ARE YOU SUFFERING FROM POSTPARTUM DEPRESSION?

By Lindsay Grubb

Dr Ruta Nonacs says in her book “A Deeper Shade of Blue”, that; “Depression can strike at any time

in a woman’s life, but women are most vulnerable during their childbearing years. About 10-15% of

women suffer from depression after the birth of a child; what may be surprising to some is that about

the same number of women actually experience depression during pregnancy.

Despite significant advances in our understanding of depression and its treatment, too often women

who suffer from depression in this setting do not receive the treatment they need and deserve. The

symptoms of depression are frequently overlooked or assumed to be a normal or expected

consequence of having a child. Many expectant and new mothers, unable to understand why they

feel depressed at a time when they are expected to feel happy, are too ashamed to ask for help.”

Ruta Nonacs, M.D., Ph.D. is the Associate Director of the Centre for Women’s Mental Health at the

Massachusetts General Hospital, and is an instructor in Psychiatry at Harvard Medical School. Her

website http://rutanonacs.com/ has many interesting articles on this topic and her resources page

has some very helpful links.

MY STORY

Each time I visited my GP in the first few months after our daughter was born, he would check her

out and write out her homeopathic prescription if needed, then turn to me and ask, “Okay, Ciara’s

just fine, how are you doing?”

Even though I was constantly feeling raw and on edge, battling feelings of helplessness, anxiety, and

frustration, and suffering from major sleep deprivation, I was too scared to admit the truth and

simply answered, “I’m okay; I could just do with a little more sleep.”

What I really wanted to do was burst into tears, and yell to anyone who would listen, “I’m not

coping! I don’t know how to handle this situation – I have no control! I’m worried all the time,

nervous I’m doing everything wrong, very little of what I am doing feels like it is working and I just

can’t seem to pick myself up out of this funk!”

I had not even admitted all of this out loud to my husband. I had told no-one. Instead, I let my

worries and desperation eat me up inside. I felt so guilty feeling like that. I told myself many times I

was a bad mother and I desperately needed someone to tell me I was doing an okay job, and that

what I was feeling was sort of normal.

As parents a lot of us have been in the same situation. Make no mistake – it’s not just mothers

feeling this way, fathers experience post partum depression too.

My salvation came when I finally plucked up the courage to tell my GP that I didn’t feel I was coping

at all, and that I was battling. I think he knew I was from the start. He was just giving me time to own

my feelings and take that first step and ask for help. I’m sure he would have brought it up eventually

but had assessed that my control freak nature meant that I needed to take the first step. He knew I

was still feeding and that I preferred a homeopathic treatment, and prescribed me a pick me up

tonic which would help me cope. We also sat and chatted for a while, and he did not chase me out

of his rooms, so he could move on to his next patient. It worked for me and I began to feel stronger

and more able to cope.

I also joined a small local mothers group at our Church and this support and friendship made a big

difference. Ciara enjoyed it too and it gave us both something to look forward to every week.

Things do get better with each passing day, and I am in a much stronger place now than I was six

months to a year ago. There are more good days than difficult ones. I was given a great mantra to

repeat when things get tough and I pass this to you: “This too shall pass”.

UNDERSTANDING THE DIFFERENT TYPES OF POSTPARTUM MOOD DISORDERS (PPMD)

It is important to recognise that a woman can suffer from PPMD regardless of the pregnancy’s

outcome, (i.e. whether the child was born healthy, still-born or a miscarriage at any stage during the

pregnancy).

Unless you have a medical degree, you should not be self-diagnosing. The information in this article is simply to assist you in identifying the signs of post-partum mood or anxiety disorders. If you think you might have a postpartum mood or anxiety disorder, please contact your healthcare provider as soon as possible. Remember it’s important to check with your healthcare provider to ensure that the medical or homeopathic / herbal remedies prescribed are suitable for you, especially if you are breastfeeding.

Postpartum “Baby” Blues

Postpartum blues occur in more than 50% of women, and is particularly prevalent in first time

mothers. It is a mild and short lived depression, characterised by feelings of anxiety, irritation,

tearfulness, and restlessness. It usually occurs in the first week after pregnancy and goes away

within two to three weeks, and generally without the need for medical treatment. Mothers

experiencing postpartum blues will ride a rollercoaster of emotions, experiencing the ecstatic highs

of joy and elation followed by the lows of despair and depression.

