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Postpartum depression

What you need to know

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Winnipeg Health Region
Wave, September / October 2013

What is postpartum depression?

It's normal to go through an adjustment period following childbirth - new mothers experience many different emotions. Women anticipate feelings of happiness with the birth of their babies. But many new mothers are surprised by other feelings such as sadness, anger, fear or anxiety.

Researchers have identified three types of postpartum depression: baby blues; postpartum depression and postpartum psychosis.

The "baby blues" is the most minor form of postpartum depression. It usually starts one to three days after delivery, and is characterized by weeping, irritability, lack of sleep, mood changes and a feeling of vulnerability. These "blues" can last several weeks. It's estimated that between 50 per cent and 80 per cent of mothers experience them.

Postpartum depression is more debilitating than the "blues." Women with this condition suffer despondency, tearfulness, feelings of inadequacy, guilt, anxiety, irritability and fatigue. Physical symptoms may include headaches, numbness, chest pain and hyperventilation. A woman with postpartum depression may regard her child with ambivalence, negativity or disinterest. An adverse effect on the bonding between mother and child may result. Because this syndrome is still poorly defined and under-studied, it tends to be under-reported. Estimates of its occurrence range from three per cent to 20 per cent of births. The depression can begin at any time between delivery and six months post-birth, and may last up to several months or even a year.

Postpartum psychosis is a relatively rare disorder. The symptoms include extreme confusion, fatigue, agitation, alterations in mood, feelings of hopelessness and shame, hallucinations, and rapid speech or mania. Studies indicate that it affects only one in 1,000 births.

It is common for women experiencing postpartum depression to have scary thoughts about harming their babies (even though it's the last thing they'd want to do) it actually happens very rarely. In these rare cases, those women who harm their babies actually lose touch with reality, usually referred to as postpartum psychosis. Even mothers experiencing postpartum psychosis very rarely harm their children.

What is postpartum anxiety?

Anxiety is often considered a symptom of postpartum depression. Anxiety disorders that develop during or after pregnancy are actually a different set of illnesses altogether. Women can often have both postpartum depression and postpartum anxiety at the same time.

Some anxious feelings or feelings of being overwhelmed are to be expected. More severe anxiety may include excessive worries or fears, racing thoughts, panic attacks, persistent irritability, restlessness or obsessive thoughts or behaviours. If anxiety begins to interfere with a mother's ability to care for herself or her child, it is a good idea to talk to someone about it and get some support.

What causes postpartum depression?

The exact cause of postpartum depression is not known. One factor may be the changes in hormone levels that occur during pregnancy and immediately after childbirth. Also, when the experience of having a child does not match the mother's expectations, the resultant stress can trigger depression. Studies have also considered the possible effects of maternal age, expectations of motherhood, birthing practices and the level of social support for the new mother.

There is no one trigger; postpartum depression is believed to result from many complex factors. It is important, however, to communicate to women with postpartum depression that they did not bring it upon themselves.

Who may be at increased risk for postpartum depression?

Postpartum depression or anxiety could happen to any new mother, but women who have one or more of the following risk factors are at increased risk of developing postpartum depression:

  • Depression or anxiety during pregnancy
  • Personal or family history of depression
  • Stressful recent life events
  • Lack of social support
  • Relationship difficulties
  • Low self-esteem or anxious personality
  • Having an unwanted pregnancy
  • Being an adolescent mother
  • Being a recent immigrant

Can fathers/partners experience depression following the birth of a child?

Research shows that 10 per cent of fathers/partners experience depression in the first year postpartum. Depression affects families and it is important to reach out and find help early.

How do I know if I or someone I know has postpartum depression?

