Coping with Postpartum Depression - Methodist Medical Center of Oak Ridge

Family, Friends Can Help New or Expectant Moms

By Cheryl Stallings, R.N.

Women are vulnerable to depression during and after pregnancy. Eighty-five to 90 percent of new mothers in this country are affected by a postpartum mood disorder. The vast majority of these women know something is wrong, but less than one in five reports even serious symptoms and receives treatment.

There are several reasons for the low number. Many pregnant women do not tell anyone that they are depressed because having a baby is supposed to be a wonderful time in their lives. They don’t feel excited and are too embarrassed or ashamed to admit their true feelings. Also, some of the symptoms of depression are similar to changes that occur in the body as part of a normal pregnancy.

New mothers need to know they are not alone. Help is available. If you are a new mom and answer “yes” to any of the following questions, you may have a postpartum mood disorder that should be reported to your doctor. If you answer “yes’ to question 9 or 10, call your doctor or other healthcare provider immediately.

Do you feel distanced from your baby, the baby’s father, and family or friends?
Have you noticed a change in your mood and your level of interest in life?
Do you have trouble sleeping even when the baby is asleep?
Has your appetite changed?
Have you been feeling unusually sad, frightened or angry?
Is your thinking foggy?
Do you have disturbing thoughts that occur again and again?
Have you felt guilty and ashamed?
Have you thought about death or dying?
Do you think about hurting yourself or your baby?

Is all depression following childbirth the same?
No, it ranges from very mild to life-threatening.

The so-called “baby blues” tend to occur by the third or fourth day after childbirth and last a few hours to a few days. Symptoms are not severe and do not require treatment. They include brief episodes of sadness, crying, irritability, anxiety, elation, headache, insomnia, confusion, and forgetfulness

Women who experience postpartum panic disorder feel anxious, become agitated, and have panic attacks that last from five to 30 minutes. During a panic attack, a woman may have a rapid heart rate, sweat, feel dizzy and nauseated, tremble, and/or have the sensation of choking or smothering.

Postpartum obsessive-compulsive disorder begins within a few days to six weeks after childbirth. New moms may have horrible imaginings and wide-ranging emotions. They may think about harming the baby, experience high anxiety and unreasonable fears, have obsessive feelings about germs and cleanliness, and visit the pediatrician numerous times.

Postpartum post-traumatic stress disorder is characterized by negative flashbacks or amnesia about the birth experience. Postpartum depression affects 15-20 percent of new moms and can occur within a few days and up to a year after delivery. It causes uncontrollable crying, sleep problems, fatigue, confusion, and feelings of hopelessness, guilt, worthlessness, and isolation.

Postpartum psychosis is the most severe of the postpartum mood disorders. It can cause women to hallucinate, experience extreme insomnia and agitation, have bizarre feelings, behave bizarrely, and/or think about harming themselves or their babies. This condition can develop up to one year after childbirth and affects one to two new mothers in every 1,000. A woman who has postpartum psychosis has a 40-50 percent chance of having it again with the birth of another baby, and the risk increases to 90 percent with the birth of another baby within 24 months.

What causes depression during and after pregnancy?
During pregnancy, several factors increase a woman’s risk for depression. Research indicates that the stress hormones, cortisol and corticotropin, steadily increase during pregnancy. The higher levels are necessary for the normal development of the baby, but they also can lead to depression in the mother.

Other risk factors include…

Problems with an earlier pregnancy or birth
Anxiety about the unborn baby
Marital or financial problems
Unwanted pregnancy
Difficult pregnancy
Unexpected outcome or change in the birth experience
Unrealistic expectations about parenting
Problems with the baby
Young age of mother
History of depression
Sexual abuse

How can family and friends help someone suffering from a mood disorder after childbirth?
Ask the new mom for specific ways you can help or offer specific things you can do to help. Encourage the new mom to get out of the house for walks and get-togethers with other new moms. Listen when the new mom wants to talk about how she feels.

For New Moms: A Depression Action Plan
Listed below are five steps to help new and depressed moms feel better. Take one step at a time.
Set simple goals.	Don’t try to do too much too soon. Plan simple activities like light reading or listening to music. Break down your work into small tasks.
Have fun every day.	Enjoy an old hobby, watch a favorite television show, or talk to a friend.
Get moving.	Set aside 10-20 minutes every day to walk or enjoy some other physical activity.
Don’t isolate yourself.	Spend time with other people.
Find ways to relax.	Breathe slowly and deeply, take a warm bath, and focus on relaxing one part of the body at a time.

About the Author: Cheryl Stallings, R.N., B.S.N., is the Family Education Program coordinator at Methodist Medical Center of Oak Ridge. She teaches a number of family classes sponsored by the medical center, coordinates several groups for new mothers, and teaches exercise classes for people of all ages. Stallings also participates in community events to educate parents, grandparents, young children in expectant families, and others about various aspects of family life. She is a graduate of Union University in Jackson, where she earned a bachelor of science in nursing. She has more than 25 years of experience in nursing, including emergency medicine, critical care, nursing management, and staff development, and is the author of a graduate preceptorship program.