Postpartum Mood Disorders:
An Informational Guide For Couples
By: Christina G. Hibbert, Psy.D.
MYTHS OF MOTHERHOOD
- Modern American
society has fostered many "myths of motherhood" that play a major role in
the development of Postpartum Mood Disorders (PPMD).
- These myths greatly
influence a woman's expectations of having a baby and how she will fulfill
her role as a mother.
- These myths include:
- The myth of "happy
motherhood", which indicates that mothers should feel happy when a new
- The myth of having
an intuitive mothering capability immediately after the baby is born.
- The myth of
unremitting motherly love for the new child.
- The myth of the
- The myth that
fathers will be equally involved in parenting the child.
- The myth of the "perfect
- For many women,
after the baby is born these expectations are met with feelings of
depression or anxiety that can lead to extreme feelings of guilt and
THE POSTPARTUM PERIOD
- In pregnancy,
reproductive hormone levels in a woman's body are 20-30 times greater than
normal. At delivery, hormone
levels drop abruptly, along with changes in amino acids,
neurotransmitters, and thyroid hormones.
- The sudden drop in
estrogen, progesterone, endorphins, and other hormones may trigger depression
the same way moodiness may be triggered by premenstrual changes in these
- Thyroid levels may
also drop sharply after birth.
A new mother may develop a thyroid deficiency that can produce
symptoms that mimic depression.
(It is always recommended that a woman have a thorough physical
examination for this reason).
- Many women feel
exhausted after labor and delivery and may need a long time to fully
recover. Cesarean births
require an even longer recovery.
- New mothers rarely
get adequate rest. In the
hospital, they are awakened by nurses and the baby's feedings. At home, feedings continue every
2-4 hours, around the clock, along with usual household tasks. This extreme lack of sleep
continues for weeks and months and can be a major reason for depression.
- Babies who are born
prematurely or with a birth defect may present the new mother with even
more stress and the overwhelming realization that her baby is not the
"perfect" being she had envisioned.
- Other tasks which
may pose a stress on a new mother include:
- coping with sleep
- forming an
attachment to the child
family relationships and responsibilities
- giving up the
fantasy of what the baby would look like or be like
- facing whether or
not one is an adequate parent
One must also effectively
integrate all these new experiences.
- Feelings of loss are
very common after childbirth.
These "losses" include:
- loss of freedom
- feeling tied down
- loss of an old
- loss of control
- loss of a slim
- loss of a sense of
- Since motherhood is
typically viewed as a "happy time" and childbirth is seen as an event from
which a woman should "bounce back" within a few days, many women
experience a lack of understanding and/or support from those around them.
- Mothers need
significant coping skills to deal with so many new challenges. Four aspects of the postpartum
period which demand significant coping abilities are:
- 1) the physical
- 2) initial insecurities about
one's ability to parent
- 3) relying on support systems for
tasks that one feels she "should" do
- 4) loss of a previous identity as
one who is taken care of and the birth of a new identity as the
THE "BABY BLUES"
- Occurs in 75-80% of
- The "Baby Blues" is
described as mild depression interspersed with happier feelings, or as
some women state, it is "an emotional roller-coaster".
- Onset is usually 2-3
days postpartum, with a peak around 7-10 days.
- Symptoms may
- Fatigue/ Exhaustion
- Feelings of sadness
- Crying spells
- Mood swings/
- Feeling overwhelmed
- Inability to cope
- Inability to sleep
- Feelings of
- Causes of the
"Baby Blues": include
biological factors (drop in hormone levels), social/environmental factors
(marital stress, lack of support system, low SES), stress, and sleep
deprivation, in addition to the physical aftermath of labor and delivery.
- First-time moms are
at a higher risk of experiencing the "Baby Blues".
- The "Baby Blues"
typically does not require professional treatment and should subside
within two weeks after delivery.
include: validation of
the existence of the phenomenon, labeling it as real but a normal
adjustment reaction, assistance with self/infant care, and family support.
- If the "Baby Blues"
persist for two weeks or longer and/or if symptoms of the blues intensify,
it is then considered to be a "Postpartum Depression" (PPD).
- 10-20% of postpartum
women will experience PPD.
- Onset of PPD can be
anytime during the first year after delivery, with the highest incidence
of onset between 4 and 8 weeks postpartum.
- PPD may last from 3
to 14 months or longer, if left untreated.
- Though most women
recover within a year, the condition may become chronic if it goes
untreated. Chronic depression
may have significant effects on mother-baby attachment and bonding.
