Postpartum depression (PPD) is a serious issue that can affect women who have recently given birth. Because PPD is caused by hormonal changes that the body goes through during and following pregnancy, it can appear regardless of if the mother gave birth to her own child or if she served as a gestational surrogate for another family. PPD can and does occur in gestational surrogacy. Let’s explore this idea in more detail.
Gestational surrogacy is a form of assisted reproductive technology in which a woman agrees to carry a child for another individual or couple who cannot have children on their own. Gestational surrogacy combines IVF technology with the selflessness of women who serve as surrogates to help people achieve their dreams of parenthood.
While gestational surrogates are not biologically related to the child, their bodies are still subject to all of the same physical and hormonal changes that occur during a pregnancy of their own. That means they are just as susceptible to postpartum depression as a mother who births her biological child.
Let’s explore more about what gestational surrogacy and postpartum depression are and how they are related.
A Little Introduction To Gestational Surrogacy
There are many reasons why someone may be unable to carry a baby themselves. People who struggle with infertility, who have medical issues that make pregnancy impossible or difficult, or someone who does not have a uterus can turn to gestational surrogacy as a means of having a child.
The main advantage of gestational surrogacy over another alternative like adoption is that surrogacy allows the intended parent(s) to have a biological tie to their baby. It is becoming an increasingly popular way for gay men in particular to have biological children.
It’s important to note that gestational surrogates are not biologically related to the child they carry. Embryos are created in a lab using donor gametes (sex cells) or gametes provided by the intended parent(s). The embryo is then transferred to the surrogate’s uterus where it will hopefully implant and turn into a successful pregnancy. Learn more about gestational surrogacy: What is Surrogacy?
The People Involved In The Process
Sometimes the lingo used in the TTC (trying to conceive) community can be unclear, especially to someone who has just begun research into the area. Here’s a list of the different people who are typically involved in the process of gestational surrogacy:
- Intended parent(s) – often abbreviated as IP(s), this is the person or couple who want to have a baby via surrogacy.
- Gestational surrogate – known in the industry as a gestational carrier, or GC, this is a woman who agrees to carry a baby for the intended parent(s). All gestational surrogates are required to have had at least one successful, healthy pregnancy of their own, with no recent history of mental health issues or antidepressant use, among many other criteria.
- Egg donor – a woman, typically age 21-29, who donates her eggs to be combined with either donor sperm or that of an intended father in order to create an embryo in the lab.
- Fertility clinic staff – led by a reproductive endocrinologist, the fertility clinic staff coordinate the medical screenings, care, and procedures related to gestational surrogacy.
- Agency staff – surrogacy agencies assist intended parents and surrogates during the long and complicated surrogacy journey. Levels of service vary by agency, with some offering matching services only and others, like Family Inceptions, offering comprehensive assistance from start to finish. Take a look at our surrogacy support team for a view of how we help.
- Assisted reproductive technology (ART) attorney – a lawyer who specializes in surrogacy arrangements will help draft the contract based on state and local laws that apply. The contract will lay out all expectations and boundaries for the involved parties.
How Does It Work?
The surrogacy journey, as it’s often referred to in the industry, is not quick or particularly straightforward. Still, there is a basic path that most journeys follow, taking anywhere from 12 months to 18 months and beyond.
Most hopeful parents and surrogates find each other by working with an agency that coordinates the match and logistical details, although some choose to match independently or with a personal connection.
Once matched, the intended parents and potential surrogate go through a variety of screenings and evaluations, including medical exams and psychological consultations. Once a surrogate has been approved by the fertility clinic as a good candidate, the involved parties work with an attorney to develop the Gestational Surrogacy Agreement (GSA). This contract establishes boundaries and expectations for everyone throughout the journey.
The intended parents work with their fertility clinic to create embryos or obtain donated embryos which are then transferred to the surrogate’s uterus during a medical procedure.
Once a pregnancy is successfully detected, the intended parents and surrogate will keep in contact, sometimes attending doctor’s visits together and exchanging regular phone calls or texts.
Many surrogates develop very close relationships with their intended parents and report feeling more attached to them than to the child they are carrying. Women who become surrogates do so out of a deep desire to see others achieve their dream of parenthood, so to them, the joy is truly in giving the parents the gift of life.
After giving birth, many surrogates and parents keep in touch with regular contact, depending on what everyone agreed to in the contract. At Family Inceptions, we encourage our families and surrogates to maintain some level of communication, in particular so the child can grow up being aware of their origin story.
What Is Postpartum Depression
Postpartum depression, or PPD, is a type of major depression that begins after having a baby. According to the American College of Obstetricians and Gynecologists, it can develop up to a year following delivery but more commonly develops within 1-3 weeks. A lot of women report feeling sad or “down” for a few days after giving birth. It’s normal to experience so-called “baby blues” for a short period of time, but if those feelings continue longer than a week or two, you may be experiencing PPD. Postpartum depression can affect your behavior and mental health as well as the health and development of your baby, so it’s vital that you receive help.
