The birth of a baby is a time of joy and precious memories. For some women, however, it can be anything but joyous; instead it is filled with self-doubt, and overwhelming guilt.
Unfortunately, it is still shameful, these days, for a mother to admit feeling overwhelmed, depressed, or irritated, following the birth of their child; and they feel too ashamed to ask for help. After all, a “good mother” is expected to be completely selfless, and have no other feelings except joy and love for their child. But with postpartum depression affecting 10% of mothers, it can no longer stay a shameful secret. We have to get the word out, to ensure those good mothers get the help they need.
The Importance of Awareness
It is encouraging to see more and more celebrities coming out and saying, “Hey! I am having a hard time adjusting, and I need help”; among them are Brook Shields, Kendra Wilkinson, and more recently Chrissy Teigan who stated -- “It does not discriminate. I couldn’t control it. And that’s part of the reason it took me so long to speak up.” This is great, because it helps to bring about awareness to the disease. More awareness not only helps patients, but also the medical professional. Physician offices are now becoming more equipped to detect and treat post-partum depression. Most physicians administer a survey at the 6 weeks post-partum visit to screen for depression. On the same note, health care providers are taking more initiative on identifying patients that are feeling overwhelmed, and many schedule closer follow-up, as early as 2 weeks post-partum, instead of only at 6 weeks, depending on their patient’s risk factors. All of this is a great start, but more awareness is needed so that, hopefully, one day, no mother will feel ashamed about asking for help.
So, is it normal to feel depressed or to have “the blues” after giving birth? Yes, it is. Normal physiologic changes in the mother, after the birth of a child, can simulate symptoms of depression, such as changes in sleep pattern, energy level, or appetite. A benign condition that many are familiar with is postpartum blues, which occurs 2-3 days after childbirth, and resolves within 2 weeks’ time without intervention. And that is one big difference between postpartum depression, and postpartum blues - postpartum blues resolves on its own; so if symptoms last for more than 2 weeks, doctors often begin suspecting postpartum depression.
Symptoms of Postpartum Depression
Besides feeling depressed, anxious, or upset, mothers suffering from post-partum depression may feel angry with the new baby, their partners, or their other children. They also may cry for no clear reason, have trouble sleeping, eating, and making choices, question whether they can handle caring for a baby. The manifestations of the disease that make the news, of course, are the extreme cases where the patient harms themselves or the infant due to suicidality or associated psychosis, but these cases are far and few between. Many patients with postpartum depression have debilitating symptoms, but suicide or infanticide is very rare.
How is Postpartum Depression Diagnosed?
Postpartum depression is a clinical diagnosis ----meaning there is no fancy, million dollar test for the diagnosis; your doctor may order some lab tests to rule out other possible medical problems, but really the diagnosis of postpartum depression is based on the doctor’s careful assessment. Besides asking about some of the above-mentioned manifestations of the disease, physicians will often focus on the timing of symptoms. Postpartum depression can occur up to 1 year after having a baby, but it most commonly starts about 1-3 weeks after childbirth. As mentioned before, symptoms that resolve on their own, within a couple of weeks, are usually of no concern. Besides the timing of symptoms, the severity of symptoms can also help doctors make the diagnosis. Women with postpartum depression can have INTENSE feelings of sadness, anxiety, or despair that prevent them from being able to do their daily tasks. Keeping a log or diary of your symptoms can help your doctor diagnose or rule-out postpartum depression.
What Causes Postpartum Depression?
It is still, unfortunately, not entirely clear what exactly causes postpartum depression (another reason for more awareness!!). What we think right now is that postpartum depression is caused by a combination of factors - “the perfect storm” of a sudden drop in the level of hormones (estrogen and progesterone), combined with common stressors surrounding pregnancy and delivery. One common physiologic stressor that seems to increases the risk of postpartum depression is a lack of sleep. Social stressors also increase the chance for postpartum depression, and these include: a lack of a support system, stressful life event (recent death of loved one, a family illness, etc.), a major lifestyle change (moving to new city, change of job). A history of depression itself is also a risk factor for developing postpartum depression.
There is also some evidence that postpartum depression can have a genetic component to it (meaning, some people may inherit a higher risk of developing the disease). As an example, there have been studies that show siblings of postpartum depression patients tend to have a higher chance of getting the disease as well.
What is the Treatment?
The very first step of treatment is getting help right when you need it. You do not need to wait for your 6 weeks’ post-partum visit to get help. Even if you don’t think you have a problem, if your significant other or family members are concerned about your mental health, get help ASAP.
Treatment may involve “Talk therapy” (psychotherapy), one-on-one or in a group setting. Others patients may need medication - antidepressants that can help restore the balance of chemicals in the brain to balance mood, or a combination of both.
As with any disease, prevention is the best ‘treatment’. If you have a history of depression or postpartum depression, please, please inform your health care provider. You may be referred to have talk therapy during your prenatal care and if you are on antidepressant, you may be advised to continue your medication.
Dr. Kendra Segura is an obstetric/gynecologist practicing in Southern California. She completed her residency in Rochester, New York. She also has a Masters of Public Health earned at Loma Linda University in Southern California. She has worked for the Los Angeles county health department, where she performed disease surveillance and health education.
Dr. Kendra feels that her God-given purpose extends beyond patients that she encounters in the office, or in the hospital. She desires to reach the women she will not see in the above settings, through various forms of media. Her mission to is inform the uninformed, and misinformed.