First, let’s consider the difference between occasional substance use and substance use disorder (SUD). With SUD, people get into a pattern of use that causes distress and impacts their life and their health. SUD can be mild, moderate, or severe. And it can involve any drug with the potential to become addictive, including tobacco (the most common), alcohol, marijuana, sedatives (benzos such as alprazolam or lorazepam), opioids (percocet or other pain medications), and stimulants (such as cocaine or methamphetamines).  

Am I at risk for substance abuse disorder (SUD)?

SUD affects people of all ages, races, genders, and socioeconomics, and there are a lot of factors that contribute. Genetics, early exposure to substances, and traumatic childhood experiences can all raise your risk. So can preexisting mental health conditions such as depression, anxiety, ADHD, and PTSD. 

Your risk is also higher during times of stress and change. For people who’ve recently given birth, all of those major life changes, especially if they’re combined with postpartum depression, may increase the risk of SUD. 

How to lower your risks

In stressful times, such as postpartum, it can help to lean into healthy coping strategies instead of substance use. For example, consider trying:

• Exercise
• Meditation
• Setting aside time for things you love to do, or picking up a new hobby
• Seeing a mental health professional when you’re feeling overwhelmed or distressed

How to tell whether you have a problem

There are lots of signs that a person’s substance use may be a problem. Here are some of the most common: 

• You’ve been using more of a substance, and for a longer time, than you meant to
• You’ve developed a tolerance for a substance, so you need more and more for the same effect
• You’ve tried to cut down or stop using the substance, but haven’t been able to
• You spend a lot of time getting a substance and then recovering from using it
• You keep using the substance, even when it’s causing a strain on your relationships or putting you in dangerous situations
• You’ve given up some of the things you love because of your substance use
• When you don’t use the substance, you have unpleasant symptoms that are relieved by using more

These are some of the behaviors you, or your friends and family, may notice if you’re experiencing SUD: 

• Confusion
• Forgetting to eat
• Withdrawing from your relationships
• Losing interest in your physical appearance
• Mood changes
• Anger or hostility if someone tries to talk to you about your substance use
• Being secretive to hide your substance use

Getting help for substance abuse disorder

If you think you may be experiencing SUD, it’s important to reach out for help. SUD is hard to manage on your own, but your healthcare provider, a therapist, or a psychiatrist can help. 

SUD is a chronic condition that needs ongoing care, and care is unique for each person. Sometimes, in addition to care for SUD, people benefit from treatment for other underlying mental health conditions. 

Treatments for SUD include:

• Help to stop taking substances and clear them out of your body
• Therapy to find coping strategies and help you address any underlying mental health conditions
• Support from a self-help group, such as Alcoholics Anonymous
• Medication to help address the brain chemistry of substance use disorder and ease cravings and withdrawal. There are medications to help people stop using opioids, alcohol, and tobacco.

Reviewed by the Ovia Health Clinical Team

Read more

Substance Use Resources

Sources:

• Chapman, Shawna L. Carroll and Wu, Li-Tzy. Postpartum Substance Use and Depressive Symptoms: A Review. Women Health. 2013 Jul; 53(5): 479–503. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742364/ 
• Cleveland Clinic. Substance Use Disorder (SUD). https://my.clevelandclinic.org/health/diseases/16652-drug-addiction-substance-use-disorder-sud

What we know about using marijuana postpartum

Here’s what the research tells us about how a parent’s marijuana use can impact infants and children:

• Marijuana affects breast milk. We know that chemicals from marijuana can enter breast milk, but there is not enough data to know the impact of those chemicals on infants. Experts suggest avoiding marijuana if you are breastfeeding. 
• Second-hand smoke can be dangerous. We don’t have studies on the impact of second-hand smoke on the developing brains of infants. However, studies of adolescents exposed to marijuana show that it has a negative effect on their attention and memory. 
• Marijuana can increase a parent’s risk-taking. Sometimes, people who use marijuana take more risks than they would otherwise, such as driving while under the influence. This can pose a threat to both parents and children.
• Accidental ingestion can be harmful. Infants and young children who accidentally ingest marijuana are more likely to need hospitalization because their bodies are smaller, and their symptoms tend to be more severe. Marijuana needs to be kept well out of reach.

It’s also worth considering a few of the risks of marijuana use for your own health:

• Studies show that using marijuana can have negative effects on a person’s memory, attention, and decision-making, which could interfere with your ability to care for your baby 
• Smoking and vaping marijuana can damage your lungs. 
• Marijuana concentrates may contain additives that haven’t been studied for safety.
• Synthetic cannabinoids can be more powerful than marijuana, and may have dangerous side effects.
• There aren’t any federal safety standards for state-based marijuana dispensaries.
• Marijuana may impact how prescription drugs work in your body. If you are taking medication, talk with your doctor about whether marijuana could impact your treatment.

