Postpartum Depression, Practical Solutions

You had so looked forward to this joyous time in your life-your baby's birth, all the friends and family surrounding you, your dream to begin building your own family now a reality, so why are you so unhappy?

Don't be alarmed. You're probably suffering from a common form of postpartum depression , or what your grandmother called "the Baby Blues". It usually begins on or around the third day after delivery and lasts about 10 to 14 days. The noticeable symptoms are crying for no apparent reason, irritability and dysphoria (feeling down).

Postpartum depression (PPD) strikes indiscriminately, having little to do with the mother's personality. All types of women can suffer from this commonly ignore problem, many never knowing that help is available.

The probable cause for the baby blues is the rapid drop in progesterone levels that occurs in every woman's body after giving birth. Progesterone levels drop from a high of 40 times their highest level during a regular menstrual cycle to levels so low they are almost undetectable in the blood. This dramatic change can have a tremendous impact on the emotions of a new mother.

Approximately 50 to 80 percent of all new mothers (whether they are delivering their first or tenth child) suffer from the baby blues. Although it can be upsetting not to be the perfect picture of a joyous mommy, the baby blues seem to disappear on their own. Most women get through the experience fairly well with the support and reassurance of family and friends.

If you are experiencing this type of PPD it is important for you to feel supported by those around you now. You need to be mothered, as well as your baby! Reassurance that this difficult time will pass and that you are loved and cared for can be very comforting.

Lack of sleep-a problem nearly all new mothers experience-can make the baby blues much worse. Make getting enough rest and sleep a high priority. It is also essential to eat well and regularly. If you are tired you may forget to eat and consequently suffer from periods of low blood sugar, which in turn lowers your frustration tolerance and your body's ability to absorb any new hormones you may be producing.

Extreme Symptoms

Approximately 10 to 15 percent of new mothers who experience the baby blues may develop a deeper level of postpartum depression characterized by several of the following symptoms:

Difficulty making decisions
Feelings of inadequacy
Fear of being left alone
Fantasies of disaster
Feelings of not wanting the baby
Desire to leave the family
Panic attacks
Fear and anxiety
Feeling out of control
Non-interest in previously pleasurable activities
Inability to sleep
Nightmares
Some of these symptoms, in mild forms, are normal adaptations to motherhood. If, however, they are persistent or extreme, they indicate a need for treatment.

This deeper level of postpartum depression usually begins within the first six to eight weeks after delivery but may appear any time in the first year postpartum. If the onset of your symptoms is later than two months after giving birth, they may sneak up on you, and you may not even identify the problem as depression until the symptoms are overwhelming. In fact, your husband or friends may notice it first.

A very small number of new mothers, about one or two in a thousand, develop very severe symptoms, usually in the first few days after birth, that turn into postpartum psychosis. In these rare cases a mother loses touch with reality and has delusions or hallucinations and severe anxiety . She may be a danger to herself or the baby. It is very important that any new mother with this type of symptom receive medical help immediately.

As was previously mentioned, drastically changing hormone levels after birth are thought to be the responsible factor in PPD. While this is most likely true, hormone treatments have been met with mixed results, and fathers and adoptive mothers have also been reported to have symptoms resembling postpartum depression. It would appear that in most cases a combination of factors is responsible.

Some of the factors that may place a woman at higher risk for PPD include:

A family history of PPD
Other major depressive episodes
A history of hormonal problems such as PMS
Marital tension, feeling unsupported by partner
Being used to spending majority of time outside the home
Husband away from home a great deal
Death of her own parent in childhood or adolescence
Medications
Positive Steps to Take

The most important thing to remember if you find yourself suffering from PPD is that it is not your fault. You are not a "bad" or incompetent mother. You have not done something "wrong". You are not going crazy and there is help available!

There are several things that you and those close to you can do to help. First, you must rest. Mother yourself and spend time with your baby. Find other people to take care of the housework, meals, other children, laundry, pets , etc. Your most important job is recovering and bonding with your new baby.

If breast-feeding is possible, it is a wonderful way for you to increase the level of Prolactin (a calming hormone) in your body. While breast-feeding can delay the production of Progesterone and Estrogen as your menstrual cycles return, Prolactin can help alleviate depression and facilitate a feeling of closeness with your baby. If you are having problems breast-feeding there are lactation consultants available and organizations such as La Leche League.

Try to avoid fixed or rigid scheduling of your baby; go with the flow. Avoid over-exertion and get lots of rest.

Eat balanced meals throughout the day. Stay away from caffeine, alcohol and smoking. Eat a small portion of complex carbohydrates (Mom used to call these "starchy foods") such as; bread, pasta, crackers, cereal, potatoes. Start eating theses small portions within a half-hour after waking and then every three hours while awake.

Don't isolate yourself or keep your feelings inside. Get outside for some light exercise (with your doctor's permission) everyday. Find other new mothers to talk to---local parenting publications or your pediatrician's office can provide you with lists of support groups. Find a safe person with whom you can express your conflicting emotions. Someone who will accept you just the way you are right now. You can also try keeping a journal.

