Although delivering a baby is typically a happy event, many new mothers may experience sad feelings during a time they anticipated would be filled with joy and excitement. Following delivery, there are changes in a woman’s hormones that can cause postpartum blues consisting of mild depressive symptoms (i.e., feeling down, changes in appetite or weight , sleep disturbances etc)that are generally self-limited, or more severe syndromes of minor or major depression. Untreated postpartum depression can result in serious consequences for the mother and infant. The prevalence of postpartum depression in the general population of the United States and Europe is approximately nine percent; however, the rate appears to be higher in low- and middle-income countries. Onset of episodes occurs before or during pregnancy in roughly fifty percent of patients. The primary risk factor is a past history of perinatal or no perinatal depression (before pregnancy, antepartum or postpartum) those with a history of depression are at higher risk and those who experienced a traumatic event during the pregnancy, i.e. loss of a spouse or partner).
Signs and Symptoms of Postpartum depression (‘’Baby Blues’’)
1. Depressed mood –feeling sad, hopeless, discouraged, “blue,” or “down in the dumps.”
2. Loss of interest or pleasure – Loss of interest or pleasure in activities that used to be pleasurable is also a cardinal symptom of postpartum depression.
3. Change in appetite or weight – Appetite and weight may decrease or increase.
4. Sleep disturbance – Sleep disturbance frequently occurs in postpartum depression and may manifest as insomnia or hypersomnia: Many depressed mothers describe their sleep as nonrestorative and report difficulty getting out of bed in the morning.
5. Fatigue or loss of energy – Lack of energy (anergia) is described as feeling tired, exhausted, and listless.
6. Neurocognitive dysfunction –impaired ability to think, concentrate, or make decisions, mothers may also appear easily distracted or complain of memory difficulties.
7. Psychomotor agitation or retardation – Major depressive episodes may include psychomotor disturbances:
- Agitation – Excessive motor activity that is usually non-productive, repetitious, and accompanied by a feeling of inner tension; examples include hand wringing, pacing, and fidgeting.
- Retardation – Generalized slowing of body movements, thinking, or speech. Speech volume, quantity, and inflection may be decreased, with increased latency in answering questions.
8. Feelings of worthlessness or excessive guilt – The self-perceptions of depressed mothers may be marked by feelings of inadequacy, inferiority, failure, worthlessness, and inappropriate guilt.
9. Suicidal ideation and behaviour – Depressed mothers can experience recurrent thoughts of death or suicide and may attempt suicide. Suicidal ideation may be passive, with thoughts that life is not worth living. Mothers are advised to seek screening e.g., the Edinburgh Postnatal Depression Scale (EPDS) is a valuable and efficient way of identifying patients at risk for perinatal´ depression. The EPDS is easy to administer and has proven to be an effective screening tool. Mothers who are identified as high risk for postpartum depression can then receive treatment from their local health care provider, if experiencing any of the above signs and symptoms.
Postpartum depression is a common complication of child bearing, here are some tips to help reduce the risks for PPD, i.e.; supportive partners, taking care of oneself, involving family members to help. It can be overwhelming when many relatives want to visit and there are dishes that need to be done, laundry to fold, etc. Remember most people coming to visit want to help in addition to seeing the new baby. Don’t be afraid to speak up and ask those extra sets of hands to spring into action. This will help combat feelings of being overwhelmed.