Latest update: June 18th, 2012
Mrs. D., the mother of two children under the age of four, came to see me – she was in the seventh month of her third pregnancy. This baby was unexpected. She had “difficulty” after her last pregnancy, and already tearful, she wanted me to get to know her now, so that I could help her later, when the depression hit. She was not sure she would be able to handle it all again.
Postpartum blues, depression or psychosis can take away all of the excitement you should feel at having just given birth and can turn your family’s world into a nightmare. Often undiagnosed or under-diagnosed, you may suffer needlessly when help is really a phone call away.
Postpartum blues, or baby blues, are very common and affect up to eighty-five percent of women. It is seen as a mild form of depression that you (especially if you’re a new mom) may experience after the birth of a baby. It generally starts within a few days after delivery, peaks around three to five days after delivery and lasts a total of a few days to a few weeks. You may feel sad, anxious or irritable, with no apparent cause. You may seem moody, angry, overwhelmed, feel a lack energy and be unable to sleep. While mildly depressed and feeling somewhat out of control and helpless, you nonetheless still may look after your baby and function quite well.
As a first time parent, you may be shocked to discover that the “perfect baby world” you visualized before birth may bear little resemblance to what your life is like after delivery. You are busier, feel less competent and are often sleep-deprived. Coupled with the hormonal changes that take place in pregnancy, delivery and while breastfeeding, you may feel very much out of control and wish for the blissful “old days.” While it’s perfectly normal to feel the stresses on many levels after childbirth, you may feel alone and unhappy, and find the transition to parenthood a difficult one. You may need help regaining a sense of control over those things you can control and at the same time reduce your stressors as much as possible. That may mean practical support around the house; help with the baby, assistance with nursing and general reassurance that you are doing everything right. Additional guidance in structuring your time and managing the various aspects of your life, and that of your new family, can give you a real sense of achievement as a new parent.
Postpartum depression (PPD) is a more serious or severe form of the baby blues that affects at least one in ten women. Often undiagnosed, it may manifest at any time during the first year after delivery and may last from a few weeks to months. Symptoms may persist for six months or more and if untreated, may worsen with many still being symptomatic a year later. Unlike postpartum blues, if you suffer from PPD, you may have difficulty in looking after yourself or your baby because of the severity of the depression. Symptoms include, but are not limited to, severe mood swings, sleep difficulties, weight loss or gain, decreased energy, a sense of feeling trapped or unhappy, numbness, a desire to avoid socialization, lack of pleasure in life, lack of caring or concern for yourself or your baby, a sense of despondency, trouble coping with and carrying out daily tasks, extreme anxiety about your baby, panic attacks, decreased sexual interest, feeling like a failure, hopelessness, suicidal thoughts, difficulty focusing or concentrating, making decisions, and somatic aches and pains.
While these are all signs of a moderate to severe depression, some of these symptoms such as exhaustion and broken sleep, or a sense of feeling overwhelmed, are naturally expected after childbirth, thus making them easy to ignore.
There is no single cause for PPD. Sleep deprivation is thought to contribute, though lack of support for you as a new mom will make things more difficult and a demanding, irritable, sleepless baby can stress any parent. Hormonal factors, a change in brain chemicals, a drop in thyroid levels, a sense of loss on many levels after pregnancy ends, and a difficult and traumatic delivery and postnatal period can increase your vulnerability to depression. If you have baby blues, a previous history of PPD or a family history of emotional problems, you may be at a higher risk for depression, as well as if you have experienced a previous loss, move, or other major stressor such as an unplanned pregnancy or one close in time to a previous pregnancy.
A clinical psychologist can help determine what is part of a normal adjustment to birth versus what is depression. If you are depressed, she can work with you, your partner, your family, and at times with you and the new baby together, with other children or various other family combinations. Your treatment is designed to alleviate or eliminate the depressive symptoms, help you improve, recover and prevent a reoccurrence. Treatment is focused on mobilizing you and your resources by having you see your strengths, make changes and get a sense of control back in your life. The psychologist can also provide developmental and parental guidance, teach you parent-infant bonding activities and play skills, and reassure you with respect to your parenting skills. She can also teach relaxation exercises to help you sleep better. When you feel calmer and more competent, you can begin to examine irrational and unrealistic thoughts, positively reframe trouble areas, problem solve, and communicate better with your partner and other loved ones. Joining a new moms’ parenting group can also provide you with additional educational information as well as an opportunity to socialize with your baby and other new moms.
