Image credit: Adobe Stock

One Mother's Story

"After my first child was born, I started to cry all the time and feel sad. And I felt guilty because you're supposed to be happy about being a new mom and all that. So I hid all of the sadness from everyone else. The funny thing is, that I was doing such a good job at making things look good on the surface, that no one knew I was depressed. But I knew it was time to get help when I started to really resent my child."

"I saw my family doctor, who told me that I had Post-Partum Depression. We started with some counselling but after a few weeks things weren't getting any better, so I started medication. And my doctor told me about this support group for new moms with post-partum depression."

 "It wasn't easy, but things did eventually get better. And although I had a lot of guilt about resenting my children, all of that went away when the depression went away - and it helped me realize that all along, the problem wasn't me (or my children!), it was the depression."

Introduction

Having a child is perhaps one of the most life-changing times in a woman's life. The joy of creating life, and the happiness it creates in others is a joyous sight to behold.

However, although having a child is a time for joyous celebration, it is easy for others to forget how much of a stressful time this is for the mother.

In addition to the hormone changes, there is the sheer physical exhaustion from being sleep deprived and having to look after a baby.

It is normal for many people to have some "post-partum blues" or "baby blues", which are feelings of sadness and tearfulness that usually goes away within the first few weeks of a delivery.

But sometimes, the process of having a child is so overwhelming that the new mother becomes too sad, anxious or overwhelmed to get back to normal.

How Common is it?

Postpartum depression is felt to occur in 12-16% of mothers (and up to a quarter of adolescent mothers).

It can happen anytime during pregnancy, to several months after childbirth.

It can affect first-time mothers or mothers who have already had children before, and it can also affect those who are adopting.

Why do people get post-partum depression?

Many different factors can increase a person's risk of post-partum depression:

1. Past episodes of depression or anxiety. This is why it is so important to make sure that you get treatment and support if you have troubles with depression or anxiety.

2. Stress. The more stress is placed on a new mother, the more likely it is that she will develop post-partum depression. This is why it is so important that a new mother receive support from others. Although having a baby is always stressful, it is particularly more stressful if...

• There is a lack of support from the father
• There is a lack of support from family and friends.
• There is a child with high needs, e.g. a child with medical or developmental problems, or even simply a child who is colicky and hard to soothe.

3. Societal pressures: New mothers are supposed to be always happy, and have endless energy and love to look after their child. These expectations put on added pressure, and can add to feelings of guilt. The truth is that nobody can be happy 24/7, and even the most loving of mothers can have occasional feelings of resentment towards their children.

Symptoms of Post-Partum Depression

Symptoms of postpartum depression can include:

• Feelings
• Feeling sad or depressed, often with crying spells
• Numbness
• Feelings of helplessness
• Anxiety or panic attacks
• Feelings of inadequacy or inability to cope
• Feelings of resentment towards the baby or other family members
• The feeling that something is not right
• Over-concern for the baby
• Guilt about the very fact that one is having any of the above feelings
• Physical changes
• Sleeping problems
• Changes in appetite
• Troubles focusing or concentrating

With more severe depression, depressed mothers may also have

• Thoughts that life isn't worth living, or even thoughts of harming oneself
• Scary, distressing thoughts about harming the baby, even though this is something the mother would never do

Other Post-Partum Conditions

The stress of having a child can trigger all sorts of difficulties. Although feeling depressed is one sign that things have been overwhelming for a new mother, other symptoms can include:

• Anxiety, including specific types of anxiety such as Panic Attacks or Obsessive Compulsive Disorder, or Post-Traumatic Stress Disorder (PTSD).
• Post-partum psychosis, which is an extremely serious condition where a new mother may have problems with seeing or hearing things which aren't there, in addition to thoughts of harming others (even her children) in order to protect them. Post-partum psychosis is extremely rare, usually felt to affect 1-2 per 100,000 women who haven given birth.

Myths and Facts about Post-Partum Depression

If You Suspect Post-Partum Depression

If you suspect post-partum depression, the best place to start, is by seeing your doctor. Your doctor can help determine if there are any medical problems contributing to your problems, and most importantly, your doctor can help provide the services you need, or connect you with those local services.

If you Suspect Post-Partum Depression in a Loved One

• Express your concerns
• Offer your support so that your loved one can see a doctor

How to Help Yourself with Post-Partum Depression (Self-Help)

Take care of yourself. Like any caring mother, you want to put your child's needs ahead of your own needs. Ironically though, putting your child's needs first and neglecting your own needs may in fact backfire, by leaving you overwhelmed and thus less able to look after your baby.

