Postpartum Mental Health Issues We Don't Talk About

There's more to postpartum mental health than "baby blues." These lesser-known challenges may not get as much attention as postpartum depression, but they're no less real to new moms who experience them.

Jade Wu, PhD
11-minute read
Episode #306
The Quick And Dirty

Postpartum mental health is essential. Knowing about the less well-known types of postpartum symptoms helps to prevent problems and improve mothers' well being. 

  • Postpartum psychosis is a rare, serious condition that begins within one to two weeks of birth. When a new mother has significantly distorted thoughts or hallucinations, seek emergency mental health care.
  • Postpartum OCD is less rare and involves a birth-giving mother experiencing intrusive thoughts (sometimes about harming the baby) and compulsive behaviors (like obsessive checking or counting) to try to reduce those thoughts.
  • Dysphoric milk ejection reflex (D-MER) is when a breastfeeding mother experiences instantaneous depression, irritability, or anxiety when she begins a nursing session.

Having a child is life-changing. Priorities shift, identities grow, bodies change—even time seems to flow differently. The challenges, joys, love, and sheer existential whiplash are difficult to describe. As a new parent, I know this wild ride all too well. My own experience, and talking to many parents, have shown me that there are many emotional layers involved in becoming a parent.

Pregnancy and childbirth can be exhilarating. It can also take a tremendous toll on the body and mind.

For women who carry a pregnancy, there are particular hormonal, physical, emotional, and social changes that come roller-coasting through around the time of giving birth. After all, a birth-giving mom is literally creating a human, delivering this delicate thing into the world, and often then nourishing this brand new person with her body.

This process, plus the excitement of everything else that's changing around mother and child, can be exhilarating. It can also take a tremendous toll on the body and mind.

A word about postpartum depression

Fortunately, there is now a lot of awareness about the common experience of postpartum depression, which globally affects about 17 percent of postpartum women who don’t have a history of depression. Postpartum depression is a serious psychological disorder. Ask your doctor about it if you experience these symptoms within a few months of giving birth:

  • Persistently low mood
  • Difficulty feeling excited or invested
  • Difficulty enjoying your baby
  • Feelings of shame or guilt that you can't shake
  • Thoughts of harming yourself or the baby

There are also lots of good resources at Postpartum Support International.

Lesser-known postpartum mental health conditions

But in this episode, we're going to take a look beyond postpartum depression. We'll talk about some of the other mental health problems that can come up after giving birth. This episode is special because, in addition to our usual science-based programming, I chatted with author Phyllis Grant about her personal experience with some of the postpartum symptoms we’ll talk about.

First, an overview of 3 postpartum conditions that are not as well known as postpartum depression:

1. Postpartum psychosis

Postpartum psychosis is a rare disorder that happens for about 0.1-0.2 percent of birth-giving mothers, and it almost always shows up within the first two weeks postpartum. This is a serious condition where the mother’s perception and thinking are drastically altered. She experiences symptoms like:

  • Intensely high moods and activity levels
  • Acting very strangely and out of character
  • Delusions (thoughts that are clearly false and abnormal)
  • Hallucinations (hearing or seeing things that are not there)

Sometimes, the delusions are about the baby. They could include things like believing the baby has special powers, is divine, is possessed, or even that the baby is dead. This can be very intense for the mother and scary for everyone around.

If someone you know seems to be experiencing postpartum psychosis, you should treat this as an emergency. Help to get her psychiatric care right away. A tiny percentage of the time, those with untreated postpartum psychosis end up harming themselves or the baby.

2. Postpartum OCD

Obsessive-compulsive disorder (OCD) is very different from psychosis. In the general population, OCD is a common psychological disorder. For women who develop OCD at some point, pregnancy and childbirth are the most likely times for it to begin.

Let’s break OCD down by its two main components:

1. Obsessions

Obsessions refer to intrusive thoughts—those that you don’t come up with or want but can’t seem to get rid of. Usually, these thoughts are scary or inappropriate. In postpartum OCD, they often involve thoughts about accidentally or intentionally hurting the baby.

The most important thing to know is that intrusive thoughts don’t reflect what you want or who you are. Just because you keep having the unwanted thought of dropping your baby doesn’t mean you want to or will.

2. Compulsions

Compulsions refer to behaviors you do in an attempt to decrease your intrusive thoughts or your anxiety about them. This might include excessively washing hands when you have an intrusive thought about germs, or repeatedly checking locks when you have intrusive thoughts about home invasion. In the postpartum context, compulsions might include things like excessively checking on the baby, refusing to hold the baby, or repeating mantras or counting in a superstitious way.

Sometimes moms with postpartum OCD fear being left alone with their baby because they’re afraid they’ll do something bad. The difference between postpartum OCD and postpartum psychosis is that with OCD, you’re aware that your intrusive thoughts are bizarre and you don’t want the scary thing in the thought to happen. In this case, you don’t need to worry that you will act on the scary thought just because your brain came up with it.

