by Mary Ann Carrado
Postpartum depression is a treatable condition that affects 10-20 percent of new mothers. However, a majority of new moms some say 80 percent experience “baby blues” in the first three weeks after childbirth. Baby blues symptoms can include mood instability, weepiness, sadness, anxiety, lack of concentration and feelings of dependency.
Postpartum depression and/or anxiety can last well beyond the third week after delivery. The onset is usually gradual, but it can be rapid and begin any time in the baby’s first year. New moms experiencing one or more of the following symptoms should consult their OBGYN or family doctor.
• Excessive worry or anxiety
• Irritability or short temper
• Feeling overwhelmed, difficulty making decisions
• Sad mood, feelings of guilt, phobias
• Sleep problems (cannot sleep or sleeps too much), fatigue
• Physical symptoms or complaints without apparent physical cause
• Discomfort around the baby or a lack of feeling toward the baby
• Loss of focus and concentration (may miss appointments, for example)
• Loss of interest or pleasure, decreased libido
• Changes in appetite; significant weight loss or gain
Mothers are at particular risk (50 to 80 percent) if they have experienced previous pospartum depression. Other risk factors include:
• Depression or anxiety during pregnancy
• Personal or family history of depression/anxiety
• Abrupt weaning
• Social isolation or poor support
• History of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD)
• Mood changes while taking birth control pill or fertility medication, such as Clomid
• Thyroid dysfunction
Source: Postpartum International, www.postpartum.net
“ You are not alone. You are not to blame.” That is the message that medical professionals want you to know about postpartum depression.
From therapists and psychiatrists to OBGYNs and pediatricians, the professional world is focusing on the diagnosis and treatment of this medical condition that affects about one in eight new mothers.
New initiatives such as a task force in New Jersey on postpartum depression focus on educating physicians to the signs and symptoms of this condition.
The New Jersey legislature last October passed the “Mother’s Law,” mandating postpartum depression screenings by professionals such as physicians and nurse-midwives at prenatal and postnatal exams. Patients are now screened, educated on postpartum issues and provided with treatment resources.
Nationally, supporters of postpartum awareness are also making great strides. U.S. Senators Robert Menendez (D-NJ) and Richard Durbin (D-IL) have introduced a “Mothers Act” that would ensure a long-term focus on postpartum depression and related issues.
New moms and their families would receive education about postpartum issues, be screened for symptoms and be provided with treatment. Research funding would increase, seeking the causes and the appropriate treatment of this condition.
Efforts to Train Doctors
“We are going into the hospitals and training OBGYNs and pediatricians,” says Anne Effron, a Montville, NJ, social worker and member of the NJ Task Force on Postpartum Depression. “We are training the doctors to recognize the symptoms and signs of postpartum depression.”
Effron says that education and training about postpartum issues is especially important when it comes to reaching pediatricians. “Pediatricians come into more contact with women after the birth of their children,” she says. “The hospital stays are so short.”
Sharon Byun, MD, an OBGYN with the University of Pennsylvania Health System agrees that many postpartum issues cannot be identified during pregnancy or at the one postpartum visit women are given after birth.
“For the postpartum period, the stay at the hospital is usually anywhere from two to four days after delivery,” Dr. Byun says. “It is hard to assess whether or not a woman has postpartum depression.”
During pregnancy, it is equally difficult to identify a patient at risk. Dr. Byun says that a previous history of depression will get noted in a patient’s file, just as any other previous medical condition would, but that is as far as it goes.
“We always give the opportunity for women to address any concerns, but there is no real screening for postpartum depression done during pregnancy,” she says.
Professionals hope new research will better help size up the likelihood of a woman to develop postpartum depression.
We do know that one risk factor is a previous history of depression, but many women who have never suffered depression before can develop it after the birth of a child.
Depression can come with any pregnancy, especially if the birth has been traumatic, Dr. Byun tells us.
Other risk factors include a difficult pregnancy, feeding issues, and a sadness or blues that last beyond two weeks after birth.
Effron says that some women who had no postpartum depression after one pregnancy could still develop it in a subsequent pregnancy. “No studies have been done on the likelihood of depression in second, third or subsequent pregnancies as opposed to just first pregnancies,” she says.
One group that is dedicated to solving issues of identification, treatment and research is Postpartum Support International (PSI). The organization offers public awareness campaigns, conferences and postpartum resources to individuals and families.
Catherine Birndorf, MD, assistant professor of psychiatry and OBGYN at New York Presbyterian Hospital is very active with PSI and hopes to spread even more awareness of postpartum depression.
“It has always been very treatable,” she says. “What is nice is that because people are now talking about it, it is more acceptable. There used to be a lot of shame that went with it. Women were supposed to feel grateful and blessed after birth. Now that shame has translated into support.”
“Other cultures focus on taking care of the mother,” says Dr. Birndorf. “Here, as soon as the baby is born, the focus is on that baby. We have no rituals or ceremonies to recognize that life transition or offer support.”
“In our culture, when people start feeling badly, they don’t want to talk to their doctor,” she says. “Sometimes they are in denial or disbelief.”
The PSI website and the people behind it hope to educate visitors about postpartum depression and provide education and support.
“More can always be done to heighten awareness,” Dr. Byun says. “The last couple of years have been good because there has been more media attention,” she says. “There is not so much of a stigma, and it is recognized as a true medical condition.”
Postpartum Support International’s website, www.postpartum.net, includes information and insights about postpartum depression.
For local support resources, see www.postpartum.net/support-map.html
Mary Ann Carrado is a local freelance writer.