PPD is a very serious but treatable condition. If you believe you are experiencing postpartum depression, reach out to your doctor or midwife as soon as possible, or contact the SAMHSA’s National Helpline at 1-800-662-HELP (4357) to receive referrals to local providers or support groups.
The Signs And Symptoms To Watch Out For
Symptoms of postpartum depression can range from mild to severe. In general, if you feel sad, empty, flat, or emotionless, you could have PPD.
Here is a non-exhaustive list of possible symptoms of postpartum depression:
- Major mood swings
- Excessive crying
- Feelings of hopelessness, shame, inadequacy
- Difficulty bonding with the baby
- Feeling withdrawn/disconnected from friends and family
- Disordered eating, loss of appetite
- Extreme irritability and/or anger
- Inability to enjoy things that used to bring you pleasure
- Difficulty concentrating or making decisions
- Extreme fatigue, loss of energy
- Anxiety and/or panic attacks
- Feeling disinterested in the baby
- Poor memory and/or brain fog
- Unexplained headaches, pains, or stomach problems
- Thoughts of harming yourself or the baby
- Thoughts of suicide
Postpartum depression is common and is not something to be embarrassed by or ashamed of. Reach out to your healthcare provider if you experience any of the above symptoms for an extended length of time.
If you have thoughts of harming yourself or others, or if you are contemplating suicide, visit your local emergency department or contact the National Suicide Prevention Lifeline at 1-800-273-8255 or by texting HOME to 741741.
The Cause Of Postpartum Depression
Postpartum depression is often caused by a combination of several factors. Possible causes include the following:
- Hormonal changes following childbirth
- Life circumstances such as death of a loved one, family illness, change in job or home status, etc.
- Emotional issues including doubts about being a new parent, feelings of self-worth, etc.
- Prior history of depression
Often, a combination of the above factors comes together to create a “perfect storm” resulting in PPD.
Risk Factor Of Postpartum Depression
Some people are more at risk of postpartum depression than others, although anyone can develop PPD. A person may be more at risk if any of these factors are present:
- Prior history of depression or other mental illness
- Family history of depression or mental illness
- Difficult pregnancy or delivery experience
- Baby who is born with health issues or special needs
- Experience difficulty breastfeeding
- Lack a local support system
- Had an unplanned pregnancy
- Experiencing stress in personal relationships and/or financial life
- Experiencing major life change like job loss, move, or family illness
If you are aware that you are at an increased risk of postpartum depression prior to delivery, be sure to discuss that with your healthcare provider during your prenatal appointments. Your doctor or midwife can help you decide what, if any, treatment or prevention is advisable.
What Does It Do To The Baby?
If left untreated, postpartum depression can have serious effects on the baby. When a new mother is experiencing depression or anxiety, she can have trouble bonding with the child.
Beyond that, research has shown that children whose mothers have untreated PPD are more likely to struggle throughout their development. Some difficulties include:
- Failure to form a secure attachment
- Emotional & behavioral problems
- Trouble sleeping
- Eating problems
- Excessive crying
- Language delays
- Cognitive delays
- Academic problems
- Higher risk of ADHD
- Risk of depression during teenage years
Who Can Experience This?
Postpartum depression isn’t limited to the person who gave birth. Anyone who is involved in the pregnancy, delivery, and post-delivery process can experience postpartum depression and/or anxiety. It is not uncommon for parents who have children via adoption or gestational surrogacy to develop a form of postpartum depression.
In a surrogacy arrangement, gestational surrogates can develop postpartum depression due, in large part, to the major hormonal changes that are happening in her body. However, not all causes of depression are hormonal. Intended parents who have had a child via surrogacy have been through a major emotional rollercoaster, likely for several years up to the birth of their child. Add to that all the overwhelm, sleep deprivation, and general new parent worries, and you have the potential for postpartum depression.
Any new parent can struggle with the emotional weight and overwhelm of having a new baby. Parents who did not carry and deliver the baby sometimes worry that they won’t bond as quickly with the child. All of these changes combined can trigger depression in a new parent, whether they delivered the child themselves or not.
What To Do When You Are Experiencing This?
The Intended Parents
First, recognize that it is possible to experience postpartum depression even as a non-birthing parent. If you are struggling with post-surrogacy parenting, finding it hard to cope with a newborn, or you’re worried that you’re not bonding as well as you should, reach out to someone.
It can help to talk with one of the professionals who helped you with the surrogacy journey. Your agency, fertility clinic, doctor, or mental health counselor would be a good place to start. They can point you to resources or support groups that may help.
Becoming a parent via surrogacy is an incredibly unique experience, so it can be very helpful to read stories about and talk with people who have been in your shoes. There are online support groups full of other surro-parents who are happy to help out. A good place to begin your search for support groups is through Resolve.org.
Depression In New Fathers
Despite it not being talked about as much, new fathers can and do experience depression related to pregnancy and parenthood. Paternal postpartum depression is experienced by as many as one in four new fathers in the United States.
Though not as extreme, men also experience some hormonal fluctuations during pregnancy and the postpartum period. Plus, sleep deprivation can have a very serious effect on a person’s mental state.
