Harbour Women's Health ~ Your Questions Answered - What is Postpartum depression?

Your Questions Answered

What is Postpartum depression?

POSTPARTUM DEPRESSION

Most families anticipate with great excitement the arrival of a new baby. We consider ourselves to be well-prepared for the sleepless nights, the intensity of a love affair with this amazing new person, and even expect that at times things might be a little overwhelming. In fact though, many women are surprised by just how stressful a time of adjustment this can be. For some the problems can be much more serious than simply feeling tired and overwhelmed. Sorting out normal expectations from what may be the sign of a developing postpartum disorder can be a confusing issue.

DEFINITIONS

Baby Blues is the term used to describe what about eighty percent of all new mothers feel in the first week or so after delivery. It is a brief period of weepiness, irritability, and depressed mood, which often follows the feeling of euphoria immediately after delivery. Feelings about the birth, questions about one’s ability to parent, sleep deprivation, and abrupt changes in hormone levels all add to the emotional imbalance of this time. Baby blues are self-limiting and women respond well to nurturing support and reassurance from those they love and trust.

Postpartum Depression occurs in ten to fifteen percent of new mothers. Although in some ways it resembles the blues, it is persistent in that the occasional weepiness becomes frequent crying. Sleep is difficult or impossible despite exhaustion, appetite may be affected, and normal self-doubt is replaced by ever-present anxiety. Instead of getting better over time, it gets worse. Reassurance is seldom useful, and there is a generalized sense of not being able to recover. Certain tendencies predispose some women to this condition. For example, women who have suffered from depression in the past are much more prone to recurrence in the postpartum period. At times concurrent anxiety disorders can also begin or recur during this time. It is sometimes characterized by hypervigilance about possible harm to the baby and over time can become obsessive.

Postpartum Psychosis is the most serious form of postpartum mental disorders, but is also extremely rare. Sensationalistic media coverage does us all a disservice by presenting such an extreme form of this disease leading us to fear that this is what might happen if you feel a little down after your baby arrives. The psychosis is often an acute mania, and women who suffer from this are unable to sleep, prone to agitation or hyperactivity, and at times delusional. These women are at risk of harming themselves or their children and require psychiatric intervention, medication and hospitalization.

RISK FACTORS

In addition to a past history of depression, certain other situations add to the liklihood that a woman may suffer from postpartum depression. These factors include unexpected birth outcomes, marital stress, lack of support, a troubled relationship between a new mother and her own mother, a traumatic or unsatisfying birth experience, and women who find themselves unable to breastfeed.

WHAT CAN BE DONE

The first step in dealing with postpartum depression is to recognize that it exists. This awareness begins during the pregnancy when we as healthcare providers try to know our patients on a personal level. By establishing a trusting relationship and by making ourselves available for nurturing as well as for assessment, diagnosis, and treatment, we try to create an open atmosphere where women know they can come for exploration of these issues. We talk a lot about preparing for the postpartum and schedule more frequent visits for women who are at risk. We discuss and sometimes initiate the use of antidepressant therapy either before or after delivery. Studies tell us that this is an extremely effective way to treat major depression in the postpartum period. We strongly recommend counseling for families who struggle with this problem as it can be effective in relieving the depression itself as well as in providing a place to explore some of the underlying issues. We help to solve some of the complex logistics of managing a household where the mother, for a period of time, may need as much care as the newborn.

While it may not be possible to completely avoid postpartum depression, it is usually possible to lessen the duration or severity. In addition to the above treatment strategies, a few general tips on handling the postpartum period are helpful for all families to consider:

Just as you have thoughtfully prepared for your birth, prepare for the postpartum period. Consider a “postpartum plan” as well as a birth plan.
Prioritize sleep. When the baby is asleep, the mother needs to sleep. For a while there is no night or day, just 24 hours a day in which you need to try to get as much sleep as possible.
Limit visitors. Never let the arrival of a visitor interrupt what you need to do in that moment. Don’t be a host or hostess. Be open hearted and grateful for the love and interest and concern, but don’t entertain.
Unplug your phone and leave a message on your machine letting people know it may be a while before they hear back from you.
only allow those who nourish and nurture you to care for you.
Ask for what you need.
In our society we make a bold assumption that women can care for newborns competently while continuing to function in their previous roles. Realize that this is a time of great role change and adjustment and be GENTLE in your expectations of yourself. Ultimately this is an opportunity to redefine both who you are and your relationship with yourself.
be flexible and real in your decision making and try not to get locked into how things are supposed to be. Maybe you thought the baby should sleep cuddled up with you but find that you all sleep better in separate places OR the opposite may be true…you may have thought it would spoil your newborn to be in bed with you and now find that you can’t bear to be out of touch. Trust that what works for you is also that right thing to do.
Seek help…we are there for you and want you to call with the slightest concern or question. If you can’t sleep, can’t stop crying, don’t know what’s going on or how you can ever be OK again…call!
11., 12. and so on…PRIORITIZE SLEEP!

Jodi DeMuth, CNM, MSN

Selected References

Cox, JL, Holden JM, Sagovsky R. “Detection of Postnatal Depression: Development of the 10 Item Edinbugh Postnatal Depression Scale.” British Journal of Psychiatry 1987;150:782-86.

O’Hara M, Zekoski E. “Postpartum Depression: a Comprehensive Review.” In R. Kumar and I.F. Brockington, Ed. Motherhood and Mental Illness. Wright, 1988; 17-63.

Miller LJ, ed., Postpartum Mood Disorders, American Psychiatric Press, 1999.

Sichel D and Driscoll JW, Women’s Moods: What Every Woman Must Know about Hormones, the Brain, and Emotional Health, William Morrow & Co., 1999.