Thinking through your relationship with marijuana

If you’ve been asking yourself whether you’re using too much marijuana, it’s time to take a deeper look at how the drug is impacting you and the people around you. Here are four questions to help you think about your use:

1. Would it be easy to stop using marijuana for a while?

If you’re concerned about your marijuana use, try stopping for a bit to see how you feel. If you can’t stop, or if you have withdrawal symptoms when you do, that may be a sign of marijuana dependence. Typical marijuana withdrawal symptoms can include anxiety, irritability, anger or aggression, disturbed sleep/dreaming, depressed mood and loss of appetite.

2. Do you sometimes use more than you meant to?

If you sometimes use more marijuana than you’d planned, or if you’re using marijuana more often than you intend to, it may mean you’ve developed a dependency. Sticking to your regular usage is a sign that you are managing your use.

3. Do you organize your days around using marijuana?

Do you spend a lot of time thinking about when you’ll have the next chance to use marijuana? Or do you avoid activities that would get in the way of using? Have you ever put yourself or your family at risk because of your marijuana use? Any yeses here could be cause for concern.

4. Do you argue with friends or family about your marijuana use?

If friends or family have come to you with concerns, this could be a sign that you’re developing a dependency. If you and your partner argue about the cost of your marijuana use, or if it makes it hard for you to get the usual things done around the house or to communicate well, these can be red flags, too.

If any of your answers concern you, please reach out to your healthcare provider for support. While many people who choose to use marijuana find a good balance, the CDC reports that about three in ten people who use marijuana may have a cannabis use disorder. Your healthcare provider can help you find the support you need to quit.

Reviewed by the Ovia Health Clinical Team

Sources:

• Amenbar, Teddy. ‘Am I using too much weed?’ Ask yourself these questions. Washington Post. https://www.washingtonpost.com/wellness/interactive/2023/marijuana-cannabis-use-addiction/ 
• American College of Obstetricians and Gynecologists. Marijuana Use During Pregnancy and Lactation. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/10/marijuana-use-during-pregnancy-and-lactation 
• Centers for Disease Control (CDC). Cannabis Frequently Asked Questions. https://www.cdc.gov/cannabis/faq/?CDC_AAref_Val=https://www.cdc.gov/marijuana/faqs.htm 
• Shukla, Samarth and Doshi, Harshit. Marijuana and Maternal, Perinatal, and Neonatal Outcomes. https://www.ncbi.nlm.nih.gov/books/NBK570616/ 
• Connor JP, Stjepanović D, Budney AJ, Le Foll B, Hall WD. Clinical management of cannabis withdrawal. Addiction. 2022 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9110555

Current health guidelines recommend that adults over 21 who drink should do so in moderation. Moderation is considered one drink or less per day for women and two drinks or less per day for men. 

Here are examples of one drink:

• 12 ounces of 5 percent beer
• 8 ounces of 7 percent malt liquor
• 5 ounces of 12 percent wine
• 1.5 ounces of 40 percent (80 proof) liquor

What are the health risks?

According to the Centers for Disease Control and Prevention, any amount of alcohol increases your health risks, including the risk of liver disease, high blood pressure, heart disease,  some types of cancer, and mental health conditions like depression and anxiety. You can lower your risks by drinking less or not drinking at all. 

Is it safe to drink alcohol when you’re breastfeeding?

If you’re breastfeeding, experts say the safest option is not to drink at all. However, moderate alcohol intake hasn’t been shown to be harmful to infants. 

If you do drink, it’s best to do so moderately—not more than one drink per day—and to wait at least two hours after a drink before breastfeeding. 

Excessive drinking (more than one drink per day) when you’re breastfeeding can have negative impacts on an infant, including problems with growth, development, and sleep.  

What about the health benefits of alcohol? 

You’ve probably heard that drinking some alcohol, such as a daily glass of red wine, has health benefits. But experts have found some flaws in the original studies.

For one, those studies didn’t consider other behaviors, like eating well, exercising, and not smoking, when they compared the different groups’ health outcomes.

Second, when researchers compared drinkers and non-drinkers, the non-drinking category included people who’d decided not to drink for any reason, including those who had to quit because of health conditions. So, the health benefits that seemed to exist for moderate drinkers may have just reflected the fact that people in that category did not have health conditions that would also have prevented them from drinking. 