It is usually as a result of the hormones of pregnancy dropping suddenly coupled with the mother

having to take care of a new baby with constant demands and fatigue. It does require emotional and

physical support from your partner, family and friends.

Ways of effectively combating postpartum blues include;

Ensuring the mother is getting enough rest – this is critical for physical and mental recovery after the

birthing process.

Ensuring the mother is getting enough healthy, nutritious means, and drinking plenty of fluids and

doing some form of light exercise like walking on a daily basis

Ensuring that there is someone to assist the mother with household chores and cooking – if relatives

are not able to be there consider hiring a postpartum doula (a professional trained to help family

after the birth of a baby. As opposed to a baby nurse whose focus is on the new baby, the focus of

the postpartum doula is on the care of the mother and the family, assisting with care of the siblings

and performing household chores such as cleaning and laundry, cooking etc.)

Join a mom’s support group – this is a wonderful way to share your experiences with other new

mothers who are probably experiencing baby blues as well

Postpartum Anxiety Disorders

There are a number of postpartum anxiety disorders including;

Generalised Anxiety Disorder (GAD)

This is usually characterised by excessive worry or anxiety which the mother battles to control. It is associated with restlessness, fatigue, irritability, muscle tension or insomnia.

Obsessive-compulsive Disorder (OCD)

This includes persistent obsessions or thoughts often about hurting the baby and or compulsions that are repetitive, ritualistic behaviours that are difficult to control such as excessive, repetitive cleaning of the home in order to ensure a sterile environment, which becomes outside the mother’s control.

Panic Disorder

Panic attacks can be debilitating. They are characterised as extreme anxiety accompanied by chest pains, dizziness, sweating, shaking etc.

Panic attacks are often triggered by a particular location, person or event and are uncontrollable.

Postpartum Depression

According to the University of Maryland’s Medical Centre Medical Reference Encyclopaedia,

Postpartum depression is defined as “moderate to severe depression in a woman after she has given

birth. It is characterised by a consistent change in mood that affects thoughts and behaviours. This

serious condition occurs anywhere from four weeks to a year after pregnancy and affects between 8

– 20% of women. It can occur anywhere from 4 weeks to a year after pregnancy and is a more

intense, longer lasting but treatable depression.

Medical attention is needed to treat postpartum depression effectively. There are a number of

medications or homeopathic remedies that can be prescribed by your doctor or homeopath, and

these are often used in conjunction with counselling and support groups.

It is often difficult to differentiate between “Baby Blues,” and Postpartum Depression in the early

stages as their symptoms are very similar. However, postpartum depression can be often be

identified if the mother shows signs of ambivalence to the infant and neglect of herself and other

family members. The duration of the depression is also an indicator.

Mother’s suffering from postpartum depression often have suicidal thoughts or thoughts of harming

the child – it is very important to reach out to your medical health practitioner and ask for assistance

Research shows that between 10-15% of women will develop postpartum anxiety disorders. Often it is recommended that any physical causes such as hypoglycaemia and hypothyroidism be ruled out before a diagnosis of an anxiety disorder is given.

As with postpartum blues, ways of effectively combating postpartum anxiety disorders include;

Ensuring the mother is getting enough rest – this is critical for physical and mental recovery after the

birthing process.

Ensuring the mother is getting enough healthy, nutritious means, and drinking plenty of fluids and

doing some form of light exercise like walking on a daily basis

Ensuring that there is someone to assist the mother with household chores and cooking – if relatives

are not able to be there consider hiring a postpartum doula (a professional trained to help family

after the birth of a baby. As opposed to a baby nurse whose focus is on the new baby, the focus of

the postpartum doula is on the care of the mother and the family, assisting with care of the siblings

and performing household chores such as cleaning and laundry, cooking etc.)

