Postpartum blues have increased during the pandemic

As with so many other mental health issues, the COVID-19 pandemic has made postpartum mood disorders worse. One third of mothers who gave birth during the pandemic had postpartum depression and one in five had major depressive symptoms, according to a study done at the University of Michigan School of Nursing.

“Mental disorders in general are not spoken about as commonly as other diseases like diabetes and hypertension, so it’s actually more common than you think,” said obstetrician Tara Chute, MD at Cape Cod Hospital OB/GYN in Hyannis. “It’s estimated that about 10 percent of women experience this, which is really high.”

Most new mothers have some form of baby blues, due to lack of sleep and fluctuating hormone levels. Typically speaking, this should go away after the first two weeks. But if you experience a darker mood, excessive worries or emotional symptoms that just won’t go away, you might be suffering from a postpartum mood disorder, such as postpartum depression or postpartum anxiety.

This is not the time to suffer in silence, according to Dr. Chute and her colleague and fellow obstetrician Lindsay LaCorte, DO. Both doctors are mothers themselves and understand, firsthand, what new moms may be going through. They urge women to reach out if they have any concerning symptoms in the first six weeks after giving birth.

Dr. LaCorte listed the following reasons to call your obstetrician for a consultation right away:

• You are not bonding well with your baby.
• You are crying frequently.
• You are worrying excessively about the baby’s safety.
• You are not taking care of yourself.
• You are having thoughts that the baby would be better off with another caregiver.

Support people like partners and other family members should also be on the lookout for postpartum mood disorders.

“Anyone who notices any behavior that is out of character should speak up and not worry about hurting your feelings,” Dr. LaCorte said. She listed other ways family members can be proactive by asking the mother the following questions:

• What can I do to help?
• Do you need to take a nap?
• Do you need a break so you can take a shower?
• How are you feeling?

Dr. Chute said that most new mothers, herself included, have a hard time asking for help because they feel like they should be able to do it all themselves. She experienced that when she had her first daughter. But when she looks back on that time, she wishes she had asked for more help because it wasn’t as enjoyable of a time as it should have been. When her second daughter was born last year, she accepted help. She let people bring meals and let her husband feed the baby a bottle in the night.

“That was a better and a more enjoyable experience,” Dr. Chute said. “I decided you need to give yourself permission to accept the help that people want to give you.”

It can be difficult for new mothers to get the mental healthcare they need, and this has been especially true during the pandemic, she said. Talk therapy takes time, which a lot of new mothers don’t have. Mothers who are nursing are often leery of taking medications because they are worried it might harm the baby, but the amount of medication from a low dose of an antidepressant that would pass through breast milk is negligible, according to Dr. Chute.

Not taking medication would be more dangerous, she said. This can be especially true for women who were already on medication before pregnancy. Those patients definitely should not stop taking their medications, she added.

“In the past, women would be told to wean off their antidepressant or their anti-anxiety medication in the third trimester,” Dr. Chute said. “And then they would have the baby, which is the highest-risk time. When they’re sleep deprived and trying to nurse in the middle of the night, and then they are off of their medication. And that is not good or safe for the baby or mom.”

Anyone who already had a mood disorder before pregnancy should be especially vigilant about their symptoms and should seek therapy, if they are experiencing any signs of postpartum mood disorder, Dr. LaCorte said. Because there can be wait times to see a therapist, she recommended reaching out early in the pregnancy to set things up and discuss medication changes.

Massachusetts also has a program called Massachusetts Child Psychiatry Access Program (MCPAP) that provides resources for both new mothers and for doctors.

“It helps train providers like us to be comfortable in recognizing and diagnosing and starting medication safely,” Dr. Chute said. “It has resources for us to be able to call a psychiatrist so that we can get a consultation to be able to help prescribe, so we feel very comfortable doing that management for women.”

Once someone is diagnosed with a postpartum mood disorder both doctors said they follow them quite closely. “We check in with women to make sure they know we want to be part of this with them – to evaluate them, diagnose it and help them through this,” said Dr. LaCorte.

A Perfect Storm for Mood Disorders

The reason postpartum mood disorders went up during the pandemic has a lot to do with the realities of the pandemic itself, Drs. LaCorte and Chute said. There was a loss of a much-needed support system due to quarantines, and new mothers were cautious about letting anyone in the house with their new baby. Plus, many grandmothers and other older female relatives, who are usually the biggest part of the support system, were absent due to contagion concerns, travel restrictions, or they had fallen sick or died from COVID-19.

On Cape Cod, many people relocated to second homes here from areas like New York City where the COVID numbers were high. That left those women separated from their normal friends and social supports.

Importance of Breastfeeding

According to the University of Michigan study, moms who fed their babies formula had 92 percent greater odds of screening positive for postpartum depression and were 73 percent more likely to screen positive for major depressive symptoms, compared to those who breastfed or bottle-fed with their own human milk.

There are some intuitive reasons why that would be true, Dr. Chute said. First of all, breastfeeding promotes positive bonding. Cape Cod Hospital is part of the Baby-Friendly Hospital Initiative, which means that all babies born at the hospital have uninterrupted skin-to-skin contact with their moms for the first hour of life. Moms are also encouraged to breastfeed because studies have shown that skin-to-skin breastfeeding and more time bonding decreases postpartum depression.

“If you think about it physiologically, the endorphins from holding a baby alone, never mind hours of skin-to-skin time, is really helpful, so it does make a lot of sense,” Dr. Chute said.

Both doctors strongly encourage women to get vaccinated for COVID-19 during pregnancy. In general, pregnant women are extremely hesitant to try something new because they don’t want to have any negative consequences on their pregnancy, but COVID, itself, is quite dangerous during pregnancy, the physicians said. Unvaccinated pregnant women who contract the virus are at a much higher risk for miscarriage, stillbirth, hypertension disorders and pre-term delivery. They also have a higher risk of being hospitalized and ending up intubated in the ICU.

Dr. LaCorte points out another advantage to vaccination: “If you think about it, children of mothers who got vaccinated during pregnancy are the only ones under 5 who are vaccinated,” she said. “This is your baby’s best chance to go the next five years without COVID.”