Postpartum
Disorders
This page was last updated 1.8.99
Post-partum depression is a severe form of "baby
blues," mild sadness and anxiety that some two-thirds of new mothers experience. A
few new moms -- one in 1000 -- suffer a complete break with reality, post-partum
psychosis.
Postpartum depression usually develops between one and
three months after childbirth and may last up to a year. The symptoms are typical of
depression, although they may take on some coloration from the mother's concern about her
baby. Depressed mothers are tearful, anxious, and easily upset, tired and yet unable to
sleep well. They have many hypochondriacal symptoms. They worry intensely about the baby's
health, yet feel guilty about their own inadequacy and lack of love for the baby. They
need constant reassurance, respond overanxiously to the baby's cries, and repeatedly ask
for help in small matters. Some even have fears that they will harm the baby, although
that very rarely happens. Often they are ashamed of their feelings and reluctant to talk
about any symptoms except physical ones.
Postpartum 'blues' or transitory minor affective disorder
:
the name most commonly used to describe the
weeping and emotional instability which occurs during the first postpartum week.
Descriptions of symptoms include frequent and prolonged crying, irritability, poor sleep,
mood changes and a sense of vulnerability which may continue for several weeks.
Physical Symptoms:
Lack of Sleep
No Energy
Food Cravings or Loss of Appetite
Feeling Tired Even after Sleeping
Mental States:
Anxiety and Excessive Worry
Confusion
Great Concern over Physical Changes
Confusion and Nervousness
Feeling, "I'm not myself; this isn't me"
Lack of Confidence
Sadness
Feeling Overwhelmed
Behavioral Reactions:
Crying more than Usual
Hyperactivity or Excitability
Oversensitivity
Feelings Hurt Easily
Irritability
Lack of Feeling for the Baby
Chronic depressive syndrome or moderate depression disorder
:
more debilitating than the `blues' and more
common than postpartum psychotic reactions, this still poorly defined syndrome is
characterized by despondency, tearfulness, feelings of inadequacy, guilt, anxiety,
irritability and fatigue. Researchers suggest that women experiencing this form of
depression rarely seek treatment and are only recently being studied.
Physical Symptoms:
Headaches
Numbness, Tingling in Limbs
Chest Pains, Heart Palpitations
Hyperventilating
Mental
States:
Despondency or Despair
Feelings of Inadequacy
Inability to Cope
Hopelessness
Over Concern for Baby's Health
Impaired Concentration or Memory
Loss of Normal Interests
Thoughts of Suicide
Bizarre or Strange Thoughts
Behavioral Reactions:
Extreme Behavior
Panic Attacks
Hostile
New Fears of Phobias
Hallucinations
Nightmares
Extreme Guilt
No Feelings for Baby
Over Concern for Baby
Feeling "out of control"
Feeling like "you are going crazy"
Postpartum psychosis or puerperal psychosis :
a relatively rare disorder following
childbirth with symptoms similar to general psychotic reactions: confusion, fatigue,
agitation, alterations in mood, feelings of hopelessness and shame, delusions or auditory
hallucinations, hyperactivity and rapid speech or mania.
Physical Symptoms:
Refusal to Eat
Inability to Stop Activity
Frantic Excessive Energy
Mental
States:
Extreme Confusion
Loss of Memory
Incoherence
Bizarre Hallucinations
Behavioral
Reactions:
Suspiciousness
Irrational Statements
Preoccupation with Trivia
The cause of all the post-partum emotional reactions remains unclear, but scientists cite
several contributing factors. One is stress. Motherhood is most disorienting for
first-time moms. Not surprisingly, they are at unusually high risk of post-partum
emotional problems. Other kinds of stress that might lead to depression are an
unhappy marriage, obstetric complications, or a baby who is temperamentally difficult.
Sometimes a woman in a shaky marriage hopes the child will cement her bond with her
husband and becomes depressed when that expectation is disappointed. For women who already
tend to feel inadequate and incompetent, difficulties in caring for the child may confirm
their poor opinion of themselves. The mood of some women is disturbed by the change in
their relationship with their husbands and the start of a new relationship with the baby.
The situation becomes worse if they lack intimate friends to share their secrets and
troubles. The universal expectation that a new mother should be happy further contributes
to guilt and depression.
Hormones also play a role. High levels of female sex hormones circulate in expectant
mothers' blood, but drop precipitously within hours of delivery, contributing to
biochemical depression. Pregnancy also increases levels of endorphins, the body's
feel-good chemicals. Endorphin levels fall abruptly after delivery, adding to risk of
depression. Hormone levels stabilize in almost all women, including those who
become depressed, two weeks after delivery; but it is possible that in some women who are
highly susceptible to the effects of changing hormone levels shortly after delivery, the
mood deepens and persists because of other past and present circumstances.
A history of depression increases risk. One-third of women with previous depression
experience it post-partum.Women with postpartum depression are more likely to
have had previous mental illnesses, depression during pregnancy, and a family history of
mood disorders, especially bipolar disorder. They are also sometimes said to have a
certain "attributional style" -- believing that their own actions cannot affect
their lives much. Some authorities believe that postpartum depression is more likely if a
woman is in conflict with her mother and dissatisfied with the care she received as a
child. According to this account, a woman who feels deprived by her own mother and rejects
her as a model may find that becoming a mother herself evokes disturbing memories, makes
her resent her husband and child, and heightens her sense of being ill-prepared for the
new role.
Like biological explanations for postpartum
disorders, these psychological and social explanations remain uncertain, since it can be
hard to tell what is cause and what is effect. A woman may remember her childhood as
deprived or think of herself as friendless simply because she is depressed. Postpartum
depression has not been proved to be correlated with the size of a woman's social network
or the number of her close friends. There is no clear evidence that being single, or poor,
or young, or relatively old, or having a first child raises the risk for postpartum
depression. More studies are needed to clarify these issues.
Some believe that modern Western society promotes
postpartum depression because it has overmedicalized childbirth, deprived women of the
support of extended families, given them too little time for seclusion and rest, and
eliminated the rituals of transition that relieve the anxiety of adopting a new social
role. Others point out that Hippocrates described postpartum disorders in ancient Greece,
and recent studies in rural Africa have found a rate of postpartum depression just as high
as that of the industrial West.
Oddly, until recently, mental health professionals have paid scant attention to
post-partum depression. The American Psychiatric Association didn't even officially
recognize the condition until the 1994 edition of the organization's Diagnostic and
Statistical Manual of Mental Disorders.
But today, post-partum depression is much better publicized. It should become even more so
in the future. New York state now requires hospitals to give new mothers information about
their risk of the condition before leaving maternity wards.
Specific measures to prevent postpartum depression or
psychosis are difficult, since these reactions are so hard to anticipate, but new mothers
can be told about the baby blues and reassured that they are a common and temporary
condition. Women with more serious symptoms may feel ashamed of them and avoid seeking
help because they fear that they are not 'normal' and will be judged to be bad mothers.
They too need to be reassured. Individual psychotherapy, family therapy, relaxation
training, and behavioral modification to improve child care have all been used. For severe
postpartum reactions, antidepressant and antipsychotic drugs can be helpful, but women are
usually advised not to breast feed while taking these drugs, since they can be secreted
into the breast milk and might affect the baby. Electroconvulsive therapy (ECT) is highly
effective and can be used safely as soon as a week after delivery. Another important
resource is mutual aid groups providing advice and comfort to women with postpartum
problems. An umbrella organization for these groups is Postpartum Support Internationa