Join a mom’s support group – this is a wonderful way to share your experiences with other new

mothers who are probably experiencing baby blues as well

In addition to this mothers diagnosed with a postpartum anxiety disorder can also benefit from;

Relaxation exercises

Support groups

Counselling by mental health practitioners with special focus on postpartum anxiety disorders

Anti-depressants or homeopathic remedies

Psychotic Depression

Postpartum psychosis is rare with only 1 in 1000 women afflicted by this condition. A mother suffering from psychotic depression will suffer from the same symptoms as the aforementioned anxiety disorders and postpartum blues. In addition to this she will often experience hallucinations or delusions. Her disorder is often not easily identified by family members because she will have periods when she appears fine. What is important to note is that during the times she is experiencing a psychotic break, her judgement is severely impaired and neither she nor the baby are safe. She may not even remember what she has done during these periods.

Postpartum psychosis must be considered an emergency and treated immediately. The mother will generally respond quickly to medication and in most cases will need to recover in a hospital or clinic.

She will also need to be aware that she is 40-100% at risk for developing postpartum psychosis at some period in the future, and that it will in all likelihood recur if she should have another child.

USEFUL CONTACTS AND LINKS

The Post Natal Depression Support Association

If you need help whether you think you have baby blues or postpartum depression, please contact

the PNDSA on the following contact details:

National help-line: +27 (0)82 882 0072

CAPE TOWN: Office Telephone / Fax: +27 (0)21 797 4498 Email: info@pndsa.org.za

GAUTENG: Help Line: +27 (0)82 429 2279 Debbie Levin: +27 (0)11 786 8803 Email:

pndsagauteng@gmail.com

Website: http://www.pndsa.co.za/index.html

PNDSA is a non-profit organisation dedicated to:

providing information and support for women from all walks of life, who are experiencing Postnatal Depression, and their families, in order to ensure early identification, timeous referral and effective treatment;

educating and creating awareness and sensitivity in all professionals who are in contact with women who may be at risk for Postnatal Depression;

providing an effective network of support for those suffering the effects of Postnatal Depression, including telephone counselling, home and hospital visiting, group support, and referral to sympathetic professionals for medication and/or therapy;

networking and lobbying health authorities nationally, with the purpose of empowering women, and influencing policy-making at all levels, in order to create a mother/baby/family-friendly society within the health system of South Africa;

educating the general public, in order to combat the ignorance, intolerance, and fear of being stigmatised, which prevents mothers from acknowledging that they are struggling with the effects of Postnatal Depression;

preventing possible child abuse and neglect, resulting from the inability of many depressed mothers to care adequately for their children;

preventing long-lasting adverse effects on the social, intellectual and emotional development of the children of mothers who suffer from Postnatal Depression;

preventing the breakdown of marriage relationships, which often result from the stresses of untreated Postnatal Depression, through support of partners and other significant members of the family;

providing training of support workers in all communities;

encouraging and disseminating research related to Postnatal Depression in South Africa;

networking with other professional and voluntary organisations, nationally and internationally, who are concerned with the support, care and education of mothers in the ante- and post-natal period.

PNDSA also provides:

Assessment interviews, counselling, support groups, training workshops for professionals & volunteers, telephonic support & counselling, conference & other presentations, distribution of informational material & pamphlets, lectures to health professionals & the general public, hospital visits by volunteers, media interviews, a resource centre & library (for PNDSA members), special interest group meetings for professional members and a quarterly newsletter.

Useful Links

Dr Ruta Nonacs - http://rutanonacs.com/blog21/about/

Article by Brenda J. Lane, ICCE,

CD(DONA)http://pregnancy.about.com/cs/postpartumdepress/l/blppd.htm

Postpartum Progress -http://postpartumprogress.typepad.com

Postpartum Support International - http://www.postpartum.net

http://www.dona.org

BMJ – clinical evidence on Postpartum Depression

http://clinicalevidence.bmj.com/ceweb/conditions/pac/1407/1407_background.jsp

http://clinicaltrials.gov/ct2/show/NCT00961402?recr=Open&cond=%22Depression%2C+Postpartum

%22&rank=9

Further Reading

Overcoming Postpartum Depression and Anxiety, Linda Sebastian

Postpartum Depression & Anxiety: A Self- Help Guide for Mothers, Pacific Post Partum Support

Society

Postpartum Survival Guide, Anne Dunnewold and Diane Sanford

This isn't what I expected, Karen Kleman and Valerie Raskin

Mothering the New Mother, Sally Placksin

Healing Herbs, Sari Harrar and Sara Altshul O'Donnell

PNDSA Suggested Reading list compiled by Liz Mills: March 2000

Atkinson, Dr Holly: Women & Fatigue (Papermac, London, 1988). Deals with Depression in relation

to Fatigue. Practical.

