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.

• The Online Postpartum Depression Support Group
• Postpartum Support International
• Listing of Local Postpartum Support Groups in Canada
• Postpartum Depressions and the “Baby Blues”, article from the American Academy of Family Physicians
• University of Michigan Depression Center – Postpartum

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.

Stress (emotional, physical, psychological, and spiritual) contributes to many of the medical conditions seen by healthcare providers. Research indicates that between sixty and ninety percent of visits to physicians are made by the “worried well.” Physical and emotional discomfort related to stress and other mind/body interactions is one of the most common reasons people seek medical help. A growing body of biomedical research is demonstrating that mind-body oriented interventions, particularly those utilizing the relaxation response and the positive beliefs of patients, have been demonstrated to be successful in treating and preventing stress-related illness and to control pain.

More than 30 years ago, Herbert Benson and his colleagues at Harvard University described a physiological reaction that is the opposite of the fight-or-flight response. They called the reaction the “relaxation response.” They define relaxation as the act of releasing muscles from habitual tension, inviting the breath to become slow and even, letting go of tension with each exhalation; emotionally cultivating an attitude of greater equanimity; and mentally observing and letting go of troubling, worrisome thoughts. Benson and his group found that individuals could learn to remember this state of wellness and draw upon it when feeling stressed.

Learning how to elicit the relaxation response results in: the release of endorphins (the “feel-good” hormones); a decrease in heart rate, blood pressure, skeletal muscle tension, and respiration; promotion of digestion; an increase in the core body temperature; and it slows brain waves thereby decreasing analytical thinking. In other words, the relaxation response can be a learned method of controlling the effects of life’s stresses.

Eliciting the relaxation response is being in a state of profound physiological, mental and emotional rest that can have a lasting effect throughout the day if practiced on a regular basis. With practice the body and mind can remember this state of relaxation or wellness. With training, when an individual is feeling stressed, anxious, panicky, or in pain, they can elicit the relaxation response and the body goes into the state of rest, restoration, and remembered wellness.

The relaxation response requires learning a technique or intervention. Two steps are usually required to elicit the relaxation response. The first is the repetition of a word, sound, prayer, phrase or muscular activity. The second is that when other, everyday thoughts intrude, there is a passive return to the repetition. Many different techniques or interventions can be used to elicit the relaxation response.

Mind-body approaches such as mindful breathing, meditation, relaxation training, guided imagery, visualization, self-hypnosis, autogenic training, and yoga have been used successfully to elicit the relaxation response. In addition, prayer can be used to elicit the relaxation response. Some examples are the rosary as in the Catholic tradition, centering prayers used in Protestant religions and pre-davening prayers in Judaism. Any of these methods can be used at rest – sitting or lying down – or during exercise. A brief description of mindful breathing and meditation follows.

Mindful breathing incorporates the two steps necessary to elicit the relaxation response. In a comfortable position, the person concentrates on the rising and falling of the abdomen with each inhalation and exhalation (the repetition of a muscular activity) or uses counting such as 1, 2, 3, 4 on the inhalation and 4, 3, 2, 1 on the exhalation, a secular phrase such as “breathe in relaxation” on the inhalation and “breathe out stress” on the exhalation, or a religious prayer or phrase such as “God is in my heart” on the in breath, “and in my soul” on the out breath.

The purpose of mediation is to go within and experience quieting. It is natural and familiar to everyone. Meditation is the practice or process of attempting to focus or concentrate the mind on an object or activity, something people do most of the time when attention is turned outward. When using meditation to elicit the relaxation response, the attention is turned inward, concentrating on a repetitive focus such as the breath or a word. When the mind wanders, the attention is brought back to the object of the repetitive focus. Like mindful breathing, meditation slows down the activity of the sympathetic nervous system and increases the parasympathetic nervous system.

Examples of meditation are: thinking about the inhalation and exhalation of the breath; focusing on a mantra (a special word or phrase); or gazing and concentrating at a fixed object such as a flame or flower. Meditation involves the process of being uncritical with oneself in attempting to achieve a quieting of the mind. With practice, individuals are able to achieve longer periods where they maintain focus without other thoughts, noises, or physiological sensations distracting them.

Learning how to elicit the relaxation response, how to help the body remember wellness, can help individuals accept responsibility for maintaining health on all levels of their being ~ physical, emotional, mental, and spiritual. It means cultivating a state of quietness in a world that demands so much. It means coping with daily stresses.

Julie Milne, PhD, LCPC, NBCCH, RhT has a PhD in Health Psychology and trained at the Mind/Body Medical Institute at Harvard Medical School. She is also an Advanced Clinical Heart-Centered Hypnotherapist and a Certified RoHun Therapist. One of her areas of specialty is stress management and relaxation training. She can be contacted at 847.650.4260.

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