Depression After Childbirth
What is meant to be an immensely happy occasion has unfortunately a very high risk of developing certain depression related illnesses, and in fact is THE PERIOD OF HIGHEST RISK STATISTICALLY FOR WOMEN IN TERMS OF THEIR RISK OF DEVELOPING THIS ILLNESS.
This is not an illness. It is a period of three to seven days usually, occurring within the first week after the birth of a baby. It happens in at least TWO THIRDS OF WOMEN, and is thought to be due to the rapid drop in oestrogen levels, which occurs in women after childbirth. Typically, the woman becomes sad, tearful, anxious and irritable, and may even state that she no longer wants her baby. However, this is unfortunately a normal phase occurring after childbirth, and hopefully the woman will have been warned in advance that this is almost certainly going to occur. The partner, family and friends have an important part to play in this situation, assuring the woman of their ongoing care and support, and continuously reminding her that this is a short-lived chemical reaction, not her true self. Occasionally, taking a tranquilliser (not an antidepressant!) such as Valium, may lessen the emotional pain of this phase, although ideally the woman will be breast feeding her baby, and we would all prefer that neither the mother nor the baby be given medication at this time, if at all possible. I emphasise that the condition is a normal reaction, occurring in the vast majority of women after childbirth, which WILL HEAL ITSELF SPONTANEOUSLY.
This is the term used for depressive illness occurring after childbirth, and it is estimated that AT LEAST TEN PER CENT OF WOMEN will develop this illness in the first 12 months of childbirth. If not diagnosed and treated, the period which is meant to be one of great happiness for the family, and intense bonding between mother and baby, can be turned into an emotionally extremely distressing time.
There are numerous changes associated with having a baby. At a purely physical level, the mother’s chemistry is suddenly changed, just like suddenly changing the transmission in a car from drive into reverse. For nine months, the mother’s physiology and chemistry have been relentlessly programmed to give priority to the baby in the womb. After childbirth, the reverse occurs, with physiology and chemistry now being programmed to look after the woman alone. It is not surprising that things go wrong during this abrupt shift.
Quite apart from the chemical and physiological changes, the role of many women is changed by childbirth, particularly when it is their first child. They may well have had to give up their jobs, losing the self-esteem and position they have developed for themselves over very many years. It is also very difficult for many women to find themselves in the position where they are no longer earning their own money. Also, for very many people, having a job in the paid work force gives them structure to their lives, social interactions and friendships, and a social label. To lose all of these components of one’s life simultaneously is very hard. Similarly, men who lose their jobs for whatever reason are faced with the same conflicts.
Life at home rearing a young baby is not easy. Babies do not come with instruction books, and it is very anxiety-provoking and exhausting to try and understand what is wrong with a baby who is crying and upset. Young babies need to be fed frequently, and this inevitably involves significant sleep deprivation. Furthermore, breast feeding, considered the ideal form of nutrition where possible, is physiologically exhausting. All of these problems are made significantly worse if the baby has problems, such as being premature, having some physical problem, or having pain after being fed (colic, reflux etc).
The mother’s tiredness and irritability due to the pressures of looking after a baby often cause problems in the relationship with the baby’s father, and matters may be made worse by the mother having lost her sex drive, due to stress or due to slowly developing post natal depressive illness.
The most important issue in this situation is the diagnosis of postnatal depression at an early stage. You may wish to complete the questionnaire on this site, as a guideline to show to your own doctor. There are support organizations for postnatal depressive illness in many countries. Emotional support from partner, family and friends, together with practical support and help in looking after the baby and the household tasks are all very useful.
ANTIDEPRESSANTS of the tricyclic group have been widely used very safely in breast- feeding women over the past 50 years, with no harmful effects on their children. (In fact, tricyclic antidepressants have been used for at least 30 years in young children with certain medical conditions, without any harmful effects being detected.) Recent research also suggests that the many of the modern antidepressants are almost non- existent in breast milk. Studies of children whose mothers took certain modern antidepressants while breast- feeding have indicated no problem in the children over the first 5 years of their lives.
It is very important to be alert for this very common illness, which can affect any woman, knowing that the emotional health and happiness of the whole family, including the baby, can turn out for better or worse, if appropriate diagnosis and treatment are instituted at an early stage.
PSYCHOTICALLY SEVERE DEPRESSION
This is a condition which affects 1 to 2 mothers per thousand, and is considered to be a variant of bipolar illness (manic depressive illness). Typically, this condition develops in the first three months after the birth of a child, and the depression in this condition is often extremely severe. The condition may or may not be preceded by a hypomanic phase, in which the mother is unusually positive and extrovert, with lots of energy and much less need for sleep than usual. When this very severe depression strikes, it may become so severe that the mother regrets having had the baby, believing this is not a good world in which to have babies. In this situation, it is very important to physically protect the baby until the mother’s illness has been treated. Typically, mother and baby are usually admitted together to a specialised unit, where the mother’s illness can be rapidly treated, while the bonding between the mother and baby continues in the normal way.
THOUGHTS OF HARMING THE BABY
Women who have just given birth to a baby may be horrified to find that they have thoughts of harming the baby, and be ashamed to discuss this with anyone. These thoughts normally come into two categories.
In post-natal depressive illness, a percentage of women will develop what are called obsessional thoughts. These are thoughts which the sufferer regards as horrible and alien, but which continue to intrude. For example, a woman may develop a fear that she will pick up a knife and stab the baby, and be horrified and distressed by these ideas. It is generally considered extremely unlikely that these ideas, when they are due to obsessional symptoms developing in depressive illness, will be acted upon.
In contrast, in the very severe depressive illness described above, as the psychotic category of depression after childbirth, women may contemplate killing the baby to save the baby the inevitable suffering of living in this terrible world. This is a very serious situation, and the baby must be continuously protected until these thoughts have been wiped out by treatment.
If you or someone close to you has any of these thoughts, please understand they are manifestations of illness, and are not real aspects of the mother or the baby. Please do discuss them with your doctor, who will be able to wipe out these thoughts very rapidly and effectively.
EMOTIONAL EFFECTS ON BABY
In recent years, considerable research indicates that the babies, and indeed the children, of mothers with depression, are negatively affected by the situation. It does seem that babies and young children intuitively respond to the emotional wellbeing, or lack of wellbeing, of their mother. Babies and children of depressed mothers therefore manifest a whole range of behaviours indicating they are not happy, ranging from difficulties with eating, sleeping and behaviour, to signs suggesting the children themselves are becoming irritable and depressed. For the sake of all involved, it is important that depressed mothers be given the best available treatment of their condition.
Important Disclaimer: This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.