Postpartum

Postpartum

What is Postpartum Depression?

Postpartum depression affects up to 15% of mothers after the birth of a child. This serious and disruptive mental health condition usually strikes several weeks after giving birth, but in some cases, symptoms can begin in the later stages of pregnancy.

The first recorded cases of postpartum depression come from the physician Hippocrates in ancient Greece. Hippocrates noted emotional difficulties in some women following the birth of a child, but it wasn’t until the mid-19th century that postpartum depression became recognized as a legitimate medical disorder.

At the time, treatment usually wasn’t sought, and when it was, the option was usually electroconvulsive therapy. Until the last few decades, most women were too ashamed to ask for help, and the condition went quietly unnoticed and was suffered in silence.

Women with postpartum depression feel the usual, whole-body depressive symptoms, such as sleep disturbances, loss of energy and motivation, sadness and negative guilty thoughts. But postpartum depression is unique in that women also feel incredibly stressed, and worried about the care of their newborn. They often feel extreme guilt related to how they are doing as mothers. Oftentimes, women with postpartum will feel they are not able to care for their newborn, or that they are failing as a parent. Excessive worry and anxiety can also appear.

In addition, the lack of sleep and time for self-care that comes with being a new parent can exacerbate depression symptoms. Sometimes, new mothers are so bogged down with fear, worry, and guilt, that they are unable to sleep once the baby is settled.

These negative feelings and the disruption of depression symptoms in any sufferer’s life can make it extremely hard for mothers to adequately bond with their child. This lack of a stable maternal bond can impact the newborn’s development. Not only does depression affect the mother, but her child cannot escape from its clutches, either.

Postpartum depression is characterized by the following symptoms:

Excessive sadness, hopelessness, and feeling overwhelmed

Although caring for a newborn is normally an overwhelming feeling, the difference between ‘normal’ and postpartum depression is the excessiveness of it. Mothers with postpartum can feel paralyzed and unable to care for their newborn. Other symptoms include:

  • Worry and anxiety
  • Withdrawal
  • Trouble concentrating, making decisions, and remembering details
  • Sleeping too much or an inability to sleep
  • Loss of interest in activities that were once enjoyable
  • Disconnect from the baby, or having trouble forming an emotional attachment to the baby
  • Persistently doubting if she can care for the baby
Guilt and shame

Most parents experience some form of guilt, but with postpartum, guilt becomes all-encompassing.

Rage, or extreme anger

Women with postpartum will often lash out at the baby’s other caregivers.

In extreme cases, postpartum depression can devolve into postpartum psychosis. When this happens, the underlying postpartum depression symptoms are present, but hallucinations, delusions, and thoughts of harming herself and/or her baby are present.

The 2001 Andrea Yates case is a tragic example of what can happen when postpartum depression is not treated. Left alone to care for five children while suffering from postpartum depression, Andrea Yates went on to develop psychosis and drowned her children in a bathtub. She was found not guilty by reason of insanity and ordered to reside in a mental hospital. Since 2006, she has been institutionalized.

Who is at-risk for developing postpartum depression?

Postpartum depression does not discriminate based on age, race, economic class, or even if the baby was planned or unplanned. Any woman who gives birth is at-risk for developing postpartum depression, but there are several known factors that can increase the risk:

  • A family history of mental health disorders
  • If the woman has a history of depression or bipolar disorder before giving birth
  • A lack of care and support after giving birth
  • Domestic violence
  • A traumatic or stressful event during pregnancy or soon after giving birth (job loss, the death of a loved one, personal injury or illness)
  • Medical issues during childbirth and pregnancy (premature delivery, a child with special needs, pre-eclampsia, etc.)
  • Mixed or ambiguous feelings about the pregnancy
  • Alcohol or drug abuse and addiction
  • Having twins or triplets
  • Trouble getting pregnant
  • Being a teen mother

What causes postpartum depression?

No single cause of postpartum depression has ever been determined, but the overwhelming physical and emotional results of pregnancy and childbirth can factor into its development.

During gestation, hormones like estrogen and progesterone are elevated and stay elevated to maintain the pregnancy. But once the baby is born, these hormones precipitously drop, falling back to their baseline levels. These sudden chemical changes can trigger mood swings.

Couple this with the fact that mothers are completely unable to rest and heal from the rigors and discomfort of pregnancy and childbirth, and the constant and long-term sleep deprivation from caring for a newborn can all contribute to the development of postpartum depression.

Mothers without adequate support from family and loved ones after birth are at an increased risk of developing the illness.

How is postpartum depression treated?

There are many treatment options for postpartum depression. Therapy, prescription medication, hands-on support, childcare help, and self-care are all effective when recovering from postpartum depression.

Support

New mothers, especially those suffering from postpartum depression, need the support of family and loved ones to adequately recover. Sleep and eating a well-balanced diet are required. Help with the childcare duties is a must for any mother, but particularly for those who are in treatment for postpartum depression.

Therapy

Talk therapy and counseling can give mothers the support and validation they need when in recovery. Therapy offers them a chance to speak to a licensed professional one-on-one about their feelings and thoughts surrounding the birth of their children without judgment.

A therapist can also help women with postpartum on how to navigate their personal relationships. Furthermore, cognitive behavioral therapy can help women recognize negative thoughts and behavioral patterns which may contribute to or worsen their depression. Therapy can also help women learn how to bond with their baby.

Medication

Prescription antidepressants, SSRIs and SNRIs, block the reception and absorption of the neurotransmitters dopamine and norepinephrine. These brain chemicals regulate mood, energy, and motivation.

Although antidepressant medications take several weeks to take full effect, they are highly efficacious at treating and managing depression symptoms. Furthermore, antidepressants are safe for babies if a woman is breastfeeding.

Depending on the severity of the depression and the patient’s circumstances, these treatment methods can be used together or on their own; however, a holistic plan is usually more effective.

What can family and loved ones do?

While it is normal for new mothers to feel tired and inundated with the responsibilities and care of a newborn, the symptoms of overwhelm, exhaustion, and anxiety found in postpartum depression are much more severe than the typical ‘baby blues.’ Family and loved ones are usually the first to notice the signs of depression in their loved one.

First, understand that postpartum depression does not happen because of something a mother did or did not do. Postpartum sufferers often feel guilty and ashamed. So, when confronting a new mother, be sure to approach from a position of understanding and patience. Be sure to let her know that what she is feeling are the symptoms of depression, that they are not an inherent part of her personality, and she is not a defective mother for having depression.

Mothers with postpartum often feel they are unable to properly care for their newborn. Let her know that her family can see how hard she is trying and give examples of where she is succeeding as a mother. Suggest how getting treatment will not only help her but her child as well.

Most importantly, many mothers fear they cannot take the time to rest, participate in self-care routines, or seek treatment. Offer ongoing, hands-on support for her. If she can see that taking some time out to care for herself will not result in diminished care for the baby, she will be more likely to seek treatment. Be aware though, that depression can take several weeks to months to heal from. She and the baby will need long-term support, and she will need help finding it.

Postpartum depression is not something to ignore or diminish in the hopes it will dissipate on its own. Women and children greatly suffer from its effects, and if left untreated, it can develop into a full-blown, and potentially dangerous, psychosis.

New mothers need support and understanding during their postpartum period, and if postpartum depression is suspected, consider reaching out to the following institutions and hotlines:

  • Contact a healthcare provider
  • If a suicide attempt or self-harm is suspected, immediately call 911
  • Contact the toll-free National Suicide Prevention Hotline at 1-800-273-8255

With treatment and support, women can go on to make a full recovery from postpartum depression, and neither she nor her newborn will experience any long-term effects.