Postpartum Depression
Postpartum depression starts later, is more intense and devastating, and lasts longer than postpartum after-baby blues. It may start anytime during the first year postpartum. The mother gradually slips deeper and deeper into depression, becomes increasingly incapable functioning, and thinks angry and hurtful thoughts about her baby, which she suppresses because she’s “not supposed to think this way.” She becomes lonely and isolated and feels she has lost control. She is truly suffering.
Beck has identified 11 themes and developed a checklist of 11 symptoms of postpartum depression a mother can experience, to be used by a health care professional in discussion with a mother:
- Lack of ability to concentrate; feeling “in a fog”
- Loss of previous interest and goals; feeling empty.
- Unbearable loneliness; feeling that no one understands.
- Insecurity and need to be mothered herself.
- Obsessive thinking about being a bad mother.
- Lack of positive emotions-perceives herself as going through motions like a robot.
- Loss of self from fear that normalcy in her life is irretrievable.
- Loss of control of her emotions.
- Anxiety attacks; feeling that she is on the edge of insanity.
- Guilt and fear at thoughts of harming infant.
- Thoughts of death to end this living nightmare.
Postpartum depression should be differentiated from postpartum psychosis, which is a very confused state of extreme highs and lows, agitation, seeing and hearing things that others don’t (including voices that may “order” the persons to do things she normally would not do), and frightening thoughts of harming herself of her baby. A mother with these symptoms needs immediate psychiatric help. Postpartum depression also must be differentiated from postpartum thyroiditis with its symptoms of extreme fatigue and weight loss, or later, weight gain. Differentiation is difficult because both postpartum depression and postpartum thyroiditis present with overwhelming fatigue, which affects the mother’s activities of daily living and her capacity for taking care of her baby. A thyroid work-up is indicated when a mother’s depression is prolonged, her weight does not stabilize, the onset of her fatigue was rapid, and fatigue is present without physical exertion.
It is most helpful in the midwife’s approach to a mother with postpartum depression to acknowledge what she is experiencing and to tell her it’s ok to express what she may think are socially unacceptable negative feelings. Connecting her with support groups may be useful. Mild forms of depression may be helped with plans for coping such as getting out of the house, doing something for herself each day, having contact with and communicating with adults, talking with a friend about what she feels, doing some form of exercise, and paying attention to nutrition.
Source:
Helen Varney. Varney’s Midwifery. Jones & Bartlett Publishers, 1997.
