Real Talk-Postpartum Depression

Vanessa and Brian had tried for months to conceive after a miscarriage 2 years ago. They were terribly excited about the upcoming birth of baby Erin and could not wait to hold her in their arms. Vanessa was a planner so for months the nursery had been done. Her bag was in the car. The car seat had been installed, and her mother, who only lived an hour away, was prepared to be with them for at least 6 weeks following the birth. They were all set. Little Erin came into the world on a rainy June morning but no one could pay attention to the weather when her little face brightened up the entire room. After 12 hours of labor, Vanessa was exhausted but in amazement of the miracle her body had performed. The past few years of disappointments and sadness were all a faint memory now. Erin was finally here!

The first week was pretty rough for Vanessa. She was healing from labor, getting very little sleep and having trouble getting Erin to latch. Throughout it all, her husband and mom were great. They would rock little Erin while she took a shower and her mother made sure she ate 3 meals a day. Because she was a planner, Vanessa had read all the books so she knew that in this first week her mood might be all over the place and that she might have trouble adjusting to her new role. What she was not prepared for however was for her mood changes to last for the next 3 weeks and become more severe. She continued to have trouble sleeping and had to start offering Erin formula because the pediatrician was concerned about the weight  Erin had lost. Vanessa felt defeated by this as she had planned to exclusively breastfeed for the first 6 months. Additionally, Vanessa felt weird around Erin. In her mind she knew what she should be feeling towards her beautiful baby but for some reason she just didn’t feel connected. Vanessa found herself crying everyday in the shower, was not interested in eating very much even though her mom was still there doing all the cooking, and she did not want to hold Erin and preferred that Brian or her mom be the one to try and rock her to sleep.

Vanessa was confused and upset at the feelings she was having. She and Brian had hoped and dreamed of this time with Erin and now that it was here, she didn’t feel like she was showing up.

There are so many things that you cannot prepare for during pregnancy. Neither all of the best-selling books, well-meaning mommy friends, nor super-supportive midwives can prepare you for the sleepless nights, dirty diapers, or countless emotions. Even when you think you have a glimpse of an idea, the reality far outweighs it. You spend months preparing, hours laboring, and with one last swift push, the little person is here. The birth of a child is also the birth of a million questions. What is that fuzz on his arms? Will she learn to latch soon? Should we start him on a pacifier right away? Is she swaddled too tightly? Do I have any clue how to do this thing called parenting? These endless questions are accompanied by just as many varying emotions. One minute you may be happily gazing into your baby’s eyes and the next hour may find you silently crying to yourself for no reason that seems apparent. We’ve all heard about the baby blues as this is pretty common after the birth of a child but a far less discussed issue is postpartum depression.

Symptoms

WebMD states that the baby blues is best characterized as a period of 1-2 days but not longer than 2 weeks, following childbirth where the mother may experience mood swings, anxiety, sadness, difficulty concentrating, and increased irritability. The baby blues is likely related to the drastic change in hormones following childbirth, changes in sleep and the overall transition of having a new family member. The baby blues is different from postpartum depression in its length of time and severity.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) indicates that a diagnosis of postpartum depression (the technical term is Major Depressive Disorder, With peripartum onset but for clarity purposes it will be referred to as postpartum depression here) can be made when a woman has 5 or more of the symptoms listed below. The symptoms will have occurred for at least 2 weeks and the onset of the symptoms will have been during pregnancy or within 4 weeks following delivery. The symptoms must represent a change in functioning.

Symptoms include:

  • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feeling sad or empty) or observation made by others (e.g., appears tearful).
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
  • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
  • Insomnia (inability to sleep) or hypersomnia (sleeping too much) nearly every day
  • Psychomotor agitation or retardation nearly every day
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Additionally, a new mother may experience a psychotic episode with the depression. This may be characterized by hallucinations that tell the mother to kill her child or delusions that the child is possessed. Unfortunately, a psychotic episode is what the media and society portrays when they discuss a woman struggling with postpartum depression, but this is a much rarer occurrence and is not at all typical of most women’s experiences.

Causes

So what gives? Shouldn’t this be one of the happiest times in your life? Though many women will immediately begin to assume that it is something they have done that is causing them to struggle with depression at this time, this is absolutely not the case. The truth is that no one really knows why some women develop postpartum depression and others do not. There is likely not a single thing that causes postpartum depression but more likely a combination of factors that may lead to the illness. Some factors suggested by the Mayo Clinic include:

  • Sudden change in hormones immediately following childbirth
  • Changes in your blood volume, blood pressure, immune system and metabolism can contribute to fatigue and mood swings
  • Sleep deprivation
  • Anxiety about your role as a new caregiver, perhaps feeling inadequate to handle new role
  • Difficulty breastfeeding
  • A lack of support from a partner or other loved ones
  • Experiencing financial difficulties
  • Prior episodes of depression

 

Treatment

If you feel like you meet the criteria for postpartum depression, it is important to know that help is available and that you do not have to continue to struggle in silence. Receiving treatment is the best thing you can do for yourself and your child. The Mayo Clinic suggests that if gone untreated, postpartum depression “may interfere with mother-child bonding. Children of mothers who have untreated postpartum depression are more likely to have behavioral problems, such as sleeping and eating difficulties, temper tantrums, and hyperactivity. Delays in language development are more common as well.” Here are some steps you can take to begin to deal with this issue:

  1. Talk to a trained therapist about your concerns. Begin searching online for therapists in your area who have expertise in working with other women struggling with postpartum depression. Although it may be difficult to take this first step as there is typically a lot of shame and guilt associated with this illness, talking to someone who will not be judgmental about what you have been experiencing is a very important part of beginning to get better.
  2. Consider talking with you OB/GYN or a Psychiatrist about medication. Though there may be some concern about taking medications, particularly if you are breastfeeding, a consultation with your physician or an OB/GYN is the only way to really assess your condition. There is a great deal of new research that suggests that the risks to a child consuming small amounts of medications through breast milk is smaller than having a mother who continues to struggle with depression. For some cases of postpartum depression, a combination of both talk therapy and medication will work best, so it is important to have this conversation with a trained medical professional.
  3. Join a support group. It may be difficult to talk to friends and family members about how you are feeling but it is important that you get support from someone! You may be able to find a group in your area for other moms who are struggling with these concerns but if this is not possible, there are tons of resources available online. The website mypostpartumvoice.com has a wealth of information available as well as chats where you can talk with other mothers.

Postpartum depression is not unlike other forms of depression in the level of silence and stigma associated with it. But there is an additional layer of complexity with postpartum depression because there is the expectation that a new baby should make everything right in the world. While it is already difficult for most people to admit they are struggling with depression, it is exponentially more difficult for a new mom who is likely already feeling insecure and anxious to admit this. For this reason, as you are receiving treatment, it is important to keep these things in mind:

  • You have not irreparably damaged your relationship with your child. Kids are incredibly resilient and you have YEARS to continue to shape a loving relationship with your little one. Do not allow guilt to consume you!
  • Be gentle with yourself and let go of ideals of being a perfect mother. Children don’t need perfect, they only need good enough! Do your best to be involved, loving, and present when you can.
  • Allow others to step in and help. If you are feeling overwhelmed and stretched thin, allow friends and family to help out in ways that will be most helpful to you.
  • Be direct in asking for help. While it is important to allow others to help, this only works if they offering the kind of help you need. If everybody only wants to hold the baby but what you really need is someone to cook some meals, ask them directly to do so. Most people are happy to do whatever you ask. They just need to know what it is you need.

Note: Post originally appeared on Thriveworks blog here

 

 

 

 

 

 

 

 

Dr. Joy