Bringing a new baby into the family can be challenging at the best of times, both physically and emotionally. It is natural for new parents to experience mood swings, feeling joyful one minute and depressed the next. These feelings are sometimes known as the ‘baby blues,’ and often go away soon after birth. However, some parents may experience a deep and ongoing depression that lasts much longer. This is called postpartum depression.
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Postpartum depression is depression that may start during pregnancy or at any time up to a year after the birth of a child. Depression is a mental illness that affects a person’s mood—the way a person feels. Mood impacts the way people think about themselves, relate to others, and interact with the world around them. This is more than a ‘bad day’ or ‘feeling blue.’ Without supports and treatment, depression can last for a long time. Signs of depression include feeling sad, worthless, hopeless, guilty, or anxious a lot of the time. Some feel irritable or angry. People lose interest in things they used to enjoy and may withdraw from others. Depression can make it hard to focus on tasks and remember information. It can be hard to concentrate, learn new things, or make decisions. Depression can change the way people eat and sleep, and many people experience physical health problems. A mother or father with postpartum depression may not enjoy the baby and have frequent thoughts that they’re a bad parent. They may also have scary thoughts around harming themselves or their baby. Although it’s rare for a parent to make plans to act on these thoughts, this situation is serious and requires urgent medical care. If you believe that a loved one is in danger, don’t hesitate to call 911 or your local crisis line.
References to postpartum depression date back as far as the 4th century BC. Despite this early awareness, it has not always been recognized as an illness. As a result, postpartum depression continues to be under-diagnosed. It is an illness that can be effectively treated. The sooner the condition is diagnosed, the more effective the treatment.
It is important to recognize and acknowledge the symptoms of postpartum depression in yourself or another as soon as possible. This can be difficult, since the depressive feelings often involve intense and irrational feelings of fear. The mother may fear she is losing her mind or fear that others may feel she is unfit to be a mother. Women with postpartum depression may feel like they are bad mothers and be reluctant to seek help. It is important to remember that hope and treatment are available to women in need.
Researchers have identified three types of postpartum depression: baby blues; postpartum depression and postpartum psychosis.
- The “baby blues” is the most minor form of postpartum depression. It usually starts one to three days after delivery, and is characterized by weeping, irritability, lack of sleep, mood changes and a feeling of vulnerability. These “blues” can last several weeks. It’s estimated that between 50 per cent and 80 per cent of mothers experience them.
- Postpartum depression is more debilitating than the “blues.” Women with this condition suffer despondency, tearfulness, feelings of inadequacy, guilt, anxiety, irritability and fatigue. Physical symptoms include headaches, numbness, chest pain and hyperventilation. A woman with postpartum depression may regard her child with ambivalence, negativity or disinterest. An adverse effect on the bonding between mother and child may result. Because this syndrome is still poorly defined and under studied, it tends to be under reported. Estimates of its occurrence range from three per cent to 20 per cent of births. The depression can begin at any time between delivery and six months post-birth, and may last up to several months or even a year.
- Postpartum psychosis is a relatively rare disorder. The symptoms include extreme confusion, fatigue, agitation, alterations in mood, feelings of hopelessness and shame, hallucinations and rapid speech or mania. Studies indicate that it affects only one in 1000 births.
Postpartum depression can affect anyone. Although it’s more commonly reported by mothers, it can affect any new parents—both moms and dads—and it can affect parents who adopt. Postpartum depression is likely caused by many different factors that work together, including family history, biology, personality, life experiences, and the environment (especially sleep deprivation).
There is no one trigger; postpartum depression is believed to result from many complex factors. One factor may be the changes in hormone levels that occur during pregnancy and immediately after childbirth. Also, when the experience of having a child does not match the mother’s expectations, the resultant stress can trigger depression. Studies have also considered the possible effects of maternal age, expectations of motherhood, birthing practices and the level of social support for the new mother. It is important, however, to communicate to women with postpartum depression that they did not bring it upon themselves. One certain fact is that women who have experienced depression before becoming pregnant are at higher risk for postpartum depression. Women in this situation should discuss it with their doctor so that they may receive appropriate treatment, if required. In addition, an estimated 10 per cent to 35 per cent of women will experience a recurrence of postpartum depression.
