Maternity Monday: The Reality of Postpartum Depression

Having a baby: It’s a delight, it’s a joy — and it is also stressful. No matter how positive the birth experience, how well-prepared you are as a parent (you read every Maternity Monday post, for instance!) and no matter how pleasantly your infant integrates into the world, the arrival of a whole new person into your family shifts the very fundamental makeup of life as you know it.

Which is why postpartum depression (PPD) happens to a lot of new mothers.

Diane Sampson, a Lamaze Certified Childbirth Educator, spends time in the classes she teaches helping parents anticipate the emotional highs and lows having a baby can produce. She explains that the post-partum period (the time after your baby arrives) is an emotionally trying and physically demanding time because:

• You and your partner will experience new demands on your relationship, where you can’t give each other the same amount of attention and time as you could before.
• You may mourn for your loss of free time, or even, if you are having a second child, for the loss of alone time with your first.
• Newborns have shifting, sometimes unpredictable patterns of feeding, sleeping, crying, etc.
• Sleep deprivation, coupled with the care newborns require, can result in extremely intense emotional strain.

While you may not be able to prepare for the postpartum period, knowing that it’s normal and expected to feel overwhelmed sometimes can help new parents seek help from friends, family and their doctor.

What is Postpartum Depression?

Everyone experiences hormonal and emotional stress when a baby arrives.

Postpartum depression should not be confused with “baby blues,” a hormonal and emotional phase that happens in the first two weeks after delivery. The irritability and sadness from baby blues comes and goes. PPD can occur anytime in the first year, lasts longer and requires treatment.

Postpartum depression:

• Happens in about 10 percent of women after giving birth
• Often coincides with returning to work after maternity leave
• Qualifies as an adjustment disorder, resulting from a woman having issues adjusting to the role and demands of becoming a mother

Signs of Postpartum Depression

Sampson explains that typically, “At the six-week checkup, during the follow-up pelvic exam, women get screened for PPD. Your OB/gyn will ask you a few questions about how you are feeling—about yourself, your baby and your relationships.” Providers consider this inquiry into how a mother feels about her new role as part of the total care of her health.

But, Sampson says, if a new mother doesn’t experience PPD until half a year after giving birth, she could miss being diagnosed, especially if she isn’t checking in with a healthcare provider or counselor on a regular basis.

So, often it’s up to the mother, her partner or a close family member to watch for the symptoms of PPD.

How can you tell if you or someone you know has PPD? Some postpartum depression symptoms to look for:

• Behavior or emotions that look like regular depression — sadness, low mood, low energy
• Emotional detachment — mom doesn’t make much eye contact with the baby, doesn’t coo or talk to baby
• Hyper-vigilance — mother tends towards excessive anxiety about protecting the baby or is fearful
• Being off kilter, not settling in
• A lack of joy with the baby
• Lasts more than three weeks (not just a bad day or week)

Partners Can Get PPD, Too

A husband or partner can also experience depression. With a new baby comes loss of autonomy, loss of attention from the mother. “You’re not the focus of her attentions anymore,” Sampson says.

Of course, the parent who did not deliver the baby will not feel PPD as acutely, not being as physically drained or as hormonally affected. But a baby changes everyone’s routines, including sleep, and lack of sleep contributes to emotional fluctuations for anyone.

Preventing Postpartum Depression: Set Realistic Expectations

According to Lynn McDaniel, MD, our cultural expectations of how a mother should behave after giving birth causes or exacerbates PPD, and explains why it’s so common in the U.S.

“In other societies, you stay in your bed for 40 days; here, we expect you to hop up and get dressed. We make ourselves crazy,” she notes.

“We have new moms whose expectations are that they will be awake all day and feed the baby. But you’re on the baby’s schedule, a 24-hour schedule, not yours.”

So, McDaniel advises, prepare to follow your newborn’s cues. And “don’t worry about preparing gourmet meals or cleaning toilets. Focus on the most important thing, and that’s this new baby.”

One Mother’s PPD

We spoke briefly with Daphne, a local Charlottesville mother, about her experience with postpartum depression.

Daphne experienced postpartum depression after her second child. “I felt depressed, very sensitive, emotionally reacting to things out of proportion for sure — teary, easily crying, easily drawn towards the negative perspective of things.”

What helped? “My parents came here for 23 days. They noticed I was very teary, and, you know, they helped me with the kids, and also they pushed me to get out of bed and do something, have a shower, put clothes on, go outside, take a walk.”

Daphne discovered her PPD to be temporary. “At that moment you feel so devastated and so dark, but it doesn’t mean that feeling will be forever long. Remember it will pass!” Daphne also recommends finding someone to talk to, whether it’s a friend or counselor. “My support network got me through,” she says.

Be Brave: Tell Your Provider

While the mother may feel hesitant to admit it, and a partner might be hesitant to point out that there might be an issue, avoiding talking to your doctor and getting treated will only make it worse.

If not treated, PPD can last.

As Sampson says, “Some moms may see PPD as a shortcoming in their mothering. You’re supposed to be really happy, and you’re not. This really puts mothers in a bind. We need to make new mothers feel okay with however they feel and asking for help.”

PPD Treatment

Usually providers:

• Proscribe Zoloft (which is safe for breastfeeding)
• Refer to counseling, especiallyy a therapist who specializes in PPD
• Encourage mothers to find support and self-care practices, like taking yoga or other exercise classes and getting out of the house with baby

Know a New Mother? Offer Support

Partners, family members and friends can support new mothers by:

• Listening
• Normalizing
• Encouraging

McDaniel says, “The biggest thing is, in the first few weeks, it’s about baby being with mom. Anything people can do to keep it going is good.” Her guidelines for visitors:

Do:

Clean toilets, make meals, run errands, clean the kitchen, vacuum, mow the lawn, wash your hands before holding the baby, give mom permission to say now is not a good time to visit.

Don’t:

Visit without checking with mother first, bring your kids to visit the baby, get in the way of the mom spending time with her baby.

Do you think you have postpartum depression?

Talk to an OB/gyn or primary care provider.