#87 | Postpartum Rage: The Outburst-Guilt-Shame Cycle

March 17, 2021

Postpartum rage is among the lesser known perinatal mood and anxiety disorders that can impact  postpartum women and even their partners. Unfortunately, what women don’t understand is that sometimes anger comes more easily than tears, and it doesn’t mean that anything is fundamentally wrong with them or with their character; but rather, they are suffering from one particular manifestation of postpartum depression or anxiety.  Postpartum rage can look like: snapping at your children or partner, yelling more than usual, swearing, or even throwing things across the room. Any type of unexpected, intense outburst can signal a one-time or ongoing case of postpartum rage.  

Tune in today as Cynthia and Trisha discuss the risk factors, triggers, emotional experience, and possible solutions for postpartum rage. 

Postpartum Support International
Call the PSI HelpLine: 1-800-944-4773

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View Episode Transcript

Nobody really understands why it's not talked about. It's one of them. You can't, you can barely even find anything on it. If you Google it, it just there's not that much out there. And it might have to do with the fact that women are really, they have never really been able to express anger, it's they have less permission to have that feeling. It's an emotion that we associate more with men.

Every single one of them was told either, oh, it's the baby blues, it'll pass. Which isn't the case if any of these emotions have lasted over two weeks, or they were simply handed a prescription. That's it.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Alright, so we know you know about postpartum depression. And we know you'll probably also know about postpartum anxiety, but do you know about postpartum rage. That's what we are here to talk about today. postpartum rage is among the lesser known and understood among the perinatal mood and anxiety disorders that can affect prenatal and postpartum women and even their partners. So we want to talk about it because it's so seldom covered. And when women don't understand that sometimes for them, anger comes more easily than tears. It doesn't mean that anything is fundamentally wrong with them or with their character, but they're suffering from one particular manifestation of postpartum depression. So today, we're going to talk about, first of all, a clear example, that one woman in our weekly postpartum support group, so wonderfully shared in our group last week. And we want to talk about triggers and risk factors, and ultimately, what you can do about it, if you think you're suffering from postpartum rage, or maybe even if your partner is many of our listeners and Instagram followers know that we do run a weekly postpartum support group every single Tuesday morning of the year on zoom at 10am. And it's open to all women. And even though I was professionally trained through postpartum support International, the global authority in the field, most of my understanding at this point has come from the women I've worked with. I mean, that's really when you start to get insight when you form friendships and connections with the people that you're supporting. And you see what their struggle is. And suddenly, the textbook examples are just much more vivid. And I'm going to give you one of those real life examples that one of our moms is struggling with right now. But before I get into that, I want to just let you know, we will be providing you with psi eyes, toll free helpline at the end of the episode and in our show notes. So with that, I'd like to get into the example that we have for you today. But I just first want to acknowledge that it isn't particularly common for a woman to be aware that she's suffering from postpartum rage. And this just might be the first or maybe second woman I've worked with who's had postpartum rage that was aware of it. This is relevant because it's the first step in mental health, to recognize what you're feeling to recognize that this is a problem that you're temporarily experiencing, that's out of your control, because then you aren't blaming the triggers, which might be your partner, it might be the baby, it might be a circumstance, you're not blaming those triggers for what's happening to you and for your outbursts, but you're recognizing it is something you're struggling with, that's within you. And second, I want to mention how it's always an indication of wellness. When we do share in the right environment, the things we are struggling with. I once heard somebody say we're only as sick as our secrets. And that expression comes to mind every time I have new respect for a woman who's willing to share with the others in the group, something that's really hard for her to share something that she feels really bad about. And this is one of those examples. So I'm going to get into it now. This mom in our group, guiltily started to confess that there was something she just had to get off her chest. She started out by saying that her baby's been going through prolonged periods of high pitched screaming, you can imagine how stressful that would be to any parent. And there's nothing she can do to console her daughter. She's home alone with her all day. And her daughter sometimes goes for three hours on end. If your compassion isn't swelling right now, then maybe you're not a postpartum parent yet, because I think if you are you, you're feeling a lot even just at the thought of being home alone with a baby that you can't console. And that's how this story began. And this woman shared that she was with her baby at the changing table and there During the changing her daughter was still just screaming. And it was just, it was just too much it just she had a moment where she just couldn't contain the stress anymore. And she screamed at her baby, Will you shut the F up.

