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More Than Baby Blues

More than the Baby Blues: Understanding and Treating Postpartum Depression
By: Melisa Schuster, ACSW

You might be surprised, as I was, to learn that postpartum depression is the number one complication of childbirth, affecting up to one in eight childbearing women. Despite this fact, postpartum depression (PPD) is often misdiagnosed or left untreated, causing unnecessary suffering for the mother and her family. Women usually are so excited, looking forward to the birth of their baby; and for some, it is terribly disappointing when the adjustment is so much harder than they expected.

There are many reasons why a mother might not recognize her symptoms as PPD or might not seek treatment even if she does correctly identify her symptoms: lack of information and preparation, confusing symptoms, guilt and shame, media portrayals, the stigma of “emotional problems,” lack of support or lack of knowledgeable treatment providers in her area.

Childbirth preparation classes do an excellent job of preparing a woman and her partner for giving birth, but often do not mention the physical and emotional changes that occur during the postpartum period. Obstetricians focus on the health of the growing fetus while pediatricians, who have the most contact with postpartum women, focus on the baby.

Most people, including medical professionals, don’t recognize the difference between the baby blues and postpartum depression. Baby blues is the weepiness, fatigue, and irritability (that feels a lot like PMS) caused by hormonal fluctuations that up to 80% of women experience in the first two weeks after birth. The essential distinguishing feature is that baby blues will go away within 14 days and requires no treatment.

Most women don’t realize that postpartum depression is an umbrella term encompassing many different types of symptoms. It’s really confusing to women when they experience anxiety symptoms (rather than or in addition to depression symptoms), ranging from mild anxiety, to a fear of being left alone with the baby, or full-blown panic attacks. These symptoms often feel like they come out of nowhere, since 70% of women with postpartum depression have no previous history of depression or anxiety.

Many women report having repetitive disturbing thoughts, often about harm coming to the baby. These thoughts can be very frightening and feel out of their control. Most women are afraid to admit to having these thoughts, afraid others will judge them unfit mothers, or think of themselves as “bad mothers.” It’s important to remember that these are only thoughts, and that they are symptoms of postpartum depression. Women are relieved to find out that those who experience these thoughts as disturbing are quite unlikely to harm their babies.

Women can also experience symptoms of post-traumatic stress disorder (PTSD) as a result of a difficult birth experience. A woman who has had an emergency cesarean section, who experienced more interventions than she expected, or who at some point during her labor feared for her life or her baby’s life may have been traumatized. Symptoms of PTSD include insomnia and nightmares, feeling disconnected from the baby, fear and anxiety, feeling emotionally numb, avoiding thinking about or talking about the birth experience, or conversely a need to tell the birth story over and over again.

In addition to the confusing symptom picture, women feel an enormous amount of guilt and shame about these symptoms. Our culture tells women, “This is supposed to be the happiest time in your life,” and if it doesn’t turn out that way, women often blame themselves. The media tend to focus on the most extreme cases of postpartum depression, and I think this has driven mothers more underground for fear of being confused with someone like Andrea Yates (the Texas mother who tragically drowned her five children while suffering from psychosis, a rare and extreme form of PPD).

Women in our culture are often isolated from physical and emotional support during the postpartum period and are expected to mother their newborn all by themselves. Ours is one of the few cultures in the world to have this expectation, and this actually increases the risk of postpartum depression. Women who give birth into an extended family or supportive community are less likely to experience postpartum depression.

And there are other cultural expectations as well that can contribute to PPD. “Mothering is instinctual. I should know how to take care of my baby.” In fact mothering is learned, and it takes time to acquire the skills of baby care. “I should be able to be a mother without any help from anyone.” Mothers need help and support just like an employee could never do her job without support staff and team members. “I should be totally fulfilled by motherhood and not need time to myself.” Very few women are fulfilled solely by motherhood. Women need time to themselves, outside interests, and some women need to work in order to be the best mothers they can be.

We bring such hope and optimism to the role of motherhood that we don’t always know how to respond if the reality turns out to be very different from our expectations. The good news is that postpartum depression is very treatable. It responds quickly to medication, therapy, or both. Participation in support groups focusing on postpartum depression can also be an essential component to treatment.

For more information go to www.postpartum.net
For information about local support groups, call 734-418-2683

Melisa Schuster, ACSW, is a psychotherapist specializing in prenatal and postpartum depression, childbearing losses, traumatic birth experiences, and parenting guidance. She can be reached at 734-302-0033.

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