Preventing Postpartum Depression
Five Helpful Steps New Mothers Can Take
Postpartum depression (PPD) is the most common complication of childbirth, affecting one in eight women. Symptoms include feelings of sadness, crying, racing thoughts, mood swings, lack of interest in the baby; lack of ability to focus; feelings of being overwhelmed; guilt; changes in appetite; inability to sleep, even when the baby is sleeping; despair; panic; and physical symptoms such as headaches, rapid heartbeat and stomach aches.
Sometimes anxious feelings predominate and there is no real “depression,” but PPD is the umbrella term used to describe all postpartum mood disorders. If these feelings persist for longer than two weeks and affect daily life, the condition might be postpartum depression.
A word of caution about the “baby blues,” which describes the emotional state of up to 85% of new mothers: the baby blues is a brief period of time (from the second day after delivery up to the third week) when most women experience weepiness, fatigue, and mood swings and feel generally overwhelmed. This emotional state is not PPD. If, however, these feelings (or any of the symptoms mentioned above) persist for more than two weeks, occur any time within the first year after a baby has been born, and affect daily functioning, the condition might be PPD.
Research clearly indicates that there are many risk factors for PPD: an unwanted or unplanned pregnancy; previously diagnosed depression or anxiety; family history of depression or anxiety; a recent major life change (such as a recent relocation or death in the family); lack of family and social support; having a baby born preterm or with a difficult temperament; caring for additional young children; marital conflict; alcohol or substance abuse; having a health complication; traumatic birth; or prior diagnosis of PPD.
Mothers who are feeling anxious and/or depressed while pregnant are likely to develop PPD and should, therefore, not wait to enter treatment. Couples who are expecting a baby and under stress from recent job changes, relocation, financial difficulties or parenting a child with special needs are far better off beginning couples’ counseling prior to the birth of the baby to reduce tensions and find ways to reduce stress.
Significant research validates the view that infants, even in utero, are affected by maternal stress, depression and anxiety. Maternal stress also affects other children within the household, but the developing brain of a fetus and infant is especially susceptible to maternal stress, anxiety, and depression. Research shows that maternal depression negatively affects healthy mother-infant attachment. Poor attachment affects a child’s development and behavior for years to come.
While there is little research that proves PPD can be prevented, there are some important points for expectant mothers and their friends and family to remember.
First, awareness is essential. Many mothers with whom I have spoken have said they didn’t know their postpartum emotions were actually PPD. They thought they were going crazy, or were terrible mothers for feeling the way they did. They knew something was wrong, but they didn’t know what it was.
Secondly, women should seek help as soon as possible when they become aware of “not feeling like themselves” after the initial post birth recovery period. Research shows that the sooner women enter treatment the sooner they feel better. The longer they wait to seek treatment, the longer it typically takes to recover. Since we know any illness affects the entire family’s well being, and “toxic stress” affects children’s mental and physical health for the rest of their lives, treatment is paramount.
Third, research indicates postpartum depression is aggravated by stress, so life stressors should be kept to a minimum after delivery. The following may help improve the postpartum environment: taking childbirth education classes; having realistic expectations about the postpartum experience; help with childcare and household chores; sufficient rest; limiting visitors (others feel isolated without company, and notice that their mood improves when they have supportive people around); and allowing yourself some enjoyable personal time.
Finally, PPD is treatable. Psychotherapy has been proven effective in the treatment of postpartum depression. Psychotherapy with a clinician who has been educated in the area of perinatal mood disorders is the best choice, but working with a psychotherapist with whom you can relate and trust is also essential. There are times that medication is warranted, though it is not always needed. A change in diet, exercise and optimizing social/family support are typically part of the treatment plan.
Women who develop PPD are not bad mothers. They should not be blamed for developing an illness. They should be supported and helped. It is important to remember that when mom is suffering, so are the children. The sooner moms get help the sooner they will begin to feel better.