• Natasha J. Thomas, MD

Preparing for Another Child After Postpartum Depression or Anxiety

Updated: Jul 30


In my clinical experience with mothers who have survived postpartum mood and anxiety disorders, the idea of having another child brings both hope and trepidation. Women fear a repeat of a postpartum period filled with worry, exhaustion, guilt and at times despair. I have heard women echo fears that they are forever 'broken,' burdens, even frauds as mothers.

However, I have seen those same women victorious over their fears when they manage to walk through pregnancy, birth, and the early years of their babies' lives armed with a plan for wellness. With a plan, compassionate and collaborating doctors and support, over 90% of my moms who are PPD/PPA survivors have subsequent postpartum periods of at least 1 year without relapse of depression, anxiety, bipolar disorder-related mania or psychosis, or hospitalization.

Take a look at the basic outline below for a starting place to a happy and healthy pregnancy, even after a history of postpartum depression or anxiety.

Preconception Care

  • Try to meet with your OB/GYN and a psychiatrist three to six months prior to attempting conception. Please form a treatment relationship with a psychiatrist, even if you plan to avoid the use of medication during your pregnancy.

  • Include your spouse/partner or support system in your preconception meeting. They may have questions/concerns, too!

  • Consider getting psychotherapy.

  • Sign a Release of Information form so that your OB/GYN and mental health providers can coordinate/collaborate on your care.

  • If members of your treatment team seem too busy to collaborate, meet with you at length about your pregnancy plans or seem dismissive, consider getting a second opinion.

*If you happen to become pregnant unexpectedly, you can still have a meeting to discuss the treatment approach to prevent mood and anxiety relapses. See your OB/GYN and psychiatrist immediately. Don't wait!

Prenatal Care

Meet once a month with your psychiatrist and possibly twice a month with your counselor/therapist. Follow-along with the schedule your OB/GYN determines is appropriate for you.

In each psychiatry appointment, make sure you tell your doctor:

  • How your mood is more days than not in a given week.

  • How long it takes you to fall asleep, and if your sleep is inexplicably interrupted or is interrupted by thoughts/worry.

  • If the content of your thoughts is changing to things that seem odd, uncomfortable, or if you notice you are perceiving things differently in your environment than you normally would.

  • If you notice a drop in your interest or motivation to prepare for the baby. Note: This is not the same as a drop in energy which is expected at certain times during pregnancy.

Between weeks 28 and 32 (if not before), have focused sessions on:

  • Your support system/support plan. Who will be helping you?

  • Breastfeeding vs. Formula-feeding plan. Feeding complications are a risk factor for PPD/PPA, so try to be flexible.

  • If you will start/restart medications and when?

Postpartum Care

  • The six-week wait to follow-up with your OB/GYN is too long to catch many cases of PPD/PPA before they began to cause significant distress and dysfunction.

  • Speak to your psychiatrist within one week of delivery. If you cannot go in for an appointment, request a phone session. It would be best to find out if your doctor is willing to do these "special" sessions with you early on in your care.

  • Follow-up with your psychiatrist at 4 weeks postpartum. Consider going in for check-ups once every 1-2 months for the first year of baby's life.

  • Don't judge yourself if making the adjustment to having a new baby seems challenging...it IS challenging! It takes most women 1-2 years to fully adjust.

  • Lean on your support system.

  • Eat and rest well.

  • If you decide to resume medications, it is NOT a failure. Collaborate with your psychiatrist to learn if you can nurse on your medications or if you will need to modify your feeding plan.

  • Sign up for one of our national pregnancy and postpartum support networks like Postpartum Support International (www.postpartum.net).

Let us hear from you! If you are a woman that has successfully completed the postpartum period without a recurrence of depression or anxiety, how did you do it? Inspire someone!

#postpartum

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