Deep breath. Let's talk about something really important.
If you're reading this and you're not feeling like yourself after having a baby, I want you to know something: you don't have to wait to feel better. You don't have to "give it more time" or "push through it" or wait until things get so bad that you can't function anymore. In fact, waiting to seek care for postpartum depression is one of the biggest disservices we do to ourselves as new moms.
I see this pattern all the time in my practice. Moms come in months after their symptoms started, apologizing for "finally" reaching out. They tell me they thought it would get better on its own. They thought they were just tired. They thought this was normal. They thought they should be able to handle it.
Here's what I want you to know: postpartum depression is not something you should have to "handle" alone.
What Postpartum Depression Actually Looks Like
Let's talk about what we're actually dealing with here. Postpartum depression isn't just feeling tired (though exhaustion is certainly part of new parenthood!). It's also not the same as the "baby blues" which can happen in the first couple of weeks after delivery and usually resolve on their own.
Postpartum depression can include: (please note here symptoms vary person to person)
If you're experiencing any of these symptoms, this is not your fault. This is not a character flaw. This is a medical condition that deserves treatment, just like any other medical condition.
Why Waiting Makes Things Harder
Here's the truth: postpartum depression doesn't usually get better on its own. In fact, the longer it goes untreated, the more it can impact you, your baby, and your whole family.
We know from research that untreated maternal mental illness can affect infant development, bonding, and even a child's emotional development years down the line. (Remember when we talked about happiness being contagious? Well, unfortunately, some of the struggles of depression can impact our little ones too.)
But here's what else happens when we wait: we suffer unnecessarily. Every day you're struggling is a day you're missing out on feeling more like yourself. Every week that passes makes it harder to reach out because now it feels like you've waited "too long" or you feel guilty about not getting help sooner.
NO! That is absolutely not the case. It is never too late to get help, but it's also never too early.
The Problem With "Just Give It Time"
As doctors we sometimes accidentally contribute to this problem. We tell new moms to "give yourself grace" and "it takes time to adjust" and while those things are absolutely true, they can also make it really confusing to know when struggling crosses the line into needing professional help.
The answer? If you're wondering whether you should reach out, reach out. If you're reading this article because something doesn't feel right, trust that instinct. You don't need to wait until you're in crisis. You don't need to wait until you "can't take it anymore." You can seek help when you're just starting to struggle.
Why Two Weeks Matters
This is where I want to tell you about something that makes me really proud of the work we do at Reproductive Psychiatry and Counseling (RPC). In most cases, we're able to see new patients within two weeks of reaching out.
Two weeks.
Not two months! Not "we'll call you when we have an opening." Two weeks.
This matters so much because when you finally make the decision to reach out for help (which can be really hard!), you shouldn't have to wait months to actually get that help. The window of time when you decide "I need support" and when you actually receive that support should be as short as possible.
At RPC, our board-certified reproductive psychiatrists and licensed therapists specialize in exactly what you're going through. We focus on mental wellness surrounding pregnancy, postpartum, infertility, and all the hormonal changes that can impact mental health. This is what we do. Every. Single. Day. We understand the unique challenges of this time in your life and we're here to help you design a treatment plan that feels right for you.
Whether that's therapy, medication (yes, there are safe options for pregnancy and breastfeeding—this is our area of expertise!), or a combination of both, we work with you to create a plan you feel comfortable with. We're not here to judge. We're here to support you.
What Reaching Out Looks Like
I know the idea of scheduling an appointment for mental health care can feel overwhelming when you're already struggling. So let me tell you what it actually looks like:
You reach out to schedule an appointment. You'll select an appointment time to talk to Danielle, our wonderful patient coordinator. She will talk you through how the clinic works and help get you set up with a clinician that fits your needs. In most cases, we'll see you within two weeks. During your first visit, we'll talk about what you're experiencing, how long it's been going on, and what kind of support would be most helpful for you. We'll work together to create a plan that makes sense for your life, your values, and your family.
That's it. No judgment. No shame. Just support from people who truly understand what you're going through.
You Deserve to Feel Better
If I could tell every struggling mom one thing it would be this: you deserve to feel better. You don't have to earn the right to get help by suffering long enough or being "bad enough." You deserve support simply because you're struggling. Period.
The narrative around motherhood tells us we should be glowing and grateful and madly in love with every moment. (Those of you who know me can feel my eyes rolling at this!) When that's not our reality it can feel really isolating and scary. But here's what I want you to know: you are not alone. So many moms struggle. You are not broken. You are experiencing a medical condition that is treatable.
And you don't have to wait to start feeling more like yourself again.
