Postpartum Depression

Postpartum depression is a form of depression a mother experiences after the birth of her child. It is a complex mixture of physical, emotional, and behavioral changes and can be divided into three categories: postpartum blues, postpartum depression, and postpartum psychosis.

What Is It?

Having a baby can be both elating and exhausting. During the first few weeks after giving birth you may feel fatigue and some pain as your body heals. If you're like most women, you may also experience "maternity" blues (postpartum blues), a very mild form of depression. It begins three to six days after childbirth and lasts for up to two to six weeks. Experts believe these feelings are caused by hormonal changes (especially low estrogen levels or thyroid abnormalities), fatigue, and interrupted sleep.

Symptoms can include feeling overwhelmed, confused, and nervous. The postpartum woman with the "blues" will frequently cry and do so for long periods of time. Patients describe having their feelings hurt rather easily, an irritability triggered by the most minor incidents, and most troubling, a lack of feeling for the baby.

Postpartum Depression (PPD)

A more serious condition, is experienced by 8% to 15% of women. It usually begins around two weeks after childbirth, but sometimes may not appear until three to six months after giving birth. It can last for several months, and if left untreated, for several years. If you've experienced postpartum depression before, you have a 70% chance of getting it again. Women who have had major complications during pregnancy are twice as likely to have it than women who've had a relatively easy pregnancy. There is a 15% to 25% risk of PPD in women with previous depressive reaction that was not associated with pregnancy.

Symptoms of PPD Are:

Feelings of inadequacy; inability to cope; impaired concentration or memory; despondency or despair; thoughts of suicide; no feelings for the baby, or over-concern for the baby's health; guilt; panic attacks; feeling "out of control" or like you are "going crazy"; headaches; chest pains; heart palpitations; or hyperventilation. Other factors that can contribute to postpartum depression include: having other children at home; giving birth to twins; ambivalence about being pregnant; and having a previous history of depression.

Postpartum psychosis is a relatively rare occurrence (1 in 1,000 births) the onset is usually within the first three months of the postpartum period and tends to be severe and quick. A wide range of symptoms includes: lack of appetite, hyperactivity, confusion, fatigue, mood swings, memory loss, and delusions or hallucinations both auditory and visual. These women are often overcome by an overwhelming sense of shame or hopelessness.

How Do I Know I Have It?

Symptoms of maternity blues include weepiness, anxiety, insomnia, mood swings, difficulty concentrating, fatigue, and loss of interest in sex- While some of these symptoms are similar to postpartum depression, keep in mind that maternity blues is milder and shorter-lasting. Call your health-care provider if you have any concerns.

Postpartum Depression Comes in Two Forms:

Major and minor. Major depression is diagnosed when five or more of the below symptoms are present for at least a two-week period. Minor depression is diagnosed when fewer than five of the below symptoms are present for at least a two-week period. In both cases, at least one of the symptoms must include being in a depressed mood for most of the day or having a decreased interest in activities almost every day. Call your health-care provider if you are experiencing any of these symptoms:

How Can I Treat It?

There are many things you can do on your own to help ease maternity blues or postpartum depression. The most important thing to do is take a step back and allow yourself some time to adjust to your new life. Here are some other tips:

Psychopharmacologic treatment is also available. There are numerous support and self-help groups, which can be an invaluable resource during this difficult and confusing time. In an attempt to prevent postpartum depression from occurring, several prenatal interventions have been proposed. The purpose is to provide a smooth transition into parenthood. These interventions address a wide variety of efforts to prevent the depressive episodes. They include prenatal classes to teach parenting skills, reliance on assistance from support personnel including spouses, family members, friends, and neighbors. Mothers--to-be are encouraged to verbalize their fears and anxieties well before the baby arrives and to continue these discussions even after delivery. This type of educational approach with specific attention to the psycho-social aspect of the pregnancy holds great promise.

If these suggestions don't help, talk to your health-care provider. Women with mild depression are usually referred to a therapist to talk about their fears and concerns. In some cases, women with moderate depression are given estrogen treatments. For major depression, antidepressants and/or anti-anxiety agents are usually prescribed. Tell your health-care provider if you are breast-feeding before he recommends any medication.

How Can I Prevent It?