If you or someone you know has been experiencing any of the following, talk to a health-care provider:

  • Strong feelings of sadness or emptiness
  • Constant fatigue (even after resting)
  • Trouble falling asleep or wanting to sleep all the time
  • Uncontrollable crying
  • Losing interest in activities you normally enjoy
  • Trouble concentrating or making decisions
  • Changes in appetite or weight
  • Feeling hopeless, trapped or worthless
  • Feeling anxious, overwhelmed or out of control
  • Worrying a lot about your baby's health or safety
  • No interest or pleasure in your baby
  • Scary thoughts or fears about harming the baby

Some women may have more physical symptoms:

  • Feeling weak, feeling flushed
  • Gas, constipation or diarrhea
  • Headaches or heaviness in the head

How is it diagnosed?

Your health-care provider or a mental health professional can tell you if your symptoms are postpartum depression. He or she will ask about your symptoms and any drug or alcohol use. Tests may be done to rule out medical problems such as thyroid, iron or hormone imbalances. There are no lab tests to diagnose postpartum depression.

Is postpartum depression treatable?

Yes. Women with postpartum depression may feel like they are bad mothers and be reluctant to seek help. It is important to remember that hope and treatment are available to women in need.

Counselling and support are helpful in treating postpartum depression. Some women may benefit from medications as well. Even if you are breastfeeding, it is important to consider the range of treatments to determine which may be best in your situation. A health-care provider can also link you to the right supports and services to help you in your recovery. The sooner you get help, the sooner you'll be feeling better.

A sign of postpartum depression is feeling like you are "the worst mother in the world." You should know that you are not alone. Many women suffer in silence with postpartum depression because they fear being seen as bad mothers or feel too ashamed to seek help. It is important to remember that postpartum depression can affect any new mother. It is not your fault.

What can my friends and family do to help me if I have postpartum depression?

They can:

  • Encourage you to talk about how you feel
  • Help remind you that it's not your fault and you're not a bad mother
  • Share in home and child care responsibilities

What can I do to help myself?

Maintaining a healthy lifestyle is crucial. Staying physically and socially active, especially with your partner, is very important. Having regular sleep and eating patterns will also help you. Since you will need to be up during the night with your baby during the first few months, it is important to take naps to keep your energy up. Learn ways to lower stress and use them every day, such as relaxed breathing and muscle relaxation exercises.

It's also important to find support. If possible, ask for help with nighttime feedings so that you can sleep. You may also find it useful to get help with meals and household chores. Take time for yourself without your baby, even if it's for 30 minutes. Hire a sitter, leave your baby with a close friend or your spouse, and get out. It is important to take a break from the demands of caring for a newborn. Spend time with friends or attend community groups and don't be afraid to share both your fears and your joys.

Where else can I get help?

There are a number of resources for people who are suffering from postpartum depression. They include:

  • Talk to your doctor or midwife. For assistance in finding a family doctor call the Family Doctor Connection Program at 204-786-7111.
  • Talk to your Public Health Nurse
  • For information about resources and supports call the Women's Health Clinic Mothers Program at 204-947-1517 ext 113.

If you're having thoughts of harming yourself or your baby or are feeling in crisis, you can:

  • Call Mobile Crisis Service 204-940-1781 (24 Hours)
  • Go to the Crisis Response Centre at 817 Bannatyne Ave (Open 24 hours)
  • Call Klinic Community Health Centre Crisis Line 204-786-8686
  • Call Manitoba Suicide Line 1-877-435-7170 (24 hours).

If you need more information and help finding resources call Health Links-Info Santé at 204-788-8200 or toll-free 1-888-315-9257 (24 Hours).

Information about postpartum mental health issues can be found on the Population and Public Health website, or on the Mental Health website.

Audra Kolesar is a registered nurse and manager with Health Links - Info Santé, the Winnipeg Health Region's telephone health information service. Laurie McPherson, a mental health promotion co-ordinator with the Winnipeg Health Region, contributed to this column.

The information for this column is provided by Health Links - Info Santé. It is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a health-care professional. You can access health information from a registered nurse 24 hours a day, seven days a week by calling Health Links - Info Santé. Call 204-788-8200 or toll-free 1-888-315-9257.

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