If you're in Texas and you're struggling with postpartum depression, anxiety, or any mental health challenges related to pregnancy or the postpartum period, please reach out to us at Reproductive Psychiatry and Counseling. We're here for you, and in most cases, we can see you within two weeks.
You don't have to do this alone and you don't have to wait.
-Dr. Haynes
By Sarah Rivers Deal, PhD, LPC With Perinatal Loss month in October, I wanted to introduce myself through this blog as well as cast a light in the often dark places that hold this kind of silent, disenfranchised grief. As a psychotherapist that specializes and has been trained in infertility counseling, I too experienced my own reproductive trauma. Five years of fertility and alternative medicine treatments yielded a roller coaster of emotions, existential crises, and ultimately, two small graves in our back yard. Allow me to share something I wrote after my first miscarriage. We read to know that we are not alone – and – you are not alone. If you’re like me, the struggle to create life took over my life. It was all I thought out, dreamt about, planned for, spoke about, made exceptions for, ate for, stopped drinking my favorite red wine for – you name it. Life became hinged on hypotheticals – What if we get pregnant after I accept this new position? What if I accept this invitation then can’t travel in a few months because I’m pregnant? Should we buy the house in the better school district or wait until little one is here? What if little one never gets here? As much as I tried to balance my life, infertility crept in at every turn. In her insightful memoir, The Art of Waiting, Belle Boggs describes this all-consuming experience, calling it the Take Over – “…the problem with infertility is that it is not a patient, serene kind of waiting, not a simple delay in your plans; it happens for many of us in the context of consuming struggle, staggering expense, devastating loss.” Deciding to pursue fertility treatments put my barrenness on the front burner, making it difficult to escape. After five years in fertility clinics, more people had seen my vagina than the inside of my home. What was supposed to be private and magical between my partner and I was now public and scientific. All around me, women were “blessed” with babies, flaunting them as little “miracles.” These terms are especially painful for those struggling to conceive, as it implies that certain people are chosen while others are not. As much as I tried to participate in the world, being around pregnant women or infants was hazardous to my mental health. I remember attending my first baby shower in several years, believing I was safe now because my partner and I were months away from our daughter (by way of adoption) being born. Hope had begun to blossom again in my heart, as I believed that soon I would be a mom too. While I was emotionally prepared for my friend Serena to be eight months pregnant (after years of trying and two miscarriages), I wasn’t informed that the shower host was visibly pregnant too, and to boot – after only one round of I.V.F. with the same doctor I used. As we munched on our blue painted cookies shaped like pacifiers, I learned that the champagne drinking host had a 9-year-old son already, and became recently engaged after finding out about the pregnancy. I wish I could say I genuinely celebrated her happy news, but on the inside, I was fuming. On the drive home, with no other car in sight, I blasted the radio and screamed bloody murder. Despite various challenging life experiences up to this point, I still somehow believed in the concept of justice – a philosophy of how fairness is administered. To put it simply, it seemed unfair to me that this host woman was pregnant and going to be a mom – for the second time – and all I had to show were memorial stones in my yard commemorating two pregnancy losses. Unfair that I had earned high marks for effort and still wasn’t getting to graduate. Unfair that I wasn’t stroking my own belly, marveling at the miracle of science and creation itself. Infertility or perinatal loss may be experienced as an existential crisis, planting seeds of doubt in life questions you thought you had basically addressed, figured out, or had plenty of time to answer. What legacy will I leave behind? Who will carry on my values? Who will remember me after I’m gone? Am I broken? Dr. Anne Malavé, mental health expert in the field of infertility, wrote – “Infertility is like trying to find your children. The child, the imagined and expected child whose presence is palpable yet missing, feels near. It feels like searching for a lost child–you keep looking and searching around every corner. To stop trying can feel like an abandonment of an actual baby, of “my/our own baby.” Pamela Mahoney Tsigdinos in her raw, genuine book Silent Sorority, poignantly captures this existential crisis – “One instant you are like everyone else. The next, you’re not. Your DNA now ends with you. You are infertile. Your branch of the family tree will forever be just a truncated twig. You’ve been denied a rite of passage, a biological imperative. You had no say in the matter. It wasn’t a conscious choice. The comfortable sense of continuity and legacy others take for granted disappears in an instant.” After experiencing perinatal loss in 1999, Amy Douglas poetically wrote: “A life inside me, a love so strong. She died inside me, but the love lives on. It broke my heart for her to go. I love her, I need her like she’ll never know.” If infertility and/or pregnancy loss have ever been downplayed as a less significant human loss, Tsigdinos, Malavé, and Douglas legitimize the profound aftershocks of devastation experienced by those affected. From my