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Postpartum depression

Many women experience difficult emotions after childbirth. Here are some tips to help you understand these feelings and when to call your doctor about them.

Bringing a new baby home is a major event. Although it is often a joyful period, there may be times when your emotions and moods are not what you have expected. Many women experience "baby blues." These are some tips to help you understand feelings of sadness and when you should call your care provider about them.

Maternity blues

As many as three of four women will have short periods of mood swings, tearfulness, or irritability during the first week after birth, which can be worse when you are tired or anxious. If you are not sleeping, or you are becoming increasingly upset, you should call to talk with your care provider.

Postpartum depression

About one of every ten women will develop serious depression during the first year after birth, more often in the first few months. Symptoms include:

  • Angry, meaning, feeling like you might explode
  • Can't make decisions
  • Crying a lot
  • Difficulty sleeping, meaning, you can't sleep, even when the baby is sleeping
  • Fear that you will hurt yourself or your baby
  • Feeling guilty
  • Feeling like a failure as a mother
  • Feeling like you are not normal or real anymore
  • Feeling lonely
  • Feelings of anxiousness and insecurity
  • Feelings of panic
  • Feeling overwhelmed
  • Inability to concentrate or focus
  • Loss of appetite
  • Thinking the baby might be better off without you

Don't wait. If you have any of these symptoms, please call your care provider as soon as possible.

Postpartum psychosis

A very small number of women will experience a more severe postpartum reaction in which they lose touch with reality. Women who develop postpartum psychosis may hear or see things that are not there, or exhibit strange and sometimes dangerous behavior. This is a true emergency and help must be sought immediately.

Who will become depressed after childbirth?

Postpartum depression affects women from all walks of life. The exact cause is probably a combination of factors, including hormone changes that occur after birth, which can affect how the brain functions. Women with a past history of depression, even times of just "feeling low," a family history of depression, or stressful life events are more likely to develop postpartum depression. Childbirth is a major life event, and it can trigger reactions to past trauma. If you think that any of these risks apply to you, talk with your care provider before your labor and birth. Planning ahead can help prevent problems that occur during depression after birth.

Adapted from: Kennedy HP, Beck CT, Driscoll JW. A light in the fog: Caring for Women with Postpartum Depression.

Care for women with postpartum depression: NURSE approach

Nourishment

  • Women who are depressed after birth often have little appetite, and no energy to prepare meals. The body needs good food to heal so every effort should be made to eat well. Family and friends can really help with food preparation.
  • A multivitamin every day will provide some of the basic requirements for vitamins.
  • Fluids are important for both health and breastfeeding. Drinking 8–10 glasses of water every day will help both mother and baby.
  • Stay away from alcohol because it has a depressant effect and can make postpartum depression worse.

Understanding

  • Women who are depressed after having a baby feel like their world has come to an end and often feel very guilty and ashamed. This is NOT her fault.
  • Understanding and acceptance by family and friends is essential for her to begin to believe in herself again.
  • It is important to get professional help to cope with the depression and to begin to recover.
  • Support groups are an excellent idea. The best understanding comes from those who have experienced postpartum depression. Information about these groups are listed below.

Rest and relaxation

  • Sleep is critical for health and healing. Most women with postpartum depression have difficulty sleeping.
  • Try different strategies, such as a warm bath before bedtime, massage, relaxation techniques, or meditation.
  • When women are breastfeeding, they may need assistance with one night-feeding in order to get some uninterrupted sleep. Call for help if she goes without sleep for more than two days.

Spirituality

  • It is helpful to draw on what has made her feel uplifted and joyful in the past. Many things, from formal religion to listening to music that helps her find a sense of well-being, will in turn, give her strength to cope and begin to recover.

Exercise

  • Physical exercise improves brain function and a sense of well-being.
  • Set up a program that is realistic, taking small steps to increase her activity. Family and friends can help with short walks, or with offers of childcare while she exercises.

Adapted with permission from Sichel, D. & Driscoll, J. W. (1999). Women's moods. What every woman should know about hormones, the brain, and emotional health. New York: William Morrow & Company, Inc.

This information is originally from Journal of Midwifery & Women's Health • Vol 47, No. 5, September/October 2002