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Postpartum Depression FAQ’S

Postpartum Depression

Postpartum depression (PPD) is a real and common occurrence that is often misunderstood, misdiagnosed, or overlooked. Many underestimate the seriousness of PPD and dismiss it as the “baby blues” which is a temporary and short-lived condition.

The majority of new mothers are not prepared for any severe depression and most baby care books barely touch upon it. A mother who has had babies before may have experienced PPD, but even for her and especially for a new mother, it usually comes as a complete surprise. And when it hits, it is terrifying. The woman often feels embarrassed, ashamed, and tremendously guilty.

PPD can happen to virtually any women regardless of age, race, religion, level of education, or socioeconomic background. It is important to remember that the woman suffering from PPD is only a human being caught in the midst of an emotional illness. It it imperative that educators, counselors, etc., be able to distinguish the differences between transient “baby blues” and chronic, debilitating PPD.

Fifty to eighty percent of all women delivering in U.S. hospitals may experience “baby blues.” Symptoms include fatigue, unprovoked crying, anxiety, confusion, and disorientation. No specific treatment for this condition is considered necessary by healthcare professionals. The “baby blues” are believed to be caused by a dramatic drop in hormone levels that accompany childbirth. Most importantly, the “baby blues” are transient in nature and self-limiting.

Like the “baby blues,” PPD is a hormonally and biochemical induced reaction to the body’s upheaval in the giving birth. However, unlike the “baby blues” which usually has an early onset (within the first two weeks postpartum), PPD can occur anytime within the first year postpartum. Whereas the “baby blues” begin and end suddenly, the onset of PPD is usually slow and insidious.

PPD may begin as the “baby blues” and develop or it can have a later onset. Whereas the primary symptom of the “baby blues” is anxiety, PPD is marked primarily by depression. Symptoms include crying for no apparent reason, numbness, helplessness, frightening feelings and thoughts, over-concern for the baby or no feelings for the baby, insomnia, change in appetite, anger, anxiety, guilt, lack of interest in sex, an inability to concentrate, a compulsive need to talk or to withdraw, exaggerated highs or lows, feelings or inadequacy and an inability to cope with day to day activities.

The incidence of PPD in the mild to moderate range is estimated at 10 – 20% of all births. Healthcare professionals tend to minimize the importance and impact of this disorder. However, if left untreated, mild to moderate depression may become progressively severe.

It is impossible to accurately predict which women will become depressed after delivery. Some women seem to run a significantly higher risk than others.

The following factors indicate a higher than average risk:

depression and/or anxiety during pregnancy
an episode of PPD after a previous birth
a history of mood illness not related to childbearing
parents or siblings with histories of mood illness
an alcoholic, abusive or sociopathic father in the home while the woman was a child
separation from a parent during childhood
an unhappy or highly stressed childhood
an anxious personality stucture
an unwanted pregnancy
a long, difficult, or complicated labor
an unsupported labor
a birth experience that failed to fulfill unrealistic expectations
delivering a premature, compromised, or defective baby.
If a pregnancy woman is aware of having some of these factors in her personal history, she would consider herself at risk and seek counseling during both her pregnancy and the postpartum period.

The at risk woman requires superior nutrition, adequate rest, and above all, emotional and psychological support during and after the pregnancy.
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Statistics

400,000 women each year (1,200 women everyday) or approximately 20% of all women who give birth will experience some degree of postpartum depression (PPD).
50 – 80% will experience “Postpartum Blues.”
10 – 18% of all pregnant women will experience pre-partum (antepartum) depression. Of these, 80% will develop PPD.
1-3/1,000 will experience postpartum psychosis (PPP).
Recurrence rate:
PPD = 66%
PPP = 33%

90% realize something is “wrong.”
20% reported their symptoms to a healthcare provider.
Average time of PPD onset = 2 months.
Average time it takes women to seek treatment = 4 months.
1 in 10 mothers will have delayed bonding.
1 in 100 mothers will have hostile feelings toward their infants.
1 in 50,000 will actually commit infanticide.
Early detection and treatment = recovery rate of 90%.
25% left untreated do not recover
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Myths of Motherhood

Buying into the Super Mom myth is unrealistic, and many times, the source of postpartum depression.

By Ilyene Barsky, LCSW

Postpartum depression (PPD) often goes unrecognized. Many healthcare professionals have been sold by the media into thinking that having a baby is joyous and trouble-free. Women often don’t realize that their symptoms actually have a name. A new mom may secretly believe that she is the only one who can’t keep the house in order, can’t sleep at night, can’t help shouting at the children or nagging her partner.

