Postpartum Depression

When a mother-to-be looks forward to life with a newborn, she might envision a scene out of a Hallmark card, the new parents bathed in a rosy glow, smiling lovingly down at their baby. And there will be those times, of course: The birth of a child is a time that most parents look back on as a high point in life.

But for many women, the period after giving birth can be an unexpected low time. An astonishing number of women -- from 70 to 80 percent, according to the American Congress of Obstetricians and Gynecologists -- feel depressed in the days after their babies are born. And about 10 percent experience a more serious ailment called postpartum depression (PPD), something that ACOG has made a top priority.

Postpartum depression is not the same as the baby blues, the short-term anxiety and fatigue that typically fades in five days to two weeks. PPD can be extremely debilitating, and it can last a year after the baby is born. However, with treatment and counseling, these feelings usually go away.

Some women with postpartum depression have difficulty performing routine tasks. They may feel emotionally numb, and they may worry that they'll harm their baby. In addition to feeling sad and empty, women with PPD may suffer from headaches, chest pain, heart palpitations, hyperventilation, and unusual weight loss or weight gain.

Scientists have also found the range of mental disorders some women develop after giving birth may be greater than previously thought, according to the New York Times. Up to one in five women will show develop some kind of mental illness, including anxiety, obsessive-compulsive disorder, bipolar disorder or a combination of symptoms. Realizing the gravity of the problem, more states have passed laws encouraging screening and treatment, the Times reported, and the Affordable Care Act has provisions for further research on the issue.

Postpartum psychosis

In rare cases, women can develop psychosis after giving birth. They lose touch with reality and may suffer from paranoia, delusions, and even hallucinations. This mental illness came to public attention in 2001, when a Texas woman diagnosed with postpartum depression and postpartum psychosis drowned her five small children. Postpartum psychosis should never be taken lightly: Seek help immediately if you realize you are experiencing any of the symptoms. But people with psychosis often aren't aware that they are out of touch, that their image of reality is skewed. If you have a partner or relatives around, talk with them about your fears beforehand. Make sure that people near you are supportive and will contact a doctor immediately if you begin acting paranoid or show any of the other symptoms above.

What causes postpartum depression?

Experts don't fully understand what causes depression after childbirth, but most believe it may be affected by your physical and emotional condition and whether you're going through any other stressful events, such as marital or financial problems.

As happy as the birth of a baby may be, pregnancy and childbirth are also stressful events, and it is important not to underestimate the toll they take on your body. Fatigue caused by pregnancy, childbirth, and sleep deprivation is one likely cause of postpartum depression. Exhaustion can be especially debilitating after a cesarean birth. It's likely that hormones also play a role. Levels of estrogen and progesterone, two hormones that help control mood, abruptly drop in the days after the baby is born. Other changes that occur naturally as a result of childbirth, including shifts in blood pressure and metabolism, may also contribute to fatigue and depression.

For many people, adjusting to parenthood isn't easy. A new mother may feel trapped by her responsibilities, insecure about her identity, disappointed in herself or her new baby, or overwhelmed by the dramatic changes in her day-to-day life. New mothers are often shocked to see hours in the day simply melt away while the piles of laundry remain untouched, the bills unpaid, the refrigerator as empty as it was yesterday.

Tasks that once seemed simple, like going to the grocery store or visiting the doctor, can seem daunting and sometimes impossible when they involve wrestling with the car seat, diapers, lack of sleep, and a fussy newborn. The postpartum adjustment period may be particularly difficult for women who are used to getting up every day and going off to work. This completely different set of responsibilities can make a woman feel ineffective, scattered, messy, and out of control.

If you have a baby who is colicky or has special needs, you are likely to feel particularly overwhelmed. Many women find nursing difficult, which can increase their feelings of inadequacy.

Risk factors

You are at greater risk for postpartum depression if you have a history of depression, especially unrelated to the pregnancy, or severe bouts of premenstrual syndrome. A woman who has no partner, or whose partner is unavailable or unsupportive, is also at greater risk. Events such as the loss of a close friend or family member, or a recent move, also make you more vulnerable to postpartum depression.