In the end, you will need to find the right balance of looking after your own needs so that you are emotionally and physically well enough to look after your child.

The emergency oxygen system for passengers on an aircraft is a good analogy for this. Imagine that you are flying on an airplane, and you are sitting beside your child. Imagine that suddenly, something happens and all the air gets sucked out of the airplane cabin, which means that you will pass out quickly from lack of oxygen if you don't do anything. Fortunately, the oxygen masks drop down from the ceiling. So what do you do? Do you 1) put the mask on your child first, or 2) give oxygen to yourself first?

If you decided to 1) put the mask on your child first, the problem is that it will take so much time fumbling with your child's mask that you will end up passing out before you're able to put on your own mask.

If you decided to 2) put the oxygen mask on yourself first, you have made the correct choice. By keeping yourself breathing, you will not pass out, and thus will be successful in helping your child too.

So the point of this analogy? Helping yourself is not selfish; it is precisely what you need to do so that both you and your child can survive.

Taking care of your physical self includes:

• Get enough sleep, which may include taking short naps during the day.
• Exercise regularly
• Stretch and relax
• Eat a healthy diet with good nutrition, and regular meals and snacks. 

Take breaks

• Every day, take breaks from your mothering duties and do something just for yourself, e.g. having a leisurely bath; having a relaxing cup of tea; going for a walk with a friend, etc.
• And every once in a while, do something extra special for yourself, e.g. getting a massage; going out for lunch/dinner with a friend, etc.

Make sure you have a support system for yourself. You are there to take care of your baby - but who do you have to take care of you?

Ask yourself:

• Am I getting enough support?
• What type of support do I need?

For example, there are different types of support, such as:

• Emotional Support: this is about having someone who you can talk to, who listens to you, and who can help you feel good about yourself.
• Practical (instrumental) support: this is having people who can help you with things like child care, groceries, or other day-to-day responsibilities.
• Do other people know that I need support? Do other people know how to support me? (i.e. how to give me support)? Most people can't read your mind. You will need to tell them both that you need their support, as well as tell them exactly what type of support you need from them.
• Who do you have to take care of you? Share both the joys (and burdens) of motherhood by asking other people for their support:
• Family members
• Friends
• Mother's groups, e.g. Join a new parent's group
• Support groups, e.g. Join a post-partum depression support group
• Babysitters / Day-care

Take care of your mind and spirit

• Give yourself credit. With all the exhaustion and tiredness from being a busy mother, it is sometimes easy to overlook the fact that mothering is perhaps the biggest challenge you will face in your life. Acknowledge how incredible it is that you are managing to do this. And even if your family doesn't know it, realize how important you are by making such a difference to your child(ren) and your family.

• Catch negative thoughts. When people are depressed, they often have a pattern of negative thoughts. Pay attention to that ‘inner dialogue' and what you are telling yourself.

• Replace negative thoughts with more positive ones. Ask yourself, "Is that a helpful thought?" and replace those negative thoughts with more positive ones.

• Make a list of the things in your life that you are grateful for...

Dealing with anger and unpleasant feelings

• Accept angry, unpleasant feelings. Everyone gets angry and sad at times; accept that you are human and its okay to have those feelings too. "Its okay to feel angry - I'm only human too..."
• Express anger in a safe way. Anger can range from mild irritation, to blinding rage. It is important to find ways to express anger in a healthy way so that it doesn't overwhelm you. This includes:
• Telling someone else how you feel
• Expressing yourself through a diary, writing a letter (though not necessarily mailing it)
• Distracting yourself, e.g. through exercise, yoga, deep breathing, visualization, music, a warm bath
• Figure out what is causing the anger and problem-solve it. What is the situation or problem making you angry? What are some possible solutions? Write them down...

How to Help Someone Else with Post-Partum Depression

"When I got post-partum depression, my husband's support made a huge difference. It helped every time that he told me that he loved me, asked me how I was feeling, or that I was a good mother. And it helped me feel taken care of when he took care of dinner, or bought flowers for me."