And then she stopped. And just took a moment and said, later in the day, when my daughter smiled at me, I felt like the worst mother in the world, I was so filled with shame, and guilt for how I had spoken to her. It's amazing, we're so hard on ourselves, because as soon as a woman shares a story like this, all that happens, there's never a judgement that I've ever seen from other women. All that happens is everyone is just filled with compassion for that mom. But her story is so valuable because it was a classic textbook example, in that there's a cycle to the rage. And a lot of people don't know about that there's a cycle. So it begins perhaps with a quiet resentment, that brews into anger. And for many women, it just stops there. It's resentment, it's anger. And that's how she goes through her her postpartum experience when she's struggling. But when it's a matter of rage, that anger boils over. And there are outbursts, sometimes the outbursts are violent physically. I once had a professional in the field, one of the best postpartum therapists that I that I know, who shared with me when she was a young mother, she went through a metal frame, across the room at her husband and chipped the wall. I mean, can you imagine if that hit him the damage it would have done to him. And she had that outburst. And now she's in the field supporting other women. But that's an example of postpartum rage. The mother who I just spoke about swearing at her baby cursing at her baby. That's a sign of postpartum rage, because that obviously isn't how we normally speak, or normally, especially speak to a newborn. So if you catch yourself not speaking, like yourself, not acting like yourself through angry outbursts, that's a sign of it, you know, if there's any other physical manifestation of it slamming things, would be another example. So let's get into what all of this means. Because right now, what we've identified is there's a pattern to it. There's an outburst, and then it's followed later by guilt, and shame. And then it just repeats. Why is there guilt and shame? Because these parents are compassionate, because they don't want to be angry. And why are they getting angry because their needs aren't being met. Because it's hard, because they're overwhelmed. And that's the most complicating factor of all, that you love your baby so much, that you feel so responsible, that you hope you're doing enough that you pray, they're developing correctly, that they're mentally developing, emotionally developing, that you're meeting all their needs, the worry, and the stress just doesn't end. When people visit, it's stressful when people don't visit, it's stressful when you go to a pediatrician appointment. It's stressful. And that just happens to be how the depression is manifesting for that parent. For some, it's tears. For some it's anger. For some it's OCD, which is something we'll talk about in another episode. I don't think many people really understand the thought processes of a postpartum mother because it is an unbearably monotonous lifestyle, but it's not monotonous. With boredom, it's monotonous with anxiety, and stress. If the CO parent is the one home with the baby, it's the same thing. I mean, there might not be the birth recovery, stress to deal with and that can be pretty immense by itself. But it's really for that person who is the default parent as as we sometimes say. Alright, so I think now Trisha, why don't you get into some of the risk factors and then after that, we'll get into triggers and, and maybe some other examples.

Before we get into the risk factors, I just want to reiterate that approximately one in four women will experience a perinatal mood or anxiety disorder. These can be postpartum depression. They can be postpartum anxiety, postpartum OCD, and postpartum rage. So if you have had any one of those things in the past, or if you have any one of those things, currently, it doesn't mean that you will experience postpartum rage. Or if you don't have any of these and never have had any of these, it doesn't mean that you can't experience postpartum rage. The risk factors for postpartum rage are very similar to the risk factors for postpartum depression and postpartum anxiety and they all relate to the underlying stress response. So a history of anxiety and depression is definitely a risk factor. Having insufficient support at home or potentially being a single mom, or having multiple twins, triplets. Parents who have a child with developmental challenges can also be at risk for this. A woman who has had a traumatic birth experience can be at risk for this a woman who has significant breastfeeding challenges can be at risk for this life. lifestyle changes are another major player in the picture. So anything that creates this underlying stress, anything that causes a significant disruption to your life.

