On Wednesday, I was invited to speak to a group of local doulas, the Mt. Diablo Doula Community, about prevention of Perinatal Mood and Anxiety Disorders (PMADs), as well as how to recognize the disorders and how to help their clients. I hope the presentation might be helpful for doulas who are wanting more information about these disorders and what role they can play in keeping moms healthy and happy. You can access the Presentation Here. Attachments to the presentation are the Edinburgh Postnatal Depression Scale and an associated Suicide Screening Interview.
By Meri Levy, MFT
Being a new mother should be a joyous time in your life. But what if you’re not feeling like yourself after having a baby? About 10-15% or of new moms experience postpartum depression, which can begin any time during the first year after childbirth. Depression is a treatable illness that causes feelings of sadness, indifference, and/or anxiety.
Postpartum depression (PPD) is different from the “baby blues.” A majority of new mothers experience the “baby blues,” a period of sadness that isn’t debilitating and passes quickly. Symptoms of the “baby blues” include tearfulness, irritability, restlessness, and anxiety. But when symptoms of sadness, irritability or anxiety continue for more than two weeks or make it difficult to care for your baby, there is more going on and it’s time to reach out for help.
Symptoms of PPD include:
- Fatigue or lethargy
- Feeling sad, hopeless, helpless, or worthless
- Trouble sleeping/sleeping too much
- Loss of appetite/increased appetite
- Difficulty concentrating/confusion
- Crying for no apparent reason
- Lack of interest in the baby
- Fear of harming the baby or oneself
Symptoms can vary in severity, but persistent depression often causes new moms feel isolated, guilty, or ashamed.
You should tell your doctor if you have several of these symptoms for more than two weeks; if you have thoughts of suicide or thoughts of harming your child; depressed feelings are getting worse; or you are having trouble caring for your baby or yourself.
Depression is an illness. It is not a sign of weakness or of being a bad mother. It can be treated successfully, and getting help is the best thing you can do for your baby.
Risk Factors for PPD
Any new mom can develop PPD. Its causes may include hormonal and other physical changes, sleep disturbance, emotional adjustments and chronic stress. However, women are at increased risk of depression if they have a personal or family history of depression, if they are have experienced particularly stressful life events such as significant losses, a high-risk pregnancy or traumatic birth, or if they don’t have adequate support from family and friends.
Other Postpartum Conditions:
Postpartum Anxiety and Obsessive Compulsive Disorder
Many new moms experience anxiety rather than sadness after giving birth. Anxiety, panic attacks, irrational fears or intrusive thoughts, or images can be associated with Postpartum Anxiety or Obsessive Compulsive Disorder. Symptoms of a panic attack can include a racing heartbeat, unusual physical symptoms, a sense of impending doom, the feeling that you are dying, dizziness or nausea.
Posttraumatic Stress Disorder after Childbirth
New mothers can also develop post-traumatic stress disorder (PTSD) following a traumatic childbirth experience. PTSD involves reexperiencing the trauma through flashbacks or nightmares, having difficulty sleeping, and feeling detached or estranged from friends and loved ones.
Postpartum psychosis is extremely rare but also very serious. It affects only two out of every 1,000 new moms. The symptoms are severe and may include insomnia, agitation, hallucinations, and extreme paranoia or suspiciousness. Postpartum psychosis is a serious medical emergency and requires immediate attention.
Treatment for Postpartum Disorders is Effective
If you believe you are suffering from a postpartum disorder, the first step is to talk to your doctor or mental health provider.
You should be evaluated by your doctor to rule out a medical cause that can contribute to depression.
Psychotherapy, medication or a combination of the two may be needed to get you back to feeling like yourself. But you must continue treatment even after you begin to feel better, because discontinuing treatment too soon can cause symptoms to recur.
The support of family and friends is also instrumental to your recovery. In addition, joining a support group for postpartum disorders can help overcome feelings of isolation, increase coping skills and provide social support.
Getting help is the most important step you can take for yourself and your baby. Untreated maternal depression is associated with developmental delays in babies, as well as potentially serious emotional consequences for your growing child.
How Partners Can Help
New moms suffering from Pospartum Depression and Anxiety need the support of their partner, as well as friends and family. Help with baby care and household responsibilities, provide an ear to listen or a shoulder to cry on, and be patient and understanding with her struggles. And make sure she gets help.
Partners also need to take care of themselves. Having a new baby is hard for partners too. And if the mother is depressed, you are dealing with two major stressors. Partners can also suffer from Postpartum Depression, a often undiagnosed problem.
How to help a partner suffering from a postpartum disorder:
- Encourage her to talk about how she is feeling. Listen without judging her. Instead of trying to fix the problems, just be there for her to lean on.
- Offer help around the house. Chip in with the housework and childcare responsibilities. Don’t wait for her to ask!
- Make sure she takes time for herself. Rest and relaxation are important. Encourage her to take breaks, hire a babysitter, or schedule some date nights.
- Be patient if she’s not ready for sex. Depression affects sex drive, so it may be a while before she’s in the mood. Offer her physical affection, but don’t push if she’s not ready for sex. She will recover in time!
- Go for walks with her. Getting exercise and sunshine can make a big dent in depression, but it’s hard to get motivated when you’re depressed. Help her by making walks a daily ritual for the two of you.
If you’re not sure if you have PPD, complete the Edinburgh Postnatal Depression Scale. It is a fairly accurate way of determine if your symptoms are normal or may require treatment.
I offer a support group In my Lafayette Office for mothers suffering from perinatal anxiety and depression. You can download a flier for the group here.
Letting Go of What We Give Up When We Become Parents, by Meri Levy, MFT
In becoming parents, along with the love and joy that a baby brings, we often face issues that arise relating to our own childhood experiences. For many people, the unmet needs and wants from our childhood simmer below the surface, and the arrival of a baby and the transition to becoming a parent can bring them to the forefront.
It is important to allow ourselves to grieve the losses that are a part of becoming a parent — the loss of nurturing we feel as the focus shifts to nurturing our child, the loss of independence, and our diminished ability to focus on our own needs — and work on letting go of unmet expectations regarding our own childhood.
The phases of grieving have long been studied and are well understood, although their duration, order and intensity can vary greatly, and each individual’s experience is unique.
The first phase is denial: in this case we deny feelings of loss because they seem inappropriate or are too uncomfortable to deal with.
The second phase is anger, and this can take many forms: anger at our partner for their lack of support, anger at our parents for perceived flaws, anger at friends for their lack of understanding of the changes we are experiencing. And even sometimes anger at our child, for the endless demands or because our baby differs from our expectations.
The third phase of grief is bargaining: attempting to avoid or undo our uncomfortable feelings. “If only I had a more supportive husband…, or an easier baby,” etc. These are ways we avoid dealing with the fact that parenting is incredibly hard work, and that our unmet needs from childhood have not and most likely will not be met.
The fourth phase of grief is depression. This can include intense sadness, feelings of hopelessness, loss of interest in life, and a feeling of numbness. Depression is a normal phase of grieving, but when it becomes severe (i.e. thoughts of harming oneself or others) or persistent (more than two weeks), it is crucial to get help.
The fifth and final phase of grief is acceptance. We feel comfortable in our new role as parents. We accept, and can even joke about, how our life has changed and how our child has become the center of our world. And importantly, we do what we can to nurture ourselves, without blaming others, without feeling guilty, knowing that we deserve taking care of, even if the only one who can do it is ourself.