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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Reprinted from "Parenting" issue of Visions Journal, 2004, 2 (2), p. 40

Childbirth is viewed by Western society and in most cultures as a joyous event. However a majority of women will experience the blues, and 12 to 16% of women will go on to experience postpartum depression (PPD) after the birth of a child.

Instead of blissful happiness, these women struggle with sleepless nights, the unexpected demands of a newborn, the loss of order and routine, the loss of their past relationship with their partner, the loss in occupation and income and increased isolation.

They also struggle with guilt, shame and fear of not being happy. This is coupled with the paralyzing fear that if “people only knew how unhappy I am being a mom, how angry I am most of the time, how I resent my baby’s constant demands, or the images I have a harming my baby – they would immediately remove the baby from me.”

Society’s expectations – fuelled by women’s cloak of silence – often don’t allow women to voice their feelings. Consequently, months usually lapse before a woman finally breaks through the barriers and gets help.

Women who are experiencing postpartum depression may have a range of symptoms that they cannot make sense of and find overwhelming:

Symptoms of postpartum depression may include

  • Lowered mood, sadness

  • Tearfulness or crying

  • Feeling worthless

  • Anxiety or panic attacks

  • Self-blame or guilt

  • Worry about own health and baby's

  • Lack of energy, feeling tired

  • Alternatives, agigation or feelin hyperactive

  • Loss of interest in activities, including sex

  • Feeling irritable

  • Forgetfulness

  • Eating too much or too little

  • Not being able to concentrate and make decisions

  • Not being able to sleep when the baby is sleeping

  • Feeling of hopefulness, inadequancy and thinking negative thoughts

  • Thoughts about death and, at times, suicide

What typically happens when women are suffering from postpartum depression?

Women may isolate themselves from their families and friends. They typically present a façade that everything is OK, but fall apart once they hang up the telephone or when the visitor leaves.

Women may become preoccupied with physical complaints. For example, they may repeatedly complain to their doctor with their own medical symptoms, or about their baby’s difficulty sleeping or poor weight gain.

When the partner becomes aware that his wife is becoming increasingly unable to cope with the demands of the baby, he may call the doctor or bring his wife to an emergency department, asking for help.

Why treatment is important

Women with untreated PPD may develop chronic depression. Women with ongoing depression don’t smile or react to their baby’s smiles or their cries for comfort, and have difficulty bonding with their babies. The infants of these women either learn to stop smiling and crying, or learn to cry more to gain some attention.

We know that the sooner women who are depressed are treated, the less the depression will effect their infants’ behaviour. Identifying women early allows them to access help quickly, begin treatment and get better. When speaking to women about their depression, they will often say their greatest regret is the time lost. This includes time ‘lost’ being depressed and not being We know that the sooner women who are depressed are treated, the less the depression will effect their infants’ behaviour. Identifying women early allows them to access help quickly, begin treatment and get better. When speaking to women about their depression, they will often say their greatest regret is the time lost. This includes time ‘lost’ being depressed and not being We know that the sooner women who are depressed are treated, the less the depression will effect their infants’ behaviour. Identifying women early allows them to access help quickly, begin treatment and get better. When speaking to women about their depression, they will often say their greatest regret is the time lost. This includes time ‘lost’ being depressed and not being able to remember their interactions with their infant. Women with PPD mourn this loss for years.

Women may say

  • "The color has gone from everything".

  • "I want to cry all the time...."

  • "I'm no good to my husband the way I am"

  • "How can I be so unhappy when I have this beautiful healthy baby".

  • "I've never been this tired".

  • "I feel like exploding.... I get so worked up".

  • "I'm confused, it seems like I am in a fog...'

  • "I use to manage an office, now I can't decide what to wear"'

  • "The baby is crying again...I just sat down".

  • "Sometimes I think my baby would be better off without me".

What help is available for women?

Even if you take good care of yourself – by eating well and getting regular sleep – you may need more help to treat your depression. This is not a sign of failure but a sign that the depression may be more severe.

Some women benefit from a combination of:

  • Medication: women experiencing a moderate to severe PPD require treatment with antidepressant medications to help lessen the duration of their mood symptoms. It may take four to six weeks to know if the antidepressant is working.

  • Psychotherapies: these include supportive therapy, cognitive-behavioural therapy (changing negative thinking patterns), group therapy and marital therapy.

  • Support Groups: ask your community health nurse about groups in your area, or contact the Pacific Post Partum Support Society at (604) 255-7999.

The postpartum blues

Occurs within two or three days of birth. Women usually experience mild and often rapid mood swings from being very happy to sad, with tearfulness, anxiety, irritablity, poor concentration and insomnia. Symptoms get worse with lack of sleep and lack of support. Postpartum blues usually end within two weeks without any help. If symptoms continue, the woman may be developing postpartum depression.

What can partners and families do to help?

  • Educate yourself about postpartum depression

  • Offer practical supports to new mothers (e.g., make a meal, take care of older children, do the laundry

  • Encourage new mothers to be with other mothers to assist them in adjusting to their new role

If you know a mother who may be depressed, encourage her to talk to her family doctor, community health nurse or a support group.

Postpartum Psychosis

Postpartum psychosis is the most severe and most rare postpartum illness. It occurs in approximately 1 in 1,000 births. It occurs quickly, usually within two weeks of childbirth, but can take up to three months after delivery to appear. Women who have schizophrenia, bipolar disorder or those with a family history of these illnesses are at greater risk of developing postpartum psychosis. Women with psychosis have rapid or disorganized speech, are agitated, distractable, have delusions (false beliefs) or hallucinations (hearing or seeing things that do not exist). They have lost touch with reality and are at increased risk of harming themselves or their infant. These women require immediate hospitalization and treatment.

If you are concerned about a woman or her baby call her family doctor, a crisis line, or take her to the nearest emergency department.

 
About the Author

Dr.Ryan is a psychiatrist on the BC Reproductive Mental Health Program and Doris is a Provincial Outreach Coordinator of the program based at BC Women's and Children's Hospital and St Paul's Hospital.

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