Yes, You Can Get PPD After A Later Pregnancy — Even If You Never Had It Before

When you’re a first-time mom, there are a lot of unknowns — including how you’ll feel once the baby actually arrives. You might picture those quiet, glowy moments, rocking in the nursery. But for some moms, postpartum depression (PPD) shows up instead, making it harder to access the joy you expected to feel.

For moms expecting their second, third, or fourth baby, PPD can feel even more confusing. After all, you’ve done this before. You know the drill. So when the sadness, anxiety, or emotional fog creeps in anyway — especially if you didn’t experience it with earlier pregnancies — it can feel like it came out of nowhere. Here’s why that happens, and how experts recommend navigating it.

Why PPD Happens With Later Pregnancies

While studies show PPD can affect up to 19% of moms, there’s limited data on how often it occurs after subsequent pregnancies. “We don’t have much data on how demands of caring for multiple young children may increase the risk of postpartum depression,” says Dr. Niyati Dhand, M.D., a double board-certified perinatal and reproductive psychiatrist at Alaire Psychiatry in Chicago.

But when you consider life with more than one kid, it’s not exactly surprising to experts. “Caring for multiple children can increase parenting stress, account for more night-time awakenings, and limit one-on-one bonding with infants,” says Dhand.

Those can be big stressors on top of the hormonal shifts after childbirth, says Adrienne Griffen, executive director of the Maternal Mental Health Leadership Alliance. “Almost everybody feels a little overwhelmed,” she says. “If it gets worse or doesn't resolve after two weeks, we consider it postpartum depression.” And it doesn’t always look like tears — irritability and rage are common, too.

Having postpartum depression with your first baby is the biggest risk factor for experiencing it again, with a recurrence rate between 15 and 21%. Other risk factors include prior traumatic birth, breastfeeding challenges, infant loss, NICU stays, lack of social support, and financial stress.

Why It Can Be So Much Harder To Pinpoint

If you have more than one child, PPD can be harder to recognize — even for experts. Experts often look at whether a new mom has lost interest in activities she once enjoyed, but that metric doesn’t always apply. “We can’t use hobbies that someone no longer has time for as the benchmark for assessing interest,” says Dhand.

The same goes for withdrawing from social support — it may not be avoidance; it may just be logistics. “Rather than focusing only on whether she is seeing friends or keeping social plans, it can be more clinically meaningful to ask whether she is engaging in ongoing communication with friends or relying on them for support through text messages or phone calls,” she says.

Guilt can also be tricky. “Pathological guilt can be associated with postpartum depression,” says Dhand. But with a second baby, it’s common to feel like you’re “cheating” on your first, says Dr. Marcie Weiner, Psy.D., senior perinatal psychologist and clinical director at the Postpartum Stress Center in Philadelphia. “Sometimes, moms experience guilt at the loss of the one-on-one relationship,” she says. “They may feel or fear the loss of the intimate relationship with their toddler.”

If you’re unsure what you’re experiencing, experts recommend reaching out to Postpartum Support International.

How To Treat PPD After Later Pregnancies

First, know that PPD can happen after subsequent pregnancies — and while it may present differently or feel more complex, there are effective treatments and support options available.

When you have more than one child, “the demands of childcare and prioritizing the needs of others can delay accessing care,” says Dhand. Symptoms may also emerge after the typical six-to eight-week OB follow-up, when screening typically occurs, just as parental leave may be ending — making it harder to seek help.

Start by being proactive, including building a support system before you give birth, especially if you had PPD before. That might mean establishing care with a perinatal therapist or psychiatrist during pregnancy, says Dhand.

It can also help to think back to what felt hardest the first time around. “If sleep was really bad, let's bring in somebody to help with some of the nights in the beginning,” says Weiner. In whatever way works for you, setting yourself up for support early can make the transition smoother.

Creating a postpartum plan can also help. Like a birth plan, it acts as a roadmap: How will you feed yourself? Who’s caring for the older kids? What happens if recovery takes longer than expected? says Griffen. Part of that may involve your “village” — family, friends, a doula, or a partner taking leave early on — to ensure you’re not managing recovery, a newborn, and older children alone.

With support in place, you can ease the transition — and potentially lower your risk of PPD.

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