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13 Steps To Managing Postpartum Sadness, Anxiety & Overwhelm

Ellen Vora, M.D.
October 7, 2018
Ellen Vora, M.D.
Holistic Psychiatrist & Best-Selling Author
By Ellen Vora, M.D.
Holistic Psychiatrist & Best-Selling Author
Ellen Vora, M.D. is a board-certified psychiatrist, acupuncturist, and yoga teacher, and she is the author of the No. 1 bestselling book "The Anatomy of Anxiety."
Image by Holly Clark
October 7, 2018

The postpartum period is an incredibly vulnerable time. Countless new moms are sitting in their gliders right now, isolated at home, surrounded by spit-up and burp cloths, delirious with sleep deprivation, nerves frayed from the confusing cries of their infants, and feeling overwhelmed, sad, anxious, and alone.

Every time this happens to a new mom, I feel we have failed as a culture. It's normal to experience the transition of becoming a mom as a complicated mix of joy and an unexpected gut punch, but when a mom is isolated and feeling like her sadness and anxiety are about to swallow her whole, there is more we can be doing to support this mom. Here are the steps I find most helpful in my holistic psychiatry practice:

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1. Optimize your nutrition.

We underestimate the role nutrition plays in postpartum depression and anxiety. Being pregnant, going through labor, bleeding, and nursing deplete our bodies of nutrients. Think about it: Mom just grew a baby in her body, then went through labor, which is like a car accident, surgery, sex, and an ayahuasca trip all in one. Sometimes mom has hemorrhaged a large volume of blood during labor. Then there's postpartum bleeding, and after all of this your boobs (if you're lucky) open up a thriving gelato cafe. The process of becoming a mom depletes us of our nutrition, our blood, our chi. And all of this happens in a context in which you're sleep-deprived and undergoing a massive hormonal shift. And, oh yeah, you have zero time or energy left over to whip up a nutritious meal for yourself.

What's the solution? In a word: help. You need help. Someone, whether it's a partner, grandparent, friend, neighbor, member of the tribe, postpartum doula, TaskRabbit, personal chef, or meal delivery service, needs to be tasked with the very important job of preparing nutrient-dense, delicious meals that magically appear on the table next to your glider at regular intervals.

What if you don't have support? In our modern-day isolated approach to parenting, you're not alone in being alone. In this case, I recommend that you outsource. What if this feels financially out of reach? Modify it as needed, and recognize that this is a temporary expense. Throw some money at this problem, even if it's money you don't really have, so you can eat nutritious meals for the first eight weeks postpartum without having to cook all those meals for yourself. Even if you can't afford this in the long term, eight weeks of good food will go a long way toward replenishing your nutrient stores, which can help prevent postpartum mood disorders.

2. Sleep

Sleep?! As if.

Protecting mom's sleep should be a high priority for the household. I'll grant that sleep won't be awesome in the postpartum period, but it should at least be a communal goal. Even if dad has to go back to work (or whichever partner is not the one who just gave birth; we'll call this person dad though that doesn't do justice to all the ways you can be partner to a new mom), I would argue it's still critical for dad to take one for the team and be involved during nights in order to help protect mom's sleep. In the grand scheme of this family unit, it's better for dad to be a zombie at work than for mom to be depressed, anxious, delirious, and vulnerable to developing mastitis and postpartum depression due to sheer exhaustion.

If mom is nursing overnight, there are still ways to protect sleep. Master the art of side-lying nursing, and basically remain in that position on your bed, half asleep, throughout the night. Other helping hands place baby next to you when baby is hungry and swoop baby away when baby needs a diaper change or to be rocked back to sleep. Mom remains lying in bed, half asleep, whenever possible. Mom, if you get up to nurse baby in a glider, please resist the urge to look at your phone. Stay awake and alert enough to keep baby safe, but keep this overnight time tranquil and meditative rather than jacked up with blue-spectrum light and headlines about the world's various geopolitical nightmares.

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3. Ask for what you need.

Brace yourself for a sweeping generalization: Women often find themselves compelled to take care of everyone around them, taking care of themselves last (and often not at all). It is not our natural tendency to a) identify our needs, b) feel entitled to have our needs met, or c) ask to have our needs met. My advice to new moms is this: It's time for a crash course in asking for what you need! Right now the neediest person in the room is the baby, and the thing the baby needs most is you. Your needs are valid and vital. If you're OK, baby is OK.

And by the way, your needs matter inherently, not just as they pertain to baby's needs. Are you thirsty? Hungry? Tired? Cold? Uncomfortable? Overwhelmed? Ask, ask, ask for what you need. And don't even think about apologizing for it.

4. Process your birth.

In the words of the ensemble at the end of Hamilton the musical, "Who tells your story?"

Birth is an epic, psychedelic, pelvis-cracking, heart-opening experience. You give birth to a baby, and you give birth to yourself as a mother. It can be the most empowering experience of your life, or you can feel completely disenfranchised. All too often, aspects of birth can be traumatic or difficult to process. Tell your story. Tell it and retell it. Tell your partner, tell other moms, tell people in your life who can sensitively hold space and help you process the monumental experience you've just been through.

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5. Embrace your ambivalence.

