Postpartum depression

The arrival of a child is usually a moment of celebration and joy, celebrated differently according to contexts and cultures.

How then could a mother not be at the height of happiness? Above all: how could she not be perfectly ready in her new role as parent, perfectly tuned to the needs of the new born?

Reality tells us that, even a year after giving birth, the thoughts and reactions of a new mother can be of a completely different kind:

  • Sense of overwhelm : ” I’m not a good mother and I never will be: why did I give birth to a child if I’m not able to raise him “?
  • Guilt : “ Why can’t I live it better? My son certainly feels how bad I am and suffers as well.” “Why am I not as happy as I should be? ” “ Why can’t I be as good as other mothers? 
  • Absence of maternal instinct : “ Why can’t I have that instinctive mother-child connection? I’m not capable of it .”
  • Confusion : “ Why does this happen to me? 
  • Irritation, anger : “ Why doesn’t my partner/mother/sister… help me? ” “ Everyone and everything irritates me! ” “ Blessed are those who have no children! ” “ Easy to talk, no one understands me! 
  • Sense of emptiness “ I feel nothing… only anguish. 
  • Deep sadness, uncontrolled crying
  • Sense of failure : ” I am worthless as a mother and as a woman … I am completely inadequate .”
  • Unhealthy relationship with food : lack of appetite or excesses.
  • Difficulty sleeping : insomnia or fragmented sleep and lack of rest.
  • Lack of concentration : difficulty remembering things, words, names. Difficulty making decisions, even the most trivial ones.
  • Sense of disconnection : “ I feel out of this world…what if I disappear completely? 
  • Fear of going crazy and never going back to how it was before giving birth : “ Am I going crazy?! ” “ I will never be the same person again .”
  • Fear of being misjudged : “ What will others think of me? ” “ Why can’t I live up to expectations? ” “ What if they took away my baby? 

These are some examples of what a woman who is going through a condition of  postpartum depression experiences , i.e. a form of general depression that has its onset within the first four weeks following childbirth.

DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) criteria for postpartum depression require that the following be present, nearly every day for a period of at least two weeks:

  • depressed mood, most of the time, most days, as reported by the individual (e.g. feels sad, empty, hopeless) or observed by others (e.g. appears tearful);
  • markedly decreased interest or pleasure in all, or nearly all, activities most of the day, nearly every day.

To speak of postpartum depression also be present at least 5 or more of the following symptoms, lasting for a period of at least two weeks:

  • significant weight loss, without dieting, or weight gain, or decreased or increased appetite;
  • insomnia or hypersomnia nearly every day;
  • psychomotor agitation or retardation nearly every day;
  • fatigue or lack of energy most days;
  • feelings of excessive or inappropriate self-worth or guilt nearly every day;
  • reduced ability to think or concentrate or indecisiveness most days;
  • recurring thoughts of death, recurring suicidal ideation without a specific plan, or a suicide attempt, or having a specific plan for committing suicide.

Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. They present in a full-blown way between eight and twelve weeks after delivery, a period that has been identified as the most frequent peak of onset.

Postpartum depression differs from baby blues , a condition of decreased mood which can be considered almost physiological after childbirth, as it is more intense and lasting over time. It should also not be confused with  postpartum psychosis , a rare and much more serious disorder: the woman who suffers from it has states of great agitation and confusion, severe alterations of mood and behavior and often hallucinations and delusions are present.
It affects between 8-12% of new mothers (data source:  Ministry of Health) and usually occurs between the 6th and 12th week after delivery. According to a 2008 Istat research, out of 576,659 births, at least 46,000 mothers were at risk of postpartum depression. To these official data must be added the number of those who are unable to ask for help and/or are not adequately supported to do so.

Cause

Postpartum depression can   have different causes, attributable to biological, psychosocial and genetic aspects:

  • Presence of a previous depressive problem in the woman’s life history : it is estimated that the probability of suffering from this disorder can increase by 50%.
  • Family history of depressive disorders : First-degree relatives of a person with major depressive disorder have a 2-3 times higher risk of having a depressive episode in their lifetime.
  • Hormonal vulnerability or sensitivity : the large hormonal changes that occur during pregnancy and after childbirth can create an imbalance in the regulation of the processes that control emotions and mood.
  • Stressful life events : bereavement or serious illness of loved ones, job loss, problematic or close pregnancies,…
  • Unfavorable contexts : economic and social difficulties, unwanted pregnancies, scarcity or absence of social support, conflict with the partner.

Prevention

Knowledge of risk factors helps develop more effective preventive strategies. Suffice it to say that the new guidelines of the World Health Organization (WHO) for postpartum provide for greater monitoring of mother and child over time, as well as targeted support and counseling interventions both physical and psychological.

In general, among the protective factors we find:

  • Environment attentive to the needs of the mother : often only the needs of the child are thought of. The mother also needs a context that supports her, which is why it is important to relieve her of the household chores, help her with the care of the newborn, listen to her and limit visits from friends and relatives at home if they are a source of stress.
  • Adequate rest in the first weeks after childbirth: together with a good and balanced diet, it allows the mother to have time to regain her energy and get used to her new condition, after the big changes of pregnancy.
  • Good social network: having supportive partners, family and friends around you allows you to have a space in which to feel welcomed and where you can bring your difficulties without being judged and to be able to confront each other constructively.

Treatment: the importance of an early diagnosis

Depression, if not treated adequately, risks dragging on for a long time with serious effects on the mother-child relationship with consequences also on physical health. In fact, a depressed person can have cardiac, immunological, endocrinological problems,…

What makes it difficult to ask for help in these cases is the fear of being considered “inadequate”, “unworthy”, “incapable”. There is often the fear that going to the health services could imply a removal of the child from the family.

Sometimes even loved ones, even if animated by the best intentions, get the opposite effect: a woman with postpartum depression shouldn’t be treated like a lazy little girl who should only be encouraged to learn something new. It is often difficult to recognize and give dignity to suffering but without these steps it cannot be faced or overcome.

Individual psychotherapy allows  you to find an adequate space for listening, welcoming and rebuilding yourself. This path can be accompanied by a group path, useful for guided comparison with other women who are going through, or have overcome, a similar condition and with whom to share their experience.

Where the specialist deems it appropriate, anxiolytic or depressant drugs can be administered, obviously to be taken according to medical indications.

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform, Maternicity.com.

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