Make the most of the time you have to rest. Learn relaxation techniques or use the ones you learned in childbirth classes. Rest, meditate or sleep whenever the baby sleeps.

You might also try thinking back to past adversities and remembering the skills and networks you used to get through those difficult times. New mother support groups can be especially beneficial.

Medical Breakthroughs

New medical information is now available about the treatment of PPD. This illness has even recently made its way into the Diagnostic and Statistical Manual for Psychologists and Psychiatrists. This means that the psychiatric community and insurance companies now recognize PPD as a real illness.

Katharina Dalton, M.D. in London, has reported great success in treating PPD and helping new mothers at high risk avoid PPD by using natural progesterone at the time of delivery. Other antidepressants are also widely used to treat this form of depression. Other well-known clinics are helping new mothers get enough sleep in the first two weeks after giving birth, thus avoiding most PPD symptoms.

Many advances have also been made in alternative forms of medicine, such as herbal remedies , holistic, Homeopathic and Chinese medicines. Many people are familiar with St. John's Wort and other natural herbs to treat depression. But it is important to always check with your doctor before taking any medication, especially if you are breast-feeding.

Many advances have been made in the diagnosis and treatment of PPD. With therapy and medication, nearly all forms of this illness are treatable. It is unnecessary for you to suffer untreated from PPD. Whether your symptoms are severe or just a case of the baby blues, remember, you are not alone and help is available.

"A Quiet Time for New Mothers", and "Overcoming Postpartum Depression , a Doctor's Own Story" available also through amazon.com

TIPS FOR ADDRESSING THE BABY BLUESBy Lois V. Nightingale, Ph.D.

1. Spend time with your baby! Remember how long you have been waiting to hold your precious angel.

2. Rest! Rest! Rest! Enjoy this time with your new baby. Let others wait on you. Enjoy being pampered for the first few days you are home (longer if you underwent a cesarean or other major complications).

3. Bring baby into your room or bed to minimize walking .

4. Avoid fixed or rigid schedules, they place undue stress on new mothers. Go with the baby's flow and your own intuition .

5. Avoid overexertion, bothersome friends and relatives. Limit length and number of visits per day. (If uninvited guests find you in a robe they are less likely to over-stay their welcome).

6. Get up for short periods of time, some exercise is good. Do not overexert yourself. Fatigue and pain can exaggerate negative feelings. Notice when you are feeling weary.

7. Whenever your baby sleeps, rest or sleep yourself. (This is NOT the time to jump up and do those 40 chores you have been thinking about!)

8. Eat right. Have healthy snack foods on hand. Nutritious, easily prepared foods are helpful. (Send the donuts home with grandma). Make sure to eat some complex carbohydrates (bread, corn, rice, rye, potatoes, oats, whole- wheat crackers, etc.) every three hours to keep your blood sugar up.

9. Drink lots of fluids. Your body is healing, and if you are breast-feeding extra fluids are essential. Drink lots of water. Unsweetened juices are also terrific. Avoid caffeine, and empty calorie sodas. Avoid or conscientiously limit alcohol use.

10. Get help with the housework, meals and other children. Take friends up on their offers of: "If there's anything I can do, just ask". Don't be afraid to ask!

11. Prioritize to conserve energy. Not all housework is equally important.

12. Thank Dad when he helps around the house, with meals or the older children. A little gratitude will go a long way during these days.

13. Hand squeezes, hugs and kisses between Mom and Dad, to keep you both going.

14. Pamper yourself. Give yourself a facial, or a manicure. Condition your hair. Take a bath by yourself or with your baby. Read a frivolous book (you deserve it after months of studying only serious baby material.

15. Get outside. Enjoy the fresh air. Take baby with you for a walk in a carrier. Don't try to do too much too soon. Work up slowly. Listen to your body.

16. Surround yourself with other moms. Find groups of new mothers with whom you can talk and go do things with your babies. (Mother and baby exercise classes, park days, La Leche League, the hospital's new Parents' group, childbirth class reunions, your roommate in the hospital, babysitting co-ops, church, temple or synagogue groups, neighbors, or start your own group).

17. Learn relaxation techniques or meditation . Learn to make the most of the few quiet moments you have. (Remember the relation exercises from childbirth classes).

18. Focus on what you are doing. Concentrate on the present, this precious time goes by very fast.

19. Do fun things with your baby. (Baby gym classes, walks, dress him/her up in that "adorable" outfit, go to the park and feed the ducks, nature walks etc.)

20. Exercise with doctors' approval. (Ask about specific exercises and how long you should wait to begin after delivery).

21. Be gentle with yourself, give yourself ample time to heal. The physical, hormonal and psychological recovery from pregnancy , labor and delivery may take longer than you had anticipated.

22. Take all advice with a grain of salt. Follow your own mothering intuition . You know what is best for your beautiful baby!!

"A Quiet Time for New Mothers", and "Overcoming Postpartum Depression , a Doctor's Own Story" available also through amazon.com

Lois V. Nightingale, Ph.D. (lic# PSY9503) director of the Nightingale Center with offices in Newport Beach and Yorba Linda, California 714-993-5343.