3. Dysphoric Milk Ejection Reflex (DMER)

Dysphoric Milk Ejection Reflex (or DMER) is a condition specifically related to breastfeeding. It's not well-known at all, even amongst mental health professionals. It was first described in medical literature only a few years ago. I personally had never heard of it. That is, until my lactation consultant nodded knowingly as I described my own experience of DMER with her.

When a woman with DMER breastfeeds or pumps, she experiences an instantaneous and very strong sense of dysphoria or a flare-up of anxiety or irritability.

When a woman with DMER breastfeeds or pumps, she experiences an instantaneous and very strong sense of dysphoria—a drop in mood, feeling of hopelessness, overwhelming sadness—or a flare-up of anxiety or irritability. This can happen every single time she has a milk letdown, which means it can occur 8-12 times or more per day when her baby is a newborn.

Because this is such a rare phenomenon, there's not much research to investigate how it works or how to treat it. Currently, researchers suspect that DMER is caused by a hormonal fluctuation. Poor sleep, caffeine, and stress seem to make it worse. But for many women, simply knowing what DMER is, and using distraction as a strategy, tend to help. 

Interview—Author Phyllis Grant's experience with DMER

I suspect that DMER is more common than we think. Many women likely don't realize they have DMER, and even many healthcare professionals aren't aware of it. This is why we're extra fortunate to have a guest on today’s show to talk about her experience with DMER and some of the other postpartum symptoms we’ve talked about today. Here is my (lightly edited) conversation with author Phyllis Grant:

My guest today is Phyllis Grant—mom, cook, writer, photographer. Her work has been featured in Esquire, The New York Times, Huffington Post, and plenty of other top-notch publications. Her book, Everything Is Under Control, is a delicious and poignant memoir of her diverse life experiences. In it, she talks about her life as a dancer at Juilliard, cooking in world-renowned kitchens in New York City, falling in love, and, of course, becoming a mother. Phyllis, welcome to the show. Thanks so much for being with us.

Thanks for having me.

There's so much honesty and beauty throughout your memoir and so much that we could talk about. But today I'd love to focus on your experience of becoming a mother and some of the struggles that came with it. So just to start with, could you tell us about your experience of new motherhood? What was that like in the beginning?

Well, let's see, we had just moved to Los Angeles after living in New York City for about 11 years—my husband and I—so in some ways, it was a very lonely time for us. We were in debt. We didn't have a lot of friends. We were struggling quite a bit. Then I got pregnant and I had one of those pregnancies where I was throwing up for the first 20 weeks.

She was whisked out of my arms and, and they had to resuscitate her, and then the oxygen and all that, it was quite dramatic.

And then I had actually a home water birth with my daughter Isabelle. So she was born 17 years ago in our little moldy bungalow in Venice Beach, California. And unfortunately, she came out and her lips turned blue. She was whisked out of my arms and, and they had to resuscitate her, and then the oxygen and all that, it was quite dramatic. And I hemorrhaged.

Her entry into the world was ... "traumatic" really is the word I would use. So those early days, it's sort of hard to untangle the trauma from the sleep deprivation from the loneliness of not having family nearby. I really struggled those first few months. I never felt like I was able to come up from under this cloud of sadness. And part of that was obviously the sleep deprivation and so on. And part of it was these hormonal shifts that were particularly difficult for me. So I never had any sort of sense of bliss with breastfeeding. It never felt good; it felt necessary.

It felt like an incredible superhero power to be able to feed my child that way. But in some ways, I think the fact that I breastfed as long as I did interfered with my ability to bond with my daughter because I had such waves of sadness.

It sounds like you really had a pretty tough time for many reasons in that beginning phase. And there's a paragraph in your book where you talk about a very specific and kind of interesting and rare experience related to nursing. So could you describe this more rare experience?

Well, it's something that I've since learned is called DMER, which is Dysphoric Milk Ejection Reflex.

So every time I breastfed—which, with a little baby, can be quite a few times during the day—I would have these waves of sadness of dysphoria. I describe it like this.

One breastfeeding session leads into the next. I use one arm to hold her to my breast with the other arm. I grasped the side of the padded nursing chair. I can't look down because I'm convinced that earth will fall out from under me.

So that's the feeling that I would have each time I breastfed. It's hard to figure out sometimes where the sadness is coming from, but when you feel that way, every time you breastfeed one session does sort of bleed into the next. So then there's just always this general sense of sadness, and what I was able to do the second time around, when I had my son four and a half years later, is I knew more about DMER and I knew too that I needed to distract myself while breastfeeding.

A lot of people discouraged me and said, You don't want to feel that way again—don't do that to yourself.

So, I never would just sit there and breastfeed and feel that sadness. Instead, I would pick up my phone, or I would turn on the TV, or I would grab a book. I would get a cup of coffee. So that was the huge sort of shift that I was able to bring into having a child again. Because I really wanted to breastfeed the second time with my second child. And a lot of people discouraged me and said, You don't want to feel that way again—don't do that to yourself. But I had some friends help me figure out how to distract myself and sort of endure it.

