Postpartum stress:

A guide for the science-minded parent

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

If you want more information about specific postpartum stressors, see these articles on

• pregnancy hormones

• childbirth experiences

• newborn sleep patterns

Introduction

After childbirth, women may experience other physical stressors--perineal pain, torn tissues, backaches, and urinary tract problems.

These physical ailments—along with the exhaustion caused by labor—contribute to the stress of new motherhood. But for women with access to good medical care, the stress of childbirth is only part of the story.

The really crazy stuff happens when parents begin taking care of their newborn babies.

Life with baby: What triggers postpartum stress

Newborns have very small stomachs, and as a result they need to feed very frequently—8 to 12 times a day. For some babies, feedings may last 30 minutes or more. This doesn’t leave much time between the end of one feeding and the beginning of the next. Add infantile digestive problems and diaper duties, and some moms are lucky to get more than 30 minutes of rest time at a stretch—day or night.

This crazy, fragmented patchwork of sleep is a profound physical stressor—perhaps the worst of them all. Other sources of physical stress may include noise stress (caused by colicky babies) and breast pain (caused by engorgement, latching problems, and/or mastitis).

But along with sleep deprivation, new mothers rate psychological stressors as the most distressing. In one study of first-time mothers (Hung 2006), women named these as their top ten postpartum stressors:

• Interrupted sleep

• Insufficient sleep

• Feeling that one’s life is restricted

• The baby’s choking during feeding

• Sudden sickness in the baby

• Unpredictability of the baby’s schedule

• The baby’s crying

• Lack of information about baby growth and development

• Worry about the baby’s sleeping position and its effects on head shape

• Upset about a flabby, postpartum belly

Interestingly, these stressors were named by women in Taiwan, where new mothers traditionally spend the first month after childbirth in seclusion. During this postpartum seclusion, the new mother is accompanied by an older woman (her mother or mother-in-law) and is relieved from most household chores. While the tradition gives rise to its own stressors (for example, some new mothers would prefer to spend their confinement with their husbands—Heh et al 2001), the social support associated with postpartum seclusion may have a protective effect. Compared to Western mothers, Taiwanese mothers report relatively low levels of postpartum stress overall (Hung and Chung 2001).

• Fears and anxieties about the baby’s health

• Breastfeeding problems

• Feeling criticized by friends, family or child care experts

• Untimely phone calls

• Social pressure to receive visitors

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

• Guilt over having negative thoughts about the baby or motherhood

• Pressures related to returning to the workplace

• Fatigue, anxiety, and other symptoms caused by postpartum thyroiditis

• Financial worries

And let’s not forget the baby blues, an extremely common condition (estimated to affect 50-80% of all postpartum women) characterized by feelings of sadness, anxiety, and mood swings (Hopkins et al 1984). The baby blues typically begin within the first 10 days postpartum (O’Hara 1995). Studies tracking mood and hormone levels in postpartum women suggest that the baby blues are triggered by the sudden reduction of progesterone levels after childbirth (Harris 1996). It seems likely sleep deprivation and disappointed expectations also play a role. Less severe and long-lasting than postpartum depression, the baby blues usually improve within a few days or weeks. But while they last, they may cause feelings of loss, helplessness, or inadequacy—important psychological stressors.

So those are the most common triggers of postpartum stress. But why are these stressors so distressing?

In some cases, the answer is obvious. If your baby is seriously ill, you experience terrible emotional stress. However, even otherwise healthy families can experience high levels of postpartum stress. There are several reasons for this.

What makes postpartum stress so intense?

Unrealistic expectations cause feelings of failure

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.

Childbirth stress can have lingering effects

Elevated stress hormones may prepare the brain for motherhood

Postpartum sleep patterns raise stress hormone levels

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.

Some newborns are more difficult to care for

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. And you’re going to experience more emotional strain and postpartum stress.

If you have a fussy or high-need baby, I recommend The Fussy Baby Book by William and Martha Sears (Little, Brown and Company 1996).

References

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. 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 12/07