Having a baby will be the greatest and most rewarding adventure you will ever encounter, but it is not without bumps and bruises, heartache and stress, fatigue and worry. Much to our detriment, we have been conditioned to believe that after baby is born we all will just bounce back to our pre-pregnancy selves on our way out the hospital door. I mean after all, look at the pictures of Kate Middleton on her way out of the hospital, gorgeous, right. Those pictures are unrealistic and the media fails to provide the full picture of these women who look like they were never pregnant two days after giving birth. While the fourth trimester is a beautiful time for the mother-baby unit to bond and learn about each other, it is hard work, it is emotional and it is exhausting. For many women the postpartum period is not all sunshine and rainbows.
Postpartum depression can be difficult to recognize because many of the symptoms are similar to the normal experiences of the postpartum period, such as fatigue, sleeping difficulties, irritability, or change in appetite. Frequently women will ignore symptoms of postpartum depression thinking it will go away. Many women are reluctant to discuss any symptoms of depression for fear of judgment or recourse. However, it is vital to recognize postpartum depression and seek help from a physician when it is suspected.
The exact incidence of postpartum depression is uncertain, but it is estimated to affect around 10-15% of women. Postpartum depression can begin during pregnancy but more frequently occurs after delivery. Approximately 50% of women with postpartum depression will develop it during the first four weeks after delivery, another 40% of women with postpartum depression will develop it two to four months after delivery. Approximately 6% of women who develop postpartum depression will have an onset of symptoms five to twelve months after delivery.
Some of the typical symptoms of postpartum depression include:
- Depressed Mood – feeling sad, hopeless, “blue”, “blah”, having no feelings at all.
- Loss of interest in previously pleasurable activities – for example loss of interest in a hobby that used to bring joy.
- Change in weight and/or appetite – increase or decrease in weight or new onset change in appetite.
- Sleep disturbances – this can be difficulty falling asleep (ok, I know everyone will raise their hand for this one, but this means even if you have time to fall asleep, you are unable) or staying asleep (ie. midnight awakenings, not for the sake of feeding or tending to the baby), prolonged sleeping at night, or daytime sleeping (ie finding it difficult to get out of bed).
- Lack of energy – just can’t get motivated to do anything, some women will describe that their limbs or body feels heavy.
- Feelings of worthlessness
- Excessive guilt
- Difficulties with concentration and memory
- Anxiety – excessive worry, feeling unsettled, having recurring thoughts, ruminating.
Who is at risk for postpartum depression? While anyone can develop postpartum depression, there are risk factors that are more commonly associated with postpartum depression. These risk factors include:
- Young age at delivery (less than 25 years old)
- Single marital status
- Family history of postpartum depression or psychiatric diseases
- History of intimate partner violence
- Negative view of pregnancy
- Unwanted or unintended pregnancy
- Poor health prior to pregnancy or during pregnancy (ie diabetes, hypertension)
- Personal history of anxiety or depression prior to pregnancy
- Breastfeeding difficulties
- History of postpartum depression in a previous pregnancy
There are multiple consequences of untreated postpartum depression. Women who develop postpartum depression are more likely not to breastfeed or breastfeed for a shorter duration of time. Postpartum depression can result in poor bonding between the mother and her newborn. There is literature demonstrating babies of women with untreated postpartum depression have a higher incidence of impaired development as a result of inattentiveness and poor infant healthcare. In addition, postpartum depression strains marital relationships and friendships. The risks for suicide and infanticide although extremely rare in the postpartum period, are higher in women with untreated postpartum depression than the general public.
Treatment options for postpartum depression include behavioral therapy with a psychologist or licensed mental health counselor, antidepressant medications, or a combination of both. It is generally believed that the risks of untreated postpartum depression outweigh the risks of anti-depressant medication use in breastfeeding women. There are mental health therapists, psychologist and psychiatrist who specialize in treating women during and after pregnancy.
Postpartum depression affects the entire family, not just mom. It is a complication of the fourth trimester that cannot necessarily be prevented and does not usually go away without some form of therapy. If you are concerned that you may have symptoms of postpartum depression then please seek care with a physician. If you have risk factors for postpartum depression please talk to your doctor or midwife prior to delivery so that you can be better prepared for your postpartum experience. You are your best advocate!
You got this momma!