Feeding happens so often with a baby that a good chunk of your experience—like hours per day—will be steeped in the sadness. So how did you (and why did you) make the decision to continue breastfeeding for so long while this was happening?

Well, that's such a good question. With my daughter, I really didn't understand what I was going through. So I thought it was a form of postpartum depression. And I just, as you said ... "steeped" is the perfect word. I wasn't able to isolate all of the pieces and step back and be kind of strategic. So in some ways with my daughter, I just knew I needed to feed her and get through. And I was really sad.

But with my son, I actually introduced solid food a little bit earlier so that he was eating less of the breast milk, more food. And I think I just had a little sense of distance and knowing it would pass because we had four-and-a-half years between kids. So I knew that I wouldn't feel sad forever, and I understood DMER a bit more.

And, and that's what I really wanted to make sure to bring that up because with other forms of postpartum depression, and you can speak to this, but there are drugs that you can take.

I'm so glad you brought up postpartum depression because I can imagine someone going through the DMER experience thinking they have postpartum depression. So how did you realize that you did not have postpartum depression and instead had this other thing?

Well, it really was this specialist who had me talk through all the details of what I was experiencing. So between breastfeeding sessions, I actually sometimes was able to feel fine. I could put the baby down and walk into the other room and have a glass of water and then sort of spring back to life in some ways. So I had less of that steeped feeling with my son. And she helped me recognize that it was not just this general sense of sadness; it was more the shifting of the hormones in the body.

So was there anything else that was helpful or anything that was unhelpful that you tried to cope with this experience?

Unfortunately, I resisted being social with both children. Like getting out in the world. I never have been such a fan of mom groups and stuff like that or music classes. And I wish I'd sort of forced myself to get out in the world because that's another form of distraction. As you said, that steeped feeling, if you're home alone, one breastfeeding session leading into the next, it's really hard to just step out of that sadness.

That is really good advice. I think it offers a sense of hope that it's not a pervasive, wet, heavy blanket that covers everything, but rather something—an experience—you can step out of. Is that your sense?

With me, stress leads to intrusive thoughts. So I had the DMER in conjunction with intrusive thoughts about harming my children.

Exactly. And with me, stress leads to intrusive thoughts. So I had the DMER in conjunction with intrusive thoughts about harming my children. Obviously, none of that happened. But it was just if I was deep in a terrible breastfeeding session, and I was stressed and tired, that I had these intrusive thoughts that kept appearing. And I've read actually recently—because I'd been diving back into this as I was writing my book—that that's a very common thing with women dealing with certain kinds of postpartum depression and DMER, where they slip into OCD.

Absolutely. I think OCD and intrusive thoughts are quite common postpartum. And I think many women become scared by those thoughts because it feels like they are having "bad thoughts." But—as you have probably experienced—these thoughts don't necessarily lead to action and they certainly don't reflect how you feel. Is that right?

Right. I just started talking to my 17-year-old daughter about this because this book is out in the world. And I wanted her to understand that just because I had these intrusive thoughts about harming her, it doesn't mean I ever, ever would have or ever did.

I think the most important message to get out there is just how common it is.

And then you know, writing about it helps. That's what I did for years. I wrote to my friends about it. So, it's okay to talk about ... and it's really helpful to talk to you about it. When you hear me say intrusive thoughts, you say "Yes, that's very common." And I think the most important message to get out there is just how common it is and how it's okay.

Absolutely. I'm so glad you wrote about your experience, too. I think there are going to be many women out there who recognize themselves in what you wrote. Any parting words of advice for moms who are struggling, whether with DMER or something else in the postpartum period? As I mentioned to you offline earlier, I myself have a newborn and it certainly is quite a handful. It's a very unique and challenging experience. Any advice for me and other moms out there?

I think I'd go back to what I said a minute ago, which is writing about it. And it doesn't mean that you need to become a writer or a writer. You know, it's not about that. It's more about putting these stories down and sending them to a few trusted friends. It normalizes it. And then it also is red flags for friends where they can say, "Oh, wait a minute. Maybe you need a little more support than we as friends can give you."

Either write it down or tell somebody what you're feeling and drink a lot of water.

So I would say that getting the stories down—and the feelings down—on paper. In some ways, it keeps it from going back to that word you used—"steeped." It keeps it from festering. Either write it down or tell somebody what you're feeling and drink a lot of water.

So, breathe, drink water, connect with people, get out of the house, use distractions, and know that this will pass. Does that sound like a good summary?

That sounds great.

All content here is for informational purposes only. This content does not replace the professional judgment of your own mental health provider. Please consult a licensed mental health professional for all individual questions and issues.

About the Author

Jade Wu, PhD

Dr. Jade Wu is a licensed clinical psychologist. She received her Ph.D. from Boston University and completed a clinical residency and fellowship at Duke University School of Medicine. Do you have a psychology question? Call the Savvy Psychologist listener line at 919-533-9122. Your question could be featured on the show.