There are all kinds of beliefs, myths, misunderstandings and assumptions about the postpartum phase of women’s lives. A time when society says women should be overjoyed with their new baby is often fraught with complex emotions, utter exhaustion, conflicting feelings, too many opinions and not enough help. Yes, some of the challenges that come during the postpartum period are due to hormones, but it is so much more than that. With growing awareness about the hardships of the postpartum phase and media attention around new postpartum depression treatments, it’s time to set the record straight about what postpartum really is, what causes the challenges within it and how to help.

First of all, postpartum itself isn’t a condition. Every single mother goes through postpartum. It is simply the period of time after a woman gives birth. Some people think of it as only the first six weeks after giving birth, or the first three months, known as the “fourth trimester.” But in actuality, the postpartum phase lasts for upwards of 2 years and is filled with different phases, experiences, emotions and changes.

Within the postpartum period there is a higher risk than usual for developing mental health challenges. The most common include postpartum depression, postpartum anxiety and postpartum OCD. Also possible are postpartum psychosis and the development of postpartum addiction. The most well-known of these afflictions is postpartum depression, which is often simply referred to as “postpartum.” But there are many mental health conditions that can develop during this phase, and it is important to expand the definition of and conversation around postpartum to include them.

It’s not simply hormones that contribute to the development of postpartum mental health challenges. Sleep deprivation plays a big role. Also at work is the intensive personal journey women go through in becoming mothers. Especially for first time moms, it is a huge identity shift to go from childless to a mother. For some it takes awhile for their inner identity to match their new outer reality, and this causes all kinds of mental health complications and strife. Grief, rage, sadness, regret and a whole host of challenging emotions can arise along with the joy of holding a tiny baby skin to skin. It can be hard to reckon with all the conflicting emotions and hard to process feelings. Another related aspect is the sudden onset of no longer having enough time to care for oneself. One day, it’s just you doing you. The next, it's you caring for another being who is incredibly needy 24/7. This is a serious shock to the system and takes time to adjust to. All the pressure to be there, not enough time for herself, too much demand on her body, the intensive healing process that happens after giving birth, all swirled together very often leads to a high amount of anxiety for a new mother, which itself can lead to OCD, psychosis or depression. It’s all interrelated and complex.

Some other big contributors to mental health challenges in the postpartum period are lack of meaningful connection with other adults and not enough help. A new baby naturally puts a strain on all a woman’s relationships, so that takes a toll. Also there is a deep isolation that occurs for most new mothers, not only situationally but interpersonally. The experience of becoming a mother is so complex and nuanced, it is hard to communicate what is truly happening inside and therefore can be difficult to feel truly connected to other people and feel understood. There is also a phenomenon that happens of all the attention being on the new baby, and barely any attention on the mother and her feelings. It can feel dehumanizing and create unease within the woman. Not enough help is also a huge problem. If a woman is lucky, she will have extra support during the first few weeks, but this often wanes. A few months later, after the excitement and newness has worn off for others, she often finds herself all alone or only with the support of her partner, and it is simply too much work for one or two people to reasonably do, while also taking care of a household and earning enough money to provide for their family on not enough sleep. Add to the mix other children and their needs too, and it is a recipe for serious struggle for most people.

Added to all of this is the tendency for mothers to not share or talk about the challenges they are going through, and a resistance from many to get help where they struggle. This is confirmed by a study from NC State. “Our study finds that many women who would benefit from treatment are not receiving it, because they don’t tell anyone that they’re dealing with any challenges,” says Betty-Shannon Prevatt, a practicing clinical psychologist and Ph.D. student at NC State.

It is also important to mention that many women experience trauma during their birth giving experience, even if it was a relatively peaceful birth, and need the support of trained professionals to heal from it, yet often do not get or seek out that support. The stigmatization of receiving therapy coupled with the societal pressure to appear perfect and happy as a new mother mix together in a harmful cocktail of not enough permission to express the hard stuff, not enough understanding of it and not enough support with it. Left for too long without proper treatment, even less severe postpartum mental health challenges can escalate into serious problems.

So you see, the solution to postpartum mental health challenges truly extends far beyond medication. New mothers need more support: physically, emotionally, mentally. They need more trusted arms to hold the babies so they can have time off to heal and feel themselves. They need other mothers to talk with and be completely honest with, without the fear of judgement or shaming. They need villages of supportive friends and relatives to continue to help them, far into their first year and beyond. They need to know it’s ok to see a therapist, and it doesn’t mean anything negative about them. They need permission from society and themselves to feel the harder stuff without it meaning that they are a bad, crazy or incapable mom. They need trauma healing. They need sleep. They need more resources and understanding. They need more normalization of all these complex feelings, emotions and challenges. They need listening ears and attentive eyes, strong arms to rest into and warm hearts to connect with.

When women receive all that and more, there will be less postpartum mental health challenges in the world. When these complex experiences and emotions of new motherhood are de-stigmatized and more normalized, medicated less and addressed with holistic, whole-person understanding, and when women are truly supported by the villages they need, postpartum mental health challenges such as depression, anxiety, psychosis, OCD, addiction and burnout will lessen and better health for mothers and families will prevail. That’s the truth as I know it, and I will keep working towards it with my words, actions and intentions. Will you join me? Together we can help create a world with less hardship for mothers and more support for all.