Postpartum: The Reality vs The Idealized Narrative

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We have all seen those pictures of new moms looking blissful, holding their babies in perfect moments, glowing with joy. But for many women, postpartum does not look anything like that. The reality is often overwhelming, emotionally draining, and full of surprises. It is a time when moms are adjusting to life with a newborn while dealing with huge hormonal and emotional changes. And yet, with the pressure from social media and society, many new moms feel like they are failing when their experience does not match that "ideal."¹

The Disconnect: What We Are Told vs the Motherhood Experience

On social media, motherhood seems effortless—perfectly put-together moms and calm babies. But for most women, it is far from that. The postpartum period can feel like a battle with exhaustion, anxiety, and just trying to keep it all together. The physical recovery, sleep deprivation, and emotional vulnerability are tough enough. Add to that the pressure to bounce back quickly—physically and emotionally—and it can be a lot. When things do not match the ideal image of motherhood, many women end up feeling guilty, anxious, or like they are not doing it right. That gap between expectations and reality can lead to real grief—not just about losing the prepregnancy self, but about the idea of motherhood that did not match up.²

The Hormonal Rollercoaster

After birth, a woman’s hormones and other key factors drop sharply. During pregnancy, hormones like estrogen and progesterone are sky-high, but once the baby’s born, they fall fast, leaving the body scrambling to adjust. One important part of this is allopregnanolone, a neurosteroid that helps keep mood and stress in check during pregnancy. But after birth, allopregnanolone drops off, and that is when anxiety and sadness can feel even more intense. The interesting part? Allopregnanolone is behind brexanolone, a medication developed to treat postpartum depression. Brexanolone mimics allopregnanolon’s effects, helping to ease the symptoms of postpartum depression more effectively.^3,4

The Timeline of Postpartum Mood Disorders

The baby blues are pretty common—about 70% to 80% of new moms experience them. It is those mood swings or sadness that usually go away after a couple of weeks. But for some women, the sadness and anxiety stick around much longer. In fact, up to 20% of women may struggle with postpartum mood disorders for months, or even longer.⁵ Getting help early—whether through therapy, medication, or simply talking to someone—can make a huge difference. Postpartum depression and anxiety are real health issues that need attention. Left untreated, they can lead to long-term struggles.¹

Dr El-Shammaa is a psychiatry-trained addiction medicine fellow at Hackensack Meridian Jersey Shore University Medical Center.

References

1. Stewart DE, Vigod SN. Postpartum depression: pathophysiology, treatment, and emerging therapeutics. Annu Rev Med. 2019;70:183-196.

2. O'Hara MW, McCabe C. Postpartum depression: current status and future directions. Annu Rev Clin Psychol. 2013;9:379-407.

3. Pearlstein T, Howard M, Salisbury A, Zlotnick C. Postpartum depression. Am J Obstet Gynecol. 2009;200(4):357-364.

4. Jarman AF, MacLean JV, Barron RJ, et al. Brexanolone for postpartum depression: a novel approach and a call for comprehensive postpartum care. Clin Ther. 2020;42(1):231-235.

5. Yonkers KA, Ramin SM, Rush AJ, et al. Onset and persistence of postpartum depression in an inner-city maternal health clinic system. Am J Psychiatry. 2001;158(11):1856-1863.