What you can do about postpartum depression

It's no fun to think about depression when you are pregnant and planning for a new baby. But if you can anticipate some of the problems that lie ahead, you can take steps to lessen their impact.

Talk with your doctor about feelings of depression, especially if they last for more than a week. It's important to treat depression in pregnant women when it occurs. Sometimes medications are necessary, and your doctor can help you find a treatment that is safe during pregnancy.

Schedule regular visits with family and friends after the baby is born, so they can keep you company, help with meals, or care for your newborn while you rest. But don't overdo it. Too many visitors and social obligations will only tire you and your new baby.

Partners should take as much time off work as possible. They will be able to share the first days of your baby's life, lend a hand, and give you an occasional break. Help will be especially valuable if you have other children who need care and attention. If you can, arrange special outings for your older children with friends or relatives. If your mother, mother-in-law, or another relative offers to help out, take them up on it, unless such a visit would only add to your stress.

If you're single and you don't have relatives or friends you can call on, consider joining a support group for pregnant moms. Check with local hospitals, public health clinics, or health care organizations to find out when they meet.

Leah Seidler, a San Francisco Bay Area psychotherapist who specializes in pregnancy-related issues, emphasizes the importance of community as women enter this new phase of life. "Find a new mothers' support group, and if you can't find one, form one yourself," she advises. "If you don't know any new mothers, contact your local parenting resource center or a chapter of La Leche League, a national nonprofit organization that provides nursing education. Other women who share the same experiences are an invaluable source of support, information, and companionship." You can also ask your doctor or midwife for additional resources.

Other concrete steps you can take to keep your spirits up:

Get plenty of rest. Be sure to nap when the baby naps to make up for your interrupted nighttime sleep.

Try to work in exercise every day research has shown that it can lift moods. Check with your doctor about what form is best for you.

If you have trouble nursing, contact La Leche League or ask your practitioner to refer you to a lactation consultant.

Be sure to eat regularly and well.

Make time just for you and your partner.

Give yourself some special attention. Get a haircut, a massage, or a manicure.

Call your practitioner right away if you find yourself overwhelmed by depression or if your feelings persist for more than two weeks.

If symptoms continue and your doctor doesn't seem to be able to help you, seek a second opinion. It could be that you are suffering from an underlying health problem that is the source of your depression and requires specialized treatment.

If you don't have a community of family and friends available to help, and you can afford it, consider investing in extra child care or housekeeping support -- if only for the first few weeks of your baby's life. You may also consider hiring a doula, a woman trained to provide support through pregnancy, and childbirth, and the period after the baby is born.

Finally, go easy on yourself. Parenting is a skill like any other, and you will learn all you need to know -- but it will take time. You may have to put off other priorities for the short term and give yourself permission to let a few household chores fall by the wayside. You and your baby will usually be better off as a result.

References

Belluck, Pam. 'Thinking of Ways to Harm Her': New Findings on Range and Timing of Maternal Mental Illness. June 15, 2014.

National Association of Childbearing Centers. Psychological Aspects of Birthing. www.birthcenters.org/genlib/eplc/psyc.php

Mayo Clinic. Postpartum depression. http://www.mayoclinic.com/invoke.

National Mental Health Association. Postpartum Disorders. http://www.nmha.org/infoctr/factsheets/postpartum.cfm

Cable News Network. The Case of Andrea Yates. Postpartum psychosis: A difficult defense. http://archives.cnn.com/2001/LAW/06/28/postpartum.defense/

American Academy of Family Physicians. Postpartum Major Depression: Detection and Treatment.

American Academy of Family Physicians. Postpartum Depression and the 'Baby Blues.' http://familydoctor.org/379.xml?printxml

Artal, M. MD et al. Exercise Against Depression. The Physician and Sportsmedicine. Vol 26. No. 10. http://www.physsportsmed.com/issues/1998/10Oct/artal.htm

American College of Obstetricians and Gynecologists. Postpartum Depression.

Abalovich M et al. Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism. 92(8).

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