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The birth of a child can be a joyous and exciting time, but
following childbirth, some women may experience postpartum
disorders that can adversely affect a woman’s mental health.
Mothers commonly experience what is called “the baby
blues,” mood swings that are the result of high hormonal
fluctuations that occur during and immediately after childbirth.
They may also experience more serious mental health disorders such
as postpartum depression, birth-related post-traumatic stress
disorder or a severe but rare condition called postpartum
psychosis.
In general, clinical depression occurs in approximately 15 to 25
percent of the population, and women are twice as likely as men to
experience depression. Because women are most likely to experience
depression during the primary reproductive years (25 to 45), they
are especially vulnerable to developing depression during pregnancy
and after childbirth. Women who develop these disorders do not need
to feel ashamed or alone; treatment and support are available.
What are the postpartum blues or
“baby blues?”
Postpartum blues are very common, occurring in up to 80 percent
of new mothers. Characterized by mood swings, postpartum blues or
“baby blues” are normal reactions that many mothers
experience following childbirth. The onset of postpartum blues
usually occurs three to five days after delivery, and should
subside as hormone levels begin to stabilize. Symptoms generally do
not last for more than a few weeks. If a person continues to
experience moods swings or feelings of depression for more than two
weeks after childbirth, the problem may be more serious.
What is postpartum depression
(PPD)?
Postpartum depression (PPD) is a major form of depression and is
less common than postpartum blues. PPD includes all the symptoms of
depression but occurs only following childbirth. It can begin any
time after delivery and can last up to a year. PPD is estimated to
occur in approximately 10 to 20 percent of new mothers.
What are the symptoms of
PPD?
Symptoms of PPD are the same as those for clinical depression
and may include specific fears such as excessive preoccupation with
the child’s health or intrusive thoughts of harming the baby.
Given the stressful circumstances of caring for a new baby, it is
understandable that new mothers may be more tired, irritable and
anxious. But when a new mother is experiencing drastic changes in
motivation, appetite or mood she should seek the help of a mental
health professional. For a clinical diagnosis of postpartum
depression to be made, symptoms of PPD generally must be present
for more than two weeks following childbirth to distinguish them
from postpartum blues.
What are the factors that
contribute to PPD?
The causes of PPD are not quite clear but research suggests that
the following factors may contribute to the onset of PPD:
- Hormonal changes: A woman experiences the greatest hormonal
fluctuation levels after giving birth. Intense hormone
fluctuations, such as decreased serotonin levels, occur after
delivery and may play a role in the development of PPD.
- Situational risks: Childbirth itself is a major life change and
transition, and big changes can cause a great deal of stress and
result in depression. If a major event coincides with childbirth, a
mother may be more susceptible than average to PPD.
- Life Stresses: Ongoing stressful circumstances can compound the
pressures of having a new baby and may trigger PPD. For example,
excessive stress at the office added to the responsibilities of
being a mother can cause emotional strain that could lead to PPD.
The nature of the mother’s relationship with the baby’s
father and any unresolved feelings about the pregnancy might also
affect a mother’s risk of getting PPD.
What treatments are
available?
Taking antidepressant medication may help alleviate the symptoms
of PPD and should be combined with ongoing counseling with a
therapist trained in issues surrounding childbirth. Studies show
that some antidepressant medications have no harmful effects on
breastfeeding infants. Psychotherapy alone may also be used to
treat PPD. New mothers should be encouraged to talk about their
feelings or fears with others. Socializing through support groups
and with friends can play a critical role in recovery. Exercise and
good nutrition may improve a new mother’s mood and also aid
in recovery. Caffeine should be avoided because it can trigger
anxiety and mood changes.
Can PPD lead to other
problems?
When a new mother has severe depression, the vital mother-child
relationship may become strained. She may be less able to respond
to her child’s needs. Several studies have shown that the
more depressed a new mother is, the greater the delay in the
infant’s development. A new mother’s attention to her
newborn is particularly important immediately following birth
because the first year of life is a critical time in cognitive
development.
Is PPD preventable?
In most cases PPD is preventable; early identification can lead
to early treatment. A major part of prevention is being informed
about the risk factors and the medical community can play a key
role in identifying and treating PPD. Women should be screened by
their physician to determine their risk for acquiring PPD. Because
social support is also a vital factor in prevention, early
identification of mothers who are at risk can enable a woman to
seek support from physicians, partners, friends, and coworkers.
What is birth-related post
traumatic stress disorder (PTSD)?
After childbirth, women may also experience post traumatic
stress disorder (PTSD). PTSD includes two key elements: (1)
experiencing or witnessing an event involving actual or threatened
danger to the self or others, and (2) responding with intense fear,
helplessness or horror.
- Symptoms of birth-related PTSD may include:
- Obsessive thoughts about the birth
- Feelings of panic when near the site where the birth
occurred
- Feelings of numbness and detachment
- Disturbing memories of the birth experience
- Nightmares
- Flashbacks
- Sadness, fearfulness, anxiety or irritability
What is postpartum
psychosis?
In rare cases, women may experience postpartum psychosis (PPP),
a condition that affects about one-tenth of 1 percent of new
mothers. Onset is quick and severe, and usually occurs within the
first two to three weeks following childbirth. Symptoms are similar
to those of general psychotic reactions such as delusions (false
beliefs) and hallucinations (false perceptions), and often
include:
- Physical symptoms: Refusal to eat, inability to cease activity,
frantic energy.
- Mental symptoms: Extreme confusion, memory loss,
incoherence.
- Behavioral symptoms: Paranoia, irrational statements,
preoccupation with trivial things.
A woman who is diagnosed with PPP should be hospitalized until
she is in stable condition. Doctors may prescribe a mood
stabilizer, antipsychotic or antidepressant medications to treat
postpartum psychosis. Mothers who experience PPP are highly likely
to suffer from it again following their next pregnancy.
For More Information:
Contact your local Mental Health Association, community mental
health center, or:
National Mental
Health Association
2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311
Phone 703/684-7722
Fax 703/684-5968
Mental Health Resource Center 800/969-NMHA
TTY Line 800/433-5959
Depression
after Delivery
A national clearinghouse that offers information, treatment
referrals, educational materials, telephone support, and support
groups for new mothers as well as links to information for new
dads.
Postpartum
Support International
Provides information for new moms and dads, on-line list of support
groups, chats and discussion boards, share a story section,
bookstore, etc.
http://www.obgyn.net/
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