Postpartum Depression Is a Completely

Postpartum Depression

Depression is a completely unexpected result in women who birth a child. Besides many other emotions that are completely normal -- joy, fulfillment, pride -- depression is especially powerful because of its inappropriate nature. The fear and anxiety just don't make sense to many child-bearing women. A large percentage -- up to 80% -- of women have the "blues" after the birth of a child. A much smaller percentage -- around 10-20% -- have a more serious type of distress that we call postpartum depression (PPD). In extreme cases, postpartum psychosis, which is a severe type of PPD, develops.

The positive side of postpartum depression (PPD) is that it isn't a permanently debilitating disease. And it has nothing to do with the woman having some sort of weakness. In many cases, treatment obtained as soon as possible manages the symptoms and allows the mother, and the family, to enjoy the new infant (Mayo Clinic Staff, 2009).

Signs and Symptoms

What are the differences between baby blues, PPD, and postpartum psychosis? Baby blues do not normally require treatment or a doctor's care. Postpartum depression is far more serious and might interfere with the woman's ability to take proper care of her baby. Postpartum psychosis requires immediate medical treatment (WebMD, 2010).

With baby blues, the mother may feel weak, upset, and alone to a surprising extent, even though there is usually more than the usual number of family and relatives present. Their after-birth feelings are worse because they never expected them and certainly do not match the joy they think they are supposed to feel. Baby blues usually begin around two to three days after the birth. Upset, depressed and anxious are the usual adjectives used to describe the thoughts and feelings. They may even feel angry with the baby, the husband, or the other children, and for no logical reason anyone can figure out.

The mother might have bouts of crying, trouble sleeping, problems with making decisions, and, almost without exception a mother with the baby blues will question her own handling of the baby. If the baby blues don't get better fairly soon, it could be postpartum depression (ACOG, 2009).

PPD is more serious than baby blues. As a matter of fact, many of the signs and symptoms are the same as in an individual suffering from major depression, which includes feelings of sadness, hopelessness, worthlessness, along with behavior changes like different sleeping and eating habits (Rogge, 2008).

With postpartum depression, though the symptoms may be somewhat similar to baby blues, they are far more intense and last longer, and, again, they do interfere with the mother's ability to care for the baby and to perform other household tasks.

Insomnia, overwhelming fatigue, loss of libido, difficulty bonding with the baby, withdrawal from family and friends, and even thoughts of harming oneself are typical signs that it is PPD rather than baby blues (Mayo Clinic Staff, 2009). However, clearly, with postpartum depression as opposed to psychosis, though a mother might fear harming her baby, those feelings are almost never acted upon. The thoughts may be scary in that she may not want to be left alone in the house with the baby and the guilt felt about those feelings may make the postpartum depression worse (ACOG, 2009).

The most severe form of postpartum depression is actually called postpartum psychosis. This is quite rare and normally becomes apparent in the first two weeks after birth. The signs that it is most definitely psychosis are that there are actual attempts to harm oneself -- not just thoughts or serious consideration -- but actual action to do so. Confusion and disorientation, hallucinations and delusions, and even paranoia are all distinguishing characteristics of this very serious form of psychosis. Immediate medical help must be sought. There is no question in this situation that harm could come to the mother, or, in extreme cases, the child.

There may also be other physical signs with PPD . Frequent headaches, chest pain, rapid heartbeat, shakiness and shortness of breath suggest the type of anxiety associated with postpartum depression.

Treatment should be sought for depression. Both counseling and medication can be helpful. It is clear that without intervention, postpartum depression can become worse, be more intense, or just last longer than if not treated.

There does not seem to be a correlation between a mother's age or the number of children she has, and postpartum depression. It will occur more often in women who do not have any familial emotional support. The other factors that increase the percentages of having the depression are having had it before with previous children, having had a psychiatric illness of some sort, or some serious recent stress event such as losing a loved one (ACOG, 2009).

Causes

There are those experts who think that the causes of postpartum depression and its associated problems are all related to imbalances or deficiencies in hormones. There is a significantly larger faction of both birth mothers and health experts who will say that is "bunk."

They would present evidence that hormones may play a part but certainly do not present the entire picture of this disorder. As there are documented cases of adoptive mothers having postpartum depression, hormones would not explain these situations. Body, mind, and lifestyle factors most likely all contribute to cases of PPD -- and in any combination.

And, since it is highly unlikely that any two women have the same experiences or lifestyle or experiences, it would be easy to see why they could be the cause of one woman suffering from PPD while another does not. When you think about it, any one of these, plus hormonal problems thrown into the mix, could explain why a woman can easily handle the rigorous demands of her day-to-day life but finds the stress of a new baby overwhelming (ACOG, 2009).