From the time we are little girls, we are conditioned to the image of the “perfect mom.” We are also supposed to have constant loving and protective feelings toward our children which are supposed to develop immediately after giving birth. What about women who don’t bond immediately and may be unfulfilled by mothering? Often they are left with a sense of failure, inadequacy and disappointment. Another myth suggests that mothering is innate, intuitive and natural. Mothers who are unable to comfort or soothe their crying or colicky baby are viewed as being unable to mother.

The greatest myth of all is that motherhood is supposed to be the happiest time in a woman’s life. As Sheila Kitzinger says in Women as Mothers, “There is so little recognition of what is actually involved in the fatiguing task of being a mother. Women are usually made to explain their postpartum experience in terms of internal state: their hormones, their psyches and their inadequate personalities instead of their realities.”

The Super Mom myth makes it difficult for women to admit to problems after the birth. Often women suffering from PPD not only suffer in silence, but try to conceal their distress from others. In our society, we seem willing only to focus on the positive side of motherhood. New mothers often feel frightened and alone. Becoming a mother is a process. We learn to become mothers. And bonding may not occur immediately.

Societal pressures for new mothers to drop out of major interests and to be with their babies constantly seems to be a significant contributor to postpartum depression. A lot of attention is paid to staying home with the child, but little to how to help mothers who make this choice. Also, women who return to paid work are regarded as cold and unresponsive to the needs of her baby. It is a myth that the infant will suffer unless the mother is always present.

Our societal myths encourage a woman to fuse and confuse themselves as people with the role of mother. It is imperative that new mothers differentiate between motherhood and reality. What these myths have in common is that they are unrealistic – no women can live up to these expectations. Mothering is extremely hard work, whether a woman stays at home or combines it with paid work. The myth of a perfect mother who has it all together is just that – a myth.
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Postpartum Depression: Who is at Risk?

By Ilyene Barsky, LCSW

Fact: Approximately 20 percent of all new mothers will experience some form of postpartum depression.
Fact: No woman can consider herself immune.

Given the above facts, can we accurately predict which women will experience postpartum depression (PPD)? Although PPD is no respector of persons, some women do appear to run a significantly higher risk than others. Experts have noted a number of factors which indicate a higher than-average risk. In doing so, they look at both biological and psychosocial determinants.

1. The single greatest predictor of postpartum depression is a previous episode of postpartum depression. Katharina Dalton, MD, in England, has been doing postpartum research for about 30 years. She has found a 66 percent recurrence rate for women who have not sought treatment. The recurrence is generally of the same type (mild, moderate, or severe). The odds of a postpartum psychosis (PPS) has been estimated to be one to three in 1,000. If a woman experienced PPS after a delivery, the chance of recurrence jumps to 33 percent.

2. In general, women with a history of psychiatric disorders, have a higher probability of repeating the psychiatric disorder which was present during the first year postpartum. (i.e.: anxiety, obsessive compulsive behavior, etc.) However, the vast majority of PPD sufferers have no history of psychiatric illness.

3. Women with a history of hormonal problems prior to childbirth, are also in a high risk category. This group includes women with PMS problems and thyroid disorders. The conditions are exacerbated by childbirth and the subsequent hormonal imbalance. A woman who has had no problems with PMS may discover that a case of PPD, without her realizing it, slowly develops into a characteristic PMS. The symptoms are that similar. In addition, these same women will probably have menopausal problems as well. It is also interesting to note that women who give birth to female babies have a higher incidence of thyroid problems during the postpartum period. Symptoms of hypothyroidism (also know as “combat fatigue”) and PPD are remarkably similar. In fact, one can mask the other.

4. Another high risk factor is a family history of PPD (i.e.: mother, grandmother, or sister) or a dysfunctional family of origin. Women who grew up in a dysfunctional family and have not worked through their own childhood issues are at risk of PPD when they have their own children.
The birth of a baby tends to rekindle past crises. Parents or siblings with mood illness (not related to childbirth) also put the new mother at risk as does separation from a parent during childhood (either through death or divorce). If the new mother’s mother is deceased, she is especially susceptible to PPD.

5. There are also certain personality structures that are vulnerable to PPD. The perfectionist woman with unrealistic expectations and anticipations is at risk. Ditto the “co-dependent” who only wants to please others. These personality “types” are hesitant to discuss their negative feelings (which only worsens the condition).

6. The bearer of an unwanted pregnancy; a long, difficult or complicated labor; an unsupported labor; a birth experience that didn’t fulfill expectations; or delivery of a premature, compromised, or defective baby is also an increased risk of PPD.

