Not Just Tired: The Darker Side of New Motherhood

 Vrinda Modi

Not Just Tired: The Darker Side of New Motherhood

“134, we got a suicidal,” the radio crackles. As my EMS crew heads to the apartment, I think back to my training, where there was little instruction on how to help those experiencing suicidal ideation. A middle-aged woman sits on the couch, visibly exhausted and cowering from the police officers surrounding her. Her husband, cradles an infant gently in his arms, his face a mix of concern and helplessness. I turn down my radio, sit beside her, and begin asking questions, careful not to sound interrogative. She confesses feeling suicidal since giving birth three weeks ago, her voice trembling with shame. She hasn’t slept properly in days. Although she has no plan to harm herself, her worsening thoughts drove her to call the suicide hotline. Her mother-in-law enters, coldly urging her to “wrap things up.”

 The woman’s shame deepens when she refuses to go to the hospital, embarrassed by the stigma around postpartum depression and the idea of this whole encounter happening in front of her family. She doesn’t trust the hospital to treat her any differently. I suggest she visit the hospital on her own terms and follow up with her doctor, but I can’t shake the inadequacy of my words. What resources do we truly have for a mother battling PPD in a society that demands perfection?

According to the CDC, PPD affects 1 in 8 mothers, yet stigma and insufficient care leave many to suffer in silence. Only 50% of women with PPD are diagnosed, and just 6% seek help. New mothers face immense mental pressures as they recover from labor, manage doctor’s appointments for themselves and their babies, rear their newborns, and navigate family expectations—all while adjusting to their changing bodies. While PPD shares symptoms with clinical depression—such as sadness, hopelessness, and worthlessness—it typically develops 1 to 3 weeks after childbirth. PPD can also lead to difficulties bonding with the baby and an increased risk of infanticide. 

While research is expanding, our understanding of PPD is still limited. A meta-analysis by researchers at the University of North Carolina at Chapel Hill highlighted the role of rapid hormonal changes, particularly the sharp drop in estrogen and progesterone within 24 hours of childbirth, as a potential trigger for PPD. These hormonal shifts, along with immune system changes, genetic predisposition, thyroid dysregulation, and altered brain activity in mood-related regions, all contribute to the development of PPD in susceptible women. 

But what makes a woman “susceptible”? The risk factors include a history of mood disorders, lack of social support, poor marital relationships, traumatic deliveries, and domestic violence, and detection occurs by questionnaire during postpartum visits, known as the Edinburgh Postnatal Depression Scale. However, a staggering 40% of women don’t attend these visits, according to the American College of Obstetricians and Gynecologists. And the screening itself has issues. Robert Berezin, a psychiatrist at Harvard Medical School, writes, “There certainly is no place for some silly multiple-choice test. It means the patient ought to be understood and known as the person she is…Unfortunately, this usually doesn’t take place in the impersonal time-limited meetings that gynecologists, pediatricians, and primary care doctors are restricted by.”

Looking at the current treatments for PPD, pharmacologic therapies are a priority and include selective serotonin reuptake inhibitors—such as Prozac and Zoloft—as the first line of therapy for moderate to severe PPD. A Cochrane review found that SSRIs can significantly improve symptoms, but questions remain about their side effects, long-term efficacy, and safety while breastfeeding. In recent times, a newer drug has emerged on the market: brexanolone. But, Kelly Brogan, a holistic women’s health psychiatrist, writes in a blog post about her skepticism of the drug. The clinical trials consisted of only 247 women, with the drug having an unknown mechanism of action, costing an average of $34,000 for a single treatment, and was not tested on breastfeeding women. Moreover, brexanolone needs to be administered over 60 hours under medical supervision, making it impractical for many.

Psychotherapy, including cognitive behavioral therapy (CBT) and interpersonal therapy (IPT), offers another effective route, particularly for women concerned about the safety of antidepressants while breastfeeding. But despite these therapies’ promise, research lags far behind pharmacological options, which are still more effective in comparison. We need more robust studies on these treatments to understand how they can work alongside or even replace medication in certain cases.

