The Baby Blues…almost every pregnant woman has heard of this vague and ominous condition. Many women struggle with the idea that they may not be happy about becoming a mother or deeply, inexplicably angry with their baby.
When is crying too much crying? When is tired too tired? It’s uncomfortable and disturbing and unpolite….and so thousands of women are suffering in silence every year.
The perinatal mental health period extends from conception up until two years after childbirth. During this time, women are susceptible to physical, psychological, and social consequences of pregnancy and childbirth; therefore, they interact more with the health system than at any other time in their lives. Although they may engage more with health services, this time period is also women are most likely to be admitted to a psychiatric hospital, have a greater chance of developing an affective mental illness, and those with a history of mental illness are more prone to relapse or recurrence of the condition (Currid, T., 2004).
Perinatal Mood Disorders (PMDs) are a group of highly stigmatized mental illnesses; therefore, they often go undiagnosed. Regardless of how long these symptoms persist they do not often garner the support from social groups or health care providers necessary for their effective management and treatment (Hayes et al., 2001).
Women’s birth experience has been clearly linked to their mental state postpartum. The two major aspects about birth that can generate a traumatic experience are: extreme pain and a sense of loss of control (Reynolds, 1997). Women who give birth by cesarean not only report more physical complications during the postpartum period, but also higher rates of depression and tiredness (Borders, 2006). PMD’s are a result of a multitude of cultural and social factors, and in the United States, the lack of support and time off from work in the postpartum period largely contribute to the high incidence of these conditions. Still, the effect of birth experience is deserving of further research and is yet another motivator to reform birth practices in this country.
Perinatal traumatic stress can influence the quality of mother-child interaction. A study by Kaplan, et al. (1999) demonstrated for the first time that babies react with far less interest to the speech of depressed mothers than they do to non-depressed mothers-that the pitch and tones in a depressed mother’s voice do not promote attention or learning in a baby. Fathers many times feel rejected and confused by a depressed mother’s action, and this could lead to marital problems, including divorce. Research suggests that infants of depressed mothers have difficulties engaging in social and object interactions as early as 2 months of age. These infants look less at the mother, engage less with objects, show less positive and more negative affect, lower activity levels, and greater physiological reactivity as indexed by higher heart rate and cortisol levels than the infants of nondepressed control mothers (Weinberg, M. & Tronick, E., 1998).
Sheila Kitzinger has carried out extensive work in the area of Posttraumatic Stress Disorder (PTSD) following birth. In Birth Crisis she describes her interactions with mothers on her postpartum crisis phone line, as they relate their experience with highly technologically managed birth. Some of the symptoms she describes are recurrent nightmares and flashbacks of the event, avoidance behaviors, and amnesia surrounding the birth. One woman, who received a routine episiotomy, described her experience this way:
They just stood talking about other things over me while they stitched me up. It was incredibly painful. I couldn’t keep still and they got upset with me. Then they wrote in red on my notes, “Uncooperative during suturing.” I can still feel it like burning. They left me feeling like I had messed the whole thing up…I feel a total failure (Kitzinger, 2006).”
The lack of research in this area is striking, especially in the United States. Most of the studies observing the effect of birth experience on mental health postpartum have been conducted outside of the United States in areas such as the UK, Scotland, and Australia (Borders, 2006).
However, our very own UNC-Chapel Hill has stepped up to the plate to respond and care for the thousands of women experiencing some form of Perinatal Mood Disorders annually. According to their website, “The Perinatal Mood and Anxiety Disorders Program specializes in mood and anxiety disorders that occur during pregnancy and postpartum. The program is directed by Dr. Samantha Meltzer-Brody. The mission is to provide state-of-the-art clinical care, research, and support groups to address the needs of women during this vulnerable time.”
If a woman is experiencing depression during pregnancy, postpartum depression (PPD), postpartum psychosis, infertility, or pregnancy loss she is able to obtain care in a variety of settings through this program. UNC is offering an inpatient clinic, support groups, educational courses, and is conducting research studies to improve their services.
The Star News Online, out of Wilmington, NC published an article about one woman’s experience with the program: UNC Clinic Helps Local Woman Tackle Postpartum Depression
Tara Willis, a labor and delivery nurse, was taken by surprise when she began experiencing PPD symptoms after the birth of her daughter Amelia. She received help from UNC on an outpatient basis and is now back at work part time.
Please visit the Center for Women’s Mood Disorders.
You can listen to the NPR Radio Broadcast covering the program here: The State of Things-Motherhood and Mental Illness
If you feel any of the following symptoms, you are not alone and should reach out.
- Depressed mood-tearfulness, hopelessness, and feeling empty inside, with or without severe anxiety.
- Loss of pleasure in either all or almost all of your daily activities.
- Appetite and weight change-usually a drop in appetite and weight, but sometimes the opposite.
- Sleep problems-usually trouble with sleeping, even when your baby is sleeping.
- Noticeable change in how you walk and talk-usually restlessness, but sometimes sluggishness.
- Extreme fatigue or loss of energy.
- Feelings of worthlessness or guilt, with no reasonable cause.
- Difficulty concentrating and making decisions.
- Thoughts about death or suicide. Some women with PPD have fleeting, frightening thoughts of harming their babies: these thoughts tend to be fearful thoughts, rather than urges to harm.
Please see below for some excellent resources on Perinatal Mood Disorders. Experiencing depression or any type of PMD is not indicative of your quality of mothering. Seeking help allows you to begin to enjoy your motherhood more fully. Even if you do not feel you can make the call to a program like UNC’s, talk with a trusted friend or family member about how you are feeling.
Resources for PMDs:
* Postpartum Support International
* The Postpartum Stress Center
* The Postpartum Resource Center of New York
Sources:
Currid, T. (2004). Improving perinatal mental health care. Nursing Standard, (19), 3,40-43.
Hayes, B., Muller, R., & Bradley, B. (2001). Perinatal depression: a randomized controlled trial of an antental education intervention for primiparas. Birth, (28), 1, 28-35.
Kitzinger, S. (2006). Birth crisis. New York, NY: Routledge.
Weinberg, M., & Tronick, E. (1998). The impact of maternal psychiatric illness on infant development. Journal of Clinical Psychiatry, (59), 2, 53-61.