- Symptoms of PPD
- Frequent crying
- Appetite changes
- Feelings of
- Racing thoughts
- Agitation and/or
- Anger, fear, and/or
feelings of guilt
- Obsessive thoughts
of inadequacy as a person/parent
- Lack of interest in
- Lack of concern
about personal appearance
- Feeling a loss of
disconnected from the baby
- Possible suicidal
- Although most
symptoms of PPD are similar to those in a Major Depressive Disorder, many
symptoms are unique to PPD, including feelings of anger, fear, or
extreme feelings of guilt, obsessive thoughts of inadequacy as a parent,
extreme exhaustion yet difficulty sleeping, agitation, feelings of
disconnection from the baby, and feeling a loss of control over one's
- Risk factors for
PPD include: 1)
2) ambivalence about keeping the pregnancy, 3)
history of PPD, bipolar, or another mood disorder, 4) lack of social support,
5) lack of stable relationship with partner and/or with parents, 6) woman's
dissatisfaction with herself, 7) history of infertility, 8) unrealistic
expectations of parenthood, 9) recent stressful event, 10) previous aversive
reaction to oral contraceptives or severe PMS.
- Causes of PPD
include: 1) biological/
physiological factors (genetic predisposition, hormone-related, severity
of physical damage from labor and delivery), 2) environmental factors
(stress, feeling alone, lack of support),
3) psychological factors
(things that affect a woman's self-esteem and the way she copes with stress),
or 4) infant-related factors (infants with difficult temperament or colic,
infants born with problems).
**Most likely it is a combination of all of these**.
include: 1) individual
and/or couple's therapy, 2) group therapy or support groups, 3)
4) practical assistance
with child care/ other demands of daily life.
- If a woman
experiences PPD, her chances of PPD with subsequent children are 10-50%.
POSTPARTUM ANXIETY DISORDERS
- Postpartum Anxiety
Disorders are common, yet are diagnosed far less than the others because
of the belief that new mothers are just naturally anxious.
- There are two forms
of Postpartum Anxiety Disorders.
- Occurs in up to 10%
of postpartum women.
include: feelings of
extreme anxiety and recurring panic attacks, including shortness of
breath, chest pain, heart palpitations, agitation, and excessive worry or
- Three common
experienced by women with a Postpartum Panic Disorder are: 1) fear of dying, 2) fear of
losing control, and/or 3) fear that one is going crazy.
- 2 significant
risk factors: 1) a
previous history of anxiety or panic disorder, and 2) thyroid dysfunction.
- Occurs in
approximately 3-5% of childbearing women.
- Symptoms include: presence of both repetitive
obsessions (intrusive and persistent thoughts or mental images) and
compulsions (repetitive behaviors performed with the intention of reducing
the obsessions), as well as a sense of horror about these thoughts.
- The most common
is thoughts or mental images of harming or even killing one's own
baby. The most frequent
is bathing the baby often or changing the child's clothes.
Obsessive-Compulsive Disorder is the most under-reported and under-treated
disorder of childbirth, since these symptoms are horrifying or
embarrassing to the mother and she may fear that others will think she is
a risk to her child.
- It is important
to note that,
unlike Postpartum Psychosis, these mothers know their thoughts are bizarre
and are highly unlikely to ever indulge in the imagined behaviors.
- Risk factors
include: history of
Obsessive-Compulsive Disorder and/ or negative feelings about motherhood
resulting from unrealistic expectations.
- Treatments for
both Postpartum Panic and Obsessive-Compulsive Disorders include: 1) individual therapy
(cognitive-behavioral is recommended) with, 2) psychotropic medications,
also 3) couple's therapy, 4) group therapy/ support group, and 5)
practical assistance with child care and/or demands of life.
- Occurs in 1-2 of
every 1,000 births
- Onset is usually
within the first two weeks- three months
- Symptoms include:
- Acute onset of
psychotic symptoms including
- Delusions and/or
- Extreme agitation
- Mood lability
- Confusion/ Poor
- Risk Factors
include: 1) previous
postpartum psychosis, 2) manic-depressive (bipolar) history, 3) prenatal
stressors (lack of supportive partner, social support, low socioeconomic
status), 4) obsessive personality traits, 5) family history of mood
hospitalization with 2) antipsychotic medication (lithium, when indicated)
and 3) temporary removal of infant from mother's care, also 4) sedatives, 5)
electroconvulsive therapy, 6) psychotherapy, and 7) social support.
