This article will mostly discuss Postpartum Depression. Please note that Postpartum Psychosis, while it only impacts approximately 1.5% of all women, is a very serious illness and deserves its own article.
This morning I went to a great workshop at Healthcare Alternative Systems on Perinatal Mood Disorders and was once again reminded how prevalent, under-treated, and serious Postpartum Depression continues to be. I thought it might be helpful for our readers to hear what signs and symptoms of Postpartum Depression (PPD) to look for and to post some helpful resources if you think that you or someone you care about may be suffering from PPD.
Prenatal or Antenatal Depression
First off, PPD doesn’t just happen to women who have already given birth. You can begin to suffer from a Perinatal Mood Disorder when you are still pregnant. Sometimes this is called Prenatal Depression or Antenatal Depression. Whatever you want to call it, it is rarely discussed and can be very debilitating, especially when the reaction that most have when you tell them you are pregnant is “You must be so happy!” Depression during pregnancy can happen particularly if an expectant mom has a history of depression, but it can happen to anyone. It can also happen at any point during pregnancy. This is a real illness and should be treated as such. Depression during pregnancy can have a negative impact on both the mother and the unborn baby. Women who are experience this sort of depression often are at risk for decreased prenatal care, less self-care, decreased nutrition, increased use of alcohol and cigarettes and are often at risk of being a victim of domestic violence. It can result in low birth weight in the baby and/or preterm labor, pre-eclampsia and irritability in the newborn or colic. When a mother is stressed during pregnancy, her levels of the hormone cortisol increase due to the body’s response to prolonged depression and/or anxiety. This results in elevated levels of cortisol in the baby, subsequently leading to elevated cortisol levels throughout the child’s lifespan, predisposing him or her towards life long health consequences such as hypertension, heart disease, anxiety diorders and adrenal burnout.
Postpartum Depression occurs anywhere from two weeks to 12 months following the birth of a baby and affects roughly 10-20% of all women. Prior to two weeks, many women experience symptoms that look just like PPD (tearfulness, irritability, emotional reactivity), however, they resolve on their own without any outside intervention needed. This is called the “baby blues” and it happens to roughly 50-80% of all postpartum moms. It typically peaks at 3-5 days following the baby’s birth and is a result of the drastic hormonal shifts that occur after a baby is born. PPD, however, does not resolved without outside intervention and is an illness that should be taken seriously just like any medical problem. Due to the fact that so many moms experience it, PPD is the #1 complication of childbirth in the United States. However, it often goes untreated due to lack of screening and other factors which we will get into later. PPD can last for months or longer if it isn’t treated. Click here for a firsthand story of a mother’s experience with PPD.
PPD Causes and Impacts
There is no one factor that causes PPD, but there are some that can predispose a woman to develop it. It often occurs when women have a history of mood disorders, mental illness, or have experienced PPD with a prior birth, have a family history of mood disorders or mental illness, a history of sever PMS or PDD (Premenstral Dysphoric Disorder), have had a traumatic birth experience, lack of support from partner, other family or friends, poor nutrition, severe lack of sleep, and/or an unplanned or unwanted pregnancy. When untreated, PPD can lead to poor mother-baby bonding and attachment problems, compromised care of the baby, conflict with one’s partner, and in the worst cases, suicide and/or homicide. For the baby of a mom with PPD, there can be problems with emotional bonding with others, delays in language development, low activity levels, anxiety and distress, delayed and/or impaired cognitive and motor development, failure to thrive, and in worst case situations, infanticide.
Barriers to treatment
So if this is such a big problem, why do so many women feel as though they have to suffer in silence? Why are more not seeking treatment? I think the problem is two fold. Part of the trouble lies with the many providers who come into contact with postpartum women. Often they are not screening for it. Sometimes they don’t know how, sometimes they are too busy, sometimes they fear that they won’t know what to do if they find out that a mother has PPD symptoms. They may be a pediatrician and more focused on the baby, they may be an OB who is doing a follow up postpartum check and is only concerned with the physical outcomes of birth. The responsibility doesn’t just lie with the physicians though (but they should all be screening, nonetheless). Anyone who works with postpartum moms can be on the lookout for signs and symptoms. This could be a lactation consultant, a physical therapist, a yoga instructor, a doula (birth or postpartum), a new moms group facilitator, etc. The other part of the reason moms are not being treated is because they may not be seeking help. The reasons for this are vast: denial, shame, misinformation about maternal mental health, the stigma of mental illness, fear that the baby may be taken away, cultural or language barriers, fear of deportation (for non-legal immigrants). My take home message for anyone who sees postpartum moms: Pay attention to what that mom is saying or even what she isn’t saying. Is she expressing feelings of frustration, inadequacy, being overwhelmed, helplessness, anxiety, shame, exhaustion (beyond the normal up-at-night with a baby exhaustion), fear of being alone with the baby, feeling as though the baby would be better off with a different mom? If she is feeling several of these things, there is help for her.
How to help
There are many excellent resources for mom experiencing PPD both in the Chicago area and nationwide. One of my favorite referral sources is a 24 hour PPD crisis hotline that is run out of Northshore Hospital called The Jennifer Mudd Houghtaling Postpartum Depression Program. Their number is (866) 364-MOMS. Moms can call them anomoyously at any time of the day to ask questions and get support from licensed mental health professionals. They also provide mental health referrals to therapists all over the Chicago area and can find someone who accepts your health insurance. I often call them myself to find good referrals for moms who contact me looking for a PPD focused therapist. For other referrals, there is the PPD program at Healthcare Alternative Systems that offers services in both English and Spanish at two locations in the city. To schedule an appointment with them, please contact Marisol Vega at (773) 292-4242 ext. 32. Healthcare providers with questions related to the diagnosis and treatment of perinatal depression can contact the UIC Perinatal Depression Consultation Service at (800) 573-6121. You can also contact the Postpartum Depression Alliance of Illinois at (847) 791-7722. For those not in Illinois, Postpartum Support International is an excellent resource. If you are unable to physically get out and get help, the internet can be a great source of support as well. Please check out My Postpartum Voice for supportive articles as well as conversations with other moms who may be suffering as well through their Twitter chat groups.