address any symptoms before they reach an unmanageable level, said Reminick, the director of women’s reproductive mental health at the University of California, San Diego.

A therapist can also connect you with a psychiatrist specializing in perinatal mental health who can prescribe medication if needed.

“Certain medications have also been FDA approved and are successful in treatment of PMADs [perinatal mood and anxiety disorders], if needed, and many are compatible with breastfeeding,” Reminick said. “Meeting with a reproductive psychiatrist to assess for possible need for medication prior to or during pregnancy can also minimize risk.”

Before the baby comes, have conversations with your partner or a close family member about what signs to look for.

What were some of your early symptoms the first time around? Discuss these — and others — with your loved ones ahead of time so you can all keep an eye out. If the signs weren’t apparent to you then or you’re having trouble remembering, ask someone close to you what they noticed at the time.

“Was it a loss of appetite? Was it not getting enough sleep? Was it feeling and acting irritable and easily frustrated? Create a checklist so that you can go through the symptoms in real time if they start to recur,” Bellenbaum said.

Lean on family, friends and caregivers for help.

Moms often feel immense pressure to do it all themselves. But having a strong support system in place — and being willing to accepting their help — is essential.

These people can provide a listening ear when you need to vent, check in to see how you’re doing, offer to pitch in with household chores like cooking and cleaning, watch your other children or help care for the baby.

“Loved ones can help recruit and organize support — this can be family, friends, or a doula, nanny, or mother’s helper,” Reminick said. ”They should encourage daily outings like a walk or running an errand and allow healthy time away from the baby to engage in self-care. Allowing for a daily, uninterrupted four to five hour period where the mother can rest, relax or sleep can be very effective in staving off and alleviating PMADs.”

“The sooner you can get on top of your symptoms with treatment, the sooner you can feel better, return to your baseline and enjoy motherhood again.”  – Paige Bellenbaum, founding director of The Motherhood Center

Reminick also encourages her patients to think about what responsibilities can be outsourced during the postpartum period to allow more time for mom to connect with the baby and other loved ones.

“Can meals be made in advance or can family and friends help with a meal train? Can the family use paper plates and cups so dishes do not have to be cleaned? Can they invest in a robot vacuum cleaner?” she said.

And if you feel PPD coming back, don’t wait to get help.

“The sooner you can get on top of your symptoms with treatment, the sooner you can feel better, return to your baseline and enjoy motherhood again,” Bellenbaum said.

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