What is Post-Partum Depression and why do people not talk about it?
I think people are scared to talk about it, but many people suffer and want to know they are not alone.
The months following the birth of a baby, especially if it is your first child, involve a great deal of adjustment and are extremely challenging for the mother. Her body chemistry is changing, her hormones are dropping drastically, her sleep is disrupted and interrupted, she needs to take care of a child that does not come with an instruction manual, she is dealing with so many conflicting and intense emotions such as guilt, anxiety, worry, helplessness, fatigue, and exhaustion. A new mother is also struggling with body image issues, there may be changes in her relationship dynamics with her partner, she has less time for herself, and there are numerous other stressors that may lead many women to experience postpartum depression in the year following childbirth.
Sadly, insufficient information and understanding of the nature of postpartum depression, along with a ubiquitous stigma in our society about its exact cause, leave many women to suffer alone, in silence and tremendous pain and shame.
I would like to stress in this article that postpartum depression is a real problem caused by many different factors and it is never the fault of the mother – nor is it an indication of her worthiness.
How Many People Experience Postpartum Depression?
Postpartum Depression is relatively common and it can be as high as 20% (one in five women)! The “baby-blues,” which are feelings of sadness, guilt, fear or anger within the first one to two weeks after birth, are even more common affecting approximately 80 percent of new mothers according to the American College of Obstetricians and Gynecologists.
When Does Postpartum Depression Occur?
Postpartum depression can happen at any time during the baby’s first year of life – not just during the first 3 weeks after birth. In fact, postpartum depression tends to spike around the time the baby is five months.
What Are the Symptoms?
As mentioned preciously, the “baby blues” are common feelings during the first two weeks after childbirth mainly because of the drastic drop in hormones after childbirth.
Postpartum depression, however, is more severe, lasts longer (at least one month), may cause impairment in the mother’s functioning, is marked by persistent feelings that last beyond the initial two-week mark, and the symptoms are much broader than “sadness.” Because sadness is not always the primary symptom, many women are not even aware that they are suffering from postpartum depression.
Symptoms often include physical, behavioral, emotional and cognitive symptoms:
• Anger, rage, restlessness, frustration, or irritability.
• Sleep disturbances: sleeping all the time or inability/difficulty to sleep even when exhausted or have the chance to sleep.
• Feeling “flat”/Indifferent, numb or empty – no strong feelings of either happiness or sadness.
• Persistent feelings of sadness and hopelessness
• Extreme mood swings
• Unexplained, excessive or uncontrollable crying.
• Intrusive thoughts of serious harm or death coming to the baby.
• Not feeling connected or loving toward the baby. Inability to bond with baby.
• A general feeling of “this isn’t what I expected it to be.”
• Eating disturbances: not eating for days (poor appetite or not feeling hungry), or inability to stop eating.
• Extreme worrying and anxiety: racing mind with fears and worries that cannot be controlled, stopped or managed.
• Feelings of guilt and shame: feeling like you’re “not doing this right,” that you’re a bad mother.
• Just not feeling “like yourself.”
• Inability to concentrate
• Trouble remembering details
• Difficulty making decisions
• Doubting her ability to care for her baby
• Thinking things are too overwhelming to handle
• Thinking she has failed or is inadequate
• Fatigue and loss of energy
• Muscle aches and pains
• Headaches
• Stomach pains
• Acting distant with partner
• Withdrawing from friends and social activities
• Unwilling to care for the baby out of fear of harming him or her
• Not being able to enjoy time with friends and family
• Not wanting to be alone with the baby
• Exhibiting angry behavior toward others
In more extreme cases (typically associated with postpartum psychosis), symptoms can include:
• Hallucinations/delusions
• Paranoia
• Thoughts of suicide or of harming the baby
• Confusion/disorientation
What Causes Postpartum Depression?
There are a combination of multifaceted factors rather than a single cause or predictor of postpartum depression. Here are some of the reasons:
Hormones
There are incredible physiological changes and fluctuations of hormones that cause real, profound and powerful changes in a woman’s body. In particular, the hormones estrogen and progesterone are considerably elevated during pregnancy, and then quickly drop to normal levels within 24 hours of childbirth. It is a tremendous adjustment for a woman’s brain chemistry to adapt to, and the primary contributor to postpartum depression.
Lifestyle Factors
Some of the practical challenges of parenting a newborn intensify the hormonal effects, leading to postpartum depression. These include:
• Lack of sleep
• Stress of parenting a newborn
• New challenges in the parental relationship or problems in relationship with your spouse/poor marital relationships
• Loss of flexibility/free time
• Lack of a good support system
• Lack of time to exercise
• Poor nutrition
• Strong desire or pressure to be the “perfect parent”/Type A personality
• Experiencing stressful events during the past year, such as pregnancy complications, illness or job loss
• Your baby has health problems or other special needs or medically ‘fragile’ infant
• Having twins, triplets or other multiple births
• Difficulty breast-feeding
• Financial problems
• The pregnancy was unplanned or unwanted
• Previous pregnancy loss or death of an infant
Social Factors
• Judgement on mother – telling her what she should or should not do and comparing her to the older generation
• Jealousy from others
• Pressure to breastfeed
• Negative life events
• Problems with in-laws and family over-involvement
Medical History and Genetics
• Having a history of premenstrual dysphoric disorder (PMDD), depression, bipolar disorder or mood disorders, either during pregnancy or at other times
• Having a family history of psychiatric disorders/depression, post-partum depression or other mood disorders
• Experiencing postpartum depression after a previous pregnancy
If untreated, how does post-partum depression affect the child?
