Almost immediately after giving birth to her daughter, Demi Kolke noticed that negative thoughts overwhelmed her. It felt like she’d never be happy again. She was unable to complete even the easiest task, and even though she loved her newborn daughter, Journey, she became agitated if the baby, now 4 months old, needed her.
“I would get frustrated and upset when she wanted to be held all the time,” Kolke, 31, of Pittsburgh, told TODAY. “I was in denial about being depressed. The first week was a complete, utter and total blur.”
Kolke has postpartum depression (PPD), which affects one of seven women after giving birth.
While Kolke is seeing a therapist for PPD, she has been grappling with another problem: physical pain. During labor, she bruised her tailbone, and she experienced a lot of discomfort.
“The intense pain lasted probably nine or 10 weeks, and then it was more of a dull pain,” she explained. “You are trying to learn to breastfeed and navigate that, and it is challenging enough, and you can’t even sit.”
Pain and mood
When it comes to pain and mood, experts understand there’s a relationship.
“People with depression often experience more intense pain,” Dr. Samantha Meltzer-Brody, director of the Perinatal Psychiatry Program at the UNC Center for Women’s Mood Disorders, told TODAY. “The link between pain syndromes and depression is very well established.”
More recently, researchers have looked at the role of pain during labor, delivery and after childbirth for women who experience postpartum depression.
“There has been a lot of work with PPD and perineal pain and other forms of postpartum pain,” Meltzer-Brody said. “Women with PPD are more likely to experience breastfeeding pain and more discomfort associated with that.”
In research examining the role of postpartum pain and PPD, Dr. Jie Zhou from Brigham and Women’s Hospital in Boston looked at data from 4,327 women from June 2015 to December 2017. The women took the Edinburgh Postnatal Depression Scale and self-reported information about pain. Any woman who ranked her pain as a four or higher on a 10-point scale was considered to have a painful condition.
There’s an “association between postpartum depression and postpartum pain,” Zhou, an assistant professor of anesthesia at Harvard Medical School, told TODAY via email. “Postpartum pain is an important factor and has a significant association with postpartum depression.”
Zhou noted that the study only examined pain a week after delivery and does not explore the impact of long-term pain and PPD. The study did not find a causal relationship, and more work needs to be done to understand the connection.
“This may inspire more research into this area with regard to better pain control for postpartum women,” he said. Early results from the research were presented at the American Society of Anesthesiologists’ conference on Oct. 14; the full study will be published later, Zhou said.
Though the findings are limited, they highlight the importance of managing pain.
Women who experience more pain with birth regain less function than women who don’t, Dr. Grace Lim, the director of obstetric anesthesiology at University of Pittsburgh Medical Center's Magee-Womens Hospital, said. She hopes these and other findings about pain and PPD will help women feel more comfortable asking for help.
“It should empower women who are having a lot of pain to talk more openly about it,” Lim noted. “In terms of helping a woman in her recovery, managing pain is an important component.”
But many women believe that being in pain during labor or afterward is simply part of delivery. Take Kolke, for example, she labored for almost 12 hours without an epidural until her partner encouraged her to finally get one.
“We want to seem like we are super women,” Dr. Christine Greves, an OB-GYN at the Center for Obstetrics and Gynecology at Orlando Health in Florida, told TODAY. “We cannot fight our bodies. If you choose to go for an epidural, it is not an element of failure.”
“It’s important for our patients to know they can communicate any of these concerns about pain or mental and emotional issues,” he said. “(It) may help us mitigate the development of postpartum depression.”
Postpartum depression and ‘fourth trimester’ care
According to the American Psychological Association, symptoms of PPD include:
- loss of interest
- appetite changes
- anxiety or racing, upsetting thoughts
- feeling guilty or worthless
- mood swings
- irritability and frustration
- worry that you're a bad mother
- loss of interest in the baby, family or friends
- sleep changes
- difficulty with memory or thinking clearly
- thoughts of hurting yourself or the baby
Kolke hoped that maybe her PPD would just improve. But as she was working and caring for Journey, the symptoms persisted.
“I thought, ‘I am capable. I am fine,’” she said. “I knew what I needed to do to get myself back on track.”
When Kolke’s doctor recommended therapists, she couldn’t get an appointment — so she gave up. Again, she thought she’d get better. But she didn’t.
“It is very hard to seek help in that state,” she said.
In May, the American College of Obstetricians and Gynecologists released a committee opinion paper regarding postpartum care, in part, because it recognized that new mothers needed extra support.
“This ‘fourth trimester’ can present considerable challenges for women, including lack of sleep, fatigue, pain, breastfeeding difficulties, stress, new onset or exacerbation of mental health disorders, lack of sexual desire, and urinary incontinence,” the paper stated.
What’s more, it recommends that “postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs.”
Meltzer-Brody said that caring for women with PPD — with or without lingering pain — requires a comprehensive approach.
“It needs to be done in a way that is really holistic,” she said. “We need to think of all of this on a spectrum, and treatment approaches need to be integrated from different contributors.”