The postpartum period is a difficult time for both mother and infant. Although the time is one for celebration- the physical and psychological changes and adjustments can be difficult. The postpartum period is a significant time for the development of a close and healthy bond between mother and infant, and disruption of this attachment - specifically from postpartum depression can have a profound effect on the family as a unit. Identification and treatment if necessary is very important if a mother is experiencing these feelings. Primary care providers and other medical personnel play a role in identifying mothers at risk- obstetricians and pediatricians may be in a position to diagnose and subsequently refer patients to mental health professionals.

Experts agree that about one mother in ten experiences postpartum depression. Though postpartum depression usually occurs in the first three months, it may occur after this time period. Despite its high incidence, the diagnosis is largely unrecognized by both the mother and to their health care providers. In some research, 97% of women with postpartum depression reported that they felt there was “something wrong” but only 32% believed they were suffering from depression. Many felt that the symptoms were not severe enough. Most strikingly, only 10% discussed their symptoms with a health care professional. Some research suggests that hormonal changes may be the cause or the precipitating factor, other research still focuses on psychosocial stresses that may play a significant role.

Are changes in mood common after childbirth? What are the baby blues?
After having a baby, many women have mood swings- one minute happy and laughing the next minute crying and contemplating the future of sleepless nights. They may feel a little sad, lose appetite, and find that it is difficult to fall asleep even when the baby is asleep. These are called the baby blues- usually lasting 2-4 days after delivery and may last several days to 10-12 days. If symptoms last longer- the diagnosis could be depression.

What are some symptoms of postpartum depression?

• Loss of interest or pleasure in life
• Feeling restless, irritable, anxious
• Loss of appetite
• Unexplained weight loss or gain
• Less energy and motivation to do things
• Feeling like life isn’t worth living
• A hard time falling asleep or staying asleep
• Thoughts of hurting yourself
• Sleeping more than usual
• Worrying about hurting the baby
• Increased crying or tearfulness
• Feeling worthless, hopeless, or overly guilty

There is a questionnaire (the Edinburgh Postpartum Depression Scale) which can help identify mothers who are depressed or who are at risk for postpartum depression. Please follow this link to take this quiz to determine if you should talk to your doctor about similar feelings. http://www.hfs.illinois.gov/assets/071105_edinburgh.pdf 

Who is more likely to develop postpartum depression (PPD)?

• Previous postpartum depression
• Severe premenstrual syndrome
• Depression not related to pregnancy
• A difficult marriage
• Limited support system
• History of child abuse
• Stressful life events during the pregnancy
• Thyroid problems
• Poor relationship with your mother
• A mother who had PPD
• Oral contraceptive use
• Stopping breastfeeding shortly after delivery
• A traumatic birth experience
• Unwanted pregnancy
• Women having their first baby after 30
• High weight gain or poor weight loss

Why do women get postpartum depression?
No one knows for sure. Hormone levels change greatly during pregnancy, childbirth, and with breastfeeding. These hormone changes may produce chemical changes in the brain that may play a role in the development of depression. Feeling depressed does not mean that you are a bad person, or that you did something wrong or that you brought this on yourself for any reason.

How long does postpartum depression last?
It is hard to say- some women feel better within a few weeks, but others feel sad for many months. Please remember that help is available if you talk to your obstetrician or your pediatrician.

What kinds of treatments are available for postpartum depression?
Postpartum depression is treated much like any other depression. Support, counseling, and medicines may help. If you take an anti-depressant medication – it will go into your breast milk- but some medications are better than others. Have a discussion with your pediatrician or your obstetrician about the best medication while breastfeeding.

What can I do to help myself?
If you have recently given birth and are feeling sad, tired, anxious, or irritable- or you have rated high on the Edinburgh postpartum depression scale- remember that many women have had the same experience- and possibly even some friends! You are not “losing your mind” or “going crazy”- these are valid feelings. Here are some things you can do that other mothers have found helpful.

• Find someone to talk to – and tell that person about your feelings.
• Find someone to help you with child care, household chores, and errands. You need to rest or have some “me” time.
• Find time to do something for yourself- even if it is only a short time everyday-reading, exercising, walking, or taking a bath.
• Keep a diary- what happened during your day, how you felt, let it all out- these feelings are important!
• Recognize the fact that some days you will get nothing done!
• You are not expected to be a “supermom”- be honest about limitations and do not worry- you are mother of the year to your child!
• Talk to your obstetrician or to Town and Country Pediatrics to find mental health professionals and/or support groups.

Postpartum Depression Resources

Postpartum Support International
1-805-967-7636
www.sbpep.org/
Edinburgh Postpartum Depression Scale
www.hfs.illinois.gov/assets/071105_edinburgh.pdf