The amount of sick leave taken during pregnancy and the frequency of medical consultation may also be warning signs. Women who have the most doctor visits during their pregnancy and who also took the most sick-leave days have been found to be most likely to develop postpartum depression. The risk increases in women who have experienced two or more abortions, or women who have a history of obstetric complications. Other factors which increase the risk of postpartum depression are severe premenstrual syndrome (PMS), a difficult relationship, lack of a support network, stressful events during the pregnancy or after delivery.
Postpartum depression can be a very difficult experience. Becoming a new parent is hard enough—and the challenges added by depression can seem overwhelming. It’s important to remember that there is no such thing as a perfect pregnancy, perfect birth, perfect baby, or perfect parent. You are doing the best you can. And with care and support, you can recover and enjoy time with your family. Remember that you are not alone – up to 20 per cent of new mothers experience postpartum depression. Equally important is remembering that you are not to blame. Here are some suggestions for coping:
- Counselling and support – A type of counselling called Cognitive-behavioural therapy (CBT) is a common treatment for postpartum depression. It may be the first treatment to try for mild or moderate symptoms. CBT teaches you how your thoughts, feelings, and behaviours work together. It also teaches important skills like problem-solving, realistic thinking, stress management, and relaxation. Another type of counselling called interpersonal psychotherapy may also help. It focuses on relationships and can help people adjust to changing roles in their relationships.
- Support Group – Support groups are also very important. Postpartum depression and new parenthood can both isolate you from others, and isolation can add to feelings of depression. Support groups are a safe place to share your experiences, learn from others, and connect with other parents who have similar experiences and understand what you’re going through.
- Self-help – Taking care of your well-being is especially important, but this can be difficult for any new parent. It may be helpful to recruit loved ones or see what services may be available so you can take some time for your own needs. Regular exercise can boost your mood and help you manage stress. Eating well and sleeping as much as you can are also very helpful. And it’s always important to spend time on activities you enjoy, find relaxation strategies that work for you, and spend time with people who make you feel good.
- Medication – Antidepressants are the main kind of medication used to treat depression. There are many different classes and types of antidepressants, and each work a little differently. While many moms can safely use antidepressants while breastfeeding, it’s important to talk with your doctor about the possible risks and benefits. Medication can help with some symptoms, including sleep, appetite, and energy levels. However, medication can’t get rid of some of the thoughts or beliefs that can fuel depression. It’s usually best to include counselling if you are taking an antidepressant medication.
Postpartum depression can be a difficult experience for everyone. Most people expect the arrival of a child to be happy and joyful, and postpartum depression is none of those things. It’s important to know that postpartum depression is no one’s fault, but you can play a big role in a loved one’s recovery. Here are some tips on supporting a loved one who experiences postpartum depression:
- Make sure your own expectations of your loved one’s experiences and day-to-day abilities are realistic.
- Remember that every parent and child is unique and it’s not useful to compare two people or two families.
- Understand that people who experience postpartum depression may want to spend a lot of time alone. This can hurt, but try to remember that it isn’t about you. They are simply trying to cope with an illness.
- Offer help with daily responsibilities. It’s hard enough at the best of times to find time for daily chores when there’s a new baby. Often, offers of help from friends and neighbours are strong in the first month or two, but may be needed just as much, or more, in later months.
- Help with child care (including overnight help for feedings), or help finding a child care provider. A short break or a chance to get back into interests can make a big difference in anyone’s well-being. It can also create more opportunities for sleep.
- Managing postpartum depression can take a lot of hard work. Recognize a loved one’s efforts regardless of the outcome.
- Talk to your doctor or public health nurse, or accompany your loved one on appointments, if you’re concerned.
- Seek support for yourself, if needed. Support groups for loved ones can be a great resource and a great way to connect with others.