A Publication of WTVP

What is big and ugly and something no one wants to talk about? It is postpartum depression (PPD). Formerly thought of as sadness or the “blues” that follows childbirth, PPD is now recognized as much more complex and can be present during a woman’s pregnancy as well as following birth.

It is estimated that 10 to 13 percent of pregnant women experience depression. As many as 80 percent feel the “baby blues” after the baby arrives—this is considered normal and resolves in a few weeks. Twenty percent experience postpartum depression or anxiety. Often, these symptoms are undiagnosed and women suffer needlessly. Symptoms may be similar to the blues but continue much longer and require treatment. A serious postpartum mental illness, known as postpartum psychosis, is very rare, occurring in one or two out of every 1,000 births. In fact, postpartum psychosis is a state in which the woman loses touch with reality and cannot differentiate between what is and is not real. These are the women who may harm themselves or their children.

Hormones associated with pregnancy may fluctuate considerably during pregnancy, birth and in the months that follow. If a woman knows that her body is sensitive to hormonal changes—if she has a history of PMS, for example—she should be alert that signs of PPD could occur.

There are a variety of ways PPD appears, which can make it difficult to diagnose. Some women experience PPD as sadness and hopelessness, but it is just as likely to appear as anger and rage. Very often women feel completely physically exhausted and/or experience physical aches and pains. Repetitive thought and worry are common. This may manifest as compulsive behavior, like cleaning the house over and over again. Scary thoughts of harm coming to the baby are symptoms women do not often discuss. It is important to recognize that imagining the baby being hurt or dying or the mother somehow causing the death of the baby is NOT psychosis because they don’t act on those thoughts. But women with PPD are horrified that they have such thoughts. Women who have postpartum psychosis are those who may act on such thoughts and see these actions as reasonable. There is a very large difference.

Unrecognized, PPD has the potential to hurt new families. Because of lack of energy and desire, women often limit the time spent with their baby in interactive ways. Families who lack information may not see the need to seek treatment for the mother experiencing PPD. Those who feel shame or embarrassment about their thoughts and feelings hesitate to tell anyone. Worry and anxiety sap energy that could be spent on the family.

Women who have high personal expectations or who are perfectionists are more susceptible to perinatal (the time surrounding birth) mood disorders. Adding the new role of “mommy” to an already very busy life can contribute to becoming depressed. Women who are anxious by nature may find that the concerns of pregnancy and motherhood may lead to obsessive worrying. A lack of money or other resources can also add to a woman’s feelings of being overwhelmed, as can the lack of family support, particularly the support of one’s own mother. Events such as moving or changing jobs can contribute to depression in a woman who has just given birth.

One commonly stated issue in PPD is the persistent myth that motherhood is a “happy-all-the-time” period in a woman’s life. Parenting is truly the most difficult “job” a person will ever have. Couple that with the fact that there is very little teaching on “how to parent,” and it can lead to feelings of inadequacy.

There is help available. Supportive professionals who know about PPD and the treatment and medications can be very helpful in breaking the depression/anxiety cycle, and most medications are compatible with breastfeeding. Having the time and a place to talk about the pregnancy, the birth and the continuing postpartum experience is an important outlet for new mothers. When women can discuss their thoughts and feelings honestly with a non-judgmental friend, this can also be a very helpful outlet. Symptoms of PPD can often manifest as anger and aggression, which families have difficulty understanding. The more we raise awareness of PPD, the better we will be able to have the physician diagnose and treat it early.

Pregnant women expect screenings in pregnancy for things such as gestational diabetes, and screening for depression will soon be just as commonplace. There are federal and state regulations mandating screening for PPD in pregnancy and in mothers for one entire year after the baby is born. A screening tool such as the one printed on the next page is recommended for use by women at their prenatal and postpartum visits. Because women visit their baby’s doctor frequently in the first year after birth, it is also recommended that this screening tool be made widely available in those locations as well. Women are to read and score the Edinburgh scale screening tool themselves; they are instructed to inform their physicians if they have a persistent score of over 10 points, or if they ever feel like harming themselves or their baby. The more that parents-to-be and their families learn about PPD and the importance of screening for it, the greater the potential to provide the services needed. TPW