Yeah, I'll give some examples of what of how extreme lifestyle changes can look because two of the most serious cases of postpartum depression I've, I've seen, it wasn't postpartum rage, but it was postpartum depression, were of women who developed it well into their postpartum period. In one case, the woman was five months postpartum, she was doing really quite well the first five months. And then she and her husband and baby simply moved from one town 15 miles away to another town. And that move alone, apparently alone, triggered her postpartum depression, which lasted for several months, she came to our support group, she went to a private club mission. And you know, she had to work hard at getting herself out of that. And she recognized the trigger as being the move just that that move. And the second case, which was actually extremely serious, too, it was actually the only mother I've ever worked with who was unresponsive to her baby. She was European and went to Europe with her husband to visit her family for a month. And after the first two weeks, her husband returned back home to the states to go back to work. And for her, that was when it began, and she was seven months postpartum when she made that trip. So as Trisha was saying, lifestyle changes mean a move, a divorce, a death, your partner losing their job, those all qualify.

One of the things also that we have seen in our postpartum support groups is that women who were in very high functioning jobs, or were very high achievers, in advance of having children and left their career also seem to be at more risk for this. And that is a significant lifestyle change that actually is a risk factor. It's women at not only the low end of the socio economic scale, but women at the high end of the socio economic scale. And in particular, women who are I don't want to say perfectionist, because I think that's, that's too extreme, but women who just really have their lives very much in order, and suddenly they have a baby. And it's just like they've never seen themselves so out of control, disorganized, and then that can bring on a lot of emotions of like, Where did I go, I used to do everything really well. And now I feel like I'm not doing anything well.

So let's talk a little bit about the symptoms of postpartum rage specifically, postpartum rage can look like outbursts, basically anything that you can imagine as a raging moment, anything that overcomes you overcomes your body makes you say things makes you physically do things that you wouldn't normally do. Something that you, you know, is out of character for you, or shocking to you. It can be physical expressions, like throwing things, slamming a door, kicking something, it can just be violent and aggressive thoughts. Again, something like cursing, swearing yelling at your baby. I mean, we heard an example that's, that's not uncommon for a woman who is completely overwhelmed and overcome with rage to actually yell at their infant, probably even more common yelling at your partner. And I recently heard another example. And this happens so frequently in relationships where it's such a mistake, when the partner does this, when they make a comment to say the at home mom, and say, You're so lucky, you get to be home, you're lucky you get to do this, I have to work. That is just not something anyone should ever be saying to that full time parents at home, because that's a 24 hour job. And even if the partner truly feels that way, they have no idea what that job is like until they're the ones doing it. 24 seven, and it's just insensitive to begin with. So sometimes a comment like that is enough to just completely set a woman off and experience full on rage toward her partner.

That's absolutely true. So what is a woman to do if she thinks she's experiencing postpartum rage? Is this just like a one time thing? Or is this something that she is experiencing? recurrently. And, you know, we know that rage is preceded by anger. But what's anger proceeded by, there's a feeling underneath anger, anger can be its own emotion. It can be a primary emotion, but most of the time, it's a secondary emotion. There's something else under there that comes first. So the first step is simply acknowledgement and can you become aware of the feeling? Is it a feeling of loneliness? Is it a feeling of isolation is feeling of resentment? Is it a feeling of hurt, right? Is there anything else you want to say or elaborate on?

Yeah, I just want to speak as a professional for a moment that the first thing you have to do, if you think you're struggling with postpartum rage is tell your partner I tell everyone in your support system. The first Everyone needs to keep in mind is whether the baby is facing any potential harm or negligence? The answer is usually no. But because it isn't 100% of the time always know, the question has to be asked Is there any condition under which the mom acts physically toward her baby acts physically toward her baby. Their stories of women who throw things at their partners when they're experiencing rage toward their partners, I once met a therapist in the field, and she wants to a metal frame across the room at her husband, and it hit the wall and put a chip in the wall. So this is a more serious situation, when her ages manifesting physically, so if she's taking care of the baby full time by herself, that's the first thing that has to be ensured that the baby is ultimately safe, above all, once we know that, that's okay, we focus on getting this mother the support that she needs. So again, it tells it starts with telling everyone in her support system. The goal is for her to understand her condition and for those around her to understand her condition, that it's out of our control completely, that it's temporary, and that there are ways to recognize the onset of postpartum rage so that it can be circumvented or mitigated and certainly working privately with a clinician would be a very important step here.