I'm a Jewish psychiatrist from NYC, so ambivalence is my middle name. (Or is it?) But owning our ambivalence doesn't come naturally to all moms. I encourage you to embrace the good, the bad, and the ugly and hold it all at once. Love your baby so much it hurts? Great. Also sometimes regret all your life choices that led to this moment? You're not alone. Feel appreciative and dependent on your partner while also finding everything they do irritating and you can't stand the sound of them chewing? Embrace that ambivalence. Feel no need to represent yourself as a flawlessly blissed-out mom goddess. If you feel sad, angry, overwhelmed, resentful, uncertain—know that it's all normal. Give yourself permission to feel everything you're feeling. It doesn't make you a bad mom.

6. Drop the guilt.

If there's one feeling that permeates moms' brains all over the world, it's guilt. Moms feel guilty for using formula, for traveling for work, for getting a massage, for snapping at their kids, for taking a long time in the bathroom to look at their phones in peace, for helicoptering, for that time they let their kid fall off the bed, for feeling so guilty all the time. Basically, moms are at risk of feeling guilty any time they're not in a state of sacrificing for their families. For the sake of your sanity—and the rise of women the world around—drop the guilt. You deserve to be happy and whole and to have your needs met. You deserve a break too.

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7. Outsource, outsource, outsource.

For the first six to 12 weeks postpartum, throw money at the problem. Outsource anything you can afford to outsource. Outsource cooking, cleaning, and laundry. I fully grasp that the financial struggle is real, especially when you introduce a baby into the situation (these little people are so expensive). Just remember this is temporary. The postpartum period is actually very short and goes by in the delirious blink of an eye. I'm convinced that if you can put some money toward your sanity for these delicate few weeks, you save money in the long run. Remember, burning out, losing your mind, and running around to doctors appointments is expensive, too.

8. Trust your intuition.

For the longest time, I tried to fit in with the rational, objective, science-worshipping, masculine ruling class. And then I learned to embrace and trust my intuition. It's not something to be ashamed of, and it doesn't make me a witch. All people have access to intuition, and it's a beautiful thing. This can provide clarity as you navigate the choices in your life. Parenting is nothing if not a series of choices and decisions. Without a connection to your intuition, these choices can be overwhelming. If you find yourself seeking constant external advice from books, blogs, and your overworked pediatrician, perhaps you could stand to tap into your intuition. You really do know what's best.

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9. Practice patience and compassion for your body.

I fully appreciate the body-scrutinizing pressures placed on women. We are received and perceived differently based on our weight, no question. And then pregnancy comes along and stretches us out, making us soft and squishy, bigger, and bloated. All the things the world tells women not to be. We make the babies, and yet somehow we're also supposed to "bounce back" and be perennially thin. When this prison of demands feels like too much, what we need to say—in a kind and loving tone, of course—is F that.

The world wants women to be thin, but we also happen to be the ones that grow babies. So can we please take this pressure off postpartum women? Your body just grew and cradled your beautiful baby, and now we want to be mad at our bodies and ourselves for being soft and squishy? No. If anything, direct your anger at the pressures placed on women. Be grateful, compassionate, and in awe of your body. Have a conversation with yourself and say, "Hey, I know we haven't always had the best relationship, but thank you for what you did here."

10. Don't worry, nothing is under control.

Maybe one or two of you out there have, oh I dunno...control issues? Pregnancy, labor, the postpartum period, and parenting in general is a master class in relinquishing control. We would all feel better as moms if we learned early and often: Don't worry, nothing is under control. We don't have to control everything, and in fact, we can't. Balance the following two things: Do your best and then let go. This is hard to do, so just do your best (and then let go). See what I did there?

11. Consider eating your placenta.

I know this is not for everyone, but I had an amazing doula who collected my placenta in a giant zipper bag and lovingly dried and encapsulated it for me. Anecdotally, I felt this was good medicine. Since the placenta is an organ bursting with hormones, taking it in pill form can theoretically soften the ramp-down of hormones that happens in the postpartum period. If you can find someone to help you with this, I recommend it.

12. Breastfeed your baby (if you can).

If you wanted to breastfeed—but for one of many possible reasons it didn't happen for you—do not take this as any reason to feel bad. But if you're on the fence about nursing, let this be some added motivation: Lactating keeps you bathed in a hormonal milieu that can help with postpartum mood. That being said, for many who want to breastfeed, the struggles with milk supply, latch, pumping, biting, etc., can be a source of immense grief. So see the above points about doing your best, letting go, and dropping the guilt. If it's an option, consider it a boost to your mood. And if it's not, be compassionate with yourself about that.

13. Seek help and don't judge yourself for it.

I hope the steps above help you keep your stability and sanity in the postpartum time. But by all means, if you're still struggling, please, please seek help. Your well-being is so important and relatively delicate at this moment. Please take the steps to get the help you need. When I hear about hesitation or stigma around seeking mental health care, I wonder to myself, why is this still a thing? There is no moral failing in finding yourself in a position of having postpartum depression, anxiety, or psychosis. It's all too common, and it can be dangerous. Please get the help you need. And if the idea of vetting doctors and booking an appointment overwhelms you, ask for the help you need and outsource this task to your partner or another trusted friend.

Ellen Vora, M.D.
Ellen Vora, M.D.

Ellen Vora, M.D. is a board-certified psychiatrist, acupuncturist, and yoga teacher, and she is the author of the No. 1 bestselling book The Anatomy of Anxiety. She takes a functional medicine approach to mental health—considering the whole person and addressing imbalance at the root. Vora received her B.A. from Yale University and her M.D. from Columbia University.

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