SUNSHINE: A postpartum wellness framework (and how to build your own plan)
by Gabrielle Theobald-Anderson, LCSW, PMH-C, PPSC
There's a very simple framework I keep coming back to in sessions with my clients called SUNSHINE, which was developed by the Utah Department of Health and Human Services with Postpartum Support International's Utah chapter (source). This framework lays out eight evidence-based protective factors that are designed to help protect your mental health postpartum, an easy-to-remember and (hopefully) implement set of practices.
I'm a licensed clinical social worker, perinatal mental health certified, and the founder of Sweet Oak Therapy, a small group practice specializing in infertility, perinatal mental health, and parenting support. I'm also a mom of a 10 and 4-year-old, and my own postpartum periods were rough. When I came out the other side after my oldest, I felt so motivated to learn more about research-based ways of shoring up our mental health postpartum and as I did, I fell in love with working with families in this life stage.
S — Sleep
Sleep fragmentation is a top predictor of postpartum mood symptoms. I remember watching the light change in the late afternoon and just weeping, not because anything was actually wrong in that moment, but because I knew the night was coming. That dread of nighttime is so tied up with the uncertainty of how many sleep interruptions you’ll get.
So this is a clinical recommendation, not an indulgent one: if you are partnered, how can you split up the night shifts? If you’re solo, can a support person come in a few nights a week? I push for one 4-5 uninterrupted stretch when possible (bare minimum three nights a week), even while nursing (this is particularly important if you have a history of or are experiencing mental health struggles). This won’t happen in the first few weeks, but aim for as soon as possible! It takes workshopping sometimes, depending on your baby’s temperament, but is so worth doing.
U — Understand perinatal mental health
PMADs (Postpartum Mood & Anxiety Disorders - an umbrella term for the mental health struggles that can be associated with the postpartum time period) are the most common complication of childbirth. Recent data shows that one in three people giving birth in California have symptoms of depression or anxiety during or after pregnancy. Some identity and experience factors raise your risk level: infertility, pregnancy loss, a history of anxiety or depression, being far from family, for BIPOC birthing parents you can also add the stress of navigating racism, both in daily life and in the healthcare system. In the Bay, where first-time moms are older than anywhere else in the country and a lot of us are transplants, many of those factors are a pretty familiar list.
Find a therapist trained in perinatal mental health (PMH-C, which is a certification from Postpartum Support International that indicates specialized training, practice, and exams around perinatal mental health). I also tell clients this constantly during intake calls: therapy fit matters more than almost anything. It’s normal for the first couple of sessions to feel awkward, but if something continues to feel off, keep looking. Research supports this: the therapeutic relationship predicts outcomes better than training or modality. Do a consult call first. You can ask questions on the call, including “Tell me about your training around perinatal mental health.”
Reflection: What's your plan for mental health support postpartum? What risk factors for PMAD’s do you currently have?
N — Nutrition
Undereating and blood sugar crashes compound mental health struggles. Your people need a plan for bringing you protein-rich food, and you need a plan for accepting it!
One of my favorite parts of postpartum was the Meal Trains I had delivered during both of my postpartum experiences. Letting people do that was protective for my own mental health. Not everyone has that community, but almost all of us are looking for it. In order to build it, you have to show up for others, but you also have to let it pour back into you—Foundations is a great place to start to form that.
Reflection: What's one thing you could ask for instead of "let me know if you need anything"?
S — Support
Social support is one of the most well-evidenced protective factors for new parents, and isolation is strongly linked to PMADs. If no one in your immediate social circle has a baby yet, a new-parent class or group could be a great option. If you’re in San Francisco, check out Natural Resources, Outer Village, Mama Roots, or one of the myriad of other new parent groups (they help!).
H — Humor
Deliberate lightness is a real mood regulation tool. I know it can sound frivolous, but for me it was dark humor with other mom friends who could be honest about how hard it was without tipping into hopelessness. That's what kept me tethered: this is not forever. I will shower again (you will too, I promise).
Pay attention if you are unable to access joy at all, or if your mood stays flat or low, or baby blues extend beyond two weeks. Those are all signs to reach for more support.
Reflection: What makes you really laugh? What brings you joy?
