Postpartum Depression and the Holidays

Chandrika Balgobin, DO, PMH-C, perinatal psychiatrist for Women’s Behavioral Health Services , Shana Bellow, Ph.D., LCP, psychologist, Inova Women’s Behavioral Health Services  and Tara Croan, LCSW, PMH-C, perinatal therapist for Women’s Behavioral Health Services

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Editor’s note: Although “postpartum depression” is the term most people know, a more fitting term is perinatal mood and anxiety disorders, or PMADs. PMADs are the most common complication of pregnancy, and about one in five moms will experience a PMAD during pregnancy or the first year postpartum.

Who is at risk of developing PMADs?

PMADs can happen to anyone who is having a baby, and there are a number of additional risk factors that can put moms and partners at higher risk. They include:

• A personal or family history of mental health disorder
• Having a history of sensitivity to hormone shifts
• Lack of support or strain in your primary relationships
• A history of losses (both family losses and pregnancy losses)
• Financial stress
• Perfectionist tendencies (a “Type A” personality)

The pandemic is another significant risk factor. “Moms (and partners) are very much struggling as a result of the pandemic. Based on recent research, the rate of PMADs has at least doubled during COVID-19,” said Tara Croan, LCSW, PMH-C, perinatal therapist, Women’s Behavioral Health Services.

What are the symptoms of PMADs?

PMAD symptoms vary widely from person to person and can include:

• Low mood
• Frequent tearfulness
• Not finding joy in things you used to enjoy
• Not being able to sleep (or fall back to sleep) when baby is sleeping
• Detachment from baby or difficulty bonding
• Intrusive thoughts or catastrophic worries
• Panic attacks
• Irritability, anger or rage
• Feeling like a bad mom
• Symptoms of post-traumatic stress, such as re-experiencing a trauma related to childbirth or a previous trauma triggered by pregnancy or birth
• Avoidance

Why the holidays can be especially challenging for women dealing with PMADs

With all of their joy – and all of their expectations – the holidays can feel like a “perfect storm” of stressors for women dealing with PMAD. There are many reasons for this. “The perinatal period is a time of massive adjustments, coupled with numerous causes for low energy,” said Chandrika Balgobin, DO, PMH-C, perinatal psychiatrist for Women’s Behavioral Health Services. “The holidays are a busy and social time focused on family, which can clash with PMAD symptoms that may include decreased enjoyment of social situations and overwhelm. For individuals with idealized expectations, there may be pressures and higher levels of stress during the holidays as well.”

“In addition, if a family experienced a pregnancy loss or other losses, the holidays can be an especially difficult time as they remember their baby or loved ones,” Croan said.

Decision fatigue can also play a role, as can difficult family dynamics and COVID-19-related concerns about exposure.

Tips for coping with the holidays

• Examine expectations for the holidays. While the holidays can be exciting, fun and memorable, they can also be stressful. While having something fun to look forward to can be helpful, you’re probably already tired and overwhelmed, so consider how you might be flexible and easy on yourself if holiday plans don’t go as hoped. Connect to what’s important to you about the holidays – they don’t have to be perfect to be wonderful.  
• Tune into your feelings and needs. Each day, ask yourself, “How am I feeling, and what do I need?” Allow yourself to feel whatever feelings come up – they might be painful, but feelings can’t hurt you. 
• Self-care. After identifying your needs, figure out a plan with your support system to carve out time to take care of yourself. It could be a warm bath or shower, a quiet walk around the block or neighborhood, getting out in nature, reading a book for fun, vegging out, or just having some quiet time to yourself somewhere.  
• Take breaks. The holidays and family dynamics can be overwhelming, particularly when you’re sleep deprived and caring for a baby 24/7. Come up with a secret signal with your partner to let each other know when you need breaks. 
• Set boundaries and ask for what you need. Complicated dynamics with family members call for thoughtful boundaries you’d like to set as your new family unit. Navigating COVID-19 concerns can add a layer of anxiety about family interactions. Think in advance about what would make you feel safe this holiday season. It’s okay to ask for what you need to feel safe during your pregnancy or with your new baby. 
• Get support. You don’t have to be alone with your pain and difficult feelings. Share your feelings with a loved one, a friend, a mental health provider or another trusted source of support. Our area has excellent support groups and resources available, including Postpartum Support Virginia and Postpartum Support International.

The most important thing for women and families to know is simple: you are not alone, and you don’t need to suffer. There are excellent, evidence-based treatments available that can help you – there is hope. “If you’re feeling down, not feeling like yourself, or feeling overwhelmed with anxiety or worries, and if these feelings are getting in the way of you doing daily tasks or connecting with others, know that there is hope, help and support available,” said Dr. Balgobin.

References and Resources

1. Postpartum Support Virginia: Resources and Fact Sheets for Parents and Families.
2. Rachel M. Diamond, Kristina S. Brown, and Jennifer Miranda. “Impact of COVID‑19 on the Perinatal Period Through a Biopsychosocial Systemic Framework.” Contemporary Family Therapy.
3. Mental Health America. Preparing for the Holidays During COVID-19.
4. Harvard T.H. Chan School of Public Health. Pregnant and Postpartum Women Report Elevated Depression, Anxiety, and Post-Traumatic Stress During COVID-19 Pandemic.
5. Archana Basu et al. “A Cross-National Study of Factors Associated with Women’s Perinatal Mental Health and Wellbeing During the COVID-19 Pandemic.” Plos One.

If you or someone you know is dealing with feelings of depression, anxiety or chronic stress, a mental health professional can help you to develop the tools to help yourself. Learn more about Inova Behavioral Health Services, or by calling 571-623-3500.