Postpartum depression in mothers

23. April 2020

… The new and overjoyed mother takes care of her newborn. The baby is content, cries only little and develops splendidly. Mother and father find themselves together in their new roles and float on cloud nine. Of course, both are over-slept and still quite overwhelmed by the new situation, but it all slowly settles on each other …

So it should be or – in some minds – it must be after the birth of a child. Many overlook in their dream ideas that the reality can look quite different. Because a birth is a drastic experience in the life of a woman. The new life with an infant upsets life, hormones and feelings. In addition to the common but short-lived “baby blues,” postpartum depression can develop, and it is imperative that it be treated professionally.

Baby blues or postpartum depression?

The baby blues is a common phenomenon. Approximately 50-80% of mothers experience brief depression-like symptoms shortly after birth (O’Hara & Swain, 1996). There are emotional outbursts, helplessness, and states of exhaustion. The joy about the newborn child is temporarily clouded. However, these symptoms subside after a few days without the need for treatment

Postpartum depression in the first year after delivery
Postpartum depression, unlike the baby blues, can develop throughout the first year after delivery. If depressed mood persists for more than two weeks within this period, postpartum depression must be considered. The better mothers and fathers are educated about the risk and symptoms of this disorder, the sooner professional help can be sought.

Education by doctors, nurses and midwives
Since early recognition of postpartum depression has a positive effect on the course of treatment, counseling and support of parents on this topic is of great importance. Postpartum depression should be addressed in the hospital by physicians and nurses and after birth by the midwife providing care. Postpartum depression is still not recognized because there is still a lack of information on this topic (Hartmann, 2011).

Incidence of postpartum depression
Postpartum depression is a taboo topic and major knowledge gaps exist among expectant parents. Yet postpartum depression is not uncommon. They occur in about 10-20% of mothers. Fathers can also suffer from postpartum depression. However, the risk is lower and is about 4% (Hartmann, 2011).

Important: Sometimes you hear the word postnatal instead of postpartum. From a medical perspective, postpartum is the correct term. Postpartum means “after delivery” and refers to the mother. The term postnatal, on the other hand, is used when talking about the newborn. In German, the term Wochenbettdepression is also common instead of postpartum depression.

Symptoms of postpartum depression

In principle, the symptoms of postpartum depression are similar to those of depression at other stages of life. However, there are special features that arise due to the new role of motherhood. Often, affected mothers have trouble developing good feelings for their child. As a result, they feel cold and uncaring and doubt their abilities as mothers. Affected mothers are often convinced that they are not a good mother for their child. This leads to a high level of suffering due to strong feelings of guilt and worthlessness.

Compulsive thoughts as a symptom of postpartum depression
In the reverse effect, postpartum depression often results in extreme concern for the child’s well-being. This can result in obsessive, recurring fears. These obsessive thoughts often revolve around the mother’s ability to hurt or endanger the child through her behavior (for more information on obsessive thoughts, click here).

Disturbances in the interaction between mother and child
Problems with feeding or breastfeeding the infant often arise in connection with postpartum depression. The reasons for this are that depression alters the interaction between mother and child. Research shows that mothers suffering from postpartum depression are less sensitive to their child’s signals. The child also changes his or her interaction behavior as a result (Field, 2010).

Important: In addition to postpartum depression, postpartum psychosis can also occur in rare cases, in which sensory deprivation is the main symptom. Again, professional help is needed immediately!

Risk factors for postpartum depression

The life-event approach to psychology states that depression often occurs after drastic experiences (Wittchen & Heuer, 2006). Most often, one thinks only of negative events, such as the loss of loved ones, a job change, or unemployment, but positive experiences can also drastically change one’s life! This is also true for a birth: As a prominent life event in a woman’s life, it increases the risk of mental illness. If other unfavorable factors are added, postpartum depression can develop:

  • Pre-existing mental health conditions such as depression, anxiety or obsessive-compulsive disorders
  • Complications during birth and pregnancy
  • Lack of social support
  • Problems with settling into the new role as a mother

These risk factors do not necessarily have to be present. Postpartum depression can develop even in mothers who are psychologically stable and socially well embedded. The exact causes are not clear. It can only ever be guessed what factors have led to the postpartum depression.

Progression and treatment of postpartum depression

Like “normal” depression, postpartum depression is readily treatable. In addition to traditional treatment approaches, there are therapy components that specifically address the new role as a mother:

  • Psychoeducation: The mother, partner and relatives must be comprehensively informed about the disorder, its causes and treatment options. Knowledge transfer alone will support hope for successful treatment.
  • Psychotherapy: In a psychotherapeutic therapy in conversational form, the mother learns how to deal with negative thoughts, changes dysfunctional thought processes and learns how to deal constructively with the disease.
  • Medications: Under close consultation with medical specialists, a medication adjustment can be made. Meanwhile, there are active substances that are well suited for breastfeeding mothers.
  • Activity building and structuring: Together with specialists (eg pediatrician, psychotherapist or midwife) daily structures are developed, which help to settle into the new everyday life with baby.
  • Mothers’ and support groups: The exchange with other mothers or those affected by postpartum depression can be healing. Here, experiences, tips and strategies can be discussed or shared with each other.
  • Breastfeeding counseling: If feeding or breastfeeding problems occur in the course of postpartum depression, professional breastfeeding counseling can help. You can find out more on this website.

Often, outpatient care is sufficient and symptoms gradually subside. Sometimes, however, mothers need more intensive help and must be treated as an inpatient. Here there are now many clinic concepts, how mother and child can be treated together.

Dissolving the stigma

Last but not least, it is important to urge mothers and their families to do the following: Get help when you are not feeling well. Address feelings and problems. Don’t be influenced by role stereotypes and too high expectations of the new mother or father role. The sooner treatment for postpartum depression begins, the sooner time with the child can be enjoyed to the fullest again.

References

(1) Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behavior and Development, 33(1), 1-6

(2) Hartmann, H. P. (2011). Causes, treatment, and course of postpartum depression. Family stress in early childhood (pp. 66-81). Stuttgart: Klett-Cotta

(3) Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: a review. Infant Behavior and Development, 33(1), 1-6

(4) O’hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression-a meta-analysis. International Review of Psychiatry, 8 (1), 37-54

(5) https://www.lalecheliga.de/

Categories: Depression Psychosis

Friederike Reuver
Autor:in Friederike Reuver
"Die LIMES Schlosskliniken haben sich auf die Behandlung von psychischen und psychosomatischen Erkrankungen spezialisiert. Mit Hilfe des Blogs möchten wir als Klinikgruppe die verschiedenen psychischen Erkrankungen näher beleuchten und verschiedene Therapien sowie aktuelle Themen vorstellen."

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