Don’t Forget to Hug the Mom: Understanding Post-partum Depression
by Poling Chan MSW, LCSW
Have you wondered about how it’s like to smell the fresh breath of a baby? What is your fantasy for being mother of a newborn? For some, the idyllic picture of mother and child as portrayed by Mary Cassat may surface. While she is surrounded by bouquets and congratulations, a new mother can feel utterly lonely and overwhelmed. Indeed a mother may suffer quietly a depression that follows her childbirth.
Depression is a common medical condition, affecting 15% to 25% of the population. Depression is twice as common in women as it is in men. Most of women’s’ depression occur during their primary reproductive years (from age 25 to 45). As one of the major physical, social and psychological stresses in a woman’s life, childbirth is identified as a major risk factor for developing mental illness.
Post-partum mood disorders can be classified in three distinct types. At the mildest end of the spectrum is what is commonly referred as the “baby blues”, affecting 40% to 85% of the mothers who have had a recent delivery. These symptoms peak between three to five days following childbirth. This condition is regarded as normal and usually warrants little professional attention since the depressive symptoms usually resolve within 72 hours. At the other extreme of the continuum is the puerperal psychosis, which unfortunately sometimes becomes our front-page news. Patients suffering from psychosis are usually severely disturbed and impaired in their judgment. They may suffer from delusions or hallucinations that involve harming themselves or others. Their symptoms can first manifest within 4 weeks to three months post-partum. In some cases, this serious disorder will exacerbate at 18 to 24 months. In the middle of the spectrum lies the post-partum depression when the criteria of meeting certain symptoms are met for two weeks. Signs of depression include feelings of restlessness, irritability, sadness, hopelessness, crying spells, low energy and motivation, excessive or decreased appetite, change of sleep patterns, trouble focusing, feeling guilty or worthless and isolation from family and friends. In some cases, mothers will frequently doubt their ability regarding parenting. They may have difficulties bonding with their child or experience excessive anxiety over child’s health.
A multitude of factors contribute to post-partum depression. Biologically, researchers have investigated in the role of deregulated neurotransmitters such as serotonin. It has been postulated that decreased tryptophan levels lead to low serotonin levels which may lead to depression. Other research focuses on the hormonal changes. During pregnancy, estrogen and progesterone increase greatly but rapidly return to their pre-pregnant levels within 48 hours of delivery. Also low levels of thyroid hormones may also contribute many symptoms of depression, such as irritability, fatigue, sleep problems and weight gain. The thyroid is a small gland in the neck that regulates one’s metabolism and a blood test can demonstrate if one’s thyroid function is normal.
On the other hand, psychological functions play an important role in affecting the development of depression. Pregnancy and childbirth can significantly change a woman’s routine, not to mention her sense of self. Change and loss of identities, lack of support, feeling overwhelmed with the demands of taking care of a newborn and sleep deprivation can make mothers more susceptible to depression. Other risk factors include previous episode of depression and /or other co-existing medical conditions.
Since depression often goes parallel with isolation, the first and foremost strategy for depression is to seek help, from within one’s support system as well as professional intervention. Most women that I work with judge themselves harshly for their depression. They may feel guilty and embarrassed to acknowledge their depression since they have healthy babies and supportive spouses. They are “supposed to be happy” since they are being congratulated everyday. “What’s there to be sad about?” they question themselves. “I have to be strong for my child,” they insist. “How can I not want to hold my own baby?” they criticize themselves. Some mothers whose children have special needs feel obligated to exhaust their resource on their children at the expense of stretching themselves thin. The demands of being a caretaker leave most mothers little or no energy to attend to their personal needs. Some women especially breastfeeding mothers, have fears of possibly being put on medication, they stay in painful denial and silence. Some women are also worried of being seen as “unfit mothers”, so the pressure to be a good mom prevents them to acknowledge and address their issues.
There are a number of ways for mothers to cope with their emotions during their post-partum period.
- Get as much sleep as possible, try to nap when the baby naps. Turn off the phone.
- Ask for help with chores and nighttime feeding. Ask spouse or partner to bring child to you if you are breastfeeding.
- Share with your trusted family and friends about how you feel, even though your emotions may sound irrational.
- Allow some quality adult time so you can be “off duty” from mothering for some brief periods.
- It’s okay to admit things are out of control at times. Trust that they will get better.
- Hang in there with the change of body size and image. Remember generally it takes at least nine months to get back in your old clothes.
- Beware of the change in your couple relationship. Both of you may feel distant and overwhelmed at times.
- Join a mothers’ group so that you have adult conversations and someone to share your experience with.
- Exercise. It will help to rejuvenate you energy and elevate your mood.
- Practice deep breathing as a way to relax.
- Replenish your body with healthy food while you diligently nourish your baby.
- You may not be able to do it all. You are managing multiple roles: mother, wife, and housekeeper and in many cases, employee. It’s time to put perfectionism on the backburner.
- Set priorities: that may mean letting go of certain expectations and projects.
- Motherhood is a life transition. Your journey will feel bumpy at times, but you do you need to ride all by yourself.
If the above suggestions do not seem to alleviate the symptoms of depression, it is important that a mother visits her midwife, physician or a therapist for an evaluation. It is important to be honest with oneself. Tools such as the Edinburgh Postnatal Scale (see under Resource) can provide a good measurement of the severity of depression. In view of the biological factors involved in post-partum depression, anti-depressant medicine is an option these days. I encourage women to discuss their concerns with their health providers and balance the pros and cons of using medication for this critical time. Psychotherapy, on the other hand, addresses the feelings and beliefs of women struggling with their depression and helps to develop support, insight and adaptive coping skills. A good listener can help clarify their emotions and perspectives.
Postpartum depression can be addressed pharmacologically and psychologically. Joint efforts of family and professionals can alleviate the burden of women during this emotional journey.
Next time when you welcome a newborn, don’t forget to hug the mom.