I never saw my daughter as happy as she was on the day that she told me she was pregnant. She had been trying to get pregnant for months and she and her husband were ecstatic. Throughout her entire pregnancy she appeared healthy, aside from being diagnosed with Graves’ disease, but even that seemed to be under control. She seemed relaxed and content and told me that she loved being pregnant.
The day that my granddaughter was born, everyone excitedly awaited her arrival. My daughters labor appeared to progress normally and was fairly easy. However, immediately after the baby was born, my daughter began to hemorrhage. It took over 5 hours for the attending OB/GYN to return, and after finding that part of the placenta was left, and removing this, my daughter finally began to stabilize.
The morning before she was discharged, my daughter told her doctor that she felt extremely depressed and that somethimg did not deep right. Unfortunately, instead of actively listening to my daughter: asking her how she felt or reviewing her symptoms, he brushed off her concerns and told her to speak with her own OB/GYN at her follow up appointment a week later. Looking back, my daughter was severely anemic, and this likely didn’t help.
My daughter was experiencing symptoms of postpartum depression (PPD).
According to the National Center for Health Statistics, there were 3,978,497 births in the U.S. in 2014 and more than 1 out of 7 new mothers experience PPD (similarly, the Center for Disease Control (CDC), estimates that 11 to 20 percent of women who give birth each year develop PPD). That means that close to 700,000 new mothers develop PPD each year and the rate of PPD increases with age, the presence of stress, and lack of social support. Importantly, PPD can affect ANYONE.
Postpartum depression generally does not go away without treatment. Untreated PPD can last indefinitely, and can lead to the development of more chronic depression. PPD also affects the entire family. When new mothers are not treated, their partners and children also have an increased risk of developing depression. So identifying and treating PPD can have positive effects on the entire family, and for many years.
Unfortunately, the reaction that my daughter received from her doctor is not uncommon. When women try to communicate their concerns to their doctors or to their families, many feel like they are not heard. So what can doctors and/or family members do to help support a new mother?
The more that a new mother feels supported, the better her prognosis. Even if you don’t specialize in mental health, don’t brush her off. As an OBGYN (or primary care doc or friend) you may be the first person that she has opened up to. The feeling of “being heard” can do wonders.
Normalize Her Feelings
Don’t make her feel as if there is something “wrong” with her. After waiting excitedly for months for her baby to arrive, it can be extremely confusing for her to feel depressed. However, her body just went through hell and back and her life has changed.
Partner with Her to Find Appropriate Treatment
Rule out hormonal conditions including anemia, and over or underactive thyroid. Many women with PPD respond to antidepressant therapy, but this may not be appropriate if she is breastfeeding. Other, more behavioral-oriented therapies (i.e., cognitive behavioral therapy, family therapy, support groups) may be very helpful.
Refer her to a psychiatrist, psychologist, or mental health counselor so that she has someone to talk to and gets treatment early. Refer her to a support group or to her priest. Then, follow up to make sure that she has made contact and is getting the support she needs.
I’m reminded of the often used metaphor in therapy regarding self car: when waiting for a flight to take off, the flight attendant always says: put the oxygen mask on yourself, before placing it on the small child beside you. You cannot take care of another person, effectively, if you don’t first take care of yourself. Encourage her to get adequate rest and to engage in healthy, mind-body practices Mindfulness Meditation.