Postpartum Blues

by Alan Greene, MD, FAAP

A new dad asks Dr. Greene, "My wife and I have a beautiful new baby girl. We were both excited about having her (we were infertility patients). Now that she is here, my wife is miserable. She cries all the time, and I am at my wit's end. I find myself feeling angry, which I don't want to do. Is this just postpartum blues?"

As magical as the journey of parenthood is, it often begins with a period of feeling blue. Women's bodies are the scene of a powerful changing tide of hormones in the days and weeks after a baby is born. The rising hormone levels that gradually effected the incredible changes in your wife's body during the time she was carrying your daughter have now precipitously dropped.

Most new mothers (perhaps as many as 90%) will have periods of weepiness, mood swings, anxiety, unhappiness, and regret. Usually this lasts for a few days or less and is quickly forgotten. It's not unusual, however, for the blue period to come and go for six weeks. For some moms, the blues don't begin until the baby stops nursing (another time of major hormonal shifts). Hormones, however, are not the entire story...

Moms who have adopted their babies also commonly go through a blue period. And now that investigators have begun to look into it, we know that most dads (though less weepy) go through a blue period of feeling unhappy, insecure, left out, and moody. One day I expect we'll discover that even dads and adoptive moms have sudden hormonal and chemical changes in response to a new baby -- but this has not been proven. We do know, though, that even at this exciting time of having a newborn, there are good reasons to be blue.

Every new beginning is also an ending of what was before. Every ending is a beginning. Whenever a baby is born, the world will never be the same. This is wonderful. It's also okay to grieve for the loss of the way life was before.

Your wife no longer has the control of her own time the way she once did. Perhaps she also misses the challenges and rewards of her work. Hobbies may have been put on hold for a while. Her romance with you is also now different -- it's no longer just the two of you.

Whether her pregnancy was comfortable or not, she may be mourning the special intimacy of feeling her daughter inside her. Many new moms describe feeling empty inside. Pregnancy is a time of looking forward to an eagerly awaited moment. Now that looking forward is gone as well.

Also, pregnancy breaks down barriers in society. Complete strangers would beam at her, want to pat her tummy, and tell her she was glowing. They would leap up to give her a hand. Now your daughter is the focus of attention, and your wife -- who would probably benefit more now from encouragement and practical aid -- is less likely to get it.

She may also be mourning the loss of her ideal appearance -- she may still look pregnant. When my youngest child was one month old, a door-to-door saleswoman greeted Mom and asked when the baby was due! (Needless to say -- no sale!) Wearing maternity clothes when pregnancy is over just isn't fun, but usually nothing else is comfortable yet.

Now add to all this -- SLEEP DEPRIVATION!. Your wife is probably more exhausted than she has ever been. Whenever people are sleep deprived they are more subject to swings of emotion and to feelings of inadequacy. This, by itself, is enough to cause a blue period (ask any pediatrician).

I couldn't tell for certain from your question whether it is your wife or your daughter who is crying all the time. Probably both! Research has shown that women with the postpartum blues tend to have babies who cry significantly more than those of their counterparts. It hasn't been proven whether the fussy, crying babies make moms sadder, or whether the sad moms make the babies less happy -- but it seems to me that both are true, and that the crying is a vicious cycle.

A true grief reaction, at a time of great stress (and insistent noise), in a person who is chronically sleep deprived, all built on a shifting foundation of tremendous hormonal surges -- it's a wonder that postpartum blues aren't more of a problem. Most of the time, though, the powerful positive feelings that also accompany this time of new beginnings soon displace the sadness.

There are several things you can do to help: