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Postpartum depression (PPD) is known to occur in new mothers after pregnancy, and it can also affect fathers, nonbinary parents, and other non-birthing parents. What many people may not realize is that PPD can also develop after a miscarriage or stillbirth.
The postpartum period is the time after pregnancy when the body undergoes changes that may affect physical and mental well-being, lasting several weeks or months. In PPD, overwhelming feelings of grief go beyond typical feelings of sadness.
To learn more about PPD after miscarriage and stillbirth, MyDepressionTeam spoke with Amy Eisenberg, a perinatal mental health clinician and licensed clinical professional counselor in the Chicago area. She works with parents who are facing challenges related to fertility, pregnancy, and the postpartum period. “The hardest part about the postpartum period after having a miscarriage or a stillbirth is that you don’t have that baby to make moving through the depression seem worth it,” Eisenberg said.
Miscarriage and stillbirth are two types of pregnancy loss. A normal pregnancy lasts 38 to 42 weeks. In miscarriage, a pregnancy suddenly ends before the 20th week. Miscarriage occurs in about 10 percent to 20 percent of pregnancies and can happen for a number of reasons. The most common cause is that the fetus hasn’t developed properly.
In stillbirth, a pregnancy ends after the 20th week. In most stillbirths, the fetus dies in the uterus, rather than in childbirth. Doctors usually detect a stillbirth well before labor begins and take action to end the pregnancy. Stillbirth occurs in about 6 in 1,000 births in the United States, with higher rates in developing countries and lower rates in some Western nations. Environmental factors, lifestyle, lack of good healthcare, and certain health problems can contribute to a stillbirth.
“With a pregnancy loss, your body still thinks you’re pregnant [or that you’ve given birth], so that’s the part that’s very hard. And then you have the compounding piece — that’s the grief from the loss,” Eisenberg said. “For instance, your milk will come in after you have a stillbirth, but then there’s no baby to feed.”
Women who’ve experienced pregnancy loss have a high risk of depression, according to the Journal of Psychiatric Research. Those who’ve experienced stillbirths are at a greater risk of depression than those who’ve had miscarriages. Symptoms of depression are typically most intense in the months right after pregnancy loss and may lessen over time.
PPD can have a range of symptoms, including:
It’s important to know that experiencing PPD with pregnancy loss increases the risk of depression with another pregnancy and after menopause.
A significant factor in PPD involves hormonal changes that occur around pregnancy. During pregnancy, various hormone levels rise to support the growing fetus. After pregnancy, hormone levels fall significantly.
Researchers believe that the dramatic drop in the hormones estrogen and progesterone after pregnancy can sometimes lead to intense fatigue and depression. These hormonal changes will happen after a miscarriage or stillbirth and can feel traumatic, both physically and emotionally.
“When you have a loss and your body has gone through a trauma, it’s a double whammy of grief,” Eisenberg said. “You also have the same hormonal shifts that a woman who has a live birth would have, and so it’s just very painful.”
Other PPD risk factors include:
“There are things that might increase your risk for postpartum depression, but women from all backgrounds experience postpartum depression,” Eisenberg pointed out.
Eisenberg emphasized that the grief that comes with a miscarriage or stillbirth isn’t generally acknowledged as much as depression after a live birth. This lack of recognition can contribute to PPD after the loss of a pregnancy. “You don't get the same validation from society as you would if you have a live baby. So, oftentimes women feel like the loss of the baby becomes invisible,” she said.
The bond that a parent develops with their baby during pregnancy often isn’t validated for those who’ve experienced miscarriage or stillbirth. “Even though they’ve gone through labor or delivery or they’ve carried a baby through a miscarriage, people will not regard them as a mom,” Eisenberg explained. “So that can also add to the depression, even though they feel like a mom and they are a mom.”
Fortunately, treatments and strategies can support healing from PPD after a pregnancy loss. However, Eisenberg stressed that this process may take time. Social support from close friends and family members can help.
“It’s important to find support, to have people around you who [you] feel you trust and who you can talk openly with and you can grieve with,” she said, adding that it's important “to not feel like you have to move on immediately.”
Eisenberg urges people experiencing PPD from pregnancy loss to find a therapist or grief counselor who specializes in perinatal depression and grief. “They can be there with you and help you sort through your feelings, to give yourself time,” she said.
If symptoms of depression continue for more than two weeks, it’s important to seek counseling — particularly if your symptoms include:
Eisenberg noted that you may not experience PPD symptoms right away, perhaps not until months later. Talk to your doctor if you need a referral for a mental health professional who specializes in perinatal depression.
Eisenberg strongly recommends talking to others who’ve gone through a pregnancy loss. “Another really helpful thing for women who have gone through miscarriage or stillbirth is to find a support group so that you don't feel alone,” she said.
Sometimes, a father or partner also experiences distress from a pregnancy loss and develops PPD. “The support of a partner, too, can be very helpful,” Eisenberg added. “Integrate them into your experience because they’re also struggling.”
Eisenberg discussed self-care as another important step for managing PPD from pregnancy loss. “Do things to take care of yourself in the day-to-day — so, maybe taking walks, eating enough, making sure you’re getting sleep,” she said.
Eisenberg described a technique called behavioral action, which can help with self-care. Behavioral activation involves taking steps to change your mood. “I’ll often say, ‘Even if you don’t want to go on a walk, just be a zombie. Put your shoes on and just walk out the door in your pajamas,’” she said. “And then once you’re out there and you feel the wind, all of a sudden you feel a little bit of a boost.”
If ongoing PPD is affecting your daily life, it’s important to talk to your healthcare provider about medication, such as antidepressants, that may help reduce your symptoms. Your doctor can refer you to a psychiatrist who can evaluate you and advise you on treatment options.
The following resources can also help you find care for PPD:
In case of an emergency:
MyDepressionTeam is the social network for people living with all types of depression, including postpartum depression, and their loved ones. Members come together to ask questions, offer support and advice, and share their stories with others who understand life with PPD.
Did you know about the risk factors for postpartum depression before your baby was born? Do you have any advice for others managing these risks? Share your experience, or start a conversation by posting on your Activities page.
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