Causes

Let's look at a number of possible causes, remembering there could be one or a combination of causes for each woman.

Hormonal/Physical -- All experts will agree that hormones play some part in PPD. One study indicates similar hormone levels or balances in mothers during the PPD period and the same levels in other women not postpartum but suffering from "general" or chronic depression. These are referred to as HPA or hypothalamic-pituitary-adrenal levels.

A separate study shows that a drop in insulin that most birth-mothers experience may be a cause. Any drop in insulin lowers the serotonin in the brain, and that lowered level of serotonin has long been known to impact mood disorders (Lane, 2007). Changes in the levels of estrogen and progesterone may also cause difficulties. And let's not forget that women who have a child in a hospital setting are exhausted and physically in pain which they must recuperate from. They usually leave the hospital within a very short time and bring their tired, "beat-up" bodies home with them, and now have to care for a new child which is physically exhausting. This can continue for months and contribute significantly to baby blues and PPD.

Emotional -- There is no question that, in many cases, pregnancies are not planned. Doubt arises. The short nine months is not enough time to adapt to the idea of an addition to the family. Even in planned pregnancies, doubt comes from many directions.

The child may enter the world early. Home and work habits and routines change suddenly. There may be a birth defect situation that causes overwhelming stress or even guilt as the woman feels she must have done something wrong during the pregnancy.

Past baggage from the birth-mother's relationship with her own mother may cause her to feel unsure about her thoughts toward the baby. Fears of inadequacy about caring for the baby are a common occurrence. And feelings of loss of one's own freedom, identity, and even the birth mother's own pre-pregnancy body shape and sex appeal can cause sadness, and eventually contribute to depression.

Lifestyle/Support -- Lack of support is a significant contributor to PPD. In many situations, the ongoing support from spouse, partner, family, relatives and friends provides all the comfort needed during and immediately after birth. but, if that support decreases over a short time after the birth, PPD can still settle in, and the mother may feel even more depressed because she feels lost or overwhelmed without that help. and, in the case of a single mom, who lives away from or has no family to support her, then PPD may be more immediate. Breast-feeding problems and associated feelings of guilt because the mom feels she is not doing something right can be alleviated with some flexibility like using formula and having a partner or supportive friend help her with feedings and allow time for rest (ACOG, 2009).

Perfect Mother "Syndrome" -- Three myths pervade the thought processes of mothers and lead them to the blues, PDD, and, in rare cases postpartum psychosis:

Motherhood is Instinctive. The belief that they should automatically know how to care perfectly for their baby and that they must have all the loving "maternal"

feelings that they have read about in all those baby magazines cause significant problems with birth moms. It takes time, reading baby-care books, talks with the pediatrician, support groups with other mothers, and experience to know how to care for a child. And the maternally bonding feelings sometimes take weeks or months to develop.

Perfect Baby. The fantasy that your baby will be beautiful in every way, sleep through the night, and never cry is exactly that -- a fantasy. And the thoughts that all your friends new babies are perfect and yours isn't is also a fantasy. In 99 cases out of 100 that won't happen. But these thoughts can contribute to PPD.

Perfect Mother. Being the perfect mom will never happen -- either for you or your friends whom you perceive as perfect. You think you are not living up to the ideally perfect mother because you have trouble sometimes balancing the baby, other children, housework, a job, a spouse, and a myriad of other tasks. These feelings are normal even with a significant amount of support (ACOG, 2009).

Risk Factors

A birth mother is at risk for PPD following the delivery of any number of children, not just the first one. and, the risk of PPD is significant in the first four weeks after birth. As time goes on with a new baby, the chances of becoming depressed decrease. A mother under the age of 20 is usually more at risk, due to maturity levels in dealing with stress. Alcohol abuse, intake of illegal substances or smoking add to the risk -- as well as seriously risking the baby's health. If the mother did not want or did not plan the baby, the lack of preparedness and mental state affect the risk of PPD. A close family member who has had depression or anxiety, especially if recent, can affect the birth mom's risk of PPD. A poor relationship with the spouse or partner causes increased risk. and, finally, previously attempted suicide will increase risk. There are several other risk factors that we have covered in other areas of this paper.

Treatment

First of all, it is important that the birth mother admits that she is experiencing the blues, sadness, or depression as soon as possible. Many feel embarrassed because they think they shouldn't feel the way they do, which, by itself, is a symptom, as we have discussed earlier.

Immediate attention is important for the mother and for any potential risk of harm to the baby should psychosis develop. If the feelings are interfering with daily tasks, that is a sure sign that help is needed (Mayo Clinic Staff, 2009).