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.
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
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
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."
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):
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,
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