Post Partum Depression?
Q: I had this pretty badly 10 years ago. The biggest help to me came from
someone else who had been through it. She lent me a book: "Ended
Beginnings: Healing Childbearing Losses." This book covers the gamut of
childbirth-related losses, including PPD. When we think of such losses we
typically think of stillbirth or miscarriage. But there are other, less
obvious, losses associated with childbirth -- even if the baby is
perfectly healthy. For women who are predisposed to depression and other
emotional disorders, childbirth can be risky business. I urge you to read
the book to enlighten yourself about what may be going on with your wife
and give her a copy of the book too -- or get a trusted woman friend to
give it to her, if you have reason to think it will be better received
A:"Much has been written in the lay press about the 'baby blues,' and many mothers, predominantly primiparas, will admit to a few hours or a day of incredible emotional seesawing some time in the first week after delivery. Episodes in which a mother dissolves in tears when she has 'so much to be thankful for' is the usual description. This is a transient state that has been attributed to the tremendous change in hormonal levels after the delivery of the placenta, although there are no studies to confirm this belief. It is usually successfully treated with reassurance and rest. True post-partum depression does occur, however, and contrary to popular fantasy, it occurs in women who are breastfeeding but usually only in women with a problem prior to pregnancy. The incidence of psyuchiatric disorders during pregnancy is remarkably lower than age-adjusted rates in the general population, but rates in the postpartum period increase dramatically to 1-2 per 1,000, with 50% - 75% involving affective disorders, 10% - 20% schizophrenic illness, 2% - 12% organic psychiatric disorders, and 12% anxiety disorders. Studies of clinically depressed postpartum women reveal that 2 out of 3 have a major depression. In an extensive review of postpartum mental illness, Seager noted that with the introduction and use of antibiotics in the mid-50's, many symptoms, described as puerperal fever or milk fever, resulting in toxic-confusional or delirious behavior are no longer reported. A growing number of investigators have been unable to demonstrate significant evidence for a unique pattern of mental illness in puerperal as compared with nonpuerperal psychiatric disorders. Although childbearing might make a woman more vulnerable to psychiatric stress, the patterns of illness symptomatology, course, and outcome are no different from those of nonpuerperal women or males. The relative risk of serious psychiatric illness when it is immediately preceded by the event of childbirth is 15-fold. Causal mechanisms remain uncertain, however. Prevailing views support a concept of multi-factorial causes or the summation of stresses. Factors of ambivalence or negative attitude toward pregnancy, primary role conflict, lack of emotional and practical support, and increased numbers of life events are all part of the picture.