Motherhood is not for the weak at heart. And anyone who tells you differently is either lying or delusional. Every stage of motherhood will come with a variety of ailments, concerns, and risks. This is part and parcel of becoming a parent.

Your obstetric and pediatric providers have seen it all and will be your biggest champions in educating you on the normal changes in your body. But there are some physical and mental changes that need more than a little extra TLC from your healthcare provider. Below are a few examples of how motherhood can make you sick.

Mood Disorders

One in three adults will experience a mood disorder in their lifetime, and Covid based research suggests women are predominantly more prone to depression, anxiety, and post-traumatic stress disorder. As many as 1 in 5 women will experience mood disturbances during or after pregnancy. However common mood disorders are, they are surprisingly unreported by women for a variety of reasons.

Common complaints of women suffering from mood disorders:

1.Unable to perform activities of daily living

2. Ongoing sad, empty, hopeless, or helpless feelings

3. Irritability, anxiety, quick to anger, or restlessness

4. Loss of appetite or overeating

5. Insomnia or oversleeping

6. Physical pain that does not respond to treatment

Left untreated, mood disorders can lead to thoughts of self-harm, harming others, or suicide. ALWAYS tell your provider if your behaviors or thoughts have changed since pregnancy. There are several medications and non-pharmacological interventions that can help, but the first step is to seek help. In addition to medication and/or counseling, women can consider exercise, sunlight, building support systems, and decreasing sugar and high-fat foods.

Irregular Periods

Menstrual cycles can take several months to return to normal, or your cycle could be significantly different. It is not uncommon for women to have increased cycle lengths, increased cramps, and irregular bleeding. In addition, women may not ovulate or bleed at all while strictly breastfeeding.

It is important to remember that ANY time you have unprotected sex during the postpartum period, you can become pregnant. Especially if your cycles have not returned to normal and you cannot track them using regular methods. Consider a barrier method in the postpartum period to prevent a surprise pregnancy.

Clots larger than a golf ball, foul vaginal odor, or soaking through more than one pad an hour are never normal in the postpartum period. Talk to your healthcare provider if any of these occur to rule out infection or postpartum hemorrhage.

Hair Loss (Telogen Effluvium)

Listen…postpartum hair loss is no joke. Women often say they feel like they are going bald. Major hair loss occurs after childbirth or a miscarriage. This is due to the hair cycle returning to the pre-pregnancy hair loss phase and is completely normal. But major hair loss can be a symptom of other health conditions and should be discussed with your healthcare provider if accompanied by other symptoms.

Low thyroid levels: Hair loss, unexplained weight gain, brittle/dry skin and nails, constipation, fatigue, depression, sensitivity to cold, and muscle aches or cramps.

Iron-deficiency anemia: Hair loss, extreme fatigue or lethargy, headaches, weakness, difficulty concentrating, shortness of breath with activity, and cold hands or feet.

Less common conditions include nutritional deficiencies, birth control pills or implants, immunodeficiency conditions, hereditary hair loss, and/or over-styling.

If you haven’t already noticed, these symptoms are vague and can occur at any point during or after pregnancy. When the symptoms do not improve or negatively impact your life, you need to report them to your provider.

This list is not all-inclusive, and pre-existing medical conditions and/or medications can alter the “normal” changes associated with the postpartum period. Make sure you discuss anticipated postpartum changes with your healthcare provider so you know what is abnormal for you.

This article was contributed by MacArthur Medical Center’s Certified Nurse Midwife Jen Rockhold.

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She was a nurse. I worked with her daily. She was my friend and also my patient. Happily married. Perfect pregnancy. Easy delivery.

How did I not recognize she was suffering from postpartum depression?

She could not get out of bed. Although madly in love with her baby, dark and dangerous thoughts filled her head. Each day she forced herself out of bed. She cried daily. The stress of hiding her depression from her husband was tearing her marriage apart.

One year later, she confessed. During her annual exam, she revealed all that she had been through. Struggling in silence. Sharing with no one. She was miserable.

I am the doctor she trusted. Once I knew of her illness, she got better. Why did I not catch it sooner?

I didn’t ask. She didn’t say.

I’m sorry.

A teen mother

She was a 17 years old child. She and her newborn lived with her mother and mom’s four other children. She grew up without a father. The father of the baby was long gone. Her house was full of family, but she was living all alone.

Four years later, she is pregnant again. She shares with me her fear of having postpartum depression again. She cried as she explained the terrifying thoughts of hurting her baby that flooded her mind after her delivery. She loved her baby. She asked what was wrong with her for thinking this way.

All the risk factors for postpartum depression were right there in front of me four years ago. How did I miss it?

I didn’t ask. She didn’t say.

I’m sorry.

A high-level executive

She was a senior vice president of a large tech company. After years of infertility treatment, she and her husband got pregnant. Always the overachiever, she was not pregnant with one baby. She had twins. During her six-week postpartum visit, she told me she was getting divorced. I was surprised. On the surface, they seemed like the perfect couple. Was postpartum depression a factor?

I didn’t ask. She didn’t say.

I’m sorry.

Depression has many faces

One patient’s husband had an affair. Another struggled with her teenager’s rebellion. One lost her job for not showing up for work. Another couldn’t pay her bills. Another repeatedly came to the office for various vague abdominal pains.

I didn’t ask. They didn’t say.

I’m sorry.

Postpartum depression is real

One in seven women suffers from postpartum depression. I had been treating it throughout my career. I caught the easy cases. I helped them, and they got better.

The world of women’s health has started paying more attention to the 4th trimester. I realized I was missing the harder to spot cases. I had overlooked the subtle clues that were there along. I had underestimated the efforts patients would take to hide their mood disorder. Shame, fear of being judged, and embarrassment forced those suffering from postpartum depression to hide alone in the dark.

We implemented universal screening

We added universal screening for postpartum depression to our office protocol. The Edinburgh Postnatal Depression Scale (EPDS).

Ten questions. Five min.

This simple tool made it safe to step into the light. Each patient fills out a simple questionnaire. The score is not diagnostic, but the questions open a window and an opportunity for dialogue. The tool triggers me to ask the right questions. Five min can change someone’s life.

My eyes are now open to the prevalence of postpartum depression and the subtle ways people hide it. It also revealed to me that these cases were there all along.

They wanted to talk, and I wanted to listen.

I just didn’t ask, and they didn’t say.

A new approach

Universal screening opened a window and shed light on postpartum depression. I have changed my approach. I am asking the right questions. Now we are talking. Patients are speaking up.

I asked. You answered.

I’m so thankful.

You are not alone.

Never be afraid to talk about postpartum depression.

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