“When my daughter was born, I told myself that I would never be happy again,” he says. Childbirth is the culmination of nine months of waiting since conception. Many women experience sudden mood swings in the days after giving birth. But from this well-known baby blues, some women progress to a more or less dangerous depressive state, postpartum depression. Diagnosed and managed, can be effectively treated, limiting its consequences for both the mother and the and the child. Many mothers with postpartum depression feel guilty. However, the specialists are formal: this depression is in no way the mother’s fault!
Table of Contents:
- What is postpartum depression.
- Symptoms of postpartum depression.
- Postpartum depression remains taboo.
- From baby blues to postpartum psychosis.
- Causes and risk factors for postpartum depression.
- Fathers also.
- Consequences for the child and family.
- Breastfeeding and postpartum depression.
- Confessions of mothers who experienced postpartum depression.
- Polish reality.
- What consequences can result from a lack of knowledge in this area?
- Treatment of postpartum depression.
What is postpartum depression.
Postpartum depression – or childbirth depression – was already mentioned in the 4th century BC. However, it has only recently been recognized as a disease. It is still often misdiagnosed, although effective treatment is possible as long as it is started early.
The arrival of a child in the world, especially the first, leads a young mother to assume a new role, which means a significant reorganization of her identity. This change often provokes a return to childhood and reflection on the relationship with one’s own mother, which can be a source of great internal upheaval. The birth of a child can be synonymous with mourning a previous life, an idealized motherhood. In addition, the arrival of a child sometimes brings great expectations, such as re-creating the couple’s intimate life, repairing the sensitive mother’s self-esteem or filling an emotional deficiency. In such cases, the arrival of a child can sometimes be disappointing in the first few weeks and cause significant depressive feelings.
The arrival of a newborn in the family can be a real challenge under the best of circumstances, both physically and emotionally. It’s natural for new parents to experience mood swings, being happy one minute and depressed the next. These feelings are sometimes called baby blues and often subside soon after birth. However, some parents experience deep, ongoing depression that lasts much longer. This is called postpartum depression.
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Symptoms of postpartum depression.
Postpartum depression is depression that can begin during pregnancy or at any time up to a year after the baby is born. It mostly affects women, although men experience it as well. It affects a woman’s mood, the way she feels. Mood affects people’s perceptions of themselves, their relationships with others and their interactions with the world around them. This is much more than a “bad day.” Without help, such as treatment, depression can last for a long time. Symptoms of depression include feelings of sadness, worthlessness, hopelessness, guilt or anxiety felt almost all the time, sometimes irritability or anger. Sick people are no longer interested in things they used to enjoy and may become isolated. Depression can reduce concentration during tasks and remembering information. Concentrating, acquiring new knowledge or making decisions can be difficult. Depression can alter eating and sleeping habits, and in many women who suffer from it can lead to physical health problems.
A mother or father with postpartum depression may not love their child and often think they are not a good parent. Sometimes a woman may have frightening thoughts, such as hurting herself or her child. Although it is rare for a parent to plan to make these thoughts a reality, the situation is serious and requires urgent medical attention
Postpartum depression is likely caused by many different factors working together, including family history, biology, personality, life experiences and environment (especially lack of sleep). Becoming a parent is hard enough, and the challenges that depression adds can seem overwhelming. It is important to remember that there is no such thing as a perfect pregnancy, perfect birth, perfect baby or perfect parent.
Postpartum depression is a mood disorder that affects 1 to 2 out of 10 women in the year after giving birth. However, it is still poorly recognized and little treated. It is a pathology that occurs during a period of significant personal, family and environmental change. In addition, these depressions have the peculiarity of being particularly common in the early postnatal period, as they have a threefold impact in the first 5-6 weeks after birth compared to other periods of life. While depressive episodes occurring at any point in life can worsen interpersonal relationships, the existence of depressive symptoms in the mother after birth increases the risk of developing altered interactive patterns with infants, which can have detrimental consequences for children’s development.
Postpartum depression remains taboo.
Women suffering from postpartum depression are plentiful. 3 in 10 of them suffer from postpartum depression. But this disorder, which occurs after the birth of a child, is still taboo. 14% of those surveyed during this study admit that they felt “shame” in the face of these depressive episodes.
