The Good News about Postpartum Depression
by Brenda Lane, ICCE, CD

After the baby comes, many new parents are simply relieved that they got through it! However many mothers are unprepared to face one of their biggest challenges - how to manage postpartum depression.

Risk Factors for Postpartum Depression/Anxiety

Prenatal or previous depression

Life stress

Lack of social support

Marital dissatisfaction

Unwanted pregnancy

History of sexual abuse

Traumatic birth experience

High expectations of birth/parenting

Physical problems with baby

Problems with health providers

"Wait a minute. We never talked about this in childbirth class. And I didn't have any depression before, so I skipped that chapter in my book," one mother says. Classes often limit postpartum discussion to mom's physical recovery and taking care of the baby. But rarely do parents have the opportunity to prepare themselves for such an emotional roller coaster.

Since statistics show that most new mothers will have some form of depression after the birth, it may help to look at the range of depression disorders from the mildest to most severe as well as ways for mothers and their families to cope.

Postpartum Blues

As many as 80% of first time mothers experience postpartum blues. Symptoms often start 2 days after the birth as the hormones of pregnancy suddenly drop and they are adjusting to taking care of a new baby with constant demands. Most mothers will have periods of elation and joy, followed by despondency and depression. These drastic mood swings are much easier to manage if mom realizes they are based on hormonal shifts and fatigue. But some mothers might feel that having symptoms mean they are not good mothers or that they shouldn't have been mothers.

The best way for moms to manage is first and foremost - rest. Mothers need sleep for both physical and mental recovery. In addition, mom should eat nutritious meals, drink plenty of fluids and take walks outside (weather permitting) every day. It also helps if family members tackle household chores and put off any major projects for several months. If relatives are not able to help, it might be helpful to hire postpartum assistance from a doula. New mother support groups can be a great way to share with other new mothers, most of whom will be experiencing post baby blues as well. Most mothers with postpartum blues will not need medication, but may benefit from other therapies such as herbs and acupuncture. Typically postpartum blues will resolve within about 2 -3 weeks after birth.

Postpartum Anxiety Disorders

There are several specific disorders that are included in this category:

• Generalized anxiety disorder (GAD) - excessive worry or anxiety which the mother finds difficult to control and associated with restlessness, fatigue, irritability, muscle tension or insomnia.
• Obsessive-compulsive disorder (OCD)- including obsessions or thoughts that are persistent, frequently about hurting the baby and/or compulsions that are repetitive, ritualistic behaviors that the mother finds difficult to control.
• Panic disorder - extreme anxiety with chest pains, dizziness, sweating, shaking, etc. often associated with a certain place or event.

New mothers can answer the following questions to help them identify any of these disorders.

• Are you so anxious that you cannot adequately care for your baby?
• Are you afraid of hurting yourself or the baby to the extent that you are not sure you can stop yourself?
• Are your compulsive behaviors harmful to the baby?
• Are you so anxious that you cannot eat or sleep?

10-15% of women will develop postpartum anxiety disorders. Health care professionals will sometimes recommend ruling out any physical problem first such as hypoglycemia and hypothyroidism before assuming it is caused by anxiety. One new mother with postpartum anxiety was surprised at how physical her symptoms were. She would frequently have "attacks" that would come early in the morning with chest and stomach pain, followed by feelings of despair and concern about caring for her baby.

In addition to good eating habits, rest and exercise, mothers can also benefit from relaxation exercises, support groups, counseling and/or anti-depressants. Some of the support groups also offer referral services to mental health practitioners with special interest in postpartum anxiety disorders.

Psychotic Depression

One of the ways to distinguish postpartum psychosis from the more common anxiety disorders is that in addition, she will often have hallucinations or delusions. Sometimes family members may not pick up on psychosis because the mother may have periods where she appears fine. However, during the time when she is irrational, her judgment is impaired and both she and the baby are not safe. She may not even remember what she has done during these periods of psychosis.

Postpartum psychosis, though rare (1 in 1,000) must be considered an emergency and treated immediately. The mother usually responds quickly to medication and is most cases will need to recover in a hospital or clinic. She will also need to know that she is at risk (40-100%) for developing postpartum psychosis sometime in the future and likely recur if she should have another child. There is some limited research that mothers at risk may benefit from the use of estrogen after birth to prevent psychotic depression.

So, the bad news is that almost all mothers will experience at least the mildest form of postpartum depression. However, the good news is that all of these disorders are treatable. We are also learning more and more about mental health issues today so new mothers and their families have many resources at their fingertips to help them through this rocky emotional journey.

Recommended Treatment for Postpartum Blues

Rest

Nutritious meals and snacks

Help from family and friends w/household chores

Exercise

New mother support groups

Herbal Remedies*

Acupuncture

Postpartum doula services

Recommended Treatment for Postpartum Anxiety Disorders

All of the above

Light therapy

Counseling

Support Groups

Medication (anti-depressants)*

Recommended Treatment for Postpartum Psychosis

All of the above

Hormone therapy to mothers at risk as prevention*

Assistance with caring for baby while mother is in recovery

Hospitalization until mother is stabilized

*Please see your health care provider for information about the most appropriate medications or herbal remedies for you and/or those safe to use while breastfeeding.

Resources for Parents

Further Reading

Overcoming Postpartum Depression and Anxiety, Linda Sebastian
Postpartum Depression & Anxiety: A Self- Help Guide for Mothers, Pacific Post Partum Support Society
Postpartum Survival Guide, Anne Dunnewold and Diane Sanford
This isn't what I expected, Karen Kleman and Valerie Raskin
Mothering the New Mother, Sally Placksin
Healing Herbs, Sari Harrar and Sara Altshul O'Donnell

Support Organizations

Postpartum Support International
DONA International (DONA)

Links

Postpartum Depression Signs

About the Author
Brenda J. Lane, ICCE, CD(DONA) is a certified childbirth educator, certified doula and approved doula trainer with an independent practice in the Annapolis, MD area. She has been teaching classes for over 10 years and had attended nearly 100 births as a doula. Several of her articles have appeared in "The International Journal of Childbirth Education", "The International Doula" and several local publications. Brenda recently became interested in this topic while assisting several of her clients this year through postpartum depression.