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So let's talk about triggers. Can we identify what the triggers are before we experienced the moment of rage? I mean, there are hundreds of them, right? I mean, for example, you just your baby crying, inconsolable baby, it could be your baby is napping and the dog barks and wakes your baby up, or the dog needing you something your partner says definitely something your partner says something your toddler does your other children. If you have an older child and the baby at home, it could be the phone call that you really need to take. But it's happens to be on the day that your baby won't take a nap and you're trying to double manage these things. The multitasking is definitely a trigger a painful breastfeed or a feed where you know your baby's hungry, and you know, they're exhausted and you just can't get them to latch. That's a huge trigger. Oh, yeah. identification. And awareness is the first step to management.

And this really ties back to emotions. Because those triggers make us you know, experienced something like frustration, or, you know, I like to sometimes say just feeling sorry for ourselves, like, I can't believe how much I have to bear right now. Sometimes it's that overwhelm. If a woman keeps saying, I'm just so stressed, or I don't feel like myself. And I want to mention something else about the anecdote that I raised earlier from the mom in our postpartum support group. After she shared her story, she really hits some valuable points in sharing everything that she did. And I mentioned one of them earlier that guilt and shame tend to follow. And that's heartbreaking to me because it shows how much this parent doesn't want to get angry at anyone. We've had women that you know this Trisha, we've had women in our support group who've cried about being mean to their husbands. And you just like these women don't come off remotely mean you can just see how much they're struggling, but it's their own good heart that makes them feel guilty later. So that is part of the cycle that comes with this. But there was something else that was really interesting that this mom said, she said, You know, I just happens when my daughter screams like this. It just it just pierces me and it just it goes right through me and it gets me feeling this rage. And then she added, but I think things are getting better now because she's crying less often. And I said, Well, that's definitely a good thing because that's your trigger. But we want to put more of the focus on what can I do the next time something triggers me because I promise you something well, and if we're just hoping that the situation is going to go smoothly, it's kind of like if you and your partner getting along really well. You can just keep crossing your fingers and hoping that things will keep going smoothly. But of course in a relationship other stuff is going to come up and you will get triggered again and there. A Day in the future, you and your partner are each going to feel difficult emotions toward each other again. So the question is, what can we do? When those things happen rather than hoping and praying, they don't come up again, I think it's also important to recognize that the guilt shame rage is a cycle. And it's a cycle that you have to break, otherwise it come, it compounds itself. And for me, and I think this is true in the literature. And just in sort of psychology, in general, the way to break the cycle is to come out of the shame and guilt by communication by talking about telling, recognizing and telling people about your feelings and admitting that you're feeling this way, sharing.

Yeah, that's why I truly feel so much respect for the women who come out with these stories in the postpartum support group, because it shows their own emotional wellness, to recognize what's going on and to be willing to share it. I always sit there and say to myself what I have if I had had a support group all those years ago, and how wonderful that would have been, if I had, I often think would I have shared this I hope I would have because I just respect so deeply the women who do she also doesn't realize it, but she's giving all the other women permission to say the same. And then sometimes other stories come out. And so often women say I never thought I would be sharing this because I thought I would sound crazy, or I thought you would all think I'm terrible. And then they share. And then the love just swells in the room, because everyone just cares so much about everyone else in the room. And then that's usually when I say, Do you feel that compassion you're feeling toward each other? You know, you're not judging each other. The woman who shares her rage is afraid of being judged. But see, all that happens is everyone feels compassion toward her. What if you turn that compassion toward yourself? Can you take that compassion you're feeling toward everyone else? Now? Can you apply it to yourself? Because that's what we're all feeling when you go through this.

I'm so glad you just said that. Because I think also, it's so important that we apologize to ourselves, when we have these moments that we don't just, we don't just get mad at ourselves and feel guilty and ashamed. And maybe we tell somebody, maybe we don't, but immediately following it. You can apologize to your baby, verbally Say it, say it out loud, and then apologize to yourself.

