As a staff psychotherapist at Seleni, many of the women I work with have had postpartum depression (PPD) and hope to calculate their odds of recurrence before deciding whether to try for another pregnancy. I like to begin by sharing some facts: PPD is more common after the birth of a first child, and a woman who has had PPD is more likely to develop it after subsequent deliveries than a woman who did not experience it the first time around.
Unfortunately these stats can only show large-scale trends in PPD development and recurrence. They offer little insight into the likelihood that any particular woman will experience PPD during her second – or third or fourth – pregnancy.
So I encourage you to shift the focus from "Will I get PPD again?" to "How prepared am I to manage PPD if I get it this time?" That's not easy because it means thinking deeply about the possibility of suffering again.
But taking an honest look at how PPD could impact you – and how you could proactively manage it – will empower you to make an informed, conscious choice about another pregnancy.
Consider the following questions when making your decision.
What were my risk factors, and can I address them?
Researchers have not yet identified the exact causes of PPD, but there are many known biological, psychological, and social risk factors. (You can review them here.) If you identify which factors may have contributed to your previous experience with PPD, you can explore whether and how those factors continue to impact your life.
Talking this through with your partner, maternity care provider, or a trained psychotherapist can help you make sense of your past PPD experience and develop strategies to address remaining vulnerabilities moving forward.
For example, perfectionism is a personality trait that has been shown to increase a woman's risk for developing PPD. So if you recognize that perfectionism played a part in your first experience with PPD, you (and your loved ones) can be aware of unrealistic expectations as you get ready to add another baby to the mix.
You can't predict or control whether you develop PPD again, but you can manage your expectations, challenge negative self-talk, and ask for help if you need it.
What were my triggers, and how can I manage them?
Personal risk factors might have left you vulnerable to develop PPD in the first place, but "triggers" are the situations, things, and even people that made your symptoms feel worse from day to day.
Think (and ask your partner) about what triggers made your symptoms more intense. Some common ones include sleep deprivation, being stuck inside all day, and a lack of contact with other adults. Then brainstorm practical strategies to cope with your triggers.
For example, can you and your partner plan to take shifts throughout the night to ensure you get a block of uninterrupted sleep? Can you find a local mom's group or library story hour and commit to getting out of the house at least once a day?
Although it's impossible to avoid all triggers, identifying the ones that can be managed will help you make a thoughtful decision about whether pregnancy after PPD is right for you.
Who's on my team, and how can they help?
Postpartum depression affects up to 20 percent of childbearing women, but the condition has a way of making each woman feel desperately alone. It can be difficult to reach out for support once symptoms set in, so when I work with clients planning pregnancy after PPD, I help them build their postpartum support teams ahead of time.
Speak candidly with your maternity care provider, partner, and trusted family or friends about your previous PPD experience. Discuss the early signs that things were getting bad, and let them know how they should intervene if they're concerned that something is wrong again.
Be specific about the type of support you might need, and ask the members of your team whether they can commit to providing it. Just knowing your sister is willing to listen when you need to vent and your midwife can refer you to a great psychotherapist can help you assess whether you – and your support network – are ready to expand your family despite the risk of getting PPD again.
Answering these questions doesn't guarantee that your next postpartum experience will be a breeze. But thinking deeply about your unique postpartum resources and environment will help you make an informed choice about expanding your family and care for yourself if you do decide to pursue pregnancy.
If you'd like more support, consider speaking with a therapist who specializes in postpartum depression, or pick up a copy of Seleni board member Karen Kleiman’s book What Am I Thinking? Having a Baby After Postpartum Depression.