Health Conditions / Sexual and Reproductive Health / Postpartum Depression

“After delivery, there’s this incredible change in reproductive hormones,” Katherine L. Wisner, MD, the Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology at Northwestern’s Feinberg School of Medicine, tells SELF. “Hormones—such as estrogen and progesterone—go from the highest they’ll ever be down to almost nothing as soon as the placenta is delivered.” And some experts believe these rapid hormonal shifts are linked to the development of PPD in people who are biologically susceptible. Plus, recovering from a vaginal delivery or a C-section is hard and can be incredibly painful. Giving birth does not always go smoothly, and some estimates suggest one-third of people who give birth experience some form of trauma while delivering their baby, which may contribute to PPD or post-traumatic stress disorder (PTSD). While trauma can include things like enduring premature labor or feeling worried about a baby’s well-being, many people report that the people in the room—their care providers, including doctors, midwives, and nurses—are responsible for these distressing experiences, say, by dismissing the severity of a birthing parent’s pain, among many other scenarios.But one of the biggest changes that will affect your day-to-day functioning as a new parent is the ability to get enough sleep. Recovering postpartum with little to no sleep is a challenge that’s underestimated by society, Dr. Wisner says. And, as you might be able to guess, studies have shown a strong correlation between sleep deprivation and emotions like depression, anxiety, and anger.In a Canadian study of nearly 300 women, published in BMC Pregnancy and Childbirth in 2022, 31% of moms reported feeling intense anger, while more than half said their sleep quality was poor. The researchers concluded that a parent’s sleep quality, as well as feeling angry about their infant’s sleep quality, were two major predictors of postpartum anger. A range of disparities also contributes to the rage.For Black birthing parents, in particular, the stigma anger carries can be a huge barrier to seeking necessary mental health support. “Anger and rage are widely under-recognized. There’s a natural shying away of emotions in fear of being the stereotype of the ‘Angry Black Woman,’” Lauren Elliott, the CEO and founder of Candlelit Therapy, a perinatal mental health care service for underserved new and expectant parents, tells SELF. “Black maternal health is in extreme crisis.”There are a host of systemic issues that prevent Black people and other people of color from receiving proper mental health care. Birth parents of color experience higher-than-average rates of postpartum depression, and yet, they are less likely to be diagnosed, less likely to know that the symptoms they’re experiencing are related to PPD, and are therefore less likely to be properly treated, according to a report from the Center for American Progress.“Black women are less likely to be screened in pregnancy for depression and anxiety,” Elliott says. The consequences of these disparities can be devastating. As SELF previously reported, Black and Indigenous women are two to three times more likely to die from pregnancy-related causes than white women, per the Centers for Disease Control and Prevention (CDC).

Bryce Dallas Howard shared how depression has impacted her life in a candid Instagram post to celebrate World Mental Health Day earlier this week. In the caption, the 41-year-old Jurassic World actor wrote that “battling depression has been the biggest challenge to my identity.”Howard has been vocal about her mental health journey before. Over a decade ago, the actor wrote at length about what she called the “emptiness” of postpartum depression after the birth of her first son, Theo. In her recent Instagram post, Howard recalled an “existential moment” in her car alone as she left the last day on her first job as a new mom. Even though she was working, she was still in the “throes of postpartum depression” at that time, she said. Driving into an “exquisite sunset,” Howard shared: “Since no one could hear me, I asked the question aloud: What is the purpose of ALL OF THIS?!”Howard said it was then that an “anonymous voice” responded to her, saying: “The purpose of the human experience on earth is to move through obstacles with grace, and if you can do that, there will always be a sunset.” She went on to say this gave her clarity during a difficult time: “Those words are the response I received: to move through obstacles with grace, and that struggle will guide you toward the sunset. We are here FOR the obstacles, not to avoid them.”Instagram contentThis content can also be viewed on the site it originates from.Howard, who has been vocal about the benefits of therapy, also went on to write that she used to have a difficult time working through negative emotions. “I’m energetic, enthusiastic, passionate—and I have this big ole belly laugh!” she wrote. “My entire life, I had been so hyper-focused on blocking negative thoughts that I failed to embrace or appreciate that these feelings and emotions and crises were not only not to be avoided, but that they were integral to the human experience.”And that realization marked a turning point in her mental health journey: “It’s taken quite a bit, but what I’ve learned since is that my form of ‘optimism’ means having the grace to navigate both internal and external obstacles. Those challenges ARE the journey, the purpose, not an annoyance we can gaslight with militant optimism and denial.”Instead of fighting back every negative emotion that comes her way, Howard said she now tries to embrace all her feelings. “I’m not the optimist I once envisioned myself to be,” she wrote. “Instead, I’m an emotionally-charged ball of wonder and awe, practicality and possibility, with an indefatigable capacity to find humor and joy in the absurdity of whatever life serves up.”Howard said she wanted to share her experience with her 2.6 million followers in the hopes others may identify with her and feel less alone: “This is where I’ve landed today on my journey, and tomorrow may be different, but I share these musings on #WorldMentalHealthDay in case they can offer any hope or simply a ‘same, same!’”Related:

Asking someone what they need might sound something like this, she says: What would help lighten your load right now? What kind of tasks can I take off of your hands today? Would you rather I help with the baby or help with the chores?Met with a response that the parent in need doesn’t need anything? That brings us to our next point…4. Don’t wait on them to ask for help.It’s a well-meaning statement: “Let me know if you need anything!” But too often, it’s met with silence from those who, well, need things. That’s why many new parenthood experts suggest simply doing without asking. “Drop off a meal or two, ask them what diapers and wipes they use and drop those off, make them a gift or goodie basket of things you think they could use or need,” says Dr. Kaeni. This takes the pressure off the person on the receiving end and provides help.“When we say ‘childcare is infrastructure,’ this is what’s meant: Every basic need is stressed under the weight of parenting young children, so parents need scaffolding to get through the day,” Erin Erenberg, the executive director of The Chamber of Mothers, tells SELF. “A simple gesture like covering a meal can sister a weak joist and keep the house from collapsing.”5. Hold space without expectation or advice.New parents need social support and to know that those around them care about them without being on the receiving end of advice or pressure to respond.“Text them just to say you’re thinking about them, but preface it with ‘no pressure to respond,’” suggests Lexi Tabor, a certified postpartum doula, certified lactation support counselor, and virtual doula with Major Care based in Ohio. “Those messages sent on the regular can really boost moods and make someone feel loved,” she tells SELF. They help someone feel less alone and do away with any feelings of guilt if a new parent forgets to respond in a sleep-deprived haze.Resist the urge to give advice, too. “New parents are so used to being inundated with unsolicited advice that oftentimes they hesitate reaching out to people because reiterating boundaries gets exhausting,” says Tabor. “Many times we respond by sharing a story of our own experience in order to try to connect, but that can feel invalidating to the other person or turn it around to be about you.”The fix: Simply be there. Ask questions unrelated to the baby’s sleep, eating, or development, and really listen. If you’re not sure what they want, ask them if they would like feedback or just need someone to hear them. Most of the time it’s the latter, says Tabor.Remember, too: Parenthood changes people but your new parent friends are still people. And as much as they want to talk about their new baby, they might also want to joke about that viral TikTok or that new show they’ve been able to catch one or two episodes of. Talk to them about the things you would have pre-baby—whether that was politics, pop culture, or hearing some juicy gossip about an ex. In fact, they’ll probably appreciate the no-baby talk.6. Honor cultural postpartum rituals.In the United States, new parents are woefully under supported. The US is one of only a few countries around the world without a federal paid family leave program, and by some counts, one in four moms return to work just two weeks after giving birth; only about 23% of people in the US have access to paid family leave. But that’s not the way things are in other parts of the world. Many cultures, including Latin American culture, Indian culture, and many Asian cultures, honor and respect the postpartum period.