Yeah, I gave that exact advice to a woman the week before, who was feeling really guilty about something related to her baby. Actually, it was just someone who made a very insensitive comment to her and her baby. And she felt bad that she didn't somehow speak up and defend her baby, even though the baby is just a couple months old. And you know, just to get this just deeply feeling beautiful person who's who's feeling such a compassion toward the newborn. And I said, Well, why don't you just you know, take some time this week and just talk to your baby about it and apologize to your baby If you feel the need to. I want to apologize to my son for something I felt really guilty about. And he was two or three years old. And it was just something I had to do. And she came back last week and said it was she used the word healing. She said it's really healing to do that. What do you What are you smiling about? I know you have a memory right now what what's going on?

When you said you apologize to your son, it was just making me remember my greatest moment of postpartum rage. And I had a couple and it was later when my kids were a little bit older. But it was still related to postpartum sleep deprivation weaning off breastfeeding, which is, I think, a huge time in people's lives that is not talked about where these feelings of postpartum anxiety and stress can surface. But that's another conversation. Anyway, I had a moment where I was so overwhelmed with anger, frustration, and there was this closet in front of me that, you know, to my defense, we were about to knock the closet, out of the hallway, we had just moved into our house and we were getting rid of the closet and I couldn't stand this ugly piece in my house. And I just took my foot and I put it right through the closet wall. In my kids were there. Fortunately, we were able to eventually laugh about it. And they still like to tell the story. And you know, we still have made we've made something humorous out of it. But it required apologizing to everyone and I had to really process it and be like, Oh my god, like I actually got violent. I actually like put my foot through a wall. We're going to talk about what to do about this and try to manage the rage, or that or the depression if you're suffering from depression in general. I also want to make a comment about doctors after this because I've got something to say about that, that I just feel is really important. But for now, what can be done? Well, in my training and in anything I've researched and found ever since everything ties back ultimately to an acronym that is the word embody. And this is going to sound like simple everyday stuff when I tell it to you. But this is actually what has been found to get women through and men when they have postpartum depression through their postpartum depression. Isolation is at the root of all perinatal mood and anxiety disorders support groups have been shown to have a significant effect on women suffering from postpartum depression. In fact, just four to six sessions of a support group with a professional moderator has been shown to not only lessen the the intensity of postpartum depression or a perinatal mood and anxiety disorder, but also to shorten the duration. And for a woman in a support group, who does not have a perinatal mood and anxiety disorder, it has been shown against control groups to reduce the likelihood of ever developing one. And remember, that can happen anytime in the first year postpartum.

So that just what you were just saying, got me thinking that, you know, we need to recognize isolation and loneliness as a major risk factor. If just being part of a support group is that effective, then we know that the loneliness that women feel postpartum is a major risk factor. Yeah, that actually belongs at the top of the list, I always picture it like a pyramid. And it's just like the denominator, it's like the base of the pyramid, it's always there. It's isolation at the root. That's a great point. So the acronym I was referencing is m body, and the E stands for exercise. I know that sounds impossible. I know that's not something anyone has the energy to do postpartum, especially when they're experiencing these emotions, but any degree of exercise, the mildest walking, even I've had women in the group say walking out to their driveway and getting the mail, they can feel a physiologic difference after doing that. So don't think of exercise in the way that you're used to thinking about it. The M stands for meditate. Again, that bar sounds too high. But what if, when you get to bed each night, or when you sit up in bed each morning, you just sit there for two and a half minutes and breathe. What if you just quiet your mind little mini meditations, it's just breathing and focusing on your breathing, even if it's for 30 seconds, and you do it a few times throughout the day, that has a measurable impact. The B stands for breathe. So that was linked to the last thing I just said. But just slowing your breath. If your baby is screaming on the changing table, and your blood pressure is going up, just breathe in for four, out for eight, in for four out for eight calms the nervous system. The O stands for outdoors. So again, this can be linked to some of the other ones, which is so nice, because you can get a couple of these at once. But just getting outside standing outside for two minutes. It doesn't have to be a 30 minute walk. But anything to do with outside. If you're sitting by a big open window and looking out at the horizon, looking at the sky that's going to calm you because humans have that response to nature. The D stands for dump, or journaling. Again, if you're a perfectionist like I can be you're picturing writing all the things you want to say in your journal pages and pages. What if you were to write one or two sentences a day, you don't know how much I wish I had been doing that all these years. You know, instead, I journal every few weeks, and it's pages and pages and pages. But just one sentence a day would be so much more precious to me. And even if it was a hard day I wish I had that I wish I had I feel so lonely today. Or I feel like I spent the whole day trying to get the baby to take a nap that's giving a nod to your emotions. And that's really, really powerful. And the last one is yoga. Any kind of yoga can help position a down dog, a cobra position that has a measurable impact.

