When Postpartum Depression Shows Up as Intense Anger
When Kate Arquilla gave birth to her second baby, she didn’t anticipate how much her new daughter’s arrival would change everything. “I was trying to balance caring for a newborn and a toddler who were just 17 months apart,” she tells SELF. “At times, I would get really frustrated and it came out as anger—and almost rage.”
Arquilla, 34, recalls a time when she was trying to feed her newborn and her toddler was climbing all over her. “He started to have a tantrum—totally normal for his age—and I started yelling,” she says. “I was so angry at the situation. I wasn’t feeling right, but I didn’t know how to verbalize how I was feeling other than yelling.”
As a neonatal intensive care unit nurse and the founder of Bumblebaby, a Chicago-based group that specializes in services for new parents, Arquilla has spent much of her career working with people who have experienced this exact situation. Despite this—and the fact that she was already familiar with the emotional roller coaster that naturally comes with parenting—the anger caught her off guard. “My mood was off,” she says. “I was either really low on energy or irritable and angry. And that’s not my typical personality.”
It wasn’t until her therapist put a name to these feelings that her experience started to make sense. She had postpartum depression (PPD). Arquilla’s PPD manifested as anger—an emotion that carried a lot of shame for her at the time. “My kids were healthy and happy, and I felt a lot of guilt for not loving every moment of motherhood,” she recalls.
Arquilla is far from alone. Despite the name, it’s not uncommon for postpartum depression to show up as anger. PPD is characterized by a wide range of emotions: Yes, it can include excessive crying or deep sadness, but also feelings of irritability, anxiety, guilt, worthlessness, or being overwhelmed, among physical signs like having trouble focusing, sleeping, or eating enough, according to the US Office on Women’s Health. Though the symptoms of what might have been PPD have been documented as far back as 460 BC, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association and offers guidelines for diagnosing mental illness, only recognized postpartum onset as a sign of depression in 1994.
In recent years, perinatal or postpartum mood and anxiety disorder (PMAD) is another term that has grown in popularity. The umbrella acronym is often used interchangeably with PPD, and encompasses the distressing feelings that crop up during and after pregnancy. This includes both physical and mental symptoms, like the ones mentioned above, which can sometimes stick around for several years.
But if anger seems to be your prevailing emotion postpartum, there are several totally valid reasons why this might be the case—and there are ways to get the help and support you need and deserve.
Turns out, there are plenty of reasons to be angry as a parent in this country.
From inadequate postpartum care to an absence of universal paid parental leave to dire health care disparities among marginalized groups to a medical system that can be downright dismissive and discriminatory of queer and nonbirthing parents, there’s a lot to be pissed off about when it comes to the lack of holistic attention around starting a family.
“Motherhood is messy,” Sarah Kauffman, MD, the physician director for the Hoag Maternal Mental Health Program in Newport Beach, California, tells SELF. “Society talks about motherhood as this wonderful, blissful time, but it’s not always like that.”
Despite being normal, the negative emotions associated with new parenthood—depression and resentment chief among them—continue to carry a certain level of social stigma. Anger often stands out, perhaps in part because it’s viewed as an emotion that feels particularly at odds with the outdated-but-oft-repeated stereotypes of a tireless, nurturing caregiver.
“We all get angry at our kids,” Dr. Kauffman says. “We have moments where we don’t act like our best self. Anger is a natural emotion, and it doesn’t mean that you are bad, incompetent, or unsafe around your child.”
Then there’s the undeniable weight of keeping this tiny human healthy. If you’re formula feeding, for example, you may feel like you’re caught in an endless cycle of washing and sterilizing nipples and bottles. If you breastfeed or pump, you may feel as if your boobs are constantly attached to a baby or a machine. Plus, while some studies suggest breastfeeding can help protect against depression or anxiety for certain parents, other studies indicate a more nuanced relationship—especially if the parent is struggling to breastfeed, per a recent review of research. It’s easy to understand how frustrating and rage inducing a situation can be when your body simply won’t do what you want (and in many cases, need) it to do.
Going back to your workplace can be a significant barrier to successful breastfeeding too. While federal law states that employers are required to provide “reasonable” time for a working parent to pump, in practice, one study found that widespread discrimination had “particularly harsh effects” for people who have low incomes. What’s more, lactation support programs can be difficult to access either due to cost or accessibility (and when, exactly, are you supposed to find the time to attend a class?). The guilt of not being able to successfully breastfeed—fueled by “breast is best” stigma—can also drastically affect a new parent’s mental health.
Finally, after having a baby, only the birth parent is asked to attend one postpartum appointment, and just 40% of parents do, according to the American College of Obstetricians and Gynecologists (ACOG). At that appointment, you fill out a form (the Edinburgh Postnatal Depression Scale) that asks you to rate how you’re doing emotionally. It doesn’t address anger directly, but it is the screening that professionals use to identify postpartum depression. It can be a helpful tool—as long as you’re honest. However, if you’re already dealing with other social stigmas, or say, a hurried doctor or receptionist who handed you a clipboard in the waiting room, it may be tempting to underestimate or misrepresent what you’re actually feeling. Having said that, even if a form feels like the bare minimum in terms of assessment, it can be a first step to getting help (more on that below).