Untreated postpartum depression can affect the early relationship between a mother and her child in the following ways:
• Problems with learning and language development
• Behavioral issues
• More frequent crying
• Agitation and stress
• Growth problems
• A higher risk of obesity
• Difficulty adjusting to social situations and school life
• Attachment problems: The infant of a depressed mother is at risk for developing insecure attachment, negative affect and dysregulated attention and arousal.
• Toddlers and preschoolers of depressed mothers are at risk for developing poor self-control, internalizing and externalizing problems, and difficulties in cognitive functioning and in social interactions with parents and peers.
• School-age and adolescent children of depressed parents are at risk for impaired adaptive functioning and psychopathology, including conduct disorders, affective disorders, ADHD and learning disabilities and anxiety disorders.
What NOT to Say to a Mother With Post-partum Depression?
• Everyone has a hard time, you will get used to it.
• I didn’t feel depressed when I had a baby. It can’t be that bad.
• You don’t need medication to get through this. Why would you need medication from your doctor? Are you sure this isn’t all in your head?
• This is the exact medication and dosage I took for my PPD. Just take that and you’ll be OK.
• I would never take antidepressants. You shouldn’t need that stuff to be a mother.
• This will probably go away on it’s own, so don’t worry about it.
• Don’t you love your baby?
• This is what you always wanted, you should be happy. It is a blessing!
• Can’t you see how lucky you are? You have a beautiful baby! You should be grateful.
• Just [go for a walk/go out with your friends/have a drink/take a vitamin/go shopping/go back on the pill] and you’ll feel all better. Once you go back to work you’ll probably feel fine. If you would just try _______ (fill in the blank) parenting style I think everything would be okay.
o DON’T SAY you will feel better if…
• Women have been having babies for tens of thousands of years, and they got through new motherhood just fine. Toughen up.
• Yeah, I had a few bad days there after my baby was born. I know what you’re going through.
• I just finished my [album/thesis/marathon/political campaign]. I know how you feel.
• Maybe postpartum depression is God’s way of letting you know you don’t have enough faith. I think you should pray harder.
• Stop making this about you. This is about the baby. You should be thinking about him/her rather than yourself.
• Quitting breastfeeding is selfish. The baby’s health is so much more important than yours.
• I know breastfeeding is really important to you, but you have to quit so you can be treated for PPD.
• You’re just mad the baby is getting all the attention.
• I wouldn’t talk about this with anyone. You don’t want them to think you’re crazy.
• You don’t need to worry about your symptoms unless you’re having thoughts of harming your baby.
• You’re just using postpartum depression as an excuse to get out of the hard work of being a mom.
• Why can’t you just talk yourself out of this? I don’t think you’re trying hard enough.
• Do we need to take your child away from you?
• You have [a supportive partner/wonderful home/great family/good job/food on the table/healthy baby]. You should be happy.
• All of this crying is bad for your baby, you know.
• We all have days where we don’t want to get out of bed.
• Did you think motherhood was going to be easy? What did you expect?
• Oh, that happens to everyone.
What Are Some Helpful Things to Say to a Mother With Post-partum Depression?
• You are a great mother. You are doing a great job.
• Those dark thoughts do not define you.
• These are some symptoms you are facing, that is not who you are.
• Those feelings of sadness, anxiety and anger are symptoms of their disorder, much like a cough is a symptom of a cold.
• This part is really hard, it will get better.
• You are not alone in this.
• I am here to help if you need me, as long as it takes.
• I know you are trying really hard. You can do this!
• You are allowed to put yourself first.
• I can come over at 2pm to hold the baby while you sleep, drop off food, help you with cleaning the house, etc. Offer specific and practical help.
• Your symptoms will go away when you get treatment. You will feel better again. This is temporary. This will pass, and it will not last a lifetime. There is light at the end of the tunnel.
• If you need to cry, I can sit here while you cry.
• What does it feel like? Help me understand.
• Take this one moment at a time.
• I support your decisions about your treatment.
How Can I Deal with Postpartum Depression?
The first step in treatment is understanding that reaching out for help is not a sign of weakness or a personal failure as a new mother and it is not something you have to suffer through alone. I will list some strategies below that can help with combatting postpartum depression:
1) Develop Support: whether with mothers in your community or with family or friends.
2) Seek Professional Help: through counseling, talk therapy or medications if needed.
3) Adjust Your Lifestyle: Ask your partner/family member to take an overnight feeding (pump if you’re nursing) to help you get a longer stretch of restorative sleep. Schedule regular exercise when possible and try to go on walks or spend time outdoors in the sunshine. Eat healthy nutritious meals.
The bottom line is, postpartum depression is real, it is common, and it is treatable. Healing and support is available for postpartum depression, and no mother should feel alone or ashamed to admit her feelings, which will help her pursue treatment for this condition that is largely biological. Mothers deserve nothing but patience, love and support. Period.