Depending on the severity of your depression, the psychologist may suggest a referral for medication as an adjunct (not a substitute) to the cognitive behavioral therapy that she will provide. Medication usually takes at least three to four weeks to begin to work and some time may be needed to find the most suitable antidepressant. While it can be less, it may take three to six months before you’ll feel better.
You can see that more than you are at risk here as PPD can have quite adverse effects on your baby’s development, as well as on the well being of other family members.
Postpartum psychosis, a very severe and rare form of depression is what one often sees depicted in movies or in court. It may begin days or weeks after delivery, comes on dramatically and often is serious enough to require hospitalization. Symptoms include severe depression, extreme agitation and anxiety, rapid and pressured thoughts, extreme uncontrollable fear, severe mood swings, a severe sense of loss of control and thoughts of harming yourself or your baby. It can be very scary for an outsider to watch and at times you may seem paranoid and “possessed.”
Treatment is urgent because both you and your baby are at high risk. Your safety is of utmost importance and often you and your family don’t realize that there is a problem or may minimize the severity. Psychiatric treatment is essential and only afterwards will psychological care be helpful.
If you, a friend or family member experience postpartum difficulties, seek professional help. If you have signs of depression or anxiety during your pregnancy – crying and generalized unhappiness or difficulty feeling good about your pregnancy – you should discuss this with your midwife or physician. If your adjustment seems “at all beyond normal” it is better for you to be seen professionally and to be reassured and followed, than to wait endlessly in hopes that it will just “go away.”
New moms may require lots of assistance. You may feel poorly equipped for “entering the trenches” and facing this new and very demanding job that requires twenty-four plus hours a day and tremendous flexibility. The rewards are limitless but sometimes, you may have difficulty focusing on the positive. Most babies are far more difficult than you might expect and getting to know and love your baby takes time. Motherhood and breastfeeding are not completely instinctive but have to be learned. Friends can encourage you to look after yourself, eat, exercise, get out alone for a bit, and rest. People can baby-sit so that you can hop into the shower, they can help with chores, delegate some non-baby related tasks, drop over with a snack and just be there to see that initially you simplify and do only what needs to be done in order to take it easy. Sometimes the hardest job you may face is learning to let things go a bit, relinquish control and attempt to settle into your new life.
If a psychologist is involved with a family early on, she has a chance to see how parents do with the older children, how older children do with the baby and help the older child to feel included while ensuring that his needs are met. Parents can be encouraged to share feelings and talk to each other and to have “dates” or time alone. A professional can help put things in perspective and encourage the development of realistic expectations. If moms are depressed or simply feel inadequate and doubt their ability to parent, they may inadvertently withdraw from their baby and neither notice or respond to their babies’ needs. A demanding and difficult baby can be hard to engage and a depressed parent may not try or be poorly attuned to the baby’s needs. This can make for profound difficulties later on. As a friend or family member, you can help a depressed mom understand the tremendous impact depression can have on her parenting and help her seek the appropriate professional help that is essential to her true enjoyment of parenting. Good luck!
Dr. Batya L. Ludman is a licensed clinical psychologist in private practice in Ra’anana, Israel. Look for her columns in The Jerusalem Post. This has been exerpted from her new book , Life’s Journey. Exploring Relationships Resolving Conflicts, available thorough bookstores and Judaica shops. Send correspondence to firstname.lastname@example.org or visit her website at www.drbatyaludman.com.
About the Author: Dr. Batya L. Ludman is a licensed clinical psychologist in private practice in Ra'anana, Israel. Look for her columns in The Jerusalem Post. This has been exerpted from her new book , Life's Journey. Exploring Relationships Resolving Conflicts, available thorough bookstores and Judaica shops. Send correspondence to email@example.com or visit her website at www.drbatyaludman.com.
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