I — Information
Give yourself grace here: executive functioning doesn't get worse after birth, but the amount of information you’re navigating dramatically rises.
I was lucky. At every OB and pediatrician appointment for the first year postpartum, I was given the GAD and PHQ (which are the two screening forms for anxiety and depression), and with my first, my providers flagged my anxiety score as high. Many providers do this, but not all. These assessments are all free and online, so you can take them yourself and bring the results to your provider so that you have a place to start conversations around your mental health with some shared and clear data.
N — Nurture
What nurtures you, really? Probably not the spa day you keep thinking about and never booking. Something small and repeatable, often free, often five minutes, that makes you feel like yourself again.
For me, it was getting outside. I live in Oakland and can get to the Redwoods in about 12 minutes, and strapping the baby on and walking in those ancient trees tethered me to a world bigger than my Huckleberry app and how many ounces I'd pumped. I also leaned on parents of older kids, who could tell me the kids will turn out fine. Bay Area parenting is its own bubble and being able to see beyond the intense pressure to optimize our children will only benefit you and your kids.
Reflection: What's one small, free thing that makes you feel like yourself again?
E — Exercise
Movement, especially outside, is a real mood regulation tool, and no, this has nothing to do with bounce-back culture (I know, this is the most cringy advice sometimes). For me, it was Redwood walks and a standing hiking group with a few new mom friends who were also on leave. Movement plus company! A meta-analysis found postpartum exercise reduces the severity of depression and anxiety symptoms and the odds of PPD. It doesn't need to be a run; a long stroller walk with some iced coffee counts JUST AS MUCH, and a 2023 UC Irvine study of 415,000+ Southern California births found mothers on streets with more tree cover had lower PPD risk. Locomotion in nature is shown to be an incredible way to dispel cortisol.
If you take just one thing from SUNSHINE, take this: postpartum mental health struggles are something you can feel better from. I’m going to say this again. You can feel better. This isn’t forever. While you can plan for supporting your mental health postpartum, if you do still struggle, that is OK, and with support you will heal!
Free postpartum wellness plan
This is a totally free downloadable Postpartum Plan we use at our practice with clients. Please use it to talk and think through planning for your postpartum! We plan our births down to the playlist and postpartum tends to get whatever’s left – as a therapist and as a mom, I would strongly encourage you to flip that ratio!
How therapy can help
If you've felt dismissed, or like you should be handling this better on your own: national estimates put PMADs around one in five, and those stats in CA are now above one in three. You're part of a huge, ordinary group, not an outlier. Risk also rises with a history of depression or anxiety, pregnancy or birth complications, and major life events like loss. A PMH-C therapist can help with what's already here, and with planning for what isn't yet. If you’re planning on seeing a therapist postpartum, we highly recommend starting in the early to mid-second trimester so that you can firmly establish care before the third trimester and birth.
Postpartum Support International (PSI) is worth keeping in your back pocket too: a free helpline, peer mentors, a therapist directory, and dozens of FREE weekly virtual support groups.
For a deeper dive
Matrescence by Lucy Jones
Good Moms Have Scary Thoughts by Karen Kleiman
Unchecked: OCD and Intrusive Thoughts After Having a Baby: Expert Guidance for New Parents by Karen Kleiman
The First Forty Days by Heng Ou
What No One Tells You by Alexandra Sacks and Catherine Birndorf
Mom & Mind Podcast with Dr. Kat Kaeni
A note on scope: this guide covers protective factors, not a substitute for treatment or screening. PSI's HelpLine is 1-800-944-4773 and the National Maternal Mental Health Hotline is 1-833-943-5746. 988 is also an option for any mental health crisis. Talk to your OB/GYN or PCP if you are struggling! Struggles aren't limited to the person who gave birth, so support is worth reaching for on a partner's behalf too.
A note on access and privilege: A lot of SUNSHINE gets easier with money: doula support, buying meals, a paid new-parent group, longer leave, etc. But the framework matters most when resources are limited, and some of the most evidence-based factors here, such as social support and moving outside, cost nothing. If you need a therapist who takes insurance, reach out to us and we can usually point you in the right direction.
About the author
Gabby Theobald-Anderson, LCSW, PMH-C, PPSC is the owner of Sweet Oak Therapy, a perinatal-focused group practice in Emeryville, California.