There are physical changes fueling your postpartum anger too.
If you’ve experienced pregnancy, you may already be familiar with the rapid mood swings fluctuating hormones can trigger. Turns out, labor and delivery are no different. There’s a dizzying combination of physical changes that hit you quickly—all of which can do a number on your emotional well-being.
“After delivery, there’s this incredible change in reproductive hormones,” Katherine L. Wisner, MD, the Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology at Northwestern’s Feinberg School of Medicine, tells SELF. “Hormones—such as estrogen and progesterone—go from the highest they’ll ever be down to almost nothing as soon as the placenta is delivered.” And some experts believe these rapid hormonal shifts are linked to the development of PPD in people who are biologically susceptible.
Plus, recovering from a vaginal delivery or a C-section is hard and can be incredibly painful. Giving birth does not always go smoothly, and some estimates suggest one-third of people who give birth experience some form of trauma while delivering their baby, which may contribute to PPD or post-traumatic stress disorder (PTSD). While trauma can include things like enduring premature labor or feeling worried about a baby’s well-being, many people report that the people in the room—their care providers, including doctors, midwives, and nurses—are responsible for these distressing experiences, say, by dismissing the severity of a birthing parent’s pain, among many other scenarios.
But one of the biggest changes that will affect your day-to-day functioning as a new parent is the ability to get enough sleep. Recovering postpartum with little to no sleep is a challenge that’s underestimated by society, Dr. Wisner says. And, as you might be able to guess, studies have shown a strong correlation between sleep deprivation and emotions like depression, anxiety, and anger.
In a Canadian study of nearly 300 women, published in BMC Pregnancy and Childbirth in 2022, 31% of moms reported feeling intense anger, while more than half said their sleep quality was poor. The researchers concluded that a parent’s sleep quality, as well as feeling angry about their infant’s sleep quality, were two major predictors of postpartum anger.
A range of disparities also contributes to the rage.
For Black birthing parents, in particular, the stigma anger carries can be a huge barrier to seeking necessary mental health support. “Anger and rage are widely under-recognized. There’s a natural shying away of emotions in fear of being the stereotype of the ‘Angry Black Woman,’” Lauren Elliott, the CEO and founder of Candlelit Therapy, a perinatal mental health care service for underserved new and expectant parents, tells SELF. “Black maternal health is in extreme crisis.”
There are a host of systemic issues that prevent Black people and other people of color from receiving proper mental health care. Birth parents of color experience higher-than-average rates of postpartum depression, and yet, they are less likely to be diagnosed, less likely to know that the symptoms they’re experiencing are related to PPD, and are therefore less likely to be properly treated, according to a report from the Center for American Progress.
“Black women are less likely to be screened in pregnancy for depression and anxiety,” Elliott says. The consequences of these disparities can be devastating. As SELF previously reported, Black and Indigenous women are two to three times more likely to die from pregnancy-related causes than white women, per the Centers for Disease Control and Prevention (CDC).
What’s more, Elliott says, when Black parents do speak up to express their needs, it is not uncommon for those needs to be dismissed or ignored by health care professionals, which is one of many reasons Black birthing parents may feel distrustful of the health care system as a whole. “As a society, we do not create enough space to be heard,” Elliott says.
The stress and irritability of new parenthood don’t end with the birthing parent, either. Up to one-quarter of dads may develop PPD, according to the American Academy of Pediatrics (AAP). The mental health challenges queer parents face are also staggering. In one study of lesbian, bisexual, and queer nonbirth parents (which refers to the partners who were not pregnant), they reported feeling like they would deal with discrimination from family, judgment from strangers, and legal complications, all of which had a negative mental health impact even before their babies were born. In the same study, this group described a lack of resources or a lack of access to services designed for their unique needs. The scarcity of studies on queer couples and nonbirth parents also underscores the need for more inclusive research, especially because what little information we do have seems to show that PPD can be universal.
As a new parent, feeling overwhelmed, unappreciated, and isolated are all common as you learn to navigate changes in your day-to-day life and evolving relationships. And, like we mentioned, it’s clear that a lack of societal infrastructure also fails parents—especially those who stem from marginalized and underserved communities. There is no universal paid parental leave, the cost of daycare is often an enormous financial burden on families, and parents often feel pressure to look and behave a certain way. (Remember, you made the choice to have kids! So why aren’t you grateful for the opportunity to pump in a closet and guard the door with your body so your coworkers don’t accidentally walk in? Effing aggravating, right?)
When to seek help for postpartum anger
While anger—whether you’re feeling extremely irritable or straight-up yelling—is a completely normal and understandable emotion to grapple with as a parent, it can sometimes be a sign that something more serious is going on. The pandemic, and the many stressors it unearthed, has only worsened the risk of PPD, and the condition is now estimated to affect at least one in three postpartum parents, according to a 2022 study in BMC Research Notes.
