Prenatal & Postpartum Depression

Pregnant and new mothers who battle with depression, anxiety or obsessive thinking are also battling the myths our society has created around having babies. Many women expect to love everything about being pregnant, bond immediately with their babies, and feel grateful and content with every moment of motherhood.
The reality is, sometimes being a mom is exhausting.
Some pregnant women have deep fears about becoming mothers. Some women have great stressors in their lives while they are pregnant that overshadow the connection to the life growing inside them.

Some babies have very high needs. Some have complications during birth that create stress and fear. Some moms have a long recovery period from the birth experience. Sometimes breastfeeding is very hard or doesn't work. Sometimes moms expect that because they waited so long and worked so hard to have a baby, (whether the pregnancy came easy or was a result of many years of fertility work,) that they should be happier than they are.
And some women are severely affected by hormonal swings or their genetic predisposition to depression or anxiety.
About 10% of pregnant women experience depression or a related mood disorder. Prenatal mood disorders are just as disturbing for the women as postpartum mood disorders, though they are often passed off as normal side effects of pregnancy hormones.

Over 15% of mothers of newborns are afflicted with depression, obsessive thoughts, and/or anxiety. Another one in a thousand suffers from postpartum psychosis. These are NOT signs of bad or ill-prepared mothers. PPMDs come from hormonal changes and genetic predispositions and can be exacerbated by life stressors.
The first step in coming to peace with depression, anxiety, or disturbing obsessive thoughts is to acknowledge how you are feeling.
The next step is to reach out for help.

Recognizing the Signs

Here are some symptoms to be aware of. Remember that, as human beings, we are complex. Therefore, it is not uncommon to experience symptoms in several different areas.

Post Partum Blues-"Baby Blues"
Onset: within the first week after birth
Occurrence rate: 80% of new mothers
Duration: from several days up to six weeks

Symptoms
*Mood instability
*Weepiness
* Sadness
*Anxiety
* Lack of concentration
*Feelings of dependency

Causes
* Rapid hormonal changes
* Physical and emotional stress of birthing
* Physical discomforts
* Emotional letdown after pregnancy and birth
* Awareness and anxiety about increased responsibility
* Fatigue and sleep deprivation
* Disappointments including the birth, spousal support, nursing, and the baby

Postpartum Depression and/or Anxiety
Onset: Usually gradual but it can be rapid and occur any time in the first year
Occurrence rate: 15-20% of mothers

Symptoms
*Excessive worry or anxiety
*Irritability or short temper
*Feeling overwhelmed, difficulty making decisions
*Sad mood, feelings of guilt, phobias
*Hopelessness
*Sleep problems (often woman cannot sleep or sleeps too much)
*Physical symptoms or complaints in excess of, or without physical cause
*Discomfort around the baby or a lack of feeling towards the baby
*Loss of focus and concentration (may miss appointments, for example)
*Loss of interest or pleasure, decreased libido
*Changes in appetite; significant weight gain or loss

Risk Factors
*50-80% risk if previous postpartum depression
*Depression or anxiety during pregnancy
*Personal or family history of depression
*Abrupt weaning
*Social isolation or poor support
*History of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD)
*Mood changes while taking birth control pill or fertility medication, such as Clomid
*Thyroid dysfunction

Postpartum Obsessive-Compulsive Disorder (OCD)
Onset: Usually gradual but it can be rapid and occur any time in the first year
Occurrence rate: 3-5% of new mothers

Symptoms
*Intrusive, repetitive and persistent thoughts or mental pictures
*Thoughts often are about hurting or killing the baby
*May include counting, checking, or other repetitive behaviors
*Tremendous sense of horror and disgust about these thoughts

Risk Factors
*Personal or family history of OCD

Postpartum Panic Disorder
Occurs in about 10% of postpartum women

Symptoms:
*Episodes of extreme anxiety
*Shortness of breath, chest pain, sensations of choking or smothering, dizziness
*Hot or cold flashes, trembling, palpitations, numbness or tingling sensations
*Possible restlessness, agitation or irritability
*During attack, the woman may fear she is going crazy, dying or losing control
*Panic attack may wake her up
*Often no identifiable trigger for panic
*Excessive worry or fears (may center around fear of more panic attacks)

Risk factors
*Previous history of anxiety or panic disorder
*Thyroid dysfunction

Postpartum Psychosis
Onset: about 3 days postpartum
Occurrence rate: 1-3 per thousand new mothers

Symptoms
*Visual or auditory hallucinations
*Delusional thinking (for example, about infant death, denial or birth or need to kill baby)
*Delirium and/or mania

Risk Factors
*Personal or family history of psychosis, bipolar disorder or schizophrenia
*Previous postpartum psychotic or bipolar episode

Postpartum Posttraumatic Stress Disorder (PTSD)

Symptoms
*Recurrent nightmares
*Extreme anxiety
*Reliving past traumatic events (events may be sexual, physical, emotion or related to childbirth)

Risk Factors
*Past traumatic events

Excerpt from: Bennett, S., Indman, P., Beyond the Blues: Prenatal & Postpartum Depression, A Treatment Manual, Moodswings Press, San Jose, 2002, pp. 22-26.

Pre-Natal Mood Disorders
If you are pregnant and experiencing symptoms of depression, anxiety or obsessive thinking, you may have a prenatal mood disorder. Treatment is essential to return to feeling like yourself again. Untreated depression can result in low birth weight, preterm delivery and occasionally suicide in the mother.

If you are pregnant and think you may be at risk for a PPMD, talk to your midwife or obstetrician and ask her to screen you. If you are prepared for the possibility of experiencing depression after your baby comes, you will have the ability to overcome it quickly or even avoid it all together if you surround yourself with resources.

What to do:

If you are experiencing any of the symptoms listed above, it is time to seek professional help. Women who are treated for postpartum mood disorders have remarkably high recovery rates. They are able to bond with their babies, feel good about their roles as mothers and lead very productive and satisfying lives.

For information about counseling or support groups contact Nancy Goodman, LCSW, Click here to email (nancy@aparentconnection.com) or call 303-916-6929.