Baby Blues or Postpartum Depression?
Did you know that the majority of new mothers may experience a period of so-called “baby blues,” sometimes lasting up to ten days? Often peaking during the fourth day, this syndrome may include irritability, weeping, sadness, anxiety and confusion. This mood disturbance is transient, does not affect functioning, and resolves spontaneously. It is attributed in great measure to hormonal changes.
When the mood disturbance is more pervasive and lasts longer, it may be classified as “postpartum depression.” Postpartum depression is diagnosed in about 13 percent (one of every eight) of women after delivery. In the United States alone, this means about a half-million women every year. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), an episode of depression is considered to have postpartum onset if it manifests within four weeks after delivery. For research purposes, an onset within three months is usually adhered to. Some practitioners may diagnose this condition even prior to giving birth. Often, it qualifies as a “major” depression.
While in some cases they may co-exist, it is important to differentiate between postpartum depression and postnatal posttraumatic stress disorder (PTSD), as treatment may differ.
Prevalence, Epidemiology and Comorbidity
Major depression is diagnosed when several symptoms are present, including a decrease in interest or pleasure in activities that were previously enjoyed or a depressed mood. In addition, various symptoms of dysregulation must be present for most of the day over a minimum period of two weeks or longer. These include sleep disturbance, changes in appetite, and cognitive changes, such as a predominance of negative cognitions and attendant feelings (“I am worthless,” accompanied by despair or guilt) and difficulty concentrating. Consequently, it may be difficult to make decisions. There may also be suicidal ideation or recurrent thoughts of death. Clearly, it is important to seek timely professional help.
Predisposing conditions and known causes of postpartum depression
The rapid decline of reproductive hormone levels after delivery.
Birth trauma – an event or series of events experienced as traumatic during labor or childbirth, including a medical trauma (e.g., unplanned emergency C-section.)
- Adverse childhood experiences, developmental trauma, other traumatic experiences.
- History of depression and anxiety, including a previous episode of postpartum depression. Here, the risk of recurrence is considered to be one in four.
- Family history of mood disorders.
Factors that make birthtrauma more likely
- lack of relevant information and/or inadequately-based “informed” consent
- lack of dignity or privacy
- a sense of not being listened to and/or being subject to insensitive treatment by staff during this sensitive and highly stressful time
- fear of loss of control
- fear of impending death (self and/or baby)
- high level of medical intervention
- indequate pain relief
- unplanned emergency C-section
- fetal distress and subsequent fear for the baby’s safety
- need for neonatal intensive care (NICU) and potential delay in contact with baby
- having a baby born with a disabiity, subsequent to birthtrauma
- poor postnatal care
- witnessing a partner’s secondary trauma (in relation to one’s birthtrauma)
- a history of previous trauma
Symptoms of birth trauma
The following symptoms of postnatal post traumatic stress disorder (PTSD) may co-exist with post partum depression:
- hypervigilance, jumpiness, irritability, catastrophic thinking that something bad will happen
- avoidance of potential triggers that remind one of the trauma
- intusive thougts and images, nightmares, flashbacks (reliving the traumatic event as if it were re-occuring in the present)
- guilt feelings and negative cognitions/beliefs regarding the self in this situation
Screening, diagnosis and treatment
Various self-administered questionnaires may assist the clinician in determining the need for further professional attention. One such scale is the Edinburgh Postnatal Depression Scale. Another might be a PTSD Checklist. A high score should be followed up by a clinical interview designed to review the symptoms and establish a diagnosis.
Treatment may include psycho-education and participation in a support group comprising other women dealing with similar issues, individual psychotherapy, couples therapy and in some cases, anti-depressant medication (with special attention given to its potential impact on the fetus and/or breast-feeding infant).
Additional Resources
Osmond, M. (2001). Behind the smile: My journey out of postpartum depression. Warner Books.
National Women’s Health Information Center (http://www.4woman.gov)
Postpartum Support International (http://www.chss. iup.edu/postpartum)
Depression after Delivery (http://www.depressionafterdelivery.com).
What is Birth Trauma? (https://www.birthtraumaassociation.org.uk/for-parents/what-is-birth-trauma)
ד"ר רות שידלו
פיכולוגית קלינית ומטפלת בטראומה (SEP). בעלת תואר ראשון ושני בפסיכולוגיה מטעם אונ' בר-אילן ותואר שלישי בפסיכולוגיה קלינית מטעם ביה"ס לפסיכולוגיה מקצועית בסן דייגו.
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