Expert OB-GYN staff members at HealthAlliance of the Hudson Valley explain the causes, symptoms and treatments for postpartum depression.
By Lisa Cesarano
For many mothers, holding their newborn baby is simply love at first sight.
But the reality of new motherhood can be far more complex. While it’s natural to experience the so-called “baby blues,” which includes sadness, fatigue and worry, new mothers are also at risk for a potentially dangerous condition called postpartum depression (PPD). One in nine women live with PPD, according to the Centers for Disease Control and Prevention.
HealthAlliance, a member of the Westchester Medical Center Health Network (WMCHealth), offers comprehensive services to help with this condition. We asked Dean Bloch, MD, Chair of Obstetrics and Gynecology, midwife Elizabeth Pickett, CM, LM, MS, and Barbara Smith-Foy, LM, MS, Associate Director of Maternal Health, Outreach and Education, to share their expertise on the subject.
What are the causes of postpartum depression?
Smith-Foy:The causes are not completely known but are thought to result from a combination of hormonal shifts, sleep disturbances, stress and the psychological adjustment to motherhood.
How prevalent is it?
Bloch: Overall, average risk of PPD is 12 to 21 percent. Among those with a history of PPD, the likelihood of experiencing it with the next pregnancy increases to about 32 percent.
Thirty percent of the women who showed signs of depression after delivery had experienced an episode of the condition before pregnancy; 40 percent had one episode during pregnancy; and more than two-thirds also had signs of an anxiety disorder.
What are the risk factors?
Smith-Foy: Risk factors include a history of a mood disorder, including bipolar disorder, living in an urban environment and single parenthood. Additionally, greater work and financial stress, as well as greater stress in pregnancy, increase the possibility of PPD. Other factors include lack of partner support, becoming a mother under the age of 20, substance abuse, medications and medication changes.
What are the telltale symptoms?
Pickett: Difficulty bonding and negative thoughts are the most prevalent symptoms. Mothers struggling with PPD also can feel disconnected and can experience delayed response and reaction to their baby’s needs. Feelings of anxiety, guilt, detachment, agitation and nervousness are common.
Smith-Foy: Social isolation and withdrawal are also big components of this condition. These mothers can often feel judged and compare themselves with other mothers. They may feel guilty about not being “in love” with the baby or feel that they are a “bad” parent. It’s not unusual for these women to lash out at their spouses and others offering support.
As this progresses, typical clinical signs of depression set in: changes in sleep, appetite, decreased energy, lack of interest, hopelessness, not making plans or looking forward to future plans or activities, isolation and withdrawal.
How is PPD diagnosed?
Bloch: It is important to evaluate prenatally to see if a mother is at risk of PPD. It’s diagnosed by an OB practitioner, usually through an in-person evaluation. If the patient scores high on a risk-assessment survey, she will then be referred to a mental health professional for further evaluation and testing.
What are some of the social factors that increase risk of PPD?
Smith-Foy: During recovery from childbirth, the mother experiences a radical lifestyle change: frequent feeding, sleep deprivation, exhaustion, staying home to care for the baby, loss of social contact during the first few months after birth — all of these are contributing factors.
What are the treatments?
Pickett: Treatments include medications (e.g., antidepressants, mood stabilizers or anxiety medications) and counseling, including talk therapy, cognitive-behavioral therapy or interpersonal, group or couple’s therapy. Also, peer support, like PPD groups or new mother groups, nutrition, exercise and lifestyle management help.
What are the risks of untreated PPD?
Smith-Foy: Untreated, PPD can progress to major depressive disorders and postpartum psychosis, as well as impaired parenting and coping strategies.
How do you distinguish PPD from a new mother just feeling overwhelmed?
Pickett: It is normal to feel overwhelmed and stressed as a new mother. “Baby blues” are typical and caused by the shift in hormones after delivery. This presents as weepiness and sadness but resolves on its own within two or three weeks. Anything beyond that time frame is considered excessive and the mother should be evaluated for PPD.
What can be done to prevent PPD?
Pickett: Make sure the new mother is getting adequate nutrition and enough rest after delivery, support with household responsibilities and good breastfeeding support. Peer support groups are a great way to aid in PPD detection and prevention.
What should concerned family members do if they suspect a loved one is suffering from PPD?
Pickett: It’s important for families to be aware of the signs, and if they are observed, to get help immediately from a healthcare provider. Prenatal teaching on a regular basis and postpartum education at discharge with both the mother and her partner help families distinguish between “baby blues” and the development of PPD.
Is PPD solely experienced by the mother?
Smith-Foy: Great question! Having a baby is a seismic event for the whole family, and as such, it can also impact the parent who did not carry the child.
Visit us at HealthAlliance Hospital, a member of Westchester Medical Center Health Network, to learn more. Advancing Care. Here.