“Postpartum depression is still too often a taboo subject. But detecting and accepting these weaknesses, often temporary, must be a strength. Parents should be taught not to ignore the first symptoms and feel guilty about talking about them and seeking help” – explains Dr. Fanny Jacq, a psychiatrist, childbirth specialist and director of the Mental Health in Qare. Only 10% of mothers surveyed said they “dared to consult a doctor“…. This is not surprising, since most of the time this topic was never discussed during medical visits of expectant mothers. “More than half of parents believe that they were not sufficiently prepared for the mental aspect of postpartum,” – reads the study.
From baby blues to postpartum psychosis.
Experts consider three main types of postpartum depression: third-day syndrome or baby blues is the mildest and most common form of postpartum depression, as 50 to 80 percent of women experience this condition. It occurs between the first and third days after birth and manifests as crying, irritability, sleep deprivation, mood swings and feelings of vulnerability. These disorders usually last a few days, two weeks at most, and disappear on their own. It is estimated that postpartum depression affects between 3% and 30% of women and occurs at any time during the six months following childbirth.
Causes and risk factors for postpartum depression.
The exact causes of postpartum depression remain unknown. This appears to be the result of a complex set of many factors. Various studies have examined the influence of certain factors on the incidence of this depression, in particular: hormonal changes during pregnancy; the course of childbirth; the young age of the mother; expectations of maternal function; and the level of maternal social support. Some factors have been identified as risk factors for postpartum depression: a history of depression before pregnancy (25% of postpartum relapses) or during pregnancy (50% of depressive disorders occurring during pregnancy persist after birth); a significant number of sick days during pregnancy and medical consultations; a history of abortion or obstetric complications; premenstrual syndrome; difficult relationships with the spouse; unfavorable socioeconomic conditions; low levels of social support, both emotionally and in terms of information; single parenthood; the occurrence of stressful events during pregnancy or after delivery; the fact that the child is premature, ill or suffering from a malformation.
Postpartum depression is not just the domain of mothers, it can also affect fathers (up to 10% according to estimates). Postpartum depression occurs in about 10 percent of fathers during the first three months after childbirth, and the rate increases three to six months after the baby is born. Subsequently, the percentage of affected fathers decreases. Largely undiagnosed, paternal depression can affect all family members, especially since the father is less likely to be accompanied by health professionals than the mother. The risk increases when the mother herself suffers from postpartum depression. While many women admit that they have already suffered from a depressive episode after the birth of their child, fathers are not spared either, as, according to data revealed by the Qare platform, 18% of fathers surveyed said they experienced this type of disorder after the birth of their child.
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Consequences for the child and family.
Postpartum depression has significant consequences for both the mother and the couple, but it also has repercussions for the newborn child. The repercussions for the child may be more or less serious depending on the severity of the depression: altered development of the emotional bond between mother and child, as the mother may feel ambivalence, disinterest or negativity toward her child; risk of rejection of the child by the mother, which may harm the child’s cognitive and emotional development with long-term consequences (school problems, relationship difficulties, development of psychiatric pathology); rare but serious risk of infanticide or suicide of the mother. Given the importance of the familial consequences of postpartum depression, its diagnosis is a serious problem
In the weeks and months after delivery. A suffering mother rarely asks for help because she often feels like a bad mother. The environment and health professionals working with the mother and/or child (midwives, nursery nurses, doctors, pediatricians, …) must be especially vigilant to detect signs of depressive disorders. Depressive symptoms usually occur as early as pregnancy and can be diagnosed even before birth. However, experts estimate that 50% of postpartum depression remains undiagnosed. Recognizing postpartum depression is crucial, because if treated early, the disease can be treated effectively, limiting the consequences for all family members. The diagnosis is based specifically on the presence of at least five symptoms from the following list (one of the first two symptoms must be present): depressed mood throughout the day, almost daily, felt by the patient or reported by the entourage; marked loss of interest in all or almost all activities; significant weight loss or gain in the absence of diet; insomnia or hypersomnia almost daily; psychomotor agitation or slowing, noted by the entourage; fatigue or loss of energy almost daily; feelings of excessive or inappropriate worthlessness or guilt; decreased ability to think, concentrate or make decisions; recurrent negative thoughts, even suicidal thoughts.
The risk of recurrence of postpartum depression is significant, ranging from 10 to 35% in subsequent pregnancies. It is further increased in cases of surviving postpartum psychosis.The developmental potential of newborns and infants allows in 24 months to go from a state of total physical and mental dependence to a state of “thinking”, capable of autonomous motor skills. Such a developmental leap allowing the integration of very diverse data in such a short time, obviously requires great plasticity of mental structures, but also a “good enough” quality environment. Thus, maternal mental disorders, especially postpartum depression, given their frequency in the perinatal period, are particular risk factors for children’s psycho-emotional development.