Ball, Jean A: Reactions to Motherhood. The role of postnatal care. (Books for Midwives Press,

Cheshire UK. 1994) Research by a midwife on the effects that psychological and social factors, and

care given by midwives, might have on the emotional state of the new mother. Interesting,

especially for midwives, childbirth educators and obstetricians.

Barnett, Dr Bryanne: Coping with Postnatal Depression. (Lothian Books, Port Melbourne, Victoria,

Australia. 1991) An excellent, understandable explanation.

Baumel, Syd: Dealing with Depression Naturally. (Keats Publishing, Connecticut, USA. 1995) Offers

“natural ways” to treat depression – vitamins, homeopathy, exercise, visualization, etc. May have

some appeal.

Bloomfield, Dr Harold H. & McWilliams, Peter: How to Heal Depression. (Thorsons, London. 1995)

Simple-to-follow explanation of depression, and suggestions of how to find healing.

Blackie, Penny: Becoming a Mother After Thirty. (Basil Blackwell, Oxford, UK. 1986) Practical

suggestions from actual experience. Helpful.

Blumfield Wendy: Life after Birth. (Element Books, Shaftesbury, Dorset, UK. 1992.) Focus on reality

of pregnancy, birth and what happens later, including a section on PND. Good.

Breen, Dana: Talking with Mothers. (Free Association Books, London.1989. The reader joins a

mother and shares her experience of pregnancy, birth and afterwards – her fears, fantasies and

reflections at this time of change. Recommended.

Buist, Anne. Psychiatric Disorders associated with Childbirth - A Guide to Management. (McGraw-

Hill, Australia, 1996) Excellent, serious, academic.

Burns, David D. M.D.: Feeling Good. (Signet Books, New York, 1981) A practical, cognitive approach -

self-help treatment for depression.

Burns, David D. M.D.: The Feeling Good Handbook. (Plume Books, Penguin Books, Middlesex,

England. 1990) See above. Exercises.

Comport, Maggie: Towards Happy Motherhood. (Corgi Books, London. 1987) A self-help book,

offering sound and sympathetic advice on managing PND.

Copeland, Mary Ellen. Living Without Depression & Manic Depression. New Harbinger Publications,

Oakland, California. 1995) Work Book for maintaining mood stability. Practical.

Cox, John & Holden, Jeni: Perinatal Psychiatry. Use and Misuse of the Edinburgh Postnatal

Depression Scale. (Gaskell, Royal College of Psychiatrists, London, 1994) Research-based, academic,

and excellent.

Cox, John L.: A Guide for Health Professionals. Postnatal Depression. (Churchill Livingstone,

Longman, Edinburgh, 1986) Classic.

Coyne, James C. (Ed.): Essential Papers on Depression. (New York University Press, 1985). Exactly

what it claims to be.

Cozad, Sheryl & Craig: Mam’s Voyage. (Willow Pond Arts, Norman OK, USA, 1999). Beautifully

illustrated graphic representation of PND. Art.

Dalton, Katharina: Depression after Childbirth. (Oxford University Press, 1985) Classic. Exponent of

hormonal treatment for PND.

Dalton, Katharina with Holton, Wendy M.: Depression after Childbirth. (Oxford Paperbacks, 1996)

See above revised 3rd edition.

DePaulo, J. Raymond, MD & Ablow, Keith Russell, MD: How to Cope with Depression. (Fawcett

Crest, New York. 1989). Guide to general Depression.

Dominian, Jack. Depression. What is it? How do we cope? (Fontana, Glasgow, UK. 1990) Readable,

general overview of depression at different stages in the life cycle.

Dix, Carol: The New Mother Syndrome. (Unwin Paperbacks, London. 1987) Easily read,

compassionate and recommended.

Dunnewold Ann L: Evaluation and Treament of Postpartum Emotional Disorders. (Professional

Resource Press, Sarasota, Florida. 1997) Academic. Excellent for practitioners.

