Until recently postpartum depression has been controversial in the
medical community and poorly understood by the general public.
Historically women experiencing this debilitating and dangerous
condition were subjected to guilt and shame of being “bad” mothers and
not being able to “just snap out of it” shortly after childbirth.
Fortunately there has been a lot more publicity and awareness of this
illness in the last twenty years partly due to many more women entering
the medical profession and several prominent celebrities sharing their
struggles with motherhood with the general public. As a result, we now
have more knowledge about this condition and evidence-based practices
that are effective in recognizing, diagnosing and overcoming it. If only
we could get women in the community, regardless of their cultural
background or socioeconomic status, to actually seek and get help.
Shame and guilt are the major obstacles to getting help for
postpartum depression. The primary message that needs to get out there
is: “Untreated depression can cause significant harm to the baby. For the sake of your child, you have to ask for help!” And another important message is: “Postpartum depression is no one’s fault.”
What is Postpartum Depression? What are the symptoms?
Postpartum Depression is a very common and serious mood disorder that
typically does not resolve without treatment. According to some
estimates up to 15% of mothers experience symptoms of Postpartum
Depression within the first month after delivery. This disorder is
characterized by the mother feeling sad, hopeless, empty or overwhelmed,
and crying more often than usual and for no apparent reason. The mother
might worry a lot or feel overly anxious. She might be feeling moody,
irritable, restless, oversleeping or unable to sleep when the her baby
is asleep. She may be having trouble concentrating, remembering details,
or making decisions. She may be experiencing anger, rage, and loss of
interest in pleasurable activities. She may be suffering from physical
aches and pains, eating too little or too much, and withdrawing from or
avoiding friends and family. She is typically having trouble bonding or
forming an emotional attachment with her baby and persistently doubting
her ability to care for her baby. She might be having scary thoughts
about harming herself or her baby, even though it is something she would
never actually do.
Even though every mother experiences anxiety, worry, self-doubt and
preoccupation with her new baby, Postpartum Depression is different from
regular “baby blues” because of the extreme nature, duration, frequency
and severity of the symptoms. “Baby blues” are experienced by about 80%
of mothers with mild symptoms of worrying a lot and being
understandably very tired. The symptoms last one or two weeks and
resolve on their own. Postpartum Depression can go on and get worse for
Postpartum psychosis is rare, affecting only about 0.1% of births,
but has severe and serious symptoms that require immediate
hospitalization. Symptoms show up within a week of birth and might
present as hallucinations, delusions, or paranoia. This condition is
very dangerous because the mother is experiencing a break with reality,
which causes high risk of danger to herself and the baby. This is a
treatable condition but it is considered an emergency.
What causes Postpartum Depression?
Postpartum Depression does not have a single cause. It is a result of
numerous physical and emotional factors, which are not well understood.
However, we know that our mental state is heavily influenced by
hormonal balance in our bodies and our brains. After birth, some of the
mother’s hormone levels drop a thousand times in a matter of hours,
affecting their brain’s ability to emotionally self-regulate. Many women
experience abnormal thyroid function in the postpartum period, which
also regulates our moods, and it is often undetected. On top of the
painful process of recovery after often traumatic birth experience,
followed by sleep deprivation and extreme exhaustion, this often leads
to extreme symptoms of a full-blown mood disorder.
What are the risk factors of Postpartum Depression?
Even though the mechanism of Postpartum Depression is not well
understood, there are several known factors that put the mother at high
risk for developing Postpartum Depression. These factors are previous
history of Postpartum Depression or any other type of depression,
including Bipolar Disorder, family history of mental illness,
experiencing a stressful life event, traumatic birth or medical
complications during childbirth for either the mother or the child,
substance abuse, difficulty with breastfeeding, and environmental
factors such as lack of support from family. The woman’s feelings about
pregnancy (wanted, unwanted, complications, etc.) can also play a role.
The brain regulates our body. When the brain is biochemically
disregulated it will create other imbalances in the body. There many
anxiety and depressive disorders that are co-morbid (co-occurring) with
Surprisingly panic attacks have protective hormonal effects. They
often go away during pregnancy but might come back with a vengeance
after birth during postpartum period.
When to seek help?
