The Facts

Having a baby is one of life's most wonderful experiences. It's exciting and joyous, but it can also be exhausting and frightening. After a woman has had a baby, she may find that she is confused and overwhelmed about the various emotions that she feels. She may worry that she's unable to deal with the responsibility of being a full-time parent.

After childbirth, many women experience symptoms of depression that can range from a brief attack of the "baby blues" to a serious and major clinical depression known as postpartum depression. A great majority of new mothers, about 80%, will experience a mild form of "baby blues," usually within a few days after giving birth. These feelings will usually resolve on their own and often go away within 7 to 10 days.

Postpartum depression affects about 10% to 20% of new mothers. This type of depression can affect women who have never been depressed before. Approximately 50% of women who were depressed during or after their pregnancy will also experience depression during future pregnancies. Postpartum depression may begin anytime in the first 6 months after delivery.

Postpartum psychosis is the most severe form of postpartum depression. It is relatively rare, and requires immediate discussion and treatment with a qualified health care provider.

Causes

There has been no single cause identified for postpartum depression. In fact, many factors can contribute to it. They may include:

• hormonal changes
• disappointment in birth experience
• a sense of loss from no longer being pregnant
• level of marital satisfaction
• caring for a very needy baby
• lack of family and social support
• exhaustion
• family history of postpartum depression
• history of depression

Symptoms and Complications

For women experiencing the "baby blues," feelings of sadness, anger, irritability, and insecurity are common. Self-doubts about being a competent mother may contribute to these feelings. Bursting into tears often occurs without reason.

"Baby blues" may also include the occasional negative thought about the baby. While these feelings are upsetting and disturbing, they're actually perfectly normal, and women shouldn't feel guilty for having them.

Postpartum depression is more severe and longer-lasting than the "baby blues." In addition to the above symptoms women may also experience:

• constant fatigue
• lack of joy in life
• sense of numbness
• social withdrawal from family and friends
• lack of concern for self or the newborn baby
• severe insomnia
• excessive concern for the baby
• loss of sexual responsiveness
• strong sense of failure and inadequacy
• severe mood swings
• appetite changes
• thoughts of suicide

Postpartum depression actually resembles many other forms of depression, with the added dimension that some of the symptoms involve thoughts about the baby. For example, the woman may not be either too concerned about the baby or not concerned enough; she may also have thoughts or fears of harming the baby.

Postpartum psychosis is a very serious condition that usually begins a couple of days or weeks after childbirth. A woman experiencing this form of depression has become severely depressed and may experience acute anxiety, restlessness, hallucinations, paranoia, and hysteria and have thoughts related to harming herself or the baby.

Making the Diagnosis

Postpartum depression is often overlooked because new mothers spend a lot of time alone with their infants, and it may take some time before anyone notices that they're depressed and in need of professional help. Because they get less sleep, most new mothers are generally exhausted anyway, and family and friends may consider the strange or different behaviour to be a reaction to being tired and coping with a new baby.

If you're a new mother and experience any of the above symptoms, you should speak to your doctor as soon as possible. Your doctor may wish to investigate the possibility of postpartum depression. Your doctor will want to spend some time discussing the symptoms with you, and may refer you for counselling or psychological support.

Treatment and Prevention

If you're experiencing postpartum depression or the "baby blues" you should take care of yourself by getting adequate rest, eating a nutritious diet, exercising in moderation, and accessing your social support system. Listen and respond to your body's cues for rest. If possible, get some rest during the day while the baby is napping. You may also need to call on friends, family, or a hired caregiver to help care for the baby so you can rest.

If you're suffering from postpartum depression, you should also seek early treatment with a doctor so you can have a more rapid recovery. Treatment methods vary and may include counselling, antidepressant medication, antianxiety medication, and hormone therapy. Support groups may also be very helpful. Concerned family members should discuss these symptoms with the family doctor if the new mother does not want to speak with the doctor herself.

In some cases, hospitalization may be necessary. Usually, the baby will be admitted with the mother or taken in for visits. The goal of treatment for postpartum psychosis is to keep mother and baby safe and to preserve the mother's sense of competence as a parent while she recovers.

Some antidepressants can enter breast milk and affect the baby's health. However, this is not the case with all antidepressants. If you want to continue breast-feeding, ask your doctor or pharmacist about medications that are safe to use while breast-feeding.

The good news is that there's a very high recovery rate for postpartum depression. While some women may have a longer-lasting experience with depression, most women will find that the condition improves in a few months with appropriate treatment.