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Postpartum Depression

March 2009

©Julie M. Milne, PhD, LCPC, NBCCH, RhT, CBT

 

Becoming a mother is traditionally associated with positive emotions or joy, happiness and fulfillment for both the new mother and her family. But for some women, the postnatal period may be quite different. It may be a time of emotional turmoil. An estimated 50 to 70 per cent of new mothers experience a time of intense emotion, “baby blues,” usually between the first and third postnatal days. Tearfulness, insomnia, and exhaustion characterize the blues. The blues are usually self-limiting, clearing up about two weeks after the birth.

When more severe symptoms accompany the blues, a condition called postpartum depression (PPD) may exist. These symptoms may include irritability, anger, confusion, anxiety, panic attacks, restlessness, depression and sadness, self doubt, guilt, feelings of helplessness, appetite changes, diminished interest in most activities, difficulty caring for, or thought of harming the baby or herself. A diagnosis of postpartum depression is considered if these more severe symptoms persist beyond two weeks, or have an onset within four weeks of delivery. Research indicates that postpartum depression affects between 10-28 per cent of new mothers.

Postpartum depression affects mothers, their infants and their families. Rationale for treating depression lies not only in humane relief from the distressing symptoms for the mother, but in the ability to facilitate building a better relationship with her partner and to promote good mothering. New mothers who suffer with postpartum depression are more uncertain about their mothering skills, are unable to fully enjoy their infants (and other children), and display negative attitudes towards their babies. Children of women with PPD have higher rates of emotional disturbances and demonstrate some cognitive deficits as late as four years old

It is estimated that at least 25 percent of woman who have postpartum depression need some form of treatment to improve. It is imperative that women struggling with postpartum depression be identified early. Work with a psychotherapist who has a good understanding of postpartum depression has proven helpful. Treatment for postpartum depression relieves distressing symptoms for the mother, helps build a better relationship with her partner, and promotes good mothering.

Research about postpartum depression supports the viewpoint that the transition to motherhood is a stressful period of change. Interpersonal relationships change, especially with partners and extended family. Roles change. The ability to identify with motherhood may be difficult. Self-image and self-esteem are affected. Sometimes family and friends feel free to give unwelcome advice and judge how new mothers care for their infants. Previous depressive episodes or emotional problems during pregnancy and lack of social and marital support during the transition to parenthood all contribute to how the woman transitions to motherhood. Of these, depressed mood during pregnancy has proven to be a consistent predictor of risk for postpartum depression.

There are many complex emotions and feelings tied up with motherhood that are an integral part of postpartum depression. There is a paradox in women’s emotional experiences: they are happy to be mothers to their infants, yet they are unhappy at the losses that motherhood imposes upon their lives. There are losses associated with autonomy and time, physical appearance, femininity and sexuality, and occupational identity. Some researchers suggest that if losses were taken more seriously and women were encouraged by family, friends, and society to grieve them, then postpartum depression might be understood as a normal reaction to the transition to motherhood. (Mauthner, 1999; Nicholson, 1999).

Signs and symptoms of postpartum depression include:
• low self-esteem
• guilt, inadequacy, worthlessness
• lack of interest, engagement with, or attachment to the baby, e.g. not holding, cuddling, or talking to the baby a lot
• feelings of hopelessness, sadness and/or helplessness
• poor concentration, confusion
• greater negativity about life
• less communicative
• obsessional thoughts regarding harming the baby or harming herself

Note: While symptoms such as poor appetite or overeating, insomnia, and low energy or fatigue are considered possible symptoms of depression, they are normal for any new mother.

If you or someone you know is struggling with postpartum depression, encourage them to see their physician to get a referral for individual counseling or for joining a support group. A couple well-known celebrities who have struggled with and written about postpartum depression are Marie Osmond (“Behind the Smile: My Journey Out of Postpartum Depression,” 2001) and Brooke Shields (“Down Came the Rain: My Journey through Postpartum Depression,” 2006). A couple of other good books are “Postpartum Depression Demystified: An Essential Guide for Understanding and Overcoming the Most Common Complication after Childbirth” written in 2007 by Joyce A. Venis and Suzanne McCloskey and “The Mother-to-Mother Postpartum Depression Support Book” by Sandra Poulin and published in 2006.

No mother, infant, couple, or family should have to struggle with postpartum depression by them selves. Individual counseling and psycho-educational support groups are of tremendous benefit. There are also medications to help. If you know a mother who is struggling with “baby blues” or postpartum depression, don’t hesitate to offer help. Prepare a meal and bring it over. Baby-sit so mom can get away or nap for a couple of hours. Do the laundry, grocery shop, validate mom’s losses, as well as the joy of the newborn. Respect the new mom and her family boundaries with whatever help is given.

Below are listed some online web sites that are dedicated to helping women and their families who are struggling with postpartum depression. There are also a couple of web sites with articles and additional resource information about PPD. These web sites were valid as of 03.15.2009.

Help is available for those struggling with postpartum depression.

References:
Mauthner, N. (1999). “Feeling low and feeling really bad about feeling low”: Women’s experiences of motherhood and postpartum depression. Canadian Psychology, 40, 143-162.Nicholson, P. (1999). Loss, happiness and postpartum depression: The ultimate paradox. Canadian Psychology, 40. 162-178.

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