Postpartum Depression - Part 1

Whether you're becoming a mom for the first time or the fourth, the days and weeks immediately following your baby's birth can be as overwhelming as they are joyful and exciting.

Many women experience major mood shifts after childbirth, ranging from brief, mild baby blues to the longer-lasting, deeper clinical depression known as postpartum depression.

Feelings of sadness and depression are more common after childbirth than many people may realize. It's important for new mothers — and those who love them — to understand the symptoms of postpartum depression and to reach out to family, friends, and medical professionals for help.

With the proper support and treatment, mothers who are experiencing any degree of postpartum depression can go on to be healthy, happy parents.

Baby Blues

Up to 80% of women experience something called the baby blues, feelings of sadness and emotional surges that begin in the first days after childbirth. With the baby blues, a woman might feel happy one minute and tearful or overwhelmed the next. She might feel sad, blue, irritable, discouraged, unhappy, tired, or moody. Baby blues usually last only a few days — but can linger as long as a week or two.

Why It Happens

These emotional surges are believed to be a natural effect of the hormone shifts that occur with pregnancy and childbirth. Levels of estrogen and progesterone that increased during pregnancy drop suddenly after delivery, and this can affect mood. These female hormones return to their pre-pregnancy levels within a week or so. As hormone levels normalize, baby blues usually resolve on their own without medical treatment.

What to Do

Getting proper rest, nutrition, and support are quite important — since being exhausted or sleep deprived or feeling stressed can reinforce and fuel feelings of sadness and depression.

To cope with baby blues, new moms should try to accept help in the first days and weeks after labor and delivery. Let family and friends help with errands, food shopping, household chores, or child care. Let someone prepare a meal or watch the baby while you relax with a shower, bath, or a nap.

Get plenty of rest and eat nutritious foods. Talking to people close to you, or to other new mothers, can help you feel supported and remind you that you're not alone. You don't have to stifle the tears if you feel the need to cry a bit — but try not to dwell on sad thoughts. Let the baby blues run their course and pass.

When to Call the Doctor

If baby blues linger longer than a week or two, talk to your doctor to discuss whether postpartum depression may be the cause of your emotional lows.

Postpartum Depression

For some women, the feelings of sadness or exhaustion run deeper and last longer than baby blues. About 10% of new mothers experience postpartum depression, which is a true clinical depression triggered by childbirth.

Postpartum depression usually begins 2 to 3 weeks after giving birth, but can start any time during the first few days, weeks, or months post-delivery.

A woman with postpartum depression may feel sad, tearful, despairing, discouraged, hopeless, worthless, or alone. She also may:

• have trouble concentrating or completing routine tasks
• lose her appetite or not feel interested in food
• feel indifferent to her baby or not feel attached or bonded
• feel overwhelmed by her situation and feel that there is no hope of things getting better
• feel like she is just going through the motions of her day without being able to feel happy, interested, pleased, or joyful about anything

Feelings and thoughts like these are painful for a woman to experience — especially during a time that is idealized as being full of happiness. Many women are reluctant to tell someone when they feel this way. But postpartum depression is a medical condition that requires attention and treatment.

Why It Happens

Postpartum depression can affect any woman — but some may be more at risk for developing it. Women who have battled depression at another time in their lives or have one or more relatives who have had depression might have a genetic tendency to develop postpartum depression.

Most postpartum depression is thought to be related to fluctuating hormone levels that affect mood and energy. Levels of estrogen and progesterone that increased during pregnancy drop suddenly after delivery. In some cases a woman's thyroid hormone may decrease, too.

These rapid hormone shifts affect the brain's mood chemistry in a way that can lead to sadness, low mood, and depression that lingers. Stress hormones may have an added effect on mood. Some women might experience this more than others.

When to Call the Doctor

If feelings of sadness or depression are strong, if they linger throughout most of the day for days in a row, or if they last longer that a week or two, talk to your doctor. A new mother who feels like giving up, who feels that life is not worth living, or who has suicidal thoughts or feelings needs to tell her doctor right away.

Postpartum depression can last for several months or even longer if it goes untreated. With proper treatment, a woman can feel like herself again. Treatment may include talk therapy, medication, or both. In addition, proper diet, exercise, rest, and social support can be very helpful. Some women find yoga to be beneficial. Some research suggests that expressing thoughts and emotions through certain writing techniques can help relieve symptoms of depression.

It may take several weeks for a woman to begin to feel better once she is being treated for depression, though some begin to feel better sooner. Ask your doctor about how soon to expect improvements and ways to take care of yourself in the meantime.

Postpartum Psychosis

A more serious and rare condition is postpartum psychosis. It affects about 1 in 1,000 women who give birth and occurs within the first month after labor and delivery. It may include hallucinations, such as hearing voices or seeing things, or feelings of paranoia.

With postpartum psychosis, a woman can have irrational ideas about her baby — such as that the baby is possessed or that she has to hurt herself or her child. This condition can be extremely serious and disabling, and new mothers who are experiencing these symptoms need medical attention right away.

Why It Happens

Women who have other psychiatric illnesses, such as bipolar disorder or schizoaffective disorder, may be at greater risk of developing postpartum psychosis.

When to Call the Doctor

Postpartum psychosis requires immediate medical attention and, often, a brief hospitalization. If you or someone you know is experiencing symptoms, don't delay getting medical attention.

Understanding the Changes After Childbirth

New mothers experience many layers of change in the days and weeks immediately following labor and delivery. In addition to the sudden drop in estrogen and progesterone — which can affect mood — other huge physical, emotional, and domestic changes can affect how a new mom feels.

Physical Changes

Pregnancy brings many physical changes, and labor and delivery are physically intense and challenging. It takes time for the body to recover, and a new mother might feel exhausted, emotionally drained, or uncomfortable after delivery.

Personal and Emotional Changes

A woman's role and responsibilities may change quite a bit when she becomes a new mother. It can take time to adjust — even if she felt prepared for the change. Some women may feel isolated, worried, or scared.

Some new mothers face added stresses related to difficult circumstances or lack of support. Enduring a tough relationship, a precarious financial situation, or some other major life event at the same time — like a move or a job loss — can add stress.

Pregnancy-related stress — such as difficulty conceiving or complications during pregnancy or labor — can add to a new mom's feeling of being depleted. Sometimes (but not always) these stresses can pave the way for depression.

Changes in Routines and Responsibilities

A newborn brings special demands on a mother's time, attention, and energy. For first-time mothers, there can be lots to learn about meeting the baby's most basic needs, like sleeping, feeding, bathing, and soothing. There are lots of new routines to establish.

The baby's sleeping, waking, and feeding schedules can make it hard for a new mom to get the sleep and rest required to help handle all these new stresses and responsibilities. And without a good night's sleep, even small things can seem overwhelming.