Your Postpartum Experience Matters
Postpartum depression, commonly known as PPD or postpartum anxiety, also known as PPA are common maternal mental health concerns that can occur during the pregnancy or postpartum period (Lewis, 2024). 10% of new parents find themselves asking if these feelings are normal, or when to seek treatment (Lewis, 2024). When discussing treatment, so many more questions might come up - is therapy the only option? What medications are safe for breastfeeding? Will I have to stop breastfeeding? Will they put me in a hospital and not let me see my baby? As a parent, and especially a new parent, there can be so much to sift through and consider for your specific situation. My hope is that this post will help provide some normalcy, answers to your questions, and give you the confidence to bring up your concerns to your provider.
Postpartum depression is described as intense feelings of sadness, or despair, that interrupts your ability to do daily tasks (ACOG). It is important to know that these feelings do not mean you are a bad parent, that you love your baby any less, or that it will feel this way forever. You are not alone in these feelings, and there is support to help this period not be as difficult!
Breastfeeding is a common concern for new parents, and how any interventions may influence their ability to produce enough milk for your baby. The line of treatment that would cause no concerns around breastfeeding or time away from the baby would be therapy. There are different types of therapy, but many parents seek out a perinatal specific therapist because they specialize in helping you navigate PPD and PPA. While some symptoms of PPD and PPA are similar to depression or anxiety that happens outside of the perinatal period, there are some differences, so having that specialty can be really helpful.
The next line of therapy that has risks and benefits is medication treatment. There are a few options for antidepressants that are safe during pregnancy and breastfeeding. There recently has been a lot of new discoveries surrounding safe breastfeeding medications – so much so that there is a whole book dedicated to medications while breastfeeding. The National Library of Medicine also has a page dedicated to medications and lactation, called the LactMed Internet that you can utilize to search specific medications and review associated research on them. One example is Fluoexetine, which is usually the first line of treatment in non-perinatal individuals, however LactMed notes that there are better treatment options because Fluoxetine has a higher transfer rate than other select serotonin uptake inhibitors (SSRI’s) (National Institute of Child Health and Human Development, 2025). Cetirizine is a great option, and while it does transfer during breastfeeding to baby, there have been no identified medical interventions needed for a baby who had Cetirizine in their system from breastfeeding (National Institute of Child Health and Human Development, 2025). It is important to consider that your baby having a healthy, and happy version of you is just as important. If that means medications, that is more than okay.
Bringing up any feelings of PPD or PPA with your provider can feel really overwhelming, and it may be tricky to figure out where to start. First, if your provider has not asked if you are experiencing any symptoms of PPD or PPA, then a great place to start is to schedule an appointment specifically to discuss mental health concerns. It is important that you have enough time to discuss your concerns with your provider, which is why scheduling an appointment to only discuss these concerns is a good step to take. A few good questions to ask at this appointment:
What are the treatment options you recommend for PPA or PPD?
Do you provide those treatments, or can you refer me to someone that does?
What are the risks of the medications available?
If you have already brought up your concerns to your provider, but have not received support through them, it is perfectly acceptable to seek out other care providers. This could mean seeking a new OBGYN, or establishing care without a referral with a maternal health psychiatrist, or a perinatal therapist. It can feel overwhelming to seek out a new provider. A few ways to move past this barrier could include asking for help from a spouse, friend, or family member. They may be able to provide a list of new providers for you, or you can sit together, call different providers to try and schedule an appointment. If you have a doula, this is a great time to use your postpartum benefits with them, and ask for their help. A couple of ways to ask for help from a trusted person:
I think I need to see a therapist, could you please make me a list of perinatal therapists in the area?
I have been thinking about getting some help for some of the hard feelings I have been having. Would you be willing to sit down with me and call a couple of psychiatrists so I can try and schedule an appointment?
You deserve to have a good postpartum experience, and it doesn’t have to be as hard as it feels. It is okay to ask for help, and you won’t be the only one who has needed the help – that is why there are specific therapists, and medications for PPD. Most importantly, whether this is your first or fifth baby, you are doing this for the first time; either learning to take care of a baby, or learning to take care of four kids and a baby. Give yourself grace, and know that you are doing the best you can.