personal and professional experience, I want you to know that the takeover is part of the journey. Well- meaning partners and friends might advise you to find a hobby to try to get your mind off of it, to relax, but that probably won’t help. It IS where you are right now, and that’s okay. Most people will be uncomfortable with your discomfort, and you’ll likely receive your fair share of unsolicited and unhelpful advice. Being the recipient of said advice, I tried to remind myself to listen to their intentions, not words. Week after week, clients that struggled with infertility would say something like – “These next few weeks I want to focus on my work and getting back into exercise” or “I want to start hanging out with my friends again and expanding my social circle.” We would set vague or concrete goals, depending on the client, and vow to focus on balance and self-care. And then, week after week, these same clients would come in ashamed, embarrassingly admitting that even if they did go to the gym or see an old friend, the ghost of infertility haunted them. They wanted to be more present in the here-and-now, they really did. Although I truly believe the takeover must run its course, there may be some coping skills and strategies to help it along. And I’m certain that whatever I tell you won’t always work. Some days the takeover will allow some wiggle room to remember the other aspects of your life; other days – it won’t. If you’ve felt quite low more days than not, and for an extended period of time, please check it out with a doctor. I will share with you the most salient professional (and personal) guidance here, and hope that on a few days, it might help. But please, don’t beat yourself up if it doesn’t. Honor the takeover, but also look for windows where you can see the larger picture. 1. Do something that has direct, observable results. You likely have felt powerless for a while. I want to you to do something, no matter how simple, where you can see results. Start with something easy. Make your bed. If you feel relatively competent cooking, use a recipe to create something, then share it with someone. Plant something that you can watch grow. Start with a plant that’s native and more likely to survive; you do not need a failure right now. Rearrange furniture in your space; a new look often evokes new feelings. 2. Practice Self-Compassion Breaks. I adopted this idea from the lovely Dr. Kristin Neff, a self-compassion researcher and professor from my town in Austin, Texas. Here’s the step-by-step process: a) When you notice that the Take Over has happened, say to yourself: “This is a moment of suffering” or “This hurts.” (It may help to place one hand over your heart = self-soothing gesture) b) Then say, “Suffering is a part of life.” c) Then, “May I give myself the compassion or understanding that I need right now.” Then breathe in and out, consciously and with intention. 3. Mindfulness (paying attention on purpose) is an Eastern practice, but its application has hit Western shores, and I’m a firm believer that it’s a necessary healing tool in your toolbox. You can become a conscious consumer of your mind, observing with a curious and gentle sense what’s going on in there. None of us would believe that a face cream could make us look a certain way after a few applications. However, we often experience our thoughts as facts, then experience powerful emotions as a result. It’s important to get some space from our thoughts, and see them for what they are – potentially unhelpful narratives. Use the letters N-N-R to remember the steps: a) Notice. Your mind is an active, interesting narrator that tries to piece information together but often falls short. Become a neutral, curious observer of your mind. Think of it as a radio, always playing music (some songs on repeat). b) Name (thoughts, feelings, body sensations, urges). For example, you may be ruminating (circular thinking that goes nowhere except down) something like “It’s not fair Tamara is pregnant. She didn’t even want another baby” and so on. As soon as you notice you’re stuck on a loop, say to yourself – “That’s a thought” You may notice tightness in your chest. Ask yourself what your feeling. Then say, “I’m having a feeling of sadness.” Noticing and naming gives you critical space to honor what’s going on with you without letting it suck you in automatically. c) Re-engage: Get back to what you were doing before you got caught in the loop. Re-engage in the moment. 4. Make a playlist or soundtrack for various themes throughout your fertility/infertility journey. For example, weeks before my 2nd I.V.F. transfer, I made a compilation of uplifting songs, burned them on a CD that I titled “Hope,” and played it every chance I got. A week after my first miscarriage, I made another playlist, calling it “Coping.” These songs were instrumental in helping me process the often contradictory emotions I experienced. Your body’s limitations don’t define you. Focus on what your body CAN do for you right now. Can you walk, jog, skip, hop, swim, or hug someone? It’s easy and completely understandable to get caught on a failure-loop narrative. But you’re not a failure. This is your roadblock, your life challenge, your grief and sorrow, your call to action. Answer the call, my friends. Above all, be patient with yourself. You are not alone. (Originally written September 2017; Revised September 2020) Dr. Sarah Rivers Deal is an Austin-based licensed professional counselor that specializes in infertility and reproductive trauma. She’s a member of the American Society for Reproductive Medicine (ASRM) and has participated in numerous trainings on infertility counseling and perinatal loss.
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