In severe situations, it can even lead to inadvertently starving your baby—a scenario Dr. Castillo-Hegyi knows firsthand. “I found myself with a dehydrated, jaundiced baby, because of my inability to produce milk when he needed it.”Imagine if the nursing staff at the hospital where you gave birth didn’t even give you the option to formula feed. This is the reality at hospitals that adopt the Baby-Friendly Hospital Initiative—a designation given to hospitals that enforce guidelines and practices that meet strict criteria around breastfeeding. In practice, this can look like a nurse who repeatedly discourages you from using formula or the complete removal of nurseries, which historically have been used to give new parents a few hours to sleep, and can involve supplementing with formula. Again, this adds to the undue pressure on birthing parents to chestfeed exclusively.Perhaps if the message were different, fewer people would find themselves in situations like the one Castillo-Hegyi faced. “Formula has been demonized, weaponized, and moralized, but as far as nutritional content, it’s so expertly developed for absorption, and it contains every macronutrient, micronutrient, vitamin, and mineral that breast milk contains,” Jody Segrave-Daly RN, MS, IBCLC, a former NICU nurse and lactation consultant, and co-founder of the Fed Is Best Foundation, tells SELF.The bottom line is that the benefits of being fully fed far exceed the differences between being breast or formula-fed, she says.It’s time to reframe this messaging so parents feel empowered.The antidote to this exclusive breastfeeding-is-the-only-way messaging, Dr. Castillo-Heygi says, is to start speaking the truth. “The differences between breastfeeding and formula-feeding are not as big as advertised,” she says. “So, if you are struggling to feed your child with breast milk alone, do not despair. The best option for you and your child’s health might be combo feeding with breast milk and formula, and if you can’t do that, or it’s impacting your mental health, exclusive formula feeding is also a healthy option.”Fed is best. Period. “We want your baby to be fed and get the nourishment that it needs to continue to meet these milestones, and give you peace of mind,” Conyers says. “The goal is to have a healthy, thriving baby.”The other big factor to consider is yourself, says Gunyon Meyer. “We want a mom who is mentally and emotionally healthy, too,” she says, for the sake of you and your baby. If chestfeeding is causing a problem with mood, depression, or anxiety, then it’s time to think through other options.There are benefits to formula feeding, too. The big one? Freedom. Since the onus is no longer on one person to shoulder the entire responsibility of nourishing the baby, other caretakers can step in to bottle feed—and bond with—your baby so you can take a shower, go for a walk, have a glass of wine without guilt, sleep, oh, and go to work for eight hours. Of course, pumping and freezing breastmilk is also an option, but that still equals less freedom due to all the pumping that has to take place.

The concept of a low sex drive in women—and frankly, in anyone—is often paired with many misconceptions. The truth is, sexual desire can be a pretty fickle thing for everyone, regardless of gender identity, sexual orientation, or relationship status. While it can be tempting to boil libido down to a biological need or innate human drive, that thinking is just not reflective of our current understanding of sexuality. “Ultimately, libido is our desire for sex, rather than a drive for sex,” Robin Buckley, Ph.D., a clinical psychologist and couples therapist in New Hampshire, tells SELF.That’s not to say there’s no biological basis for how often you want to have sex. Research shows libido is greatly influenced by hormones1, and there are so many things that can have an impact on your hormonal makeup and on the hormonal changes that occur within your body throughout your life. Sex drive is also affected by physiological factors (like your neurologic, vascular, and endocrine system),2 as well as a number of psychosocial factors (like your self-esteem and the way you feel about your body).3Some of these factors are in our control and some simply aren’t, yet they all have a thread in the complex web of sexual desire. So it’s no wonder that humans would have a wide range of, well, horniness. In fact, what seems like a “low sex drive” to one person might seem high to another—there’s really no simple answer to a question like “why is my sex drive low?”But if your own desire to have sex seems off from your baseline, or you are wondering if you’re experiencing some symptoms of low libido in women, including those assigned females at birth and those who are transgender, there can be some specific underlying causes to consider. SELF spoke to sex and sexuality experts about what those can be—and what you can do if it’s truly bothering you.First, is it normal to not want to have sex?Our desire for sex exists on a spectrum and can be fluid from person to person—and within ourselves—over time. So, simply put, it can be normal to not want to have sex.There are so many periods in your life when sex is (understandably) the last thing on your mind, according to the Mayo Clinic. This includes things like a major life change like a move to a new city, becoming ill or experiencing an injury, feeling depressed, starting a new medication with unexpected side effects, or living through a global pandemic, to name a few.But you also don’t need to be going through a Big Life Moment to “justify” a low libido. Fluctuations in the desire for sex are extremely common. “Just because someone has a low libido at one point in their life doesn’t mean that they’ll have low libido all of their life,” Lauren Streicher, M.D., professor of clinical obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine and author of Sex Rx, tells SELF.These changes can happen over months or years, even day to day. It’s also normal to never or rarely experience the desire for sex. (People who relate to those feelings may identify as asexual.)However, there is a clinical condition characterized by a sex drive that’s persistently lower than baseline: hypoactive sexual desire disorder (HSDD). “Hypoactive sexual desire disorder can have a negative impact on a person’s relationships and personal health,” Brett Worly, M.D., an ob-gyn at The Ohio State University Wexner Medical Center, tells SELF.When a person is diagnosed with hypoactive sexual desire disorder, it means they have lost some or all motivation to engage in sexual activities for at least six months or longer. On top of that, this lack of sex drive must be causing a lot of personal distress. Experts estimate that the condition may affect up to 10% of women.4Generally speaking, though, there is no “normal” amount of sex you should be having, whether you are in a relationship or not. The “right” amount of sex to be having is the amount that you and your partner or partners mutually feel comfortable with and consent to—and that doesn’t have to look the same for everyone.