Somehow women have learned to expect that the birth of a baby automatically produces exhilaration and joy. They are led to believe that the period following childbirth should be the happiest time in their lives. In truth, it is one of the most stressful and anxiety producing periods in the life cycle of a family. More than half of the women who give birth each year experience some negative change in their mental health. For 10 to 15% of those women, the period following childbirth becomes a nightmare as they experience sleeplessness, confusion, memory loss, and anxiety during the already stressful adjustment to motherhood.
New mothers are especially vulnerable to depression anytime within the first year after delivery. Along with the overwhelming demands of caring for an infant comes a loss of time with one's spouse, the loss of adult friendships, and a loss of freedom and familiar routine. This is also a challenging time for the entire family, as they attempt to adapt to a new way of life, while knowing that their lives will never again be the same.
What is postpartum depression?
Postpartum depression is a biological illness caused by changes in brain chemistry that can occur following childbirth. During pregnancy, hormonal levels increase considerably, particularly progesterone and estrogen, and fall rapidly within hours to days after childbirth. Also, the amount of endorphins, the feel-good hormones that are produced by the placenta during pregnancy, drop significantly after delivery. Even the thyroid gland can be affected by the enormous hormonal changes that are associated with pregnancy and childbirth, leaving women more at risk for depression.
How do I know if I have postpartum depression?
Experts identify three broad types of postpartum mood disorders that are classified according to the severity and the duration of symptoms. The "baby blues" affects approximately 50 to 75% of new mothers and generally surfaces within a few days of delivery. Women with the maternity blues describe more tearfulness, irritability, and anxiety than usual with an overall sense of overwhelm. Because these symptoms usually decrease by two weeks without medical or psychological help, most women do quite well with added rest and extra help caring for their infant, along with reassurance and emotional support that their feelings are normal and temporary.
Psychosis is an extreme form of postpartum depression. Although it is rare, psychosis is a life-threatening emergency that requires immediate medical treatment to protect both you and your child. If you have psychosis, you may be experiencing some of the following symptoms:
- Hearing sounds or voices when no one is present.
- Feeling afraid that you might harm yourself to escape the pain.
- Having thoughts about harming your baby.
- Rapid weight loss and refusal to eat
- Going without sleep for forty-eight hours or more.
- Feeling as though your thoughts are not your own
- Feels like you are "going through the motions" of taking care of your baby without feeling much love.
About 1 out of 10 women who give birth will develop a postpartum depression. If you think that you are one of them, you might be:
- Crying more than usual
- Feeling sad much of the time
- Unable to concentrate and feeling in a fog
- Finding it difficult to remember where you've put things
- Unable to enjoy the things that you used to enjoy
- So exhausted but still unable to sleep even when your baby sleeps
- Tired most of the day
- Feeling like you will always feel this way
- Afraid to be alone
- Wishing you were dead instead of having to feel this way any longer
Frequently, symptoms go unrecognized because you may think they are part of the stress of caring for a new baby. You might delay in asking for help out of embarrassment, guilt, and a mistaken belief that a "good mother" should be capable of handling the overwhelming adjustment of caring for a new baby with little or no need for help. Also, weaning a baby from the breast and the return of menstruation are significant hormonal events that can alter the biochemical balances in the body and affect the timing of a depression.
Am I at risk for a postpartum mood disorder?
Although there is no exact way to predict a postpartum depression, it is possible to identify the factors that increase your risk. The most important risk factor is your personal and/or family history of a depression or a bipolar disorder. If you have had a previous postpartum depression, that also increases your chances of another depression. In addition, your risk increases if you have been depressed during pregnancy and have a history of premenstrual mood syndrome.
Stressful situations that include marital tension, health problems with the baby, a complicated pregnancy or delivery, and a lack of social support increase your risk for a postpartum depression. Among the psychological factors that predispose you to postpartum depression are a childhood history of sexual abuse or trauma, chemical dependency in your family, and confusing or negative feelings about the pregnancy and uneasiness about your new role as a mother.
What are the treatments for a postpartum mood disorder?
Decisions about treatment for postpartum mood disorders vary according to the severity of symptoms. Professional opinion, however, often supports the use of antidepressant medications in combination with psychotherapy from a qualified family therapist. Family and couples therapy is also effective, allowing the family and/or partner to better understand the depression and be a source of support for the mother. A marriage and family therapist may work with the couple to explore the history of each person's feelings, and will focus on solutions that the family can implement right away.
Group psychotherapy, involving the participation of other women who are experiencing a postpartum mood disorder, has also been found to improve depression by reducing the feelings of isolation that many women feel in the early months after childbirth. It is important to know that if you are breastfeeding, it may not be necessary to stop while taking antidepressants. Be sure to consult with your doctor about medication options that are appropriate for your particular circumstances.
Can I prevent postpartum depression?
Although a postpartum depression might not always be preventable, it certainly is possible to diminish the severity of symptoms, should they occur. Even before delivery, locate the stressors in your life and eliminate them. Put a support system in place during pregnancy so that you will feel less alone and overwhelmed after the baby arrives. In the months following childbirth, plan for free time, get plenty of rest, and do not deny your feelings or feel guilty for having them. Educating yourself about postpartum mood disorders is one of the best ways to ensure early diagnosis and proper treatment. Postpartum mood disorders are treatable, and seeking the help of a qualified therapist is essential.
The text for this brochure was written by Diana Lynn Barnes, Psy.D., LMFT.
Use the AAMFT Consumer Update "Postpartum Depression" pamphlets to market your practice.