The Center For Postpartum Adjustment

A: Briefly stated, a postpartum disorder is a hormonally induced state affecting a mother both mentally & physically. Drastic changes take place during pregnancy and after childbirth in the mother's hormonal and biochemical make-up which may lead to a chemical imbalance in the brain. Added responsibilities of a new baby, changes in lifestyle, personal expectations, and chronic exhaustion are only a few of the factors which may lead to a postpartum disorder.

A: There are 3 types of postpartum disorders and they move along a continuum of severity. The baby blues, being the most common, affect approximately 50-80% of all new mothers. This condition usually emerges between the third day and first week include mood swings, crying spells, sadness, irritability, and mild anxiety. These feelings are considered a normal response to the dramatic hormonal changes following delivery; They are transient, short-lived and typically go away on their own. They are seldom associated with any lasting problems for the mother, child, or family.

It is also estimated that between 10-20% of all new mothers experience a more severe and enduring postpartum disorder; Postpartum Depression (PPD) which can begin any time within the first year after delivery. PPD is a term used to describe a variety of moderate to severe symptoms of depression and/or anxiety. It is important to note that despite the term "postpartum depression", this emotional disorder can exist with or without symptoms of depression! Often, women who are only experiencing anxiety symptoms, panic attacks, or obsessive thoughts are not diagnosed with this disorder, tend to "fall through the cracks" and are frequently not referred for treatment. PPD is usually characterized by insomnia or other sleep disturbances, extreme fatigue, irrational fears about the baby's health or safety, loss of appetite, lack of concentration, difficulty making decisions, impaired memory, agitation, lack of pleasure or motivation in previously enjoyable activities, low self esteem, inability to cope, and sometimes even suicidal thoughts. The health, careers, and marriage of the new parents are often compromised.

There is a third but relatively rare (1-3 in a thousand) postpartum disorder, Postpartum Psychosis. The time of onset is the same as PPD but the symptoms are far more intense and may require hospitalization. Symptoms of this disorder may include all those listed for PPD plus hallucinations, delusions, great agitation, marked deviation in moods (severe depression and/or mania) and fears or intent of harming oneself or the baby.

A: Although no woman can consider herself immune from this disorder; some do appear to run a significantly higher risk than others. By looking at both biological and psychosocial determinants, experts do agree that some women are more susceptible to this emotional disorder than others. They include:

1. Women with a previous episode of PPD. There is a 66% recurrence rate for women who have not sought treatment. If a woman experienced postpartum psychosis (1-3 in a thousand) after a delivery, the chance of that recurrence jumps to 33%.

2. Women with a family history of PPD (i.e. mother, grandmother or sister) are at risk. Also, women who grew up in a dysfunctional family and have not worked through their own childhood issues are at risk of PPD when they go on to have their own children.

3. The perfectionist woman with unrealistic expectations is at risk. Ditto the "co dependent" who only wants to please others. These personality "types" are hesitant to discuss their negative feelings (which only worsens the condition).

4. The bearer of an unwanted pregnancy; a long, difficult or complicated labor; an unsupported labor; a birth experience that didn't fulfill expectations, or delivery of a premature baby or baby with problems is also an increased risk.

5. Older women, career women, women who have had an abortion, miscarriages or infertility problem are also viewed as high risk.

6. Marital issues such as denial of a previous PPD or being non-supportive only increases the likelihood of PPD.

Postpartum depression is not due to a personal weakness or flaw. New mothers need not feel ashamed of having this condition or of seeking professional mental health assistance. Early detection and prompt treatment have a very positive prognosis, with a recovery rate of over 90%.

A: Treatment for these disorders varies, depending on the type and severity of symptoms. All of the symptoms, from the mild to the most severe, are temporary and treatable with skilled professional help and support. A woman experiencing any of these symptoms should contact her healthcare professional. She should have a complete medical evaluation, including a thyroid screening. The "ideal" treatment plan includes:

Medical evaluation (to rule out physiological causes such as thyroid)
Psychiatric evaluation
Psychotherapy
Participation in a PPD support group
At times, medication to correct the chemical imbalance created by the dramatic hormonal changes.

Education is the first line of defense, because realistic expectations about new motherhood can decrease the occurrence of depression and anxiety. For those women who experience a postpartum disorder, it is of critical importance that they have access to information and an understanding that with proper treatment, education and support, they can not only recover, but make a positive adjustment to motherhood.