Postpartum depression is the most common complication of childbirth; affecting about 15% of new mothers as well as 10% of new fathers. It is normal to experience “baby blues” within the first two weeks following childbirth; symptoms include anxiety, weepiness, crying spells, irritability, loss of sleep and appetite. Symptoms typically worsen by the fourth day and should subside on their own within two weeks. Postpartum depression is when “baby blues” worsen into a deeper, lasting depression. Symptoms of postpartum depression include all of the same symptoms as baby blues as well as loss of interest in daily activities, feelings of guilt or worthlessness, reduced energy (beyond what is typically experienced with a newborn), inability to concentrate, and thoughts of suicide (“Beyond Baby Blues” p.1). Parents with this condition will worry obsessively about baby’s health, while feeling guilty about their own insufficient love and inadequacy as caretakers. Physical symptoms may also be experienced such as racing heart, rapid breathing, tremors, dizziness, and panic attacks (“Postpartum Disorders” p.1).
Postpartum depression is a form of major depression that develops due to a combination of biological vulnerability, psychological factors and life stressors. During pregnancy a woman’s levels of estrogen and progesterone both rise dramatically. These hormones help the uterus to expand, maintain the uterine lining, and sustain the placenta. Within the first two days after delivery, estrogen and progesterone levels plummet. Because these hormones also interact with the neurotransmitters that affect mood, this postpartum hormonal crash can cause emotional instability in women whose biology makes them more vulnerable to the change. Regulation of stress hormones is also disrupted during pregnancy, adding to distress. It is very important for the doctor to rule out other medical conditions that could cause symptoms similar to those of postpartum depression. The most likely possibility would be anemia which is a common complication of pregnancy that can cause fatigue and depression. Thyroid deficiency can also cause these symptoms. Pregnancy can sometimes cause thyroid to be inactive which can bring mood and energy levels down. Parents who have had any form of depression in the past are more susceptible to postpartum depression. “10% of women who have never been depressed develop postpartum depression, compared with 25% of those who have been depressed. And at least 50% of women who recover from one episode of postpartum depression experience a relapse of symptoms after another delivery.” There are many factors that can contribute to the onset of postpartum depression including lack of support, marital conflicts, social isolation, or additional life stressors (“Beyond Baby Blues” p.2).
The best way to approach the risk of postpartum depression is to form a plan for prevention during pregnancy. One important thing you can do is to form a good support system of family, friends, or church group that will be available for support, advice, and help with childcare once baby is born. Getting as much sleep as possible can also be a method of prevention. As impossible as that may seem with a newborn, there are strategies that can be effective such as taking naps during the day while the baby naps. Additionally, you can help baby develop sleep-and-wake circadian rhythms by walking baby in a stroller every morning to expose them to natural light. Arranging visits from a midwife can also combat postpartum depression. Women who received support from a midwife were 40 percent less likely to report depression. If you know that you are at a high risk for postpartum depression, there are extra preventative measures that you can take to protect yourself including psychotherapy and medication.
There are various treatment options for postpartum depression that are chosen based on severity of symptoms and personal preference. If symptoms are moderate, psychotherapy alone can be effective in improving mood. Cognitive therapy is a form of psychotherapy that can help people change the way they think about their postpartum experiences and expectations, helping to reduce stress and improve mood. Intrapersonal therapy focuses on quality of relationships and helps people to sort out conflicts and understand how past experiences can affect symptoms. Couples therapy can also help when marital difficulties are preventing parents from resolving disagreements and caring for child.