Unfortunately, postpar1um depression cannot be prevented, but planning ahead can help, While you are pregnant, try to mentally prepare for the numerous lifestyle changes that will soon take place, Find someone who will help with household chores and the baby during your first week home from the hospital; choose child care so that you can get a break on an ongoing basis; and decide ahead of time what you need to have on hand when the baby arrives. Having these things worked out before you give birth will provide some stability during a very unpredictable time.

Frequently Asked Questions

Q : I've been feeling wonderful ever since I brought my baby home a month ago. Is this good feeling going to go away and lead to depression?

A : Most likely, no. While maternity blues are common, and some women get postpartum depression, that doesn't necessarily mean you will. Since the majority of maternity blues starts the first week after giving birth and postpartum depression sets in after the second week, it's safe to assume that you've escaped both conditions.

Q : What about the baby's dad? Can he get postpartum depression, too?

A : New fathers, especially first-timers, may also have feelings of sadness or anxiety, especially about feeling left out when all of the attention is focused on the mother and baby. Now is a good time to talk to each other about being new parents. Try to spend some time alone together, even if it's just for an hour. Many parents try to plan a regular date night so they can be together without the baby.

Q : Is it safe to take antidepressants while breast-feeding?

A : Unfortunately, experts don't know much about the effects of antidepressants on nursing newborns. Because most medicines that moms take do show up in their breast mils, it is advisable to avoid taking antidepressants while breast-feeding. If your postpartum depression is servere, you may want to consider bottle-feeding so that you can safely take the medication without passing it to your baby. It is a good idea to address these concerns with your health-care provider.

Changes In Your Body

Your life as you knew it is about to go topsy-turvy once your baby arrives. Taking care of a baby is a full-time job, and you're going to feel it - physically and emotionally. Some first-time moms find it difficult to adjust to their new role, but if you know what to expect it may be easier:

Episiotomy Aftermath:

The healing process may take two to three weeks, but eventually your stitches will dissolve and you will be able to sit on a normal surface again. Meanwhile your healthcare provider will give you a list of things that you can do to expedite the healing process and to soothe the discomfort.

Hemorrhoid Care:

One of the most common after effects of pushing during labor is a hemorrhoid, or swollen blood vessels around the anus that may bleed and be painful. Depending on the severity of the swelling, you may want to soak your bottom in a few inches of warm water in the bath or wear a cotton pad soaked with cold witch hazel cream in the anal area. Eating foods high in fiber will help to alleviate constipation, which may exacerbate hemorrhoids. If the pain is unbearable, you may need prescription medicine.

Uterine Contractions:

During the first week after birth while your uterus returns to its prebirth state (over a six-week period), you may feel afterbirth pains or contractions, especially during nursing and after multiple pregnancies. To relieve the pain, you may need prescription medicine (analgesic). Sometimes lying on a pillow and changing positions may help the discomfort as well.


It is normal to bleed after birth for anywhere up to two to three weeks. This normal occurrence is called lochia, and it takes a while to subside as your uterus and the lining are going back to their regular size. The length of time is different for every woman but it will change from red discharge to white or yellow discharge and then it will stop.

Breast Changes:

Whether or not you are breastfeeding, you'll know when your milk comes in because your breasts may be so full of milk that they get hard and engorged. To best protect your breasts from engorgement pain - and from sagging - be sure to wear a well-fitted, supportive bra at all times. If you do get engorged (which may be accompanied by a slight fever and flu-like feelings for a day), apply cold washcloths or ice packs to reduce the swelling.

Urinary and Bowel Movement Issues:

For the first few days (and sometimes weeks) after birth, your urine and bowel movements may be out of sorts. Some women experience a lack of control and others find it difficult to urinate or have a bowel movement.

The Culprit:

Stretching of the base of the bladder, the stretching and weakening of the pelvic floor muscles, tearing of the perineum, and nerve injury to the sphincter muscles around the anus. The treatment: Kegel exercises to improve the bladder, special doctor-prescribed exercises to control your bowels. If you continue to have trouble with either one, it is important to inform your health care provider.

Intense Fatigue:

Every new mom suffers from sleep deprivation. To help manage your fatigue, you can line up or accept offers of help from friends or family to help you initially. Try and make time to nap if possible and get some rest, as you are recovering too.

A Rollercoaster of Emotions:

You may feel overwhelmed, stressed out, teary, elated, or even depressed. Some of those feelings are normal and to be expected, but if you're unable to function or shrug off the blues you should consult a professional.

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