Postpartum depression
There is so much talk in the world today about postpartum depression (PPD). So many people struggle with depression in general, and so many people are writing about it, discussing it, studying it, and treating it. People want to know what it is and how to understand it better. Depression seems to be a subject on many people’s minds. Some women find they are quite concerned that they themselves may become depressed following the birth of a baby. In my work as a midwife it is something I am aware of, and I do my best to asses how a new mother is doing in the first days, weeks, and months.
Who is at risk for postpartum depression? There are various risk factors, many of them common. In the process of information gathering, a standard part of midwifery care, I begin with is discussing her birth experience. How was it? Was it traumatic? Disappointing? Does a woman feel negative feelings as a result of something that occurred physically or emotionally? Because a woman’s birth experience directly affects her mood post-birth, it’s important to gather an honest and thorough history. In the cases of women whom I’ve worked with in pregnancy and during the birth process, I usually have a good understanding of their risk factors by virtue of the in-depth care I provide. I get to know them and listen to them, so I know about their family situation, health issues, history, and support structure.
There tends to be a dip in the mood following the birth of a baby. It can be a mild mood swing that is barely felt, or a giant emotional crash that takes months to recover from. In general, for most new mothers, there are a number of things that tip the scales for her. The “birth high” wears off, fatigue sets in, the mother’s normal routine is topsy-turvy, the round-the-clock demands of a newborn are intense and require considerable stamina, breastfeeding may present a challenge, or she may be still feeling discomfort or pain from healing or other health issues. Isolation from friends is common, as are irregular sleep patterns and hormonal changes from natural postpartum fluxuations of endocrine system (the system responsible for the hormonal balance of the body).
Put simply, giving birth and having a newborn is challenging and exhausting. Many women do not realize the sheer difficulty of this job. In some cases, unrealistic expectations of what having a new baby will be like can create a profound sense of failure, robbing her of her self-confidence before it even has a chance to take root. The challenges of being a new mother are often unspoken and the woman goes through the experience without validation. She may wonder why is it so hard for me? She may perceive motherhood as being so much easier for everyone else. This is the biggest shame for a new mother in my professional opinion. I would be curious what a study of normal women who had accurate and realistic expectations and adequate support and information after birth would show about the incidence of postpartum depression.
As the midwife, I asses the following things: Physical well-being, emotional well-being, health history, mother’s and grandmother’s history specific to depression, medications, financial stability, family situation, nutritional intake, help at home, help with other children, marital status and marital harmony, history of thyroid issues, hormonal issues, and surgeries. I also ask about a woman’s history of any trauma, resolved or unresolved, or abuse or or loss/ grief.
I would like to make a distinction between a woman who is feeling emotionally down after a birth and actual, clinical postpartum depression. Usually with the right support, a woman struggling with a dip in her mood can recover completely within a reasonable timeframe. A woman with actual postpartum depression can become quite ill and even need intervention from a psychiatrist, medication, hospitalization. With the right support, understanding, love, attention, and assistance, a woman with actual postpartum depression will do much better than a woman who is struggling with this and lacks those important tools for healing.
In my practice, I often remind women that in any situation, there is the situation itself, and then there is how we feel about the situation. For example; a woman is depressed, and she feels down and isn’t enjoying her new baby, her life, etc. She feels guilty, ashamed, embarrassed, a failure for feeling this way, and that just compounds the depression. I like to try to encourage women to be loving and compassionate with themselves and forgive themselves for feeling things that they have no control over. The sad, hopeless feelings are bad enough without the guilt and additional things that we layer on. If we want our children to love themselves, we must begin by accepting our shortcomings, and the disappointments that go hand in hand with life. We will get through the tough times, and there is a light at the end of the dark alley, even if we don’t see it. The important thing is to reach out for help, let someone in, let others help you. It’s okay to be vulnerable and imperfect. It’s okay to be human.