• Be helpful.
• Ask her how you can help. You might say: "I want to be helpful. What can I do for you that would be helpful?"
• If she doesn't know, then do the usual things that most mothers find helpful...
• Be helpful with home responsibilities. Ideally, help out before she has to ask.
• Help out so that she can take a break. Taking a break from parenting is essential; without it, she will get fatigued and that won't help the depression.
• Accept help from friends and family. Don't let pride stop you from accepting help from others.
• Help her reach out to others, which includes helping her with:
  • Getting support from family and friends
  • Getting support from health care professionals. For example, offer to drive or accompany her to a doctor's appointment.
• Encourage her to talk to you about how she feels. Accept how she is feeling and give empathy.
• Don't invalidate or judge her for her feelings.
• Express affection
• Verbal affection: Tell her you love her and are there for her.
• Physical affection: Give hugs, stroke her hair.
• Don't pressure her to have sex until she's ready.
• If you are working outside the home, then don't expect your partner to be ‘super-mom' just because she's been home all day. Be grateful that you've been able to be at work, which is much less stressful than being a new mother and having to constantly look out for an infant's needs.
• Help out with child caring duties. Spend time alone with your child, so that the mother can have a break.
• Talk to other mothers who have gotten over their post-partum depression.
• If she is angry, then don't take it personally. Anger and irritability is a symptom of post-partum depression. If she is getting angry and irritable, then take a time out until you are both feeling calmer.
• You might something like: "I want to hear what you're saying, but its hard for me to listen right now. Can we take a break, and talk later, when we're both feeling more calm?"
• Be hopeful. You might say something like: "I know we can get over this. Its going to get better."
• Keep up your relationship.
• Make the time to have some dates with your partner.
• Be patient. It is very frustrating when she remains distressed even after your support and encouragement, but don't take out this frustration on her. She is as much a victim of the depression as you are. Although post-partum depression does take time to go away, remember that it does not last forever and does eventually get better.

Treatment for Post-Partum Depression

When you see a health care professional for post-partum depression, treatments may include:

• Psychotherapy: talking therapies can be extremely helpful for treating depression. There are different types of effective psychotherapies such as:
• Cognitive behaviour therapy, which looks at a person's thoughts, feelings and behaviours
• Interpersonal psychotherapy, which focuses on dealing with any relationship stresses, as well as improving social support from others.
• Medications: given that post-partum depression is a heavily "physical" depression, due to changes in brain chemistry and hormones, medications can be particularly effective.

Typical medications (listed alphabetically) include but are not limited to the following:

• Citalopram (generic name) aka Celexa (tradename)
• Escitalopram (generic name) aka Cipralex (tradename)
• Fluoxetine (generic name) aka Prozac (tradename)
• Fluvoxamine (generic name) aka Luvox (tradename)
• Paroxetine (generic name) aka Paxil (tradename)
• Sertraline (generic name) aka Zoloft (tradename)
• Venlafaxine (generic name) aka Effexor (tradename)

One fear about medications is that they will harm the child. Studies show however, that the risk of untreated depression has much worse consequences on a child than medications. And fortunately, there are newer classes of antidpressants considered safe to use while pregnant or breastfeeding.

Recommended Websites

From Family Services Ottawa (retrieved Nov 18, 2008 from http://www.familyservicesottawa.org/english/postpartum.html) 

www.parentresource.on.ca - The Parent Resource Centre is located here in Ottawa. On their website you will find information on various groups and signs and symptoms of postpartum depression. There is also information on parenting issues and programs available throughout the city.

www.postpartum.org  - This is the Pacific Postpartum Support Society, located in Vancouver, B.C. They publish the book "Postpartum Depression and Anxiety: A Self Help Guide". This site offers such information as signs of postpartum depression, personal stories, resources and support offered as well as a specific section for dads.

www.postpartumstress.com  - The Postpartum Stress Centre is based out of Pennsylvania. There is information here for professionals, mothers and even partners who are looking for ways to understand and support their partners who are experiencing postpartum depression.

www.postpartum.net - This website for Postpartum Support International offers information on how to educate, advocate and provide support for maternal mental health worldwide.

www.postpartumdads.org - This website, which is affiliated with Postpartum Support International, is designed for dads, by dads who have successfully supported their partners through postpartum depression. It offers resources such as Dads Dealing with Depressed Partners and Depressed Dads.

www.dadscan.ca - This is a Canadian website based out of London, ON. It offers tips and practical information to fathers on how they can support their partner who is experiencing postpartum depression as well as offers them advice on how to cope with the day-to-day stress of having a new baby. This site offers help to men who want to be involved in the fathering role.

Recommended Books

• Down Came the Rain: My Journal Though Post-Partum Depression, by Brooke Shields.
• Behind the Smile: My Journey out of Post-Partum Dperession, by Marie Osmond.
• This Isn't What I expected: Overcoming Post-Partum Depression, by Karen Kleiman and Valerie Raskin.
• Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression, by Shoshanna Bennett
• Overcoming Postpartum Depression and Anxiety, by Linda Sebastian

About this Document

Written by the eMentalHealth Team.

Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.

Creative Commons License

You are free to copy and distribute this material in its entirety as long as 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes (non-commercial), 3) this material is not altered in any way (no derivative works). View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/