It’s 3:00 AM. Your ten-day-old baby has been lying in her crib for over an hour crying. You lie there, wondering why you can’t stir-up the motivation to see if she’s OK. You don’t understand it—you were thrilled when you found out that you were pregnant. Now that you’re home, you just don’t seem to care. As you wonder what’s wrong with you, your little baby continues to cry and cry.
Up to 80% of new mothers experience some type of mood change after having their baby. These mood changes, which the medical establishment terms “postpartum mood disorders,” consist of postpartum blues, postpartum depression, and postpartum psychosis.
Postpartum blues, or “baby blues”, affect 40% to 80% of women who give birth. These women experience sadness, crying spells and sleep disturbances. The blues usually begin during the first week after the baby arrives, and can last anywhere from a few hours to a few weeks. Postpartum blues usually has a minimal effect on the mom’s ability to function, and usually resolves without problems. The cause of postpartum blues is poorly understood. A hormonal reason has been suggested; during pregnancy, hormone levels increase dramatically, and then drop significantly after birth. This sudden drop may produce emotional disturbances.
Postpartum depression affects 10% to 20% of new moms. While postpartum blues usually occurs hours-to-days after delivery, postpartum depression can occur anytime within the first six months of delivery, and is more persistent than postpartum blues. Women with postpartum depression may experience despair, hopelessness and loss of normal interests. One of the most profound problems is a feeling of guilt. Mom may feel guilty about her perceived lack of maternal feelings, which causes further despair, which causes further guilt. This can lead into a real depressive spiral. Postpartum depression is more severe than postpartum blues, and usually occurs in women with underlying or pre-existing mood disorders. Luckily, most women overcome this problem with counseling and antidepressant medications. As with postpartum blues, the cause of postpartum depression is poorly understood; however, certain risk factors have been identified. A new mom is more prone to postpartum depression if she has a personal history of depression, a high level of stress during her pregnancy or a poor marital relationship. About 20% to 30% of women who experience postpartum depression experience it again with future pregnancies. Unlike postpartum blues, postpartum depression can be serious and disrupt the harmony of family life.
Postpartum psychosis is an extremely serious problem that can affect the mom’s perception of reality. She can experience hallucinations, delusions and severe depression. Postpartum psychosis usually occurs within 30-to-60 days of childbirth. Thankfully, postpartum psychosis is rare, occurring in one to two pregnancies per thousand pregnancies. Women who have had previous episodes of psychosis are 200 times more likely to experience postpartum psychosis than women who haven’t had psychotic episodes. The risk of a mother harming her baby is quite high if she has postpartum psychosis. Mothers with this problem usually have delusions of the infant being possessed with extraordinary powers, usually of an evil nature. Auditory hallucinations, such as, ‘Kill the baby before it kills you’ are not uncommon.
So what can be done for women who have a problem with a postpartum mood disorder? Any woman who has just had a baby needs to recognize that she may have a mild case of “baby blues” after delivery. All the guests have gone home, the husband had returned to his normal work schedule, and the other kids at home have (finally) calmed down. Mom is expected to be doing well by this time, and it is also assumed that she is coping well on her own. But what if she’s not?
Unless a severe problem develops, time is a big help. Most women with postpartum blues start to perk-up after two or three weeks. The biggest thing that helps is the love and support of a husband or significant other. If he understands what is going on, he’ll be in a better position to be supportive.
If the irritability, the sleeplessness, and the mood swings become more pronounced, the possibility exists that postpartum depression may be setting in. The best advice is to see a health care provider. The issue could be merely physical. Keep in mind that the thyroid gland, located in the front of the neck, may function less well temporarily after childbirth. Since the thyroid regulates metabolism, less-than-normal amounts of thyroid hormone in the body can cause some of the same symptoms that women with postpartum blues and postpartum depression are experiencing.
So don’t be surprised if the clinician asks questions about thyroid function or orders thyroid tests. If thyroid hormone levels are low, a woman may be given a thyroid supplement until the thyroid is up-to-par again.
If physical causes are ruled out, postpartum depression is treated just like any other significant depression. Counseling and short-term use of antidepressants is all that is usually needed. Some antidepressants can be prescribed to breast feeding mothers.
As mentioned before, postpartum psychosis is the most severe postpartum mood disorder. Hospitalization, medication and psychiatric evaluation are needed to protect the baby and to help the mother adjust to her maternal role.
Since early postpartum hospital discharge is becoming more common, postpartum mood disorders may go unrecognized by the hospital staff. It is important to talk to your health care provider during your baby’s well-child exams, as well as during your postnatal check-up. All new moms want to be the best moms that they can be; the best way to do this is by keeping in touch with your feelings.
Postpartum Support International, found at http://www.postpartum.net/ has PPMD support groups broken down by state. If a support group cannot be found in your area, contact your obstetrician – she would be able to give you the location of local support groups.
Joe Knight is a family practice Physician Assistant and medical writer in Fresno, California.