Reviewed by the Ovia Health Clinical Team

Sources:

• Centers for Disease Control and Prevention. (CDC). About Moderate Alcohol Use. https://www.cdc.gov/alcohol/about-alcohol-use/moderate-alcohol-use.html 
• Centers for Disease Control and Prevention. Breastfeeding Special Circumstances. https://www.cdc.gov/breastfeeding-special-circumstances/hcp/vaccine-medication-drugs/alcohol.html 
• Centers for Disease Control and Prevention. Alcohol Use and Your Health. https://www.cdc.gov/alcohol/about-alcohol-use/index.html

But even if your family doesn’t have this kind of tradition, support from extended family can be a huge help during the postpartum period. Families offer cultural understanding that can help you adjust to your new role as a parent, and they can give you the kind of help that comes from knowing you well. 

Studies even show that having a strong support system of family and friends can help new parents manage symptoms of postpartum depression. Family can remind you that you’re not alone, give you a safe space to talk about your feelings, and provide practical help and breaks for self-care. (If you experience postpartum depression symptoms, please also reach out to your healthcare provider for support.) 

But even with all the support families can offer, there can be stress, too. It’s a balancing act to welcome help while you’re also developing your own parenting style. 

Tips for communicating across generations

Pretty much everyone—parents, grandparents, aunts, uncles, and cousins—has their own ideas about the best ways to raise a baby. So, as a new parent, you may need some strategies for communicating your own preferences gently but firmly. Here are a few tips:

• Be specific about the help you need. When family members offer their support, it’s okay to tell them exactly what you need. Maybe it’s help with the laundry, dishes, meal prep, or running errands. People want to help in meaningful ways, so telling them what you really need shows respect for their time and wishes. 

• Let them know that you value their experience, even if you want to do things differently. Parenting philosophies and safety guidelines change from generation to generation. When you and your family have different approaches, you may need to say something like, “I respect your experience as a parent, but we’d like to do things this way.” It can help to mention what you’ve learned from research, or what your pediatrician suggests.

• Set boundaries and share them. It’s okay to set guidelines for things like sharing photos of the baby on social media, or asking family members who smoke to change clothes before holding the baby. Clear boundaries can help you understand each other and avoid anger or hurt feelings. 

• Share the practical details. Inform your family members about sleep and feeding schedules and ask for their help keeping them consistent. Writing out your expectations, boundaries, and tasks will help everyone understand your needs.

Reviewed by the Ovia Health Clinical Team

Sources:

• Grigsby, Lynda Lin. Parents. What Other Cultures Can Teach the US About Postpartum Rituals. https://www.parents.com/pregnancy/giving-birth/what-the-u-s-can-learn-about-the-time-after-birth-from-cultures-around-the-world/ 
• Kachi, Elvis. Parents. How Family Support Eases Postpartum Depression, According to a Doctor. https://www.parents.com/family-support-postpartum-depression-8357410 
• Kemmerer, Shelley. Mommy’s Bliss. Managing the Extended Family During the Postpartum Period. https://mommysbliss.com/blogs/relationships/managing-the-extended-family-during-the-postpartum-period 
• Modak, Anushree. Cureus. A Comprehensive Review of Motherhood and Mental Health: Postpartum Mood Disorders in Focus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10613459/ 

Sometimes, partners feel resentment because they don’t have as much time for each other or don’t feel they have the support they need. In heterosexual couples especially, it’s common for the mother to take on more of the housework and child care, even if you shared responsibilities more equally before the baby was born. New parents may also feel tremendous stress over the financial responsibilities of raising a child.  These things can greatly affect your mental health, and it’s important to work on ways you can manage your mental wellbeing as partners.

All of these are common experiences, but the hard part at the beginning is temporary. Even though there are challenges, becoming parents together is also a chance to grow and deepen your connection.

Here are seven things you can do to help support each other and make the transition easier.

1. Make time to talk about changes. Open, honest communication about how you’re feeling is so important in the early days of parenthood. It helps set up the lines of communication you’ll need to parent together over the long haul. Now is a good time to talk about what you each need from each other and about how you want to raise your children together. 

2. Make a list of tasks and then divide them up. It’s easy to feel resentful if you find yourself doing more work than you think is fair. And it’s easy to overlook the work your partner is doing if you don’t talk about it. So try making a list of the big tasks, from housework to child care, and divide them up in a way that feels right to everyone. Some tasks can take more time and energy than others. So these may be ones that you might want to work on together or make sure one person is not taking on way too much. It may take some work to hash it out, and you may need to tweak it as time passes. But a plan can help everyone feel seen, supported, and appreciated. 

3. Don’t take over. Each parent is building their unique parenting style and one-on-one bond with the new baby. But it can be hard to watch someone do the small things differently than you do. If you feel tempted to step in whenever your partner does things differently, try going out and doing something for yourself while your partner and the baby spend some time together. 