- There is a 10% rate
of suicide/infanticide associated with this disorder. Thus, immediate treatment is
- Women are 20-30
times more likely to be hospitalized for a psychotic episode in the first
30 days after delivery than at any other time in their life.
- Women with a history
of bipolar illness have a 40% chance of developing Postpartum Psychosis
after their first child is born.
- Almost all women
with previous episodes of Postpartum Psychosis will experience repeat
episodes in subsequent pregnancies.
Preparing for this ahead of time is key.
POSTPARTUM MOOD DISORDERS
ON THE COUPLE'S RELATIONSHIP
- When a woman has a
Postpartum Mood Disorder (PPMD), she, her partner, and the entire family
system may suffer.
- Due to the extreme
stress of having a baby, the first year postpartum has the highest rate of
divorce than at any other time during a marriage.
- Conversely, the most
cited non-biological cause of PPMD is marital/ relationship problems.
- Typically the woman
feels very overwhelmed and may feel that her partner is not very helpful,
even if he is trying his best to be understanding and/or helpful.
- Because PPMD can
have such a debilitating effect on the woman, the man is often left with
the burden of caring for his new baby, his wife, the household, and
WHEN YOUR WIFE/PARTNER HAS A
What He May Be Feeling
- He may feel:
- "Pulled" between the demands
of work and home
- He can't do anything right
- His efforts go unnoticed by
- He is taking on the role of
- He may fear his wife will
never be the same
- He may feel angry that his
wife is not "pulling her weight" at home
- He wants to "fix" this
problem and is frustrated because there is no apparent solution
What Can He Do?
- Take time to learn all you can
about postpartum mood disorders in order to understand what she is
- Let her know that you
recognize that she is not making up her symptoms and that this is not her
- Let her know that you love
her, support her, and are there for her.
- Help with the care of the baby
as much as you are able, allowing time for your wife to take naps or sleep
during the night.
- Enlist family, friends, and/or
the community to help with care of the baby, household, other children,
and/or meals in order to provide your wife with time to care for herself.
- Let her know that you
understand she may not be interested in sex and that you love her and
enjoy holding her.
- Be sure to take some time for
yourself and encourage your wife to do the same.
- Help her monitor her symptoms
and seek out professional help when needed.
- Remember that this is 100%
treatable and she will be well.
ADVICE FOR NEW
- Postpartum Support
International lists three important messages that new mothers
who are experiencing a postpartum mood disorder need to hear. They are:
- 1) You are not
- 2) You are not to
- 3) You will be well
(this is treatable).
What Can You Do?
is extremely important. Sleep when the baby sleeps, or get someone to help care
for the baby while you nap.
yourself permission to do less.
Allow others to help with household chores and other daily tasks. Don't try to overdo it.
and dress each day. This will help
keep your spirits up.
out of the house or take some "me" time each day. This is extremely important in helping you keep yourself
sure to monitor your nutrition habits and water intake in order to keep your
body healthy and full of energy.
(after your doctor gives the 'ok') is an extremely important tool in helping
you feel healthier and stronger both physically and emotionally. Even going for a short walk can help.
about your feelings with your partner, a friend, or family member. Find others who have experienced
motherhood and use them as a support system.
a postpartum support group or mother's group where you can talk with others who
are sympathetic to your situation.
specific about how your husband and/or others can help you. Assign specific tasks and don't allow
yourself to feel guilty.
that your husband and other loved ones are going through this too. Try to appreciate the efforts they are
your "baby blues" don't go away within two weeks, if your symptoms are intensifying,
or if you are having suicidal thoughts, seek professional help in order to
obtain therapy and medications when needed.
that becoming a mother is a life-altering event that takes time to completely
understand and get used to. Don't
Support International (PSI):
- National hotline,
with referrals in your area and resources available.
927 N. Kellogg Avenue, Santa Barbara, CA, 93111,
Telephone: (805) 967-7636
Support- Arizona (PSAz):
- Local chapter of
PSI- Warmline with referrals
and resources in the state of Arizona.
- Kleiman, K.R., &
Raskin, V.D. (1994). This isn't what I expected: Overcoming postpartum depression. New York, NY: Bantam Books.
- Kleiman, K. (2000). The postpartum husband: Practical solutions for living with postpartum
- Sebastian, L. (1998). Overcoming postpartum depression and anxiety. Omaha, Nebraska: Addicus Books.
for this handout was obtained from training seminars by Postpartum Health
Alliance as well as from the doctoral dissertation research of the author.