It is important to be aware of your own risk factors and bring it up
to your doctor very early, even before conception or very early in
pregnancy, so that you can collaboratively come up with a plan to reduce
the risk and minimize the symptoms.
What help is out there?
Research shows that a combination of medication and psychotherapy
works best. Medication can be prescribed by primary care physician or a
psychiatrist. In severe cases of the disorder antidepressants are
absolutely necessary, but they take a while to be effective. Cognitive
Behavioral Therapy is a therapeutic approach that builds on the
interaction of feelings, thoughts and behaviors and has been proven to
help with Postpartum Depression, especially when working with a
therapist that has training and experience with this disorder.
It is critical for the mother to take good care of herself in the
postpartum period by engaging in physical activity, going for long walks
with the baby and socializing with other new moms. Getting adequate
rest, eating healthy foods, not using any drugs or alcohol, making time
for yourself, and accepting help from a friend to make a meal or watch
the baby while the mother takes a nap are all great ways to starting and
maintaining recovery from Postpartum Depression.
What happens if it goes untreated?
Maternal sensitivity is a mother’s attunement to the baby, her
ability to perceive her child’s signals accurately and to respond to
them promptly and adequately. Studies of mother–infant interaction
provide evidence that mothers who are more sensitive are more likely to
have a child with a secure infant–mother attachment experience.
Attachment security, in turn, is widely recognized to be a protective
factor fostering life-long, healthy socio-emotional and psychological
development. Unfortunately, mother’s physical presence is not enough to
create attunement and secure attachment. The mother needs to be
continuously emotionally present and connecting with the baby in order
for the child to thrive. This does not happen if the mother is severely
and clinically depressed, such as in the case of the mother suffering
from Postpartum Depression. The risk is less than optimal brain
development for the child and lower social-emotional functioning that
will affect the child for the rest of their life.
What are the barriers to care?
The stigma of any mental illness and especially of postpartum
depression is still huge, despite publications as popular as People
magazine routinely writing about postpartum experiences of Gwyneth
Paltrow and Hayden Panettiere after the birth of their babies. Yet,
somehow women still get the message that asking for help is a sign of
weakness and if they just try hard enough everything will be “just
fine.” False societal expectations are based on unrealistic perceptions
of having a new baby being a beautiful care-free time in a young
mother’s life. Most of these perceptions are based on advertisements and
commercials of baby products that show gorgeous polished well-rested
moms in freshly ironed white shirts, perfect make-up and professionally
done hair, playing with their cherubic babies in a crystal clean room or
socializing with other moms in a picturesque park. These advertisements
do a great disservice to young moms, who think these are the
expectations they need to live up to.
In addition to the negative stigma, women suffering from Postpartum
depression experience feelings of guilt, shame, and hopelessness that
are typical for any depressive disorder. This leads to isolation and
lack of support, and makes it even less likely that the woman will seek
help. Lack of alternate child care and financial obstacles prevent many
people from going to see a doctor or a therapist.
How can we support the new moms?
The best way to support the new mom is to remind her and reassure her that:
– Postpartum Depression is not her fault.
– Postpartum Depression is treatable.
– It is OK to ask for help.
– The best way to take care of the baby is to take care of yourself first.
Specific practical ways the father can help:
– Plan to take time off work for at least the first few weeks so that
you can help with taking care of the baby while the mom rests
– Consider taking paternity leave, even if it is unpaid (budget and save
ahead of time), especially if your wife is high-risk for PPD
– Hire a helper if at all possible or enlist friends and family to help
– Offer lots of emotional support
– Give your wife a break when you get home
– Send her out of the house and let her have time by herself
– Tell her she is doing a wonderful job and her critical mother and mother-in-law is wrong
Most importantly, always
encourage the new mom who is struggling with extreme moods to seek help
from a professional. Reach out to a counselor, therapist, or a
psychiatrist experienced in treating postpartum mood disorders. Getting
professional help early is critical for the well-being of the mother,
the baby, and the whole family.
Postpartum Support International:
Postpartum Education for Parents (PEP):
805-564-3888 Warmline is a free 24-hour service that provides
confidential one-on-one support from trained volunteers, parents just
like you. From basic infant care to breast or bottle feeding issues to
postpartum adjustment, the Warmline can be a great source of information