“I Miss When You Were Inside of Me”— a conversation about postpartum depression

I remember around age 10, first hearing the words “postpartum depression”.

“It’s when a mom has a baby and is sad because she misses when the baby was inside of her,” a friend of mine explained.

Having witnessed my mom’s pregnancies and postpartums with my three younger siblings, this didn’t make sense to me. I imagined that the discomfort of pregnancy being over and finally meeting your baby, holding them in your arms, would be a relief and an excitement.

My friend shrugged and we quickly moved on. But nearly twenty years later, in graduate school for psychology, I still couldn’t fully comprehend postpartum depression. I studied its biological, psychological, and societal causes, read case studies, and worked with women who described their experiences. It wasn’t until I gave birth to my son in 2022 that I truly understood. 

And boy, do I understand. 

Postpartum depression (PPD) is diagnosed when a mother experiences more than two weeks of depressed mood, insomnia, agitation, fatigue, intrusive thoughts, extreme anxiety, difficulty concentrating, and in extreme cases suicidal ideation or psychosis. It is also common for PPD to interfere with the connection between mother and baby, and often causes difficulties in the relationship between the mother and her partner. And, according to the CDC, this occurs in one in eight women.

So what is happening to our moms? Biologically, women experience the most significant hormonal shift of their lives between the days before birth and the days after birth. These extreme hormonal shifts drive some of the main symptoms of PPD, such as fatigue, insomnia, and mood disturbances. Another biological factor is nutrition; vitamins and minerals are severely depleted during pregnancy, birth, and breastfeeding— nutrient deficiencies can cause severe physical and mental disruptions. And while hormonal levels usually return to normal between 6-12 months after birth, replenishing vital nutrients can take anywhere from weeks to years, depending on the mother’s access to nutrient-dense food.

When we talk about psychological and social factors, we are speaking to changes in our family unit and the presence or lack of community support. When a newborn is introduced into a family, whether they’re the first or somewhere down the line, the family dynamics change. There’s new pressure on both the mother and her partner— how are these new responsibilities shared? Is her partner there to support her as she recovers? Are her family and friends showing up? Does she have space to share her birth story? Women often talk about the “village” that they so desire (and need) in this time— and how the lack of this support system can amplify the PPD that they are already biologically susceptible to. Added societal stressors include a lack of paid family leave, the fact that the risk of domestic violence increases as women become pregnant, and the fact that women of color are more than twice as likely to die in childbirth than white women.

There are ways to prevent and treat PPD. Preventatively, hormonal and nutritional support is available. Talk to your reproductive healthcare team (whether a primary care physician, an OB-GYN, a doula, or a midwife) about how to support yourself or your partner through pregnancy and postpartum. Communicating your needs to your support team before birth (family, friends, partners, and therapists) is a huge mitigating factor in PPD. And if PPD does set in, treatment is available— a combination of therapy and/or medication is highly effective in treating PPD.

If you are struggling, it’s never too early or too late to reach out for help. You deserve support.

After my son was born, I remember thinking— “I miss when you were inside me”. I finally understood what my friend’s mother went through all those years ago.