The arrival of a newborn can be a joyous occasion for pregnant women, their families, and friends. Contrary to popular beliefs, the postpartum period can also be a time of increased stress and difficulty transitioning into new roles for both parents and their loved ones.

• Postpartum Blues
• Postpartum Depression
• Conclusion
• Resources

Postpartum Blues

Postpartum blues, also known as baby blues, is a transient condition that affects up to 80 percent of new mothers just after delivery.

Symptoms

Symptoms may include abrupt mood swings from happiness to sadness, anxiety, irritability, decreased concentration, insomnia, tearfulness, and crying spells that can occur for no apparent reason. These disturbances in mood can peak on the fifth day after delivery, and typically resolve within two weeks.

Treatment

Treatment for postpartum blues is focused on providing support for the mother and her family, as well as reassurance that her feelings are quite normal and experienced by many other women postpartum. It is important that mothers make time for adequate sleep and rest, eat a well-balanced diet, and allow others to care for the baby at night if possible.
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Postpartum Depression

There are times when the symptoms of postpartum blues can progress to postpartum depression. Postpartum depression can occur within the first month after delivery, but may also occur up to one year after delivery. Unlike postpartum blues, it lasts longer than two weeks. At any given point in time, it can occur in 15 percent of new mothers, with a lifetime risk as high as 10-25 percent. It can be higher in some populations, but may go undetected due to underreporting.

Postpartum depression may occur for a variety of reasons. It may be related to the abrupt withdrawal of estrogen and progesterone levels after birth that are much higher during pregnancy, as well as the risk factors listed below.

Risk Factors

Risk factors may include:

• Personal history of depression prior to, during, or after pregnancy
  
• Personal history of anxiety or bipolar disorder
  
• Family history of depression, anxiety, or bipolar disorder
  
• Marital conflict
  
• Stressful life events within the preceding 12 months of delivery
  
• Lack of perceived social support from family and friends for the pregnancy
  
• Social isolation
  
• Single motherhood
  
• Unplanned pregnancy
  
• Lack of emotional and/or financial support from partner
  
• Previous oral contraceptive related mood changes, or history of premenstrual tension
  
• Previous consideration of terminating current pregnancy
  
• Previous miscarriage
  
• Not breastfeeding or abrupt weaning
  
• A poor relationship with one's own mother
  
• Unemployment in the mother who held a previous job or unemployment in the partner who is the main source of income
  
• Depression in the partner
  
• Child-care related stressors
  
• High number of prenatal visits
  
• Sick leave during pregnancy related to a medical condition
  
• A congenitally malformed or sick infant

No one hormonal, personal, or external factor has been found to cause the condition alone. Method of delivery (vaginal vs. Cesarean section), has not been found to affect the occurrence of postpartum depression.

Symptoms

Symptoms of postpartum depression may include:

• Insomnia or excessive sleep
  
• Fatigue
  
• Change in appetite with weight loss or weight gain
  
• Loss of interest or pleasure in life
  
• Decreased libido (sex drive)
  
• Excessive worry or anxiety
  
• Intense irritability and anger, short temper
  
• A sense of being overwhelmed or unable to care for the baby
  
• Difficulty making decisions
  
• Not bonding with the baby, leading to further shame and guilt

New mothers can have thoughts about harming themselves or their baby. If this occurs, mothers should seek immediate help from their physicians.

If postpartum depression is left untreated, there may be several adverse outcomes. Partners can develop depression. Postpartum depression may impact the new mother's ability to bond with her infant, and may also impact future child development. It can be associated with behavioral problems in children. These children may also relapse into major depression later on in their lives.

Treatment

A woman's physician can screen for postpartum depression using the Edinburgh Postnatal Depression scale, a 10-item self-report questionnaire. This test may be conducted by an obstetrician, pediatrician, family practice physician, internist, lactation consultant, or certified nurse midwife. It can also be administered by a psychiatrist or psychologist. Based on the results, the health care professional can offer various treatment options.

In general, physical health should be optimized with adequate sleep, nutrition, and light exercise when possible.A brisk walk, dancing, or biking can help a woman's mood. Just taking a few steps out of the home to look up at the sky, stretch her arms out wide, and breathe deeply can help a new mother to feel less enclosed and weighted down by her condition. It is also often helpful to find supportive people to help care for the mother and baby, such as partners, extended family, neighbors, co-workers, friends, or even hired help from nannies and housekeepers. Contrary to popular belief, a new mother is not selfish for spending time away from the baby to care for herself. Sometimes it is the only way she is able to recharge her own batteries so that she can return to the baby with love and energy that is replenished during her period of rest.

A new mother's psychosocial health also needs to be addressed appropriately with individual, couples, and/or group counseling, depending on her and her family's needs. Hotlines, internet chat rooms, and telephone conversations with supportive family members, friends, or co-workers are also resources to keep in mind when the new mother cannot leave her baby due to infant care or time constraints. Light therapy, medications, and/or other therapies may be used depending on the severity of the mother's symptoms.
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Conclusion

Postpartum depression is often under-diagnosed because women are reluctant to complain about their mood based on cultural and societal expectations of new mothers. These women suffer in silence, unaware of their condition and the support in the community available to them and their families. Several resources are available for information and understanding of postpartum depression. A short list is included here. This list is not meant to replace open discussion with health care professionals about each individual's personal needs.
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Resources

Organizations

Postpartum Support International
www.postpartum.net
Provides telephone support (805-967-7636) and an international directory of members.

Massachusetts General Hospital Center for Women's Mental Health
www.womensmentalhealth.org

Postpartum Support Page
www.ppdsupportpage.com
Provides online information, support and assistance to those dealing with postpartum mood disorders, as well as their families, friends, physicians and counselors.

Bay Area Postpartum Depression Stress Line
1-888-678-2669; toll free, San Francisco Bay Area
Lines are open daily from 9 a.m. to 9 p.m. Leave a message and a trained volunteer will promptly return your call.

Books

Beyond the Blues, A Guide to Understanding and Treating Prenatal and Postpartum Depression, S. Bennett and P. Indman, 2003 (www.beyondtheblues.com)

Down Came the Rain, Brooke Shields, 2005

The Hidden Feelings of Motherhood, Kathleen Kendall-Tackett, 2005

Postpartum Survival Guide, A. Dunnewold and D. Sanford, 1994

This Isn't What I Expected, K. Kleinman and V. Raskin, 1994

The Postpartum Husband, K. Kleinman, 2000




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