Dunnewold, Ann & Sanford, Diane G.: Postpartum Survival Guide. “ It wasn’t supposed to be like

this …” (New Harbinger, California, 1994). Excellent, accessible and practical. Highly recommended.

Eagan, Andrea Boroff: The Newborn Mother. (Own Books, Henry Holt & Co. New York, 1987) A

sensitive description of the process of adjustment to motherhood.

Eisenberg, Arlene, et al: What to Expect the first year. (Simon & Schuster, London, 1996)

Feinmann, Jane. Surviving the baby blues. (Ward Lock, 1997) Excellent, understandable and helpful

book about postnatal depression.

Field, Peggy Anne & Marck, Patricia Beryl, Eds: Uncertain Motherhood. (Sage Publications, London,

1994) Sensitive and thought-provoking book about maternal behaviour in non-optimal outcomes of

pregnancy. Recommended for health professionals.

Figes, Kate: Life after Birth. What even your friends won’t tell you about motherhood. (Viking,

1998) Comprehensive, and readable. Good.

Flach, Frederic F., MD: The Secret Strength of Depression. (Bantam, London 1986).

Gillett, Dr Richard: Overcoming Depression. A practical self-help guide to prevention and

treatment. (The British Holistic Medical Association. Dorling Kindersley, London. 1987). This book

does what it promises to do!

Hamilton, James Alexander, & Harberger, Patricia Neel (Eds.): Postpartum Psychiatric Illness. A

Picture Puzzle. (University of Pennsylvania Press, Philadelphia, USA, 1992). A scholarly, informative

classic.

Huysman, Arlene M: A Mother’s Tears. Understanding the Mood Swings that Follow Childbirth.

(Seven Stories Press, New York. 1998) An excellent, research-based, accessible book, useful for

clinicians and lay public.

Irwin, Cait: Conquering the Beast Within. How I fought depression and won … and how you can,

too. (Times Books, Random House, New York, 1998) A teenager’s powerful description of her

journey into the darkness.

James, Jennifer: Women & the Blues. Passions that hurt Passions that heal. (Harper & Row, San

Francisco, 1988.) Deals with depression at different times in a woman’s life, offering practical advice.

James, Kath. The Depressed Mother. A Practical Guide to Treatment and Support. (Cassell, London.

1998). A nurse writes, explaining PND, its effects and management.

Kendall-Tackett, Kathleen A. & Kantor, Glenda Kaufman. Postpartum Depression. A Comprehensive

Approach for Nurses. (Sage Publications, London, 1993) What you would expect. Very good.

Kleinman, Karen R. & Raskin, Valerie D.: This Isn’t What I Expected. Overcoming Postpartum

Depression. (Bantam Books, New York, 1994) An excellent book for sufferers and those around

them, with lots of practical guidelines.

Kumar, R. & Brockington, I.F: Motherhood and Mental Illness. Causes and consequences. (Wright,

Butterworth & Co., London, 1988) Academic, important reference work.

Lake Tony: Defeating Depression. (Penguin, 1987). General depression.

Lewis, Cynthia Copeland: Mother’s First Year. (Betterway Publications, Virginia, USA, 1989)

Lipkin, Mike: Lost and Found. My Journey to Hell and Back. (Human & Rousseau, Cape Town, 1995).

Rivetting, personal experience of depression.

Littlewood, Jane & McHugh, Nessa. Maternal Distress and Postnatal Depression. The Myth of the

Madonna. (Macmillan, 1997) Takes a multifactorial view of PND; research-based. Very useful for

care-givers.

Marmorstein, Jerome, and Marmarstein, Nanette: Awakening from Depression. A Mind/Body

Approach to Emotional Recovery. (Woodbridge Press, Santa Barbara, USA, 1992). A Self-Help Guide

to managing general depression.

Maushart, Susan: The Mask of Motherhood. (Vintage Australia. Random House, 1997) An excellent

book that looks at the reality of becoming a mother. Recommended.

McConville, Brigid: Beating the Blues. (Headline Book Publishing, London, 1996) Very readable, self-

help book about depression, including PND.