PPD differs from the “baby blues,” or general feelings of sadness, which up to 80% of people who give birth experience, according to the AAP. The “baby blues” are temporary, lasting only a few days to a few weeks. If symptoms such as deep sadness, a feeling of hopelessness, difficulty sleeping—and, yes, anger, even rage—stick around for more than a few weeks after you give birth or cause you to worry about your safety or your baby’s safety, you should speak to your doctor or a mental health professional as soon as possible.
Anger has long been an oft-overlooked sign of PPD. In addition to the many symptoms we’ve covered, there are a few more signs that your unrelenting anger may be a symptom of PPD, according to Dr. Kauffman:
The amount of time you spend feeling angry is bothering you and affecting your quality of life.
Anger is affecting your ability to bond with your baby.
Your relationships with others, such as your partner or friends, are becoming increasingly strained.
The first thing you should know is that PPD (and the anger that can come with it) is treatable, Dr. Wisner says. You can feel better, which is good for you, your baby, and your family unit. It might feel scary to ask for help or open up about how much you’re struggling—but ultimately it’s so important and worth it for you to reach out. Here are a few places you can look:
Call the HHS Maternal Mental Health Hotline: This just-launched line is a confidential, toll-free hotline for pregnant people and new parents to call or text to talk to trained counselors and get referrals to providers. Reach the hotline at 1-833-9-HELP4MOMS.
Call or text Postpartum Support International: PSI is an organization that can connect you with several means of treatment for postpartum depression, such as their call/text line (1-800-944-4773). They can help you find a provider, join a PSI online support group, or even connect you to a trained mentor who has experienced and fully recovered from a perinatal mood disorder. Peer support is incredibly important in PPD recovery, says Dr. Wisner, because you’ll see that there are other parents who are “going through the same things you are.”
Talk to a professional: Open up to a trusted health care provider (your ob-gyn, midwife, doula, or nurse) about your anger and how it’s impacting you. They can connect you with a qualified therapist who specializes in perinatal mental health or talk to you about other options.
Find sleep support: You will lose sleep—it’s the nature of having a newborn and infant. (And to be honest, toddlers wake up at night too.) “A big part of the work I do is finding some degree of sleep protection [for my patients],” says Dr. Kauffman. How this works will depend on the individual, but there are some factors to consider. For example, if you have a partner, you may ask them to take care of the first feed of the night or ask them to handle the burp-change-swaddle-back-to-bed routine after you feed your infant. Napping, if possible, is also highly encouraged. “Once you can get a consolidated five hours of sleep, you’ll feel quite a bit better,” Dr. Kauffman says. It does take time to “catch up” on lost sleep, but you’ll get there.
Where you can find help
In addition to seeking professional help, there are also a few steps our experts suggested you could take to better manage your anger at home. These practices can be generally helpful, not just during the postpartum period, but during other times of stress as well.
Start a mindfulness practice: Anger can seemingly bubble up out of nowhere. But usually, there’s a stimulus that starts the domino effect—your baby crying, your partner asking you what you’re having for dinner, or one more pile of laundry that needs to be folded. A mindfulness practice, says Dr. Wisner, can help you put a pause between that stimulus and your reaction, allowing you to use a different coping skill to respond. Not that you need another to-do, but you can listen (or half-listen) to an app on your phone, like Headspace or Calm, to start cultivating a mindfulness practice. Even better: If you’re currently pregnant, start this practice now. If meditation isn’t your thing, consider other habits that make you feel grounded—say, gentle stretching, deep breathing, or anything else that helps you recenter.
Tap into your triggers: After calming down from an anger spiral, stop and check in with yourself: What set you off? We all have triggers that cause us to boil over, and if you’re not sure what yours are, ask your partner or a trusted friend to help you figure it out, suggests Renee Goff, PsyD, a licensed clinical psychologist certified in perinatal mental health in Kentucky and Ohio. Another clue is to cue into your body’s responses right before you lose it. Maybe your face feels hot, your heart races, you clench your jaw, or you start sweating. “If you identify these, you can pinpoint when you’re getting ready to explode and then intervene,” she says. As soon as you feel your teeth clench, for example, that’s your signal to walk out of the room, stop to take a breath, or step outside.
If you take nothing else from this piece, know that a diagnosis of PPD does not make you a bad parent. You can be overjoyed to finally have the baby you’ve hoped for, planned for, and wanted so badly—and still be intensely angry at times. All parents deserve adequate prenatal and postpartum support, and setting up that plan ahead of time can be extremely helpful.
For Arquilla, a prescription for antidepressants and regular visits with her therapist stabilized her mood and helped her process her feelings. All these things set the stage for recovery, which she continued during her third pregnancy. After her third child was born in March 2020 she says her PPD did not come back—and she credits the treatment plan she had in place. “I was juggling three kids, and things felt easier,” she says. “Know that this is not your fault and there is a way out.”
By: SELF