On the other hand, social support is also crucial for helping women with PPD, alongside traditional treatments. However, the US lags behind, offering no paid parental leave in most states, while countries like Britain, Sweden, and Japan offer 39 to 82 weeks. Postpartum rituals in many cultures, such as Mexico’s 30-day "cuarentena" and China’s "doing the month," offer rest, special diets, and support that help protect against PPD by providing guidance and social support. Mandy Major, a postpartum doula, suggests that the absence of these formal postpartum customs in Western societies may contribute to higher rates of PPD, writing “It’s a very hard sell to tell [American mothers] that they need to slow down. And even if they know they should slow down, they don’t know how to slow down.”

As I left the apartment, I couldn’t shake the feeling that we are failing women like the mother I met. The healthcare system addresses PPD with a patchwork of incomplete solutions, while societal stigma adds another layer of silence. Medication, therapy, and support services all play a role in recovery, but they are often inaccessible, insufficient, or both. As Brogan writes, “[We must] ask why a woman is struggling, and to respond with a sincere cultural effort to meet her basic human needs before telling her she is broken and in need of medication.” We need to create a system that acknowledges the immense pressures of motherhood and meets mothers where they are, with empathy and support.
















References

  1. Centers for Disease Control and Prevention, Division of Reproductive Health. (2020). Pregnancy Risk Assessment Monitoring System (PRAMS). Washington, DC: Centers for Disease Control and Prevention. https://www.cdc.gov/prams/prams-data/mch-indicators/states/pdf/2020/All-Sites-PRAMS-MCH-Indicators-508.pdf. 

  2. Amer, S. A., Zaitoun, N. A., Abdelsalam, H. A., Abbas, A., Ramadan, M. S., Ayal, H. M., Ba-Gais, S. E. A., Basha, N. M., Allahham, A., Agyenim, E. B., & Al-Shroby, W. A. (2024). Exploring predictors and prevalence of postpartum depression among mothers: Multinational study. BMC public health, 24(1), 1308. https://doi.org/10.1186/s12889-024-18502-0

  3. Grissette, B., et al. (2018). Barriers to Help-Seeking Behavior Among Women With Postpartum Depression. Journal of Obstetric, Gynecologic & Neonatal Nursing, Volume 47, Issue 6, 812 - 819

  4. Suryawanshi, O., 4th, & Pajai, S. (2022). A Comprehensive Review on Postpartum Depression. Cureus, 14(12), e32745. https://doi.org/10.7759/cureus.32745

  5. Schiller, C. E., Meltzer-Brody, S., & Rubinow, D. R. (2015). The role of reproductive hormones in postpartum depression. CNS spectrums, 20(1), 48–59. https://doi.org/10.1017/S1092852914000480

  6. McKinney, J., Keyser, L., Clinton, S., & Pagliano, C. (2018). ACOG Committee Opinion No. 736: Optimizing Postpartum Care. Obstetrics and gynecology, 132(3), 784–785. https://doi.org/10.1097/AOG.0000000000002849

  7. Berezin, R. (2016). Baby Blues, Postpartum Depression & Psychosis: Countering the Danger of Antidepressants. Mad in America.

  8. Frieder, A., Fersh, M., Hainline, R., & Deligiannidis, K. M. (2019). Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development. CNS drugs, 33(3), 265–282. https://doi.org/10.1007/s40263-019-00605-7

  9. Stowe ZN, Casarella J, Landry J, Nemeroff CB. Sertraline in the treatment of women with postpartum major depression. Depression. 1995;3(1–2):49–55. doi: 10.1002/depr.3050030109. 

  10. Molyneaux E, Howard LM, McGeown HR, Karia AM, Trevillion K. Antidepressant treatment for postnatal depression. The Cochrane database of systematic reviews. 2014(9):Cd002018. doi: 10.1002/14651858.CD002018.pub2.

  11. Milgrom J, Gemmili AW, Ericksen J, Burrows G, Buist A, Reece J. Treatment of postnatal depression with cognitive behavioural therapy, sertraline and combination therapy: a randomised controlled trial. Aust N Z J Psychiatry. 2015;49(3):236–45. doi: 10.1177/0004867414565474.

  12. Major, M. (2020) What Postpartum Care Looks Like Around the World, and Why the U.S. Is Missing the Mark. Healthline.

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