There are also a variety of antidepressants to help alleviate symptoms in men and women who are not breastfeeding. Drug choice depends on side effects, symptoms, and personal preference. Certain medications categorized as SSRI’s (selective serotonin reuptake inhibitors) are not likely to cause drowsiness but can cause sexual problems such as loss of libido or trouble reaching orgasm. Tricyclic antidepressants cause sedation which could be favorable for parents who suffer from insomnia as part of postpartum depression. Women who are breastfeeding can safely take certain medications that are not passed onto infant, or they are but at such small amount that doctors consider it safe. A good strategy for nursing mothers is to start at the lowest dose and watch infant closely for signs of irritability, grogginess, or failure to gain weight. Only increase dose if necessary. Infants who are younger than 8 weeks, born premature, or have other medical problems are more vulnerable to drug reactions.(Beyond Baby Blues p.3)
Electroconvulsive therapy (ECT) is used when symptoms are severe, suicide is a possibility, or postpartum psychosis occurs because it is effective and works quickly. To perform this procedure, the doctor will sedate the patient and deliver an electrical impulse to the brain that causes a seizure. “The mechanism of ECT action is not understood, but the seizure seems to restore the brain’s ability to regulate mood.” (Beyond Baby Blues p.3). It is possible for this therapy to cause brain damage and memory loss. A seizure can cause a surge of “well-being” neurotransmitters and hormones. It is this physical reaction that can temporarily mask mental disorders immediately after the administration of ECT. (Sackeim, et al., 2006, p. 3)
Research suggests that postpartum depression negatively affects the quality of care parents provide and can cause cognitive and social problems, poor physical development and disruptive behavior in the first year of life. Previous research has found an association between perinatal maternal depression and children’s behavioural problems in school age (Junge et al. 2016 p.608). The effects of depression are heightened because it coincides with a period of substantial brain development. “Our findings indicate that children of mothers who were depressed during the postnatal period were at increased risk of language acquisition problems at 12 months of age” (Quevedo et al.,2011, p.423). Studies have found that depressed mothers are less positive, playful, and interactive. ”In some cases, offspring of parents with any kind of untreated depression suffer delays in cognitive development, take longer to mature emotionally, or develop depression themselves”(Beyond Baby Blues p.1).
As a Certified Nursing Assistant, I can help by educating parents about warning signs and symptoms of the disorder and encouraging them to seek treatment. I can also be watching out for signs of depression to report to the nurse. I believe that if parents were more informed about postpartum depression including– how common it is, what it is, how it can be treated, and how it can negatively affect parent and baby– they would be more willing and likely to seek treatment. Most doctors hardly talk about it at all and only ask if you have been feeling depressed once at your post-delivery appointment which is usually 4-6 weeks after giving birth. It would be more effective to do and intensive screening and follow up more than once during postpartum period. Every mother should be considered at risk and treated accordingly. As a CNA, and as I further my nursing career, I will be sure to speak up about postpartum depression in hopes to make mothers feel more comfortable seeking help.
References
Beyond the “baby blues”: Postpartum depression is common and treatable. (2011). Harvard Mental Health Letter, 28(3), 1–3. Retrieved from http://ezproxy.hancockcollege.edu:3048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=hxh&AN=63988137&site=ehost-live
De Craene, M. (2002). Postnatal Pampering. Psychology Today, 35(3), 29. Retrieved from https://hancockcollege.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=hxh&AN=6512255&site=ehost-live
Junge, C., Garthus-Niegel, S., Slinning, K., Polte, C., Simonsen, T., & Eberhard-Gran, M. (2017). The Impact of Perinatal Depression on Children’s Social-Emotional Development: A Longitudinal Study. Maternal & Child Health Journal, 21(3), 607–615. https://doi-org.hancockcollege.idm.oclc.org/10.1007/s10995-016-2146-2
Postpartum disorders. (1997). Harvard Mental Health Letter, 14(3), 1. Retrieved from https://hancockcollege.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=hxh&AN=9710064267&site=ehost-live
Quevedo, L. A., Silva, R. A., Godoy, R., Jansen, K., Matos, M. B., Tavares Pinheiro, K. A., & Pinheiro, R. T. (2012). The impact of maternal postpartum depression on the language development of children at 12 months. Child: Care, Health & Development, 38(3), 420–424. https://doi-org.hancockcollege.idm.oclc.org/10.1111/j.1365-2214.2011.01251.x
Sackeim, H. A., Prudic, J., Fuller, R., Keilp, J., Lavori, P. W., & Olfson, M. (2006). The Cognitive Effects of Electroconvulsive Therapy in Community Settings. Neuropsychopharmacology,32(1), 244-254. doi:10.1038/sj.npp.1301180