Postpartum Depression

Postpartum mood disorders affect an estimated 10-15% of women during the months after she gives birth.  Generally these mood disorders are referred to under the umbrella of ‘postpartum depression,’ or PPD.  This term is rather inaccurate but widely used.  Manifestations of postpartum mood disorders can include depression, but can also include anxiety, obsessive compulsive disorder(s), postpartum panic disorder, postpartum post traumatic stress disorder, and postpartum psychosis.  Detailed descriptions of these conditions is available on What If I Don’t Feel Depressed? by Postpartum Progress. 

Since so many women experience postpartum mood disorders, it is important to be aware of the signs and symptoms, and how to get help if they occur.  There are some known risk factors for women who develop postpartum depression or another mood disorder after the birth of their baby, and these include;

-depression during pregnancy
-anxiety during pregnancy
-experiencing stressful life events during pregnancy or the early puerperium
- low levels of social support
-previous history of depression

(General Hospital Psychiatry Journal)

Women with risk factors should take extra care to educate themselves and their families and close friends on the signs and symptoms of PMADs (postpartum mood and anxiety disorders), but all pregnant and birthing women need to know about PMADs, since we are all at some risk of developing them in the 12 months following a birth.  What are the signs and symptoms?  They vary according to the disorder and the individual, but common ones include;

-feeling overwhelmed
-sadness
-anger
-constant low levels of irritation
-difficulty concentrating
-difficulty making decisions
-withdrawal
-thoughts of self harm
-thoughts of harming others, including the baby
-deep fears, often involving the baby
-repetitive or persistent disturbing thoughts
-compulsive behaviours, sometimes repetitive
-nightmares
-difficulty sleeping
-anxiety attacks
-delusions, hallucinations, or mania

(Postpartum Progress)

What can we do if we start to recognize some of these symptoms in ourselves or someone we care about?   It is really important to get help.  Talking about these symptoms can be incredibly scary, and the fear is that talking about it will make it ‘more real.’  But in fact, talking about it can make postpartum mood and anxiety disorders more manageable~ it is scarier to recycle signs and symptoms in our heads than it is to actually have them out in the open.  The first person we choose to talk to about symptoms of PMAD will be the scariest, so it is important to choose wisely; if your mother doesn’t believe in psyciatric illness, for example, she may not be the best person to first confide in.  For many women, their partner is an understanding and supportive person, and the right person to turn to, but sometimes this is not the case.  Who can we tell?  Tell a friend.  Tell your doctor.  Tell your pastor or spiritual mentor.  Tell the public health nurse when you go to weigh your baby.  Tell someone.

What’s next?  Come up with a treatment plan.  This can feel incredibly daunting but is key because the longer PPD lasts and the more severe it is, the longer it takes to recover.  This is where your doctor or naturopath can really help you determine which approach is best, and what fits your beliefs, your body, and your situation the most.  Treatment can include medication, naturopathic supplements, cognitive behavioural therapy (CBT), support groups, exercise, books, self care, and building a community of supportive people to help you cope.  This link is a PDF pamphlet outlining a breastfeeding friendly approach to depression in new mothers~it is very comprehensive and provides an excellent tool for learning about the various approaches and their effectiveness.  It is worth the time it takes to download, and I have recommended it even for women who are not mothers, because the research based information  it contains on treatment for depression is so solid.  Treatment plans need to be flexible to change, and weekly evaluations as to effectiveness and manageability. Get help devising a treatment plan, too, so that the task of planning isn’t so daunting.

What now?  Self care.  What does this mean?  It means, in essence, being kind to yourself.  The road back to health and wellness is curvy and often long.  It will include easy days and difficult ones.  Some days you will not be able to get dressed or brush your teeth, and others you will need to use the television as a babysitter: be kind to yourself.  You are doing the best you can, and it is enough.  The support group I went to for PPD after the birth of my third child broke self care down into four categories:

-Nutrition: eating well is important for mental health but can be incredibly challenging with a new baby.  Nutritious and easy to prepare are key.  Keep goals attainable, steer clear of elaborate dinner plans or food that involves a lot of preparation time.  Just make sure you eat.  Try to eat healthy.  Keep your eye out for easy sources of protein; nuts, seeds, nut butters, eggs, and healthy meat options, and try and include some of these each time you eat.  Eat when you can, and don’t get down on yourself if you can’t manage to ‘eat well’ one day.  Just do the best you can!

-Exercise: exercise is very effective in mitigating symptoms of depression and can be an integral part of overcoming PPD.  We’re not talking running marathons, here!  A walk around the block with your baby in the sling or stroller is enough.  If you can manage more, great!  If not, that’s just fine, too.  Walking is good exercise and cheap and easy to do.  Again, be kind to yourself!  Just do what you can manage.

-Sleep: this is a big challenge for all new parents.  Babies are biologically programmed to feed often and wake several times at night.  Sleeping for eight uninterrupted hours with a baby in the house is not realistic.  But lack of sleep can significantly worsen PPD (and anxiety disorders in particular), so it is an important part of self care.  The key here is simply to try and increase the total number of hours you sleep in a 24 hour period.  Nap when your baby naps.  If someone offers to take care of your older children, take them up on it, and sleep.  Some partners will be willing to get up for part of the night with a new baby so that new mothers can sleep a bit more~pumping breast milk beforehand for the partner to feed the baby with can be a feeding solution for nighttime parenting.  Also, partners can help increase overall sleep time for postpartum women by doing all of the other nighttime parenting tasks; diaper changes, pyjama changes for inevitable diaper leaks, soothing, rocking, burping, etc, so that all the mother needs to do is breastfeed and then go back to sleep. 

Another option for improving sleep is to cosleep with your baby.  There are two ways to do this; one is to sleep with your baby in your bedroom with you, but in a separate bed such as a cot or crib.  Health Canada recommends that all infants aged 6 months or younger sleep in the parents’ bedroom, in a separate cot or crib.  Research indicates this is the safest sleeping environment for babies.  The other way to cosleep is to bedshare.  This creates a familiy bed which often has the overall effect of more sleep for postpartum mothers because they don’t have to rouse quite as much out of a sleep state to feed their babies, and their babies don’t need to rouse quite as much to communicate their need to breastfeed.  Safe bedsharing tips are available on Dr Sears’ website, and more information on cosleeping here. 

-Time for yourself: wouldn’t it be lovely if MSP covered daily, in home massages for all postpartum women?  Until that day, we have to be creative in coming up with ways for us to make time for ourselves.  Again, nothing elaborate, but a few minutes alone to have a bath or to walk around the block without the baby, or to visit with a friend, can be a key ingredient to healing from postpartum depression or other mood disorders.

There is a distinct lack of effective resources for postpartum depression in Canada, and a lack of awareness of what PMADs are, how they impact families and overall health, and that it is not possible to simply snap out of it.  PMADs are real, and they are complex, physiological disorders which have emotional and social components.  Sometimes it takes several tries to get a doctor to recognize your symptoms, or to convince your partner that you need help, or to find a therapist who is a good fit for you and knows how to do CBT effectively.  Sometimes in small communites, support groups and other resources are only available online.  But healing from PMADs is possible even in less than ideal circumstances.  It takes time, help, and treatment, but it is so very important!