McConville, Brigid: Mad to Be a Mother. (Century Hutchinson, London, 1987). Readable anaysis of

the pressures and anomalies that face mothers in today’s society.

McCormick, Elizabeth Wilde. Nervous Breakdown. A Positive Guide to Coping Healing and

Rebuilding. (Unwin Paperbacks, 1988) Discusses symptoms and management of life crises that

overwhelm people.

Misri, Shaila, M.D.: Shouldn’t I be Happy? Emotional problems of pregnant and postpartum

women. (Simon & Schuster, New York, 1995) Comprehensive, compassionate and realistic.

Recommended.

Murray, Joanna: Prevention of Anxiety and Depression in Vulnerable Groups. A Review of the

Theoretical, Epidemiological and Applied Research Literature. (Gaskell, Royal College of

Psychiatrists, London, 1995) Academic and professional.

Murray, Lynne & Cooper, Peter J. (Eds): Postpartum Depression and Child Development. (Guildford

Press, New York, 1997). Scholarly and excellent. Recommended.

Musikanth, Susan: Depression Matters. (Jonathan Ball Publishers, Jeppestown, 1997) Readable,

useful and practical. General Depression.

Newton, Jennifer: Preventing Mental Illness. (Routledge & Kegan Paul Ltd., London, 1990).

Academic, reviews research, makes recommendations for treatment.

Oakley, Ann: From Here to Maternity. (Penguin, Middlesex, England, 1986) An overview of various

stages of early motherhood, from pregnancy onwards. Realistic and readable.

Pacific Post Partum Support Society: Postpartum Depression and Anxiety. A Self-Help Guide for

Mothers. (1997). Simple, readable and down-to-earth.

Page, Andrew: Don’t Panic! Overcoming anxiety, phobias & tension. (Health Book Series, Australia).

Self-help booklet.

Phillips, Jenny. Mothers Matter Too! A positive approach to life for mothers at home. (Penguin,

Middlesex, England, 1985). Feminist, realistic and helpful.

Placksin, Sally: Mothering the New Mother. Your Postpartum Resource Companion. (Newmarket

Press, New York, 1994) An excellent resource book for new mothers.

Price, Jane: Motherhood. What it Does to your Mind. (Pandora Press, Unwin Hyman, London, 1988)

A realistic, helpful and readable book about early motherhood, including postnatal depression.

Priest, Robert: Anxiety & Depression. A practical guide to recovery. (Martin Dunitz, 1983). Very

simple. General.

Raskin, Valerie Davis, M.D.: When Words are Not Enough. (Broadway Books, New York, 1997)

Rix, Juliet: Is There Sex After Childbirth? (Thorsons, Harper Collins, London, 1995)

Roan, Sharon L. Postpartum Depression. (Adams Media Corporation, 1997)

Rowe, Dorothy. Breaking The Bonds. (Fontana, Harper Collins, London,1991)

Rowe, Dorothy: Choosing Not Losing. (Fontana, Harper Collins, London, 1988)

Sanders, Deidre: Women and Depression. (Sheldon Press, London, 1987)

Sapsted, Anne Marie: Banish Post-Baby Blues. (Thorsons, England, 1990)

Scarf, Maggie: Unfinished Business. (Ballentine Books, New York, 1988)

Sebastian, Linda. Overcoming Postpartum Depression & Anxiety. (Addicus, 1998)

Shaw, Fiona: Composing Myself. A Journey Through Postpartum Depression. (Steerforth Press,

Vermont, USA, 1998) . Dramatic, disturbing personal account of Postnatal Depression.

Shaw, Fiona: Out of Me: The Story of a Postnatal Depression. (Viking, 1997) See above – British

Edition.

Smith, Gerryilyn & Nairne, Kathy: Dealing with Depression. (The Women’s Press, London, 1995)

Swigart, Jane: The Myth of the Bad Mother. The Emotional Realities of Mothering. (Doubleday,

New York, 1991). Excellent look at the psychological processes of care-giving from birth to

adolescence.

Taylor, Verta: Rock-a-By Baby. (Routledge, New York, 1996)

Viorst, Judith: Necessary Losses. (Simon & Schuster, London, 1986)

Welburn, Vivienne: Postnatal Depression. (Fontana, London, 1986)