Post Partum Depression
I’ll be speaking on this topic at a MOPS group on Thursday. I figured this might be a helpful blog post, too.
You have waited nine unbelievably long months to hold your baby. Lots of anticipation is built up about being a parent and bringing a child into your family. Finally, you are home with your baby. The pain of childbirth is slipping away (or maybe not!), you cherish the moments you have to gaze at this amazingly beautiful and oh so tiny person. It’s supposed to be a time of joy, at least that’s how we romanticized it. Then fantasy begins to drip, your tears are smearing the paint and the salty water is revealing another picture on the canvas, reality. Crying baby, sleepless nights, and exhausted parents give way to an entirely different picture. That is normal. Then, you notice that you don’t have the energy to get out of bed, you hear your baby’s cries but can’t attend to him, you lie there feeling like a shell of a person, you aren’t interested in anything, sometimes you can’t sleep at all, sometimes you sleep all day, you start longing not to be alive anymore, you just want to leave everything, even your baby. Now reality has given way to something more dangerous, post partum depression (PPD).
PPD occurs in about 20% of women usually within 24 hours to four weeks after the delivery of their newborn. Though not as common, it can occur several months after delivery. The symptoms of PPD are the same as those for major depressive disorder: general sense of being sad or down, loss of interest in activities that were once enjoyable, increased or decreased appetite and sleep, agitation, and thoughts about suicide. A few of the symptoms can be tricky for the post partum woman. She may be nursing and thus have an increased appetite. She just gave birth to a baby and the weight naturally begins to melt away. With newborns waking up every two to three hours to eat, new mothers are bound to have “sleep problems”. The key to identifying if what you are dealing with is PPD is the pervasiveness of the symptoms. Another factor to look at is how long you have been noticing the symptoms. The symptoms must be present all day, nearly every day for at least two weeks.
PPD isn’t the only difficulty to deal with, another more common experience for new moms are the baby blues. The baby blues are defined by a cluster of symptoms that affect up to 80% of women. The baby blues usually show up two-three days after delivery and last for less than two weeks. The symptoms are: transient mood swings, irritability, periods of crying, difficulty sleeping and difficulty with concentrating. You can differentiate baby blues from PPD by the amount of time the symptoms are present (less than two weeks) and the intensity of the symptoms. Remember the part in the paragraph above that the symptoms must be present all day, nearly every day for two weeks.
One of the casualties of PPD is the mother’s detachment from her baby. Although some women experience hyper-vigilance about caring for their baby with PPD, a more common problem is a lack of interest in meeting the baby’s needs. The bonding of a baby with her caregiver is crucial to healthy emotional, intellectual, and physical development. Attending to a baby’s cries, holding the newborn, feeding, changing, and ensuring a soothing environment are all part of the bonding experience. The occasional time lapse in meeting the baby’s needs is not going to result in a bonding problem, but persistent ignoring will.
So what do you do? If you are a new mom, be aware of the symptoms of the baby blues and PPD. As soon as you notice symptoms of either, notify your doctor. (If you are experiencing thoughts about suicide call your doctor immediately. If you have a plan in place to end your life, call 911 or get yourself to an emergency room.) In addition to your doctor, notify your significant other and close trusted family or friends of the symptoms you are experiencing. You will need a support system to get through this. The point in notifying people as soon as you become aware of the symptoms is to bring people in before you spiral. A spiral is a term I use (I didn’t create it) to describe the slide down from reality into perceptual distortions. As we initially slip into the spiral, we have enough attachment to reality that we can identify something is not right. As we slide deeper into the spiral, that reality attachment, fades. If the symptoms have just begun, there is no need to panic because you don’t know exactly what is going to happen. You may feel back to normal in a day or a few days, or not. Letting people around you in on what’s happening allows them to join you in monitoring your emotional state. You may get to a place where you no longer make rational decisions or see yourself accurately.
Your doctor is an important person to have on your support team. You may need medication if you slip past the baby blues and into PPD. If you are breast feeding, there are several effective medications that pose little to no danger to your baby. Studies have been conducted on the most commonly prescribed medications for PPD looking primarily at the amount of the medication that travels into breast milk and the effect the tiny amount has on the baby. Only those that are minimally present in breast milk are prescribed. The studies I have looked at suggest paroxetine, sertraline, and nortriptyline as the most recommended anti-depressants because of the limited presence in breast milk and effects on the baby. Work closely with your doctor if you do take anti-depressants to address any side-effects you might experience as well as the effectiveness of the medication in treating your depressive symptoms.
There tends to be some shame associated with post partum depression (PPD), more so than with major depressive disorder. Women may avoid talking about it or seeking treatment in part because they think they are “bad moms.” Women who had to work really hard to even conceive often feel guilt about the negative feelings they may have toward this baby they paid a lot of money to get or endured failed pregnancies to achieve. If this is you, please allow these words to soak in, you are not a bad mom, you have depression. Depression is not something people choose, it is a physiological malfunction in your brain that you did not cause to happen.
For those of you who are experiencing the baby blues or you are experiencing sadness about not being as happy as you thought you would be, that is OK. It is actually quite normal. We set ourselves up for failure when we create a picture that no baby or parent can live up to. Talk about this with trusted, supportive friends and family. Let yourself be released from the unrealistic picture you have of yourself as the perfect mom, and replace it with who you really are. The best gift you can give to your child, besides healthy bonding with your baby, is an imperfect mother who admits her faults and is willing to work on her stuff. “Perfect” creates an unrealistic illusion for our children and a bar to which they will never be able to measure up. Agree to end the “perfection” cycle starting with yourself, right now, while you cry about the fact that caring for a newborn is incredibly difficult and exhausting, no matter how badly you wanted this baby.
I also want to encourage new moms who are experiencing any sad feelings, uncomfortable thoughts, anxiety, baby blues or PPD to work with a therapist. Therapy has been proven to reduce depressive symptoms 🙂