You're absolutely right, Cynthia, I love the embody acronym. And it's just keep it simple. Just go outside and put your feet on the ground for two minutes. Feel the sun on your face, take a deep breath, open the windows, feel the air, run your hands under hot water. That's so calming. It's amazing, simple things. That's all it takes. But one more point I want to make is that postpartum rage has been overlooked for a long time. And nobody really understands why it's not talked about. It's one of them. You can't you can barely even find anything on it. If you Google it, it just there's not that much out there. And it might have to do with the fact that women are really they have never really been able to express anger. It's they have less permission to have that feeling. It's an emotion that we associate more with men. And that's right and postpartum screening tests, they've typically left out questions asking women if they're having angry outbursts. So we're finally recognizing that this is a quite common manifestation of postpartum depression.

And probably one of the reasons that rage can really present in some women is that frustration without with of not having permission to express it. It's like we're holding this in, we're holding this in Why can't I express this feeling? Exactly.

The last thing I'm going to say is this. Almost anytime you read online in articles about postpartum rage or postpartum depression, you're going to keep reading check with your doctor. Tell your doctor, every time I read that, I think that's a real injustice to women. There are actual experts specifically in this field. Doctors have not had 10 minutes of education in perinatal mood and anxiety disorders, they haven't had 10 minutes of it. We are always saying in this country, go to your doctor, check with your doctor. This is simply not what they've studied. They're experts, but not in this. And nothing can be more harmful than reaching out for support and getting the wrong response. In these years of supporting hundreds of women postpartum, so far, each and every single one who shared with us that they spoke to their doctor about how they were feeling, and dared to broach this difficult topic with them, every single one of them was either handed a prescription, or dismissed as simply having the baby blues, which isn't the case, when these emotions last longer than two weeks. the right support is the support you need. They weren't told, make sure you tell your partner, tell your support system, get yourself into a support group or find a clinician, not just any therapist, a therapist specializing in perinatal mood and anxiety disorders because it does differ from generalized anxiety, generalized depression. So that's the last thing I wanted to say if you're doing any research and you keep reading, talk to your doctor, yes, talk to someone but do find the right person to speak with start with postpartum support international at postpartum dotnet. They have a helpline, the number is 800-944-4773. It's a toll free number anyone can call to get basic information, support and resources.

One caveat, and that is that if you are experiencing extreme postpartum depression, anxiety, rage, and you know that you need more urgent help, or a prescription, that any doctor any medical professional, any medical professional that you can see urgently is a first step but that is not going to be the long term remedy.

On that note, the first step when a woman really has a serious case of perinatal mood and anxiety disorders, depression, rage, or if there's any chance that that baby could be in harm's way. And this is why we say tell your support system first. Step number one is getting that woman 24 hour support. She's never to be alone with the baby if there's any risk of her having an extreme case, and yes, in that case, the doctor is a part of that and wide support system. So as the pediatrician or lactation counselor, everyone in that network should be informed. But please don't ever like your first and your last stop be with your doctor because there are professionals who dedicate their entire careers to this. And they are doing wonderful work in supporting when also as just a reminder that we have ongoing postpartum support groups on Tuesday morning and Friday evenings a prenatal support group that is available to all of you and we would love to have you join.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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