Recognizing and Seeking Support for Postpartum Depression
By Mary P. Riddle, Ph.D.
Published in the Centre County Women’s Journal, June/July 2008
“If this is supposed to be the most joyful time in my life, why do I feel so rotten?” This is a sentiment shared by many women after they have experienced childbirth.
The transition to motherhood may be one of the greatest changes that a woman ever experiences. Whether for the first time or the fourth, the time just after giving birth is a vulnerable one. There are both physiological and psychological changes that occur and even those who feel well prepared can find this to be a difficult time in their lives.
It is estimated that up to 80% of new mothers experience variations in mood. These fluctuations in mood are commonly referred to as the “baby blues”. One minute you might be elated and joyful, then burst into tears 5 minutes later. This can start just after childbirth and last up to a couple of weeks. For many women the feelings subside, but for a significant number of women, the feelings persist, and sometimes even worsen. For these women, profound mood variations continue; this is known as postpartum depression, and it is these symptoms that need medical and psychological intervention.
In 1996, researchers M.W. O’Hara and A.M. Swain published results from a meta-analysis on rates of postpartum depression in the International Review of Psychiatry. This article estimated prevalence rates of 13%. Symptoms of postpartum depression (similar to that of other depressive disorders) can include feelings of sadness and hopelessness, loss of appetite, sleep disturbance, feelings of guilt and worthlessness, frustration and irritability, and loss of interest in caring for their baby. Of women who experience these depressive symptoms, many can struggle for long periods of time. This takes a psychological toll on the entire family. Marital relationships can become strained, and the well-being of the child is also at risk.
The tricky thing about postpartum depression is that is not uncommon to misinterpret these symptoms. Depression is often insidious in nature, and many women don’t recognize the symptoms in themselves. It is often only in hindsight that they realize how badly they were feeling. Women are often told that their feelings are normal and that they will pass. Many assume that it is just “hormones”, and that time will heal. For women experiencing “baby blues”, time often does bring relief. However, for women experiencing postpartum depression, treatment is likely necessary in order to relieve symptoms.
Although the symptoms of postpartum may occur just after childbirth, a woman’s vulnerability may last up to 6 months after the birth of her child. Although fluctuations in hormones may contribute to what is known of as the “baby blues”, there has been no scientific research to date to suggest that it can account for the symptoms of postpartum depression. All women experience hormonal changes after childbirth, but not everyone develops postpartum depression.
it does appear that some women may be at higher risk for developing postpartum depression. C.T. Beck conducted a meta-analysis of factors that are predictive of postpartum depression. This was published in the journal Nursing Research in 2001. Some of these factors include:
A history of depression (either during pregnancy or otherwise)
Having experienced postpartum depression in the past
Life stressors (such as marital difficulties or financial strain)
Limited social support
Having an unplanned or unwanted pregnancy
What are the treatments?
Treatment for postpartum depression is similar to treatment of major depressive disorder. There are pharmacological as well as psychological interventions. There has been research that has shown that medication and/or different types of psychotherapy can be effective in treating postpartum depression. Treatment such as cognitive-behavioral psychotherapy is geared toward teaching skills the new mom can take into her daily life to help with the symptoms of depression, as well as adjusting to this new role that can be overwhelming.
Also useful is group therapy. The goal here is to bring together several women who are all experiencing the same difficulties. Given the lonely and isolated nature of postpartum depression, as well as the fact that lack of social support is one of the risk factors, a group geared towards support and coping skills can be very effective.
One of the most difficult aspects of depression, and specifically in postpartum, is that new moms are loathe to admit that they are feeling depressed. Although this is changing somewhat with increased education prior to childbirth, it can still be a significant hindrance to receiving treatment. It is imperative that new moms be encouraged to be honest with their loved ones, and in particular, their physician, so that they can receive the proper treatment. Postpartum depression is very treatable, and certainly not shameful.
Another difficulty is the media attention that certain cases of postpartum psychosis have received in recent years. Postpartum psychosis is not the same as postpartum depression. It is a relatively rare mental disorder in which a woman loses touch with reality and experiences psychotic symptoms. These can be in the form of delusions or hallucinations. For example, someone experiencing postpartum psychosis might hear voices telling her to hurt herself or the baby. Additionally, a person suffering from this psychosis would be unaware that they are ill. This is a very serious disorder and should receive immediate medical treatment.
Unfortunately, many people lump all of these mood problems (baby blues, postpartum depression, and postpartum psychosis) together, when in fact they represent different problems. This can contribute to the hesitation many women feel at admitting that they are struggling in those early postpartum months.
it is important for healthcare workers to help educate women to recognize the signs and symptoms of postpartum depression. It is also important for loved ones and family members to offer support so that a new mother feels safe to seek treatment. Lastly, it is important to recognize that becoming a new parent is a profound transition. There is nothing shameful about seeking support. One of the best things you can do for your new baby is to take care of yourself. Speak openly and honestly with loved ones and health care providers so that you can enter this new phase of life equipped with the coping mechanisms that will benefit not only you, but your whole family.
Mary P. Riddle, Ph.D. is a licensed psychologist specializing in women’s health issues. This article is intended to be educational and is not a paid advertisement. Dr. Riddle can be reached at The Scenery Park Psychology Group (814) 237-0551 (x8)