What causes postpartum disorders?
Briefly stated, a postpartum disorder is a hormonally induced state
affecting a mother both mentally & physically. Drastic changes
take place during pregnancy and after childbirth in the mother's
hormonal and biochemical make-up which may lead to a chemical imbalance
in the brain. Added responsibilities of a new baby, changes in lifestyle,
personal expectations, and chronic exhaustion are only a few of
the factors which may lead to a postpartum disorder.
What are the different types of postpartum disorders?
There are 3 types of postpartum disorders and they move along a
continuum of severity. The baby blues, being the most common, affect
approximately 50-80% of all new mothers. This condition usually
emerges between the third day and first week include mood swings,
crying spells, sadness, irritability, and mild anxiety. These feelings
are considered a normal response to the dramatic hormonal changes
following delivery; They are transient, short-lived and typically
go away on their own. They are seldom associated with any lasting
problems for the mother, child, or family.
is also estimated that between 10-20% of all new mothers experience
a more severe and enduring postpartum disorder; Postpartum Depression
(PPD) which can begin any time within the first year after delivery.
PPD is a term used to describe a variety of moderate to severe symptoms
of depression and/or anxiety. It is important to note that despite
the term "postpartum depression", this emotional disorder
can exist with or without symptoms of depression! Often, women who
are only experiencing anxiety symptoms, panic attacks, or obsessive
thoughts are not diagnosed with this disorder, tend to "fall
through the cracks" and are frequently not referred for treatment.
PPD is usually characterized by insomnia or other sleep disturbances,
extreme fatigue, irrational fears about the baby's health or safety,
loss of appetite, lack of concentration, difficulty making decisions,
impaired memory, agitation, lack of pleasure or motivation in previously
enjoyable activities, low self esteem, inability to cope, and sometimes
even suicidal thoughts. The health, careers, and marriage of the
new parents are often compromised.
is a third but relatively rare (1-3 in a thousand) postpartum disorder,
Postpartum Psychosis. The time of onset is the same as PPD but the
symptoms are far more intense and may require hospitalization. Symptoms
of this disorder may include all those listed for PPD plus hallucinations,
delusions, great agitation, marked deviation in moods (severe depression
and/or mania) and fears or intent of harming oneself or the baby.
Q: Can we accurately predict who will experience postpartum
Although no woman can consider herself immune from this disorder;
some do appear to run a significantly higher risk than others. By
looking at both biological and psychosocial determinants, experts
do agree that some women are more susceptible to this emotional
disorder than others. They include:
Women with a previous episode of PPD. There is a 66% recurrence
rate for women who have not sought treatment. If a woman experienced
postpartum psychosis (1-3 in a thousand) after a delivery, the chance
of that recurrence jumps to 33%.
Women with a family history of PPD (i.e. mother, grandmother or
sister) are at risk. Also, women who grew up in a dysfunctional
family and have not worked through their own childhood issues are
at risk of PPD when they go on to have their own children.
The perfectionist woman with unrealistic expectations is at risk.
Ditto the "co dependent" who only wants to please others.
These personality "types" are hesitant to discuss their
negative feelings (which only worsens the condition).
The bearer of an unwanted pregnancy; a long, difficult or complicated
labor; an unsupported labor; a birth experience that didn't fulfill
expectations, or delivery of a premature baby or baby with problems
is also an increased risk.
Older women, career women, women who have had an abortion, miscarriages
or infertility problem are also viewed as high risk.
Marital issues such as denial of a previous PPD or being non-supportive
only increases the likelihood of PPD.
depression is not due to a personal weakness or flaw. New mothers
need not feel ashamed of having this condition or of seeking professional
mental health assistance. Early detection and prompt treatment have
a very positive prognosis, with a recovery rate of over 90%.
What about treatment?
Treatment for these disorders varies, depending on the type and
severity of symptoms. All of the symptoms, from the mild to the
most severe, are temporary and treatable with skilled professional
help and support. A woman experiencing any of these symptoms should
contact her healthcare professional. She should have a complete
medical evaluation, including a thyroid screening. The "ideal"
treatment plan includes:
evaluation (to rule out physiological causes such as thyroid)
in a PPD support group
- At times,
medication to correct the chemical imbalance created by the
dramatic hormonal changes.
is the first line of defense, because realistic expectations about
new motherhood can decrease the occurrence of depression and anxiety.
For those women who experience a postpartum disorder, it is of critical
importance that they have access to information and an understanding
that with proper treatment, education and support, they can not
only recover, but make a positive adjustment to motherhood.