Postpartum Depression: There is No Shame

In May we took the time to address and acknowledge mental illness in our country, Mental Health Awareness Month. There are many issues that plaque us as far as women and children's mental health is concerned. However as pediatricians an area that many of us are starting to deal more with is postpartum depression. The reason being, as pediatricians we encounter moms who deal with this often in our offices. These are the moms who come in looking more disheveled, thoughts seem disconnected, they are extremely tearful and overwhelmed, and their babies are sometimes also stressed as a result. For many years medicine approached the care of the mother as an issue for the mother’s physician only, for an OB, family medicine doctor, or midwife. However, we recognize as pediatricians that a mothers' wellbeing has a direct impact on the child.

We are the first to encounter these families often after delivery. The average baby after discharge from the newborn nursery is to see their pediatrician 2-3 days afterward for the initial visit. In some practices they may wait 2 weeks. Regardless we often see these families before their follow up with OB in a standard uncomplicated pregnancy. We have the opportunity to intervene in a critical time.

Postpartum depression is a common problem for women after having children. In fact it is so common that the American College of Gynecology has several screening tools your OB/GYN will implement after you deliver and they see you follow up. This standardized screening tool is a wonderful way for your provider to get a sense of how much this pregnancy has affected you emotionally. It's hard sometimes for mothers to open up about their emotions or to even recognize the level to which they are affected by thoughts of sadness and depression.

As mothers we spend months anticipating the arrival of this beautiful baby, imagining each finger and the color of their eyes, the way they smell and look. It's terrifying and disturbing for many mothers to note that the excitement may result in sadness. They feel guilty, they feel inadequate and ashamed. They are sometimes afraid to articulate or are feeling isolated in a world that expects all mothers to be celebrating new life. So mothers suffer in silence.

A mother who is fatigued may not realize the extent to which her thoughts of sadness and depression are beyond what is normal as hormonal changes occur postpartum. In this state of fatigue she can confuse her thoughts for exhaustion; poor judgement is explained by lack of sleep. Differentiating between what is normal postpartum blues and true depression may be difficult. The baby blues or postpartum blues generally happen within the first 2 weeks after delivery. They are mild, don't require medication, and do not significantly impact functioning. The blues may include tearful moments, appetite problems, trouble sleeping, feeling overwhelmed, reduced concentration, anxiety. All things which can easily be attributed to the life of a new mom adjusting to a baby. Babies have challenging sleep wake cycles and need to feed constantly which contribute to all the symptoms mentioned. However, the clear difference is that with the blues, things get better, on their own, and there isn't an upheaval caused by this adjustment.

Postpartum depression is more severe. It usually starts 3 weeks after delivery but can begin at any time in that first year after having your baby. Unlike the blues it will not self-resolve, it does not get better without medical intervention or therapy. The feelings and thoughts that describe depression are extremely disruptive to daily life and functioning, affect relationships, and can result in risk or harm to the baby or mother. We have all seen news headlines of children that have been harmed or abandoned by a new mother in those early months of infancy. Depression and on the more severe end postpartum psychosis can play a role in this. Often mothers who have a pre-existing history of mental health problems are at greater risk for postpartum depression but, it can happen to any woman.

Our role as family members, friends, and pediatricians is to help mothers with newborns recognized they need help, and then take the action steps to get help. Part of my passion for building a tribe of motherhood, and normalizing conversation about parenting stress is it creates an emotional environment where mothers can speak their truth. They don't need to exist in bubble where everyone else is perfect and they feel alone and unfit. The criticism and judgement that occurs with mom shaming creates a fertile ground for motherhood isolation. However if we live in a pretend world, we risk great damage to mothers and their children. How can we really make the stigma of postpartum depression go away?

There is a lot to celebrate about motherhood, but mothers who are hurting need a safe space to heal and grow. As we raise awareness, let us all take the next steps. Reach out to a woman you are concerned about, pick up the phone and call to check in, drop by with some food for her, meet up for coffee. It might be the lifeline or intervention she needs. As pediatricians, when we ask about your emotional wellbeing mothers, we are not judging you. Please remember, we are here to help.