• Natasha J. Thomas, MD

Preparing for Another Child After Postpartum Depression or Anxiety

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 late 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.

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!


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