Major Depression or just the blues?
When her baby is born, a woman anticipates joy and looks forward to relief from the discomforts of the later months of pregnancy. However, many women experience a period of sadness, irritability and feelings of inadequacy. Why should the birth of a new child be followed by tears?
The Baby Blues In America, about 50% to 80% of new mothers experience a mild, self-limited period of depression, anxiety, and emotional reactivity called the postpartum blues. This usually occurs about three to five days after delivery.
Postpartum Depression, a more severe, lasting depression is experienced by up to 12% of women after delivery. Symptoms may include hopelessness, guilt, difficulty concentrating, poor appetite, and thoughts of suicide. Frequent trips to the baby’s pediatrician may be a sign of depression.
Postpartum Psychosis is much rarer. It is associated with about once in a thousand deliveries. The new mother may have paranoia, hallucinations, rapid speech, confusion and mood shifts. This condition is often associated with Bipolar Disorder.
Risk Factors Women with a prior history of major depression or postpartum problems may have more difficulty with postpartum depression. Other factors associated with increased risk are: difficult labor, a premature child, severe PMS, low self-esteem, unwanted pregnancy, and lack of social support.
Cultural Factors The incidence of postpartum psychosis is fairly similar around the world. However, there is much less postpartum blues or depression in more traditional cultures. In these cultures, there may be special rituals that help transition the woman into her new role as a mother. Extended family gather to provide support and instruction. In our more mobile culture, the extended family is less available to provide extended support. The new mother may be expected to get her parenting instructions from books or simply to “know” it. Our more flexible view of the role of a mother can be liberating but can also be overwhelming.
Getting Support A supportive spouse who can take time off work, or the presence of older family members can ease the transition to motherhood. Some new mothers hire a “baby nurse” or a housekeeper to help out for several weeks.
Getting Psychiatric Help Most women with postpartum depression are not diagnosed or treated. This may lead to long-term depression and difficulty bonding with the baby. One study showed that young children of depressed mothers are more likely to have problem behaviors and to score lower on standardized tests. Fortunately we now have effective treatments for postpartum depression. Counseling and support groups are helpful. For some women, antidepressant medication can make a big difference. Often a woman can, after consulting with her doctor, continue breastfeeding while taking these medications. With successful treatment, the new mother is more fully able to enjoy her baby.