You Asked: Do I have postpartum depression?

Tears are expected when you first meet your newborn. Most women will cry tears of joy, and some may even become teary-eyed while grappling with the stress and responsibilities thrust on a new parent. However, if you experience depressive episodes or don’t feel a connection with your baby at all—more than two weeks after giving birth—these could be tell-tale signs of postpartum depression.

Baby blues or something more?

In the first two weeks after giving birth, many new mothers suffer from the ‘baby blues.’ Mood swings after birth are not uncommon, and many women may feel confused about struggling with sadness or anxiety about adding a new family member.

Symptoms of baby blues (crying for no apparent reason, impatience, anxiety, fatigue, insomnia, sadness, mood changes) normally peak within five days of delivery and will begin to dissipate within 10 days. A woman may need to be screened for postpartum depression if symptoms begin to worsen or if they persist past the 14-day mark.

“Baby blues affect approximately 50 to 80 percent of women,” said Elizabeth Wells-Beede, MSN, RN, an obstetric nurse and clinical assistant professor with the Texas A&M Health Science Center College of Nursing. “A nurse who is helping with postpartum visits should screen for postpartum depression if baby blues carry on past 10 days post-delivery.”

Right after birth, a woman’s hormones are in flux because the body is used to functioning with high levels of estrogen and progesterone (pregnancy hormones). A drop in these hormones could be to blame for many depressive-type symptoms, but other factors shouldn’t be overlooked. “A mother is coming off the ‘high’ of pregnancy and is experiencing a type of ‘withdrawal’ after a decline in pregnancy hormones,” Wells-Beede said.

What are the signs?

Postpartum depression is most likely to occur four weeks after giving birth, and severe cases may last up to a year if not treated appropriately. Wells-Beede said the biggest indicator of postpartum depression is when a mom just isn’t making a connection with her newborn.

“Most moms innately have some kind of emotional connection with their baby,” Wells-Beede said. “However, detachment can occur if she is feeling especially overwhelmed and stressed. When mothers feel these ‘inadequacies,’ this somewhat ‘bluesy’ change can progress into extreme irritability, which is another main sign of postpartum depression.”

For example, it’s never normal for a mother to wish her baby harm. If a mom says something like, “The baby is crying so much, sometimes I just want to shake him/her,” this is a glaring red light signaling a deeper issue. If this occurs, a health care provider should be consulted. They may advise taking a break from the situation and separation from the baby until symptoms improve or abate.

Who is most susceptible?

Postpartum depression is a non-discriminatory disease and can affect any woman, but, those who have already been diagnosed with conditions like anxiety and depression may be more at risk. “These are underlying disorders that can amplify postpartum depression,” Wells-Beede said.

Even if predisposed, postpartum depression is still a multi-faceted problem. Is it purely medical, or more psychological? Researchers are still trying to determine the cause.

“We still don’t know all the risk factors,” Wells-Beede said. “Diabetes and thyroid imbalances can play a part, and women who receive fertility treatments could develop it as a result of compounding hormones and the anticipation of birth. Unfortunately, postpartum depression is not like cancer. We can’t draw blood and determine markers about who’s most at risk. It just doesn’t work like that.”

How is it treated?

 Treatment of postpartum depression begins with developing a support group and psychotherapy before pursuing medications. Most psychotherapists will see patients at least once a week and may encourage therapeutic outlets like journaling.

“We want to try all possible routes first before prescribing anti-depressants, which can be harmful to a baby if mom is breastfeeding,” Wells-Beede said. “Therapy is always the first line of treatment.”

While breastfeeding has great nutritional value for a newborn, a mother’s wellness is more important than the feeding method. “A mother’s health and the ability to bond with her baby should always come first,” Wells-Beede said. “Anti-depressants will most likely be prescribed if alternative treatment methods aren’t working.”

How can families and physicians help?

 A woman’s family is often on the front lines when postpartum depression hits. “Family will normally be the people who spot the symptoms first,” said Wells-Beede. “It’s important to be aware of what’s happening in a mother’s life post-delivery, without smothering or overwhelming her. A strong support system is invaluable for women who experience this condition.”

According to Wells-Beede, health care professionals may need to take cues from German midwives in order to further understand and catch symptoms of postpartum depression earlier.

“Many midwives in Germany will do weekly home visits after delivery to help out the new mother, answer her questions and screen for postpartum depression symptoms,” she said. “This is a great way to shepherd new (and seasoned) mothers through the process, and make sense of the overwhelming amounts of information received once they’re discharged from the hospital. Babies don’t come with instruction manuals. It would be interesting to see if registered nurses in the United States could develop a similar protocol.”