Symptoms of depression in new fathers are similar to those of postpartum mothers. Irritability, mood swings, loss of interest in activities he usually enjoys, feelings of hopelessness, and other signs that don’t go away after a week or two can all point to depression.
If you suspect that you or your partner are experiencing paternal postpartum depression, reach out to your healthcare provider, a counselor, or a support group that can help you find treatment.
Postpartum Depression For Surrogate Mothers
Although all gestational surrogates should be thoroughly screened by a mental health professional prior to starting the process, it can be nearly impossible to predict how you’ll feel once you’ve carried and given birth for your intended parents.
The entire surrogacy journey is an emotional rollercoaster, and most surrogates become quite close to their intended parents. Once the journey comes to an end, some surrogates feel a little lost and sad to not be in regular contact with the new parents.
Recovering from childbirth without a baby, while expected by a gestational surrogate, can be a difficult experience. Your body will still go through all the same hormonal and physical changes. Experiencing all of that without a newborn to snuggle can be hard to cope with for some women. Surrogate mothers who suspect a case of postpartum depression should seek help and support from professionals and friends and family.
When someone is suffering from depression of any type, it can be hard to tend to basic daily activities. Make sure you reach out for help and extra support so your children are well cared for. The sooner you seek treatment, the sooner you’ll be on the road to recovery.
Prior to signing a surrogacy agreement, it’s advisable to talk about the possibility of postpartum depression. Set clear expectations in your contract that outline if and for how long the intended parents should pay for health insurance or any mental health treatments related to postpartum depression. If you start to suspect PPD, notify your agency for guidance and resources.
Intended parents can help surrogate mothers in the postpartum period by expressing gratitude, sharing photos or updates about how the baby is doing, and by checking in from time to time. This type of emotional support can help alleviate some feelings of depression.
Your partner also plays a big role in helping you deal with postpartum depression. Let your partner know how you’re feeling and how he or she can help.
As the partner of someone who is experiencing depression, you can help by providing support, encouragement and understanding. Educate yourself about depression and attend doctor’s appointments with her. Postpartum depression can be treated but it takes a lot of love and support from others to get there.
However, You Actually Can Prevent This
While it’s true that postpartum depression can appear at any time, even in people who have never struggled with mental health in the past, there are a few things you can do to prevent PPD. Prevention is especially important if you have any history of depression.
During The Pregnancy
Speak with your doctor about any past depression, anxiety, or mental health issues. You may be given a depression screening questionnaire during and after pregnancy to monitor your mental health.
Your doctor can refer you to support groups or counseling to help you cope with depression, or they may recommend antidepressants. Many antidepressants are safe to use during pregnancy. Your doctor can talk to you about any potential risks that come with medication and pregnancy.
After The Birth
Educate yourself and your partner about the signs, symptoms, and risk factors of postpartum depression. Early recognition leads to earlier treatment, which can prevent a more serious case of depression. You’ll likely be given a depression screening in the hospital after delivery and also at your six-week postnatal visit. If you suspect PPD, don’t wait the full six weeks—call your doctor’s office and let them know how you’re feeling.
Partners, it’s important for you to pay attention and speak up if you notice any signs of depression. Often, it’s hard for the person experiencing it to notice or identify what’s happening. Your early detection can be vital to getting your partner the help she needs.
If you’ve had a history of PPD or other mental health issues, or if there are complicating circumstances such as a difficult pregnancy or a pregnancy loss, your doctor might have you begin antidepressants or other therapies right away as a form of prevention.
Other Post Childbirth Syndromes That You Need To Know
“Baby blues” is a term that refers to a feeling of sadness, disappointment, moodiness, or irritability after giving birth. These feelings are quite common, with some sources stating that as many as 4 in 5, or 80% of all women experience this.
Baby blues can occur a few days after giving birth and last a week or two. If these feelings last longer than two weeks, it’s possible you’ve developed postpartum depression, which requires the care of a medical professional.
Symptoms of baby blues include:
- Feelings of sadness
- Frequent crying
- Mood swings
- Trouble sleeping and/or eating
- Feeling overwhelmed
- Trouble concentrating
Postpartum psychosis is a less common by very severe condition that can develop in the weeks following delivery.
Symptoms of postpartum psychosis include:
- Obsessive thoughts
- Sleep disturbances
- Excessive energy
- Excessive agitation
- Harmful behavior toward self or others
- Extreme mood swings
This rare condition requires immediate emergency treatment. Someone suffering from this has had a break from reality and is unpredictable, irrational, and can be dangerous to herself or her child.
People who have a past personal or family history of bipolar disorder, schizophrenia or previous episodes of postpartum psychosis are at a greater risk for the condition.
Help Each Other Out To Make A Happy Family
Postpartum depression is a medical condition that can happen to anyone who has just gone through the pregnancy and birthing process. Mothers, fathers, gestational surrogates, intended parents, and adoptive parents can, and do, experience PPD.
It’s important to look out for one another during such a major life event and to seek help when you suspect your feelings are more than just some temporary baby blues. At Family Inceptions, the health and wellbeing of our surrogates, egg donors, and intended parents is always top of mind. Reach out to our team if you need support or have questions about whether surrogacy is right for you.