Woman's WorldWoman's WorldMost families expect the birth of a baby to herald a joyful period in their lives. Published images of smiling parents plant expectations of happy times.
Unfortunately, for many women, the postpartum period turns out to be a time of unexplained tearfulness, fatigue, insomnia, and anxiety.
Postpartum blues with mild symptoms that begin within 10 days of birth are not that unusual. They occur in up to 80 percent of women with little long-term effect and usually resolve within days without further treatment.
However, in some 10 percent of cases, the symptoms are more severe and, untreated, can last for months.
Symptoms that affect normal functioning are classed as postpartum depression.
Postpartum depression is nothing new. It has been described in almost every culture and class. It can develop in anyone, but a history of depression is the greatest risk factor. These women may consider starting preventive antidepressant medications late in pregnancy or immediately postpartum. Studies have shown that the benefits outweigh any potential risks to the baby although close monitoring is crucial.
The diagnosis is often difficult, since caring for a newborn is always physically and emotionally stressful. In addition, many women are reluctant to admit that they have any negative feelings about motherhood.
Symptoms include profound lack of energy, inability to rest even when the baby is sleeping, loss of appetite, severe anxiety, a sense of being overwhelmed, inability to care for the baby, feelings of guilt, and intense anger.
“Scary thoughts” about harming oneself or the infant are not uncommon although many women are ashamed to reveal them. Most would never act on these thoughts, but they do warrant urgent psychiatric evaluation and treatment. True postpartum psychosis is rare, but very dangerous and can result in violent acts.
Treatment for mild degrees of depression includes counseling, community support groups and relaxation therapies, plus a healthy diet and regular exercise.
New mothers should be encouraged to schedule time for themselves and to seek and accept help when offered. Psychotherapy and medications are warranted in severe cases.
The risks of medications in breastfeeding women need to be weighed against the risks of persistent depression. Recent studies show that untreated maternal depression has far-ranging effects on the mother-child relationship, child development, relationships with the father and even his mental health.
Mothers suffering from depression find it difficult to provide emotional support for their babies. As a result, these infants tend to interact less with their caregivers and show more irritability. A downward spiral begins as these infants become more and more difficult to care for and the mother experiences increasing feelings of guilt and rejection.
Preparing the entire family for the emotional impact of caring for a newborn and the symptoms of postpartum depression, as well as planning for extra physical and emotional support for the mother may alleviate some stressors.
Most important, postpartum depression should not be considered a weakness or the woman’s fault and is not usually something that she can “snap out of.”
For help, Falmouth Hospital has an on-going free support group (coordinator Linda Sayers, 508-457-3632); the Family Support Information Line of the Cape Cod Neighborhood Support Coalition (1-888-992-2672) can help families to contact skilled therapists; and there’s an informational Web site www.postpartum.net. And don’t forget your primary care, pediatric and ob/gyn providers.
No mother should feel she must suffer alone.
(Dr. Talbert is a board certified OB/GYN specialist practicing with Cape Obstetrics, Midwifery & Gynecology in Falmouth and Sandwich, 508-457-0088.)