7. Older women, career women, women who have had abortion, miscarriages, or infertility problems are also viewed as high risk candidates. After all, they waited or went through a great deal of trouble to have a baby. The older woman may be set in her ways and her peers probably have grown children. It’s difficult to adjust. The same is true of the career woman – especially if she’s been “successful.”

8. One of the highest predictors or risk for postpartum illness is the stability of the marriage. Marital issues such as denial (of a previous PPD), being non-supportive or unavailable in some way, only increase the likelihood of PPD.
Good prenatal care, good preparation for childbirth, support during birthing, household help during the postpartum period, and strong emotional support are necessary ingredients in order to avoid or minimize PPD.

Any expectant woman who is aware or having several of the factors mentioned here should consider herself at risk. During pregnancy is not the time to work through these issues. There are a number of viable treatment alternatives available before, during, and after the pregnancy. They include counseling and/or pharmacological treatment. However, none of them work unless the depressive or potential PPD candidate is identified.
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Resources for Fathers

Articles

Postpartum Dads – By David Klinker
New fathers can have postpartum depression, too – By Bob LaMendola
Postpartum Illness

Helping a Mother Through Postpartum Depression: Offers a definition of postpartum depression and outlines each set of symptoms along with tips to help ease them.

Partners and Postpartum Depression: Emphasizes simple ways to be supportive when your partner has postpartum depression.

Postpartum Dads: Offers guidance from men who have helped their wives through recovery from postpartum illness.

New Fathers

Boot Camp for New Dads: This website shares advice for first time dads on topics including postpartum depression, breastfeeding, forming a bond with your new baby. In addition, it offers tips on how to deal with basics like crying babies and taking care of the child by yourself.

The First 12 Months of Fatherhood: This article walks first time fathers through the first year of adjusting to being a parent. It offers advice for dealing with the transition yourself, as well as how to help your partner during this time.

Diary of an Expectant Father: This article explores the experience of a first time father whose baby girl is born prematurely.

Parenting

National Center for Fathering: This is a website for dads with children of all ages. The organization aims to help fathers’ strengthen their bonds with their children. This website has articles on divorce, adoption, and stay-at-home parenting.

Fathering Magazine: Through first person stories and advice, this website offers tips on parenting as well as relevant links to men’s health. It offers reviews for books and movies relevant to fathering.

Questions to Ask Yourself About Fathering: In these series of questions, fathers’ are asked to consider their priorities and their feelings about fatherhood. It is aimed at fathers who have experienced a divorce, but is relevant for anyone.

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Postpartum depression and the couple

By Ilyene Barsky, LCSW

The arrival of a baby is a powerful event that brings permanent changes to the life of the couple. Parenthood affects the perception of one’s self, one’s partner, other relationships and the world in general. To be totally responsibly for the life of a helpless infant is an awesome realization. Whether or not this is the couple’s first baby, its arrival is always a time of transition and possible crisis.

Many marriages that were based on a foundation of equality and sharing, often lapse into traditional roles after the baby is born. The man views himself as the breadwinner and the woman (whether she works outside of the home or not) views herself as housekeeper as well as the one responsible for the emotional and physical well-being of the family as supporting the family falls on him while she is resentful that the whole burden of baby and domestic care is thrust on her. It is no wonder that many new parents end up separating and/or divorcing because they cannot cope with the overwhelming changes.

The stress and strain on the marriage is exacerbated if the woman is suffering from postpartum depression (PPD). The mother feels exhausted, depresses, anxious and unable to deal with the baby ad household chores. The new father is also confused (and possibly depressed) by his wife’s behavior. He usually does not know what to do or say so he’ll try to help by pitching in with the housework. Those men who have been helping all along with the housework may double their efforts and do even more. They may also take over some (or most, or even all) of the childcare responsibilities. The woman suffering from PPD knows she needs the help and that she “should” appreciate her partners efforts. However, as her husband takes over more and more of “her” duties, she believes to feel increasingly inadequate. This puts the man in a double bind situation. In order to help his wife, he does more of her work. The more of her work he does, the more inadequate she feels and then starts to resent him. Meanwhile, he starts to resent her for being unable to cope. In addition, the new mother may be overwhelmed by her own reaction. PPD carries with it, its own shock factor. The woman didn’t expect to feel depressed or anxious. The depression begins to feed on itself – she feels guilty and inadequate because she was weak enough to become depressed in the first place.

Rather than help with the housework, sometimes all the new mother needs is; emotional support. If she is caught up in the grips of PPD, she may not even know what she needs. Or, worse, she may expect her husband to instinctively know what she needs or wants and if she has to ask for it, his response (no matter how positive) becomes meaningless. This is, of course, irrational and implies that the husband should be able to read her mind and anticipate all her needs.

