Postpartum stress:

An evidence-based guide

© 2007 -2013 Gwen Dewar, Ph.D., all rights reserved

What causes postpartum stress?

Giving birth is stressful. During labor, the hormones associated with psychological stress--epinephrine and cortisol--rise by a whopping 500% (Alehagen et al 2001). After childbirth, women may experience a number of physical stressors, like perineal pain, torn tissues, backaches, and urinary tract problems.

But for many parents, the most intense stress is psychological. Parents may find themselves plagued by

• Poor sleep

• Fears and anxieties about the baby’s health

• Worries about the post-pregnancy body and sexuality

• Disappointment about the quality of support received from one’s partner

• Guilt over having negative thoughts about the baby or parenthood

• Financial worries or pressures related to returning to the workplace

And parents may also suffer from the "baby blues," postpartum depression, or postpartum obsessive-compulsive disorder.

The "baby blues," characterized by feelings of sadness, anxiety, and mood swings, is the most common condition, estimated to affect 50-80% of all postpartum mothers (Hopkins et al 1984). Symptoms typically begin within the first 10 days postpartum (O’Hara 1995) and may be triggered by the sudden reduction of progesterone levels after childbirth (Harris 1996).

Postpartum depression and postpartum obsessive-compulsive disorder are less common, but not unusual.

What makes postpartum stress so intense, and what can we do about it?

Get social support

The evidence is compelling on this point. Parents suffer less distress and handle things better when they get good social support (Hung et al 2011). More generally, people experience greater well-being, less disease, and live longer when the individuals around them are helpful and responsive.

You can read more about the evidence that social support buffers us against stress in my blog post "Stressful, unsupportive mates can shorten your life," and in my articles about responsive, sensitive parenting and the links between social support, religious affiliation, and health.

Get sleep

New parents are stressed because they don’t get enough sleep. But it’s not just a question of lost hours. For one thing, the weird timing of newborn sleeping schedules can disrupt the parent’s internal clock. Recent research suggests that baby “jet lag” causes insomnia and postpartum depression (Flora 2005).

For another, sleeping in short intervals is less restorative than sleeping in longer sessions. Short naps skimp on slow-wave sleep (SWS), a sleep stage associated with reduced stress hormone levels. When people are chronically deprived of SWS, their basal stress hormones climb.

For more information about newborn sleep--including tips that may help reduce postpartum stress--see this article on newborn sleep patterns.

Abandon unrealistic expectations

New mothers may themselves to unrealistic standards—expecting to feel only happiness and selfless, nurturing love after the birth of their children. When the postpartum experience doesn’t measure up to expectations, mothers may feel inadequate, disappointed, and let down (Pancer et al 2000).

If you are the victim of unrealistic expectations, take a reality check. Newborn care is often exhausting, stressful, dirty work. And recent research suggests that negative thoughts and emotions are a normal part of the postpartum period.

A study conducted by the British National Health Service (Hall and Wittkowski 2006) found that healthy mothers experienced many of the same negative thoughts as do women with postpartum depression. Another study found that women reported similar rates of anger, annoyance, resentment, and irritability before and after childbirth (Graham et al 2002). New mothers have reason for joy. But childbirth does not magically transform women into perfectly patient and serene Madonnas.

Understand that childbirth stress can have lingering effects

Women who receive little social support during childbirth have more difficulty postpartum, even weeks later. In fact, in a recent study of American mothers, 18% of respondents reported symptoms of post-traumatic stress disorder (Beck et al 2011).

Read more about it in my article about childbirth trauma.

Recognize that some newborns are more difficult to care for

Newborns have individual temperaments. Some are relatively easy going. They’re good sleepers and relatively easy to soothe. Some are very fussy or “high need” babies who need constant attention. And some suffer from colic—bouts of excessive, inconsolable crying.

Clearly, babies who are “high need” and/or colicky are more work. You’re going to have a tougher time if your infant cries persistently despite your attempts to feed, soothe, and hold him. But learning more about persistent crying may help you cope. For more information, see the Parenting Science article, "Infant crying, fussing, and colic: An anthropological perspective on the role of parenting."



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References

Alehagen S, Wijma K, Lundberg U, Melin B, and Wijma B. 2001. Catecholamine and cortisol reaction to childbirth. International journal of behavioral medicine, 8(1): 50-65.

Beck CT, Gable RK, Sakala C, and Declercq ER. 2011. Posttraumatic stress disorder in new mothers: results from a two-stage U.S. national survey. Birth. 2011 Sep;38(3):216-27.

Flora, C. 2005. An ordinary trigger for the baby blues. Psychology Today 38(2): 21.

Graham JE, Lobel M, DeLuca RS. 2002. Anger after childbirth: An overlooked reaction to postpartum stressors. Psycholgoy of women quarterly, 26: 222-233.

Hall PL and Wittkowski A. 2006. An exploration of negative thoughts as a normal phenomenon after childbirth. Journal of midwifery and women’s health 51(5): 321-330.

Harris B. 1996. Hormonal aspects of depression. International Review of Psychiatry 8(1): 27-36.

Heh SS, Fu YY, and Chin YL. 2001. Postpartum social support experience while “doing the month” in Taiwanese women. J Nurs Res 9(3): 13-24.

Hopkins J, Marcus M, Campbell SB. 1984. Postpartum depression: A critical review. Psychological bulletin, 95: 498-515.

Hung CH, Lin CJ, Stocker J, and Yu CY. 2011. Predictors of postpartum stress. J Clin Nurs. 20(5-6):666-74.

Hung CH. 2006. Correlates of first-time mothers’ postpartum stress. Kaohsiung Journal of Medical Science 22(10): 500-7.

Hung CH and Chung IL. 2001. The effects of postpartum stress and social support on postpartum women's health status. Journal Adv Nursing, 36(5):676-84.

McLean M and Smith R 1999. Cortioctropin-releasing hormone in human pregnancy and parturition. Trends Endocrinol Metab 10: 174-178.

O’Hara MW 1995. Postpartum depression: Causes and consequences. New York: Springer-Verlag.

Content last modified 3/13