Many mothers who have just had a mountaintop experience in the delivery room are often dismayed to find themselves in a dark, turbulent, emotional valley during the first weeks after their babies are born. Between 50 percent and 60 percent of women have a temporary emotional slump commonly known as baby blues, while 5 percent to 10 percent of women suffer from a more severe disturbance known as postpartum depression. A less common — but more severe — disturbance known as postpartum psychosis occurs after about one in 1,000 deliveries.
When one considers all the intense physical and psychological changes that accompany the birth of a baby, it is surprising that storm clouds aren't part of every mother's emotional weather after childbirth.
- Dramatic shifts in the levels of some hormones (estrogen, progesterone, prolactin, cortisone and others) after delivery.
- Physical exhaustion following labor.
- Blood loss during and after delivery.
- Pain after childbirth, especially following a cesarean section. Drugs that may be needed to kill pain can also affect mood and energy level.
- Loss of sleep, perhaps starting with an all-night labor and continuing with the around-the-clock needs of a newborn.
- Genetic factors. Depression, anxiety syndromes, panic attacks and even more severe disturbances have a biochemical component.
Personal and family issues that can affect emotions include:
- A difficult labor and delivery during which little went according to plan.
- Problems with the baby. These might include a complex medical concern such as prematurity or a normal baby with feeding problems or unusual irritability.
- Mismatch of expectations. The time and effort involved in caring for a newborn may come as a shock to some (especially first-time) mothers, who may have never experienced being on call 24 hours a day.
- Lack of family support. If Dad is gone most of the day (or there is no dad in the picture) and relatives are not available to lend a hand, taking care of a newborn can be overwhelming.
- Perfectionism. With a new baby (or even with one or more older children) it is not possible to be the Mother of the Year, keeper of the showcase home, rising young executive and amorous wife.
- Financial pressure. Budgets are often tight in new families, and the expenses surrounding childbirth will add stress to family finances.
- Feelings of being stuck or trapped in the new role. A woman who has been pursuing a rewarding career or who is accustomed to a carefree lifestyle might feel that nonstop responsibility for a helpless newborn is a ball and chain.
How do I know the severity of my situation?
Baby blues, the most common mood problem related to childbirth, usually develops during the first week after delivery. Symptoms include irritability, tearfulness, anxiety, insomnia, lack of energy, loss of appetite and difficulty concentrating. This emotional and physical slump typically resolves itself within two weeks. However, it should not be met with an attitude of "ignore it and it will go away." Support and reassurance from husband, family and friends are important. In addition, help with the baby, housekeeping and other practical details can make a difference.
Postpartum depression (PDD) is a more serious condition, though many of its symptoms are similar to those of baby blues. Not only does it last longer, but its impact on both mother and baby is more profound. A mother with PPD may be so depressed that she has difficulty caring for her baby, or she may develop extreme and unrealistic anxiety over the infant's health. Furthermore, ongoing disruption of mother-child interactions can adversely affect the infant's long-term development.
PPD can begin at any time during the first six months after childbirth. While two out of three mothers recover within one year, this problem should not be left to run its course. Like a major depression occurring at any other time in life, PPD is not a situation in which a little "attitude adjustment" is all that is needed. If symptoms such as those listed above continue for more than two weeks, seek professional help.
Postpartum psychosis is a rare but serious disorder in which a woman experiences not only a disturbance in mood but also a break with reality. At some time during the first month after delivery, she may become confused and experience hallucinations and delusions. She may even consider harming herself or her baby. A woman who develops postpartum psychosis must be evaluated immediately by a qualified psychiatrist, though it might be difficult to convince her that this is necessary. This condition can and should be treated with appropriate medication. There is, however, a 1 in 7 chance that it will recur with a subsequent pregnancy.
It is important to note that postpartum depression and psychosis can occur without warning. A woman's mood during her pregnancy does not necessarily predict how she will feel after the baby comes home. However, if a woman has a history of depression or other significant emotional problems, or if these problems have occurred in her immediate family, those close to her should be alert for signs of turbulence during the days and weeks following childbirth. A mother who has suffered postpartum psychosis in the past must be observed carefully for signs of recurrence after future deliveries. If you have additional questions about postpartum depression or feel you need to talk with someone in more detail, contact your physician.