4. Sleep when you can. Exhaustion makes everything, including relationships, so much harder. So grab sleep when you can, even if that means skipping things that can wait, like folding the laundry or mowing the lawn. Reach out to friends and family to watch the baby for a bit so you can get some rest.

5. Expect changes to your sex life. There are a few big reasons that couples’ sex lives change after a baby is born. The birthing parent is recovering and adjusting to many physical and emotional changes, which can affect libido. Both parents are typically getting less sleep and time alone and are adjusting to their new roles as parents. It can feel like there is little time left for each other after having a baby. This phase is usually temporary, but it’s important to talk about it to set realistic expectations and avoid hurt feelings. It’s also a good time to talk about ways to stay connected, including non-sexual forms of intimacy.  

6. Reach out to friends and family for support. Being a new parent often means that you’re spending much less time with friends and colleagues. But remember that you and your partner can’t be everything for each other. Stay in touch with friends who can support you, especially those with similar experiences to yours. And let willing friends and family watch the baby so you and your partner can find some one-on-one time together, too. 

7. Get help from a therapist if you need it. If you’re really struggling with your relationship, consider talking with a therapist. It can make a big difference to bring in a neutral person to help you communicate with each other. 

Important safety note: Most couples go through challenges as they adjust to having a baby, but physical, sexual, and emotional abuse is never okay for you or your child. If you’re experiencing abuse, please get help. Talk to your healthcare provider or call the National Domestic Violence Hotline at 800.799.SAFE (7233). For emergencies, call 911. 

Reviewed by the Ovia Health Clinical Team

Sources:

• UCLA Health. “Family dynamics: How relationships change after having a baby.” UCLA Health. September 2022, https://www.uclahealth.org/news/article/family-dynamics-how-relationships-change-after-having-a-baby 
• National Health Service (UK). “Relationships after having a baby.” NHS. https://www.nhs.uk/conditions/baby/support-and-services/relationships-after-having-a-baby/ 
• The New York Times. “Fighting Constantly After Baby? Read This.” https://www.nytimes.com/article/fighting-after-baby-guide.html 

Rochaun Meadows-Fernandez, Mother and writer

I was so busy learning to take care of a new human the first couple weeks after giving birth that I didn’t have time to process the event. Between kidney issues and my postpartum complications, everything was moving fast. It’s safe to say it was nearly a month after giving birth before I realized everything would change forever.

After discovering the source of my health complications, I began to feel like myself again. I wanted to resume life as normal now that I felt better, but it hadn’t set in that my usual freedom was gone. “Let’s go somewhere,” I would say.

“But what about the baby?” my husband would ask. Of course, I knew my son existed – I was his main caretaker. But until my support system returned to work, I didn’t realize things would never be the same. That realization led to a short spell of hopelessness and depression. I loved my son, but I hated being stuck in the house around the clock. The resentment towards my new life caused the dreaded baby blues.

Negative feeling post birth, or baby blues, are a common occurrence postpartum. The National Institute of Mental Health reports that up to 80% of new mothers report some experience the baby blues. But while they’re common, the baby blues can be debilitating if they catch you off guard.

My sadness was the result of an isolated depressive spell. However, for many women giving birth can cause long-term feelings of chronic and pervasive sadness that can quickly become life-threatening.

These feelings happen for a multitude of reasons. For some, it’s a natural part of adjusting to a new life. For others, like those who have postpartum depression, these negative feelings are related to hormonal changes and a cumulation of other factors.

According to the Center for Disease Control, you are at increased risk for postpartum depression if you lack social support, have had a baby preterm, or are under a period of considerable stress. Similarly, if you deal any of the following symptoms frequently after having a baby it is recommended that you speak to a mental health professional:

• Crying more than usual
• Feelings of anger
• Social withdrawal
• Guilt associated with motherhood
• Feeling disconnected from loved ones, especially your new baby

If symptoms persist, your mental help professional might suggest medication in combination with therapy to manage symptoms. In my case, my symptoms were mild enough that regularly scheduled talk therapy was sufficient. The mental health of new mom is an important yet frequently overlooked part of what’s sometimes called the “fourth trimester,” or the months just after giving birth.

Establishing a reliable network of support will help with managing both baby blues and postpartum depression. Seeking help from a mental health professional at the first sign of persistent negative feelings can help moms gain control before things get out of hand.

At my son’s first checkup it was clear I should consider help. The mandatory mental health assessment our care provider gives at each appointment revealed a score that suggested I should speak with a mental health professional. I decided it would be best for all involved to follow their advice. My initial appointment affirmed that my negative feelings were rooted in struggling to balance my new role as a mother with my personal goals.