Breastfeeding and postpartum depression.
Various studies have sought to understand whether breastfeeding has a protective effect against postpartum depression or, on the contrary, is a risk factor. These studies often lead to contradictory results. However, there is no evidence that breastfeeding increases the risk of postpartum depression. Successful breastfeeding usually helps build a mother’s self-confidence, reducing the risk of depressive disorders. Conversely, the implementation of breastfeeding can be a source of stress and cause guilt if it fails. When depression is diagnosed, breastfeeding may be compromised by drug treatment. However, breastfeeding can play a beneficial role for a mother with depression if she wants to continue it. The relationship between postpartum depression and breastfeeding thus appears complex, but without a direct causal link between the two.
Confessions of mothers who experienced postpartum depression.
“At the age of 23 I became a mother for the first time. I never imagined what would happen to me: violent postpartum depression. However, it all started well: even though becoming a mother was not innate in me, I was in a relationship for five years and saw my future child as the fulfillment of this passionate love,” admitted one of the women interviewed.
“I didn’t feel immediate love for my daughter. I got pregnant quickly, and my pregnancy couldn’t have gone better. I loved carrying my baby, feeling him move in my belly and watching my body change. I also liked the period when I was taken care of: I was pampered and taken care of. There was also something wonderful and sweet about preparing for the baby’s arrival, decorating his room or making a guest list. I let myself be lulled by all of these. A week after returning home, anxiety and doubt increased: I started having anxiety attacks and I stopped eating because the stress made me lose my appetite. I also couldn’t sleep because I was hyper-vigilant as a mom: I didn’t sleep anymore because I was afraid something would happen to my baby. It was the opposite of the happiness I had been promised so much. I asked myself a thousand and one questions: “how long will he sleep?”, “what will happen next?”, “how will I cope?”. The unknown frightened me and I felt helpless. I was dead.” confessed another.
Postpartum depression can befall a working woman, a businesswoman, as well as a housewife who does not work professionally. It is necessary to talk about depression to make people aware of the scale of the problem and suggest how to fight the disease,” says Anna Wyszkoni, singer, ambassador and co-organizer of the social campaign “Faces of Depression. I don’t judge. I accept – in Poland”
Suicide is the leading cause of death among women in the first year after childbirth in the UK and is one of the most dramatic consequences of untreated depression. And what is it like in Poland? “We as a country do not publish such statistics, so we can only rely on conclusions from other countries. Importantly, our program shows that, unfortunately, only 30 percent. women who have an elevated result in the screening test benefit from further assistance,” says Dr. Magdalena Chrzan-Dętkoś, psychologist, psychotherapist, substantive coordinator of the project “Przystanek Mama”, researcher at the Department of Psychology and Psychopathology of Development Institute of Psychology at the University of Gdansk.
What consequences can result from a lack of knowledge in this area?
According to a Canadian economic analysis, the cost of untreated pregnancy depression, including discontinuation of antidepressants, was valued at $14 billion a year. Poland has so far lacked not only data on the cost of untreated depression, but above all any systemic solution for screening and treating parents suffering from pre- or postnatal depression.
Treatment of postpartum depression.
Adequate management of postpartum depression is crucial to protect the mother, child and the rest of the family from the consequences of this disorder. It is based on three main axes: psychotherapy, sometimes used alone, especially when the mother is breastfeeding and/or refuses antidepressants or when depressive disorders are mild; support networks, through parenting groups and paternal involvement; drug treatment with antidepressants, necessary when depressive disorders are important.
In this context, different classes of antidepressants can be prescribed, and some of them are compatible with breastfeeding. In general, postpartum depression is treated like any depression. However, there is an additional difficulty, represented by the mother’s acceptance of the depressive disorder and treatment. However, without treatment, the average duration of postpartum depression is seven months, which sometimes has significant consequences for the child. Because treatment is most effective when postpartum depression is detected early, a mother or father who thinks he or she has it should talk to a health care professional (e.g., doctor, psychologist, nurse, clinician). The specialist consulted will determine the appropriate treatment based on the extent of depressive symptoms and mental health problems present before the pregnancy.