What the new mother might really need is a simple hug, kiss or some display of physical affection. However, she may be unable to ask for this because experience had taught her that physical affection often leads to sexual activity. A very real symptom of PPD is loss of libido or sexual drive. In the book, The New Mother Syndrome, Carol Dix cites a Masters in Johnson study which has discovered, “A lower level of sexuality even at three months postpartum and that achieving orgasm after birth can be more difficult because of fatigue or tension, because of breast tenderness, soreness after episiotomy, exhaustion from a C-section delivery, or fears that sexual organs have changed and that vaginal muscles are either tighter or looser.” Difficulties with sex adds to the postpartum woman’s sense of low self esteem. This is also related to her body image. There are probably stretch marks and excess weight to contend with. She probably doesn’t spend as much time or effort taking care of her appearance as she used to. She simply doesn’t have the time or energy and if she’s depressed, she doesn’t have the motivation.

All of this can be perceived by her partner as a rejection of him (rather then PPD). He may react by distancing himself from her emotionally and physically by working longer hours, or “going out with the boys.” He might even seek other relationships and have an affair. His withdrawal may cause her to feel even more isolated and deepen the depression.

Therefore, anger, resentment, and even jealousy can rear its ugly head on both sides. Each may be envious of the other’s attention to the baby. This is especially true for the father of the breastfed baby. Even though he may know rationally that he is not being replaced by the baby, he still feels the loss of his partner’s attention. On the other hand, the new mother may feel as though the baby is more interested in the the baby than her. If there are other children around, they will naturally gravitate to their father who is more likely to be more available to them than their mother whose time and energy is more absorbed by the infant. This can be quite devastating. Unfortunately, all of this happens at a time when each of the parents really need extra doses of nurturing from the other.

Most issues that arise during this stage of the marriage can be resolved through communication, compromise, and commitment to making the relationship work. Being a parent is a tough job – there is no previous training, no “how-to” manuals. It requires choices which include giving up things previously valued in the interest of the child and the marriage. As each individual adapts, the relationship may very well be strained, but with a concerted effort by both, the couple can grow and not break

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10 Key Facts About Maternal Mental Health

*It is a myth that pregnancy is a universally glowing, happy time and that new parenthood is “the most wonderful time in your life.”

*The reality is that symptoms of depression and anxiety occur in ten to twenty percent of expectant and new mothers. This means that these emotional symptoms are the most common complication of pregnancy, affecting up to 800,000 women per year in the USA.

*Depression and anxiety during pregnancy can decrease blood flow through the umbilical cord, resulting in low birth weight, small head circumference, and possible effects on the baby’s brain development.

*Depression and anxiety in the mother after birth can affect the parent-child relationship, resulting in developmental, learning, and behavioral problems in the child.

*Postpartum depression is a misnomer; symptoms of anxiety in new mothers are more common.

*Women are not to blame! Maternal mental illness is not a weakness, and women cannot will themselves better. Women with a personal or family history of emotional difficulties are at greatest risk.

*Warning signs during pregnancy or postpartum includes difficulties with sleeping, eating, or caring for herself or the baby, thoughts about hurting herself or the baby, or intense feelings of energy, anxiety, or sadness.

*Postpartum obsessions, thought about harm that can come to the baby, affect 3-5% of new mothers. These thoughts represent no danger to the baby, and can be distinguished from postpartum psychosis, where there is risk for the baby.
Education is the first line of defense, because realistic expectations about new parenthood can decrease the occurrence of depression and anxiety.

Help is available! These disorders are treatable.

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Symptoms of Postpartum Depression

If you are experiencing any of the following:

Crying for “no reason”
Feelings of inadequacy
Difficulty making decisions
Asking directions for simple tasks
Forgetfulness, confusion
Failure to keep appointments
Fear of being alone
Anxiety and/or panic attacks
Nervousness, shaking or trembling
Dizziness, heart pounding, chest pains
Fantasies of disaster, bizarre fears, intrusive thoughts
Feelings of hopelessness
Significant changes in eating patterns
Sleep disturbances
No interest in previously enjoyable activities
Withdrawal and isolation from family and friends
Breastfeeding problems
Inability to touch or care for baby
Feelings of not wanting the baby
Desire to leave family, feeling trapped
Angry feelings toward husband, baby, or self
Hostility, tantrums, “feeling out of control”
Thoughts of hurting self or baby
Compulsive behaviors, checking and rechecking things
Increased alcohol consumption or drug use
Unresolved feelings about a complicated delivery and/or postnatal complications
Help is available!!

SOURCE:- Ilyene Barsky, ACSW, LCSW© 2006 THE CENTER FOR POSTPARTUM ADJUSTMENT- SO. FLORIDA

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