When our families change, it’s important to discuss how that can affect your family dynamic and your goals. Also, remember these feelings may be triggered by the arrival of your little one but doesn’t make you any less of a good parent. Emotional changes are a natural part of adjusting to the flow of life.

Through counseling, I was able to make sense of my feelings. Prioritizing myself through practicing self-care in the form of writing and journaling was also useful when I was faced with hard times. Once I understood the cause of my emotions I was able to find effective ways to manage symptoms. Within a couple of months, I had established a new routine and was able to enjoy my new baby.

About the author:
Rochaun Meadows-Fernandez is a writer who specializes in sociology, health, and parenting. Her work has appeared in Healthline, Yes! Magazine, HuffPost, Allure, and many other publications. Follow her on Facebook, Twitter or check out her website.

Sources

• Mayo Clinic Staff. “Postpartum Depression.” Mayo Clinic. Mayo Clinic, August 11 2015. Retrieved July 27 2017. http://www.mayoclinic.org/diseases-conditions/postpartum-depression/basics/causes/con-20029130.
• “Depression Among Women.” Centers for Disease Control and Prevention. U.S. Department of Health and Human Services, February 15 2017. Retrieved July 27 2017. https://www.cdc.gov/reproductivehealth/depression/index.htm.
• “Postpartum Depression Facts” NIH. National Institute of Mental Health. NIH Publication No. 13-8000. Web.

 

Talia Glickman-Simon Contributing writer

Now that you’ve had your baby, you may be feeling out of sorts or overwhelmed about what comes next. Pregnancy can be extremely challenging, but the perceived focus is clear: take care of yourself and by definition you’re taking care of your little one. Then your baby is born and suddenly everything changes. 

It can feel like in a day the conversation shifts from “how are you doing” to “how’s the baby?”. And while those around you admired your changing body during pregnancy, afterwards, there can be so much pressure to return to the body you had “before.” This can be very overwhelming, particularly if you’ve ever had an eating and/or mental health disorder. 

First of all, try to remember you are not alone. Many new parents have trouble with their body image. If you are struggling with yours, that doesn’t mean you’re not grateful for your new baby. Instead of engaging in the understandable (yet painful) thoughts running through your mind, you might spend that energy getting curious about how to support yourself. Keep reading for a few ideas. 

Gently check in

One of the best first steps you can take is figuring out how you are feeling today. As you notice what’s coming up for you, try not to attach stories or specific meaning to your thoughts. Sitting with the sensations and feelings, if tolerable, can help you move through them. Here are some questions you might ask yourself when doing that:

• How am I feeling physically, mentally, and emotionally?
• What do I need to feel supported?
• Which family members, friends, or colleagues can I reach out to for that support?

Feelings of depression, anxiety, stress, or any other mood disorders are important to investigate as soon as you can. In addition to reaching out to a trusted provider, you can try using tools to assess mental health.

Be mindful of thoughts about body image

Because our culture emphasizes appearance, it makes sense that you might be experiencing some discomfort around body image after pregnancy. Try to give yourself credit — your body just went through a lot. It was a home, and provided sustenance for your baby. That’s a big deal. Also, it’s okay (and necessary) to let your body recover slowly. You don’t need to jump into intense exercise and restrictive eating habits. Instead, see if you can give yourself the permission and space to check out intuitive eating and experiment with new exercise routines until you find one that works best for you. 

Move your body

Depending on how you’re feeling and what sounds most appealing, this could involve a brisk walk, strength training, swimming, light stretching, or any other movement, big or small. Notice if you put pressure on yourself to get “back in shape” right away. Instead, can you allow yourself to do what feels most supportive? If you do choose to exercise, make sure you consider these postpartum exercise guidelines beforehand. 

Nourish yourself

Similarly to exercise and movement, “nourishment” is a subjective term. This could mean eating enough, getting better sleep, finding time to recharge, meditating, taking up a new hobby, seeing friends, or something else entirely. Anything that involves taking care of yourself, filling your cup, contributing to your own wellness is worth considering.

If you have questions about how to nourish yourself through nutrition, it’s a good idea to check out intuitive eating and schedule an appointment with a dietitian or nutritionist. 

Find support

Try speaking with a postpartum doula, therapist or another professional about how to take care of yourself as a new mom. If you have a good relationship with your provider, you could also ask for their advice during your postpartum visit.

Reviewed by the Ovia Health Clinical Team

Read more

• How much stress is normal with a new baby?
• Types of postpartum mood disorders
• Strategies for coping with postpartum depression