All of us may know someone who is pregnant or has given birth within the last twelve months, but have we all done our part to help that wife, partner, family member or friend cope with the most common complication of childbirth?
That complication is Postpartum Depression (PPD), and it can appear during pregnancy or in the twelve months following childbirth according to the American College of Obstetricians and Gynecologists (ACOG), the World Health Organization (WHO) and the Centers for Disease Control (CDC). Having a baby changes women’s bodies and very lives in ways that are very hard to predict. Some form of Postpartum Depression affects ten to twenty percent of women globally. In the United States of America, the percentage of those women dealing with Postpartum Depression varies from eight to twenty percent by state, with a national average of eleven and one-half percent.
The exact cause(s) of Postpartum Depression is (are) unknown. It is suspected that some factors are hormonal due to a rapid post-delivery decline in reproductive hormones present in higher levels during pregnancy than at any other time in a woman’s life, including during puberty, menstruation and menopause.
There are also possible social and psychological factors involved, such as difficulty with a previous birth, stress over childcare, lack of social support, low economic status, poor (or no) spousal or partner relationship, single parenthood or stressful life events. Other risk factors include PPD with a former birth, problems with delivery, PMS, and a history of other mental health issues.
Postpartum Depression can appear in different forms. It is not “Baby Blues,” which are very normal and simply cause a new mother to feel sad, moody or tired. There are actually four levels of PPD. The mildest form is called Postpartum Blues. This level involves emotional liability or reactivity, crying at the drop of a hat, feeling overwhelmed and feeling anxious.
The next level is Postpartum Depression, which exhibits more severe levels of those symptoms. Mothers experiencing this level often feel like things will just never get any better. There is more anxiety involved, and it is often focused on the child.
The third level is Postpartum Obsessive Compulsive Disorder, which mirrors OCD but occurs in pregnant women or after delivery. It may involve compulsive behaviors such as washing and/or counting repetitively. Those suffering from PPD OCD may also experience intrusive thoughts regarding the welfare of the baby, such as being obsessive about such things as dropping the child or otherwise injuring him or her.
The most severe level of PPD is Postpartum Psychosis. This affects approximately one to two women per thousand and occurs within the first two weeks of delivery. Postpartum Psychosis involves the inability to perceive reality and requires immediate treatment.
Cases of any level of Postpartum Depression left undiagnosed and untreated can cause many consequences for women, infants and families. Women suffering from PPD may not be able to help run their households. They may not be able to care for themselves.
They may not be able to provide nurturing interactions with their infants, and the lack of a strong mother-child bond can hinder physical, mental and emotional development in the child. The infants may have greater occurrences of crying, fussiness and anger. Cognitive delay may happen as a result, as well. Often PPD results in decreased likelihood of breastfeeding and an increase of gastro-intestinal symptoms in infants.
All people need to be more aware of the various symptoms of PPD, which include, but are not limited to:
Feeling sad, hopeless, empty or overwhelmed
Crying more often than usual
Worrying or feeling overly anxious
Being moody, irritable or restless
Oversleeping, or being unable to sleep
Trouble concentrating and making decisions
Frequently feeling angry or full of rage
Losing interest in enjoyable activities
Suffering physical aches and pains
Eating too little or too much
Avoiding friends and family
Trouble bonding with baby
Doubting the ability to care for baby
Thinking about harming self or baby
It is important to note that only a medical professional can diagnose and treat any level of Postpartum Depression. Without screening, up to one-half of PPD cases may go undiagnosed. Women may not deal with their symptoms or talk to medical professionals about PPD due to several factors. They may experience feelings of shame, fear, embarrassment or guilt. They may be reluctant to bring up their true feelings for fear of being seen as an unfit parent. Also, many women are not formally screened by their medical professionals.
What can pregnant or postpartum women do? Talk about PPD with their health care providers during pregnancy and after delivery. Advocate for themselves by asking questions and speaking up. PPD is a common complication. There is no fault and no shame involved.
What can all of us do? Be aware of the levels and symptoms of Postpartum Depression. Take extra time and care to talk to the pregnant and new mothers in our lives. Offer help whenever possible. Most of all, do not succumb to the stigma that often makes us afraid to address head-on a subject surrounding mental health. Breaking the silence is everyone’s responsibility.