In this second post on our series of Postpartum Depression and cross-cultural workers let’s get specific. No doubt you have heard the term “PPD”, but might not know what it really is or what to look for. There are tons of educational resources online about postpartum depression, including assessments, when to get help, and support networks. Here is an overview of postpartum mood and anxiety disorders:

Postpartum depression can be broken down into the following categories:

Postpartum blues: (affecting 60-80% of all new mothers) is often expressed as frequent and prolonged crying, anxiety, irritability, poor sleep, quick mood changes, and a sense of vulnerability. It usually occurs within the first three days following birth, continues for up to two weeks, and is usually self-limiting.

Postpartum depression & anxiety: (affecting 10-20% of all new mothers) is more debilitating and longer lasting than the ‘blues’ and is characterized by despondency, tearfulness, and more intense feelings of inadequacy, guilt, anxiety, and fatigue. There may also be physical symptoms such as headaches and rapid heart rate. A lack of feeling for the baby is of special concern. These feelings can appear any time during the first few months to one year after the birth. Unfortunately, women experiencing this form of depression rarely seek treatment although almost all respond well.

Post-traumatic stress disorder (PTSD) following childbirth: is usually triggered by trauma during the time leading up to, during delivery, or shortly afterward. It can affect up to 6% of mothers. The trauma leads the woman to feel that either her life or the life of her baby is at risk. 

Postpartum psychosis: or puerperal psychosis (found in 0.1% of new mothers) is a serious, but relatively rare disorder, with reactions such as extreme confusion, refusal to eat, delusions, auditory hallucinations, hyperactivity, and rapid or irrational speech. Most of these reactions occur within 3-14 days following birth. Psychosis is serious and requires immediate medical attention and at times medication and hospitalization.

Symptoms of Postpartum Depression and Perinatal Mood Disorders

WHAT CAUSES PPMD & WHO IS AT RISK?

The causes of postpartum mood disorders are complicated. Some researchers think PPD is due to the rapid hormonal changes linked to pregnancy and birth or those with a family and/or personal history of emotional problems. Others feel personality and coping skills can make one vulnerable. Researchers seem to agree that some of the following social risks may predict problems: the recent death of a loved one, economic stress, a recent move, relationship problems, language barriers, or social isolation. No doubt biological, psychological, and social factors all play a role.

Women experiencing postpartum depression or mood disorders often express the following:

• I feel like running away.
• I don’t know who I am anymore
• I feel like I’m going crazy
• I’m a terrible mother for feeling this way
• I’m scared I’m going to do something crazy.

A mother experiencing postpartum depression may:

• Feel constantly tired
• Cry often for no apparent reason
• Feel panicky or in a constant state of dread
• Worry excessively about her own or the baby’s health
• Have a lack of feeling for the baby
• Have difficulty sleeping or eating
• Have problems concentrating or have racing thoughts
• Have frightening thoughts or fantasies (fear they or someone else might harm baby)
• Feel an overwhelming sense of loss
• Have intrusive fears or worries
• Have repetitive behaviors or rituals
• An inability to take care of day-to-day needs
• Have intense rage or irritability
• Have thoughts of harming oneself or believing the family would be better off without you.

It’s a long list. A daunting list. And even experiencing just one or two of these symptoms can cause a parent to become paralyzed by fear. But, as with other mental illnesses, postpartum mood disorders are most easily treated when they are caught early–during pregnancy and at postpartum check-ups. Treatment after diagnosis includes medication, counseling, and self-care.

Treating Postpartum Mood and Anxiety Disorders (PMAD):

Postpartum depression is not the mother’s fault. It’s a medical condition that needs treatment to get better. Many women have PPD after having a baby–it’s the most common problem for new moms. If you think you have PPD, tell your provider. After an evaluation, the following treatments can be prescribed or recommended:

• Counseling
• Support groups–there are many Christian support groups online. 
• Medicine–PPD often is treated with medicine, like antidepressants, antianxiety meds, or hormones like estrogen. Some medications aren’t safe while breastfeeding, so it’s important to talk to your provider to make sure what you’re taking is best for both you and your baby.

What are other ways to feel better?

• Stay healthy and fit.
• Do something active every day. Go for a walk or get back to the gym.
• Eat healthy foods. These include fruits, vegetables, whole-grain breads and lean meats. Try to eat fewer sweets and salty snacks; avoid alcohol and caffeine.
• Get as much rest as you can. Try to sleep when your baby sleeps.
• Only take medicine or supplements prescribed by your provider
• Ask for and accept help.

• Keep in touch with people you care about and who care about you. Tell your partner, family, and friends how you’re feeling.
• Take time for yourself. Ask someone you trust to watch the baby so you can get out of the house. Visit a friend, get outside or do something you enjoy. 
• Let others help around the house. Ask your friends and family to watch the baby, help with housekeeping or go grocery shopping. Don’t be afraid to tell them what you need.
• Reduce your stress.

• Do the things you liked to do before you had your baby. Listen to music, read a good book, or take a class. Do the things that used to make you feel good about yourself before you got pregnant.
• Try not to make any major changes in your life right after having your baby. These include moving or changing jobs. Major changes can add stress to your life that you don’t need right now.

Call your doctor, nurse, midwife, or pediatrician if:

• Your baby blues don’t go away after 2 weeks
• Symptoms of depression get more and more intense
• Symptoms of depression begin within 1 year of delivery and last more than 2 weeks
• It is difficult to work or get things done at home
• You cannot care for yourself or your baby (e.g., eating, sleeping, bathing)
• You have thoughts about hurting yourself or your baby

Ask your partner or a loved one to call for you if necessary. Your doctor, nurse, or midwife can ask you questions to test for depression. They can also refer you to a mental health professional for help and treatment.

Resources: 

Alliance of Illinois: Postpartum Depression Symptoms of PPMDs

US Department of Heath & Human Services; Office on Women’s Health: Postpartum Depression

The American College of Obstetrician and Gynecologists: FAQs on Postpartum Depression

The Mayo Clinic: Postpartum Depression

Healthline: Everything You Need to Know About Postpartum Depression

The March of Dimes: Postpartum Depression

NAM—National Alliance of Mental Illness: Ways to Cope and Heal from Postpartum Depression

The Emily Effect: an organization offering family support

In summary, in this article we looked at the different categories of PPD, what causes PPD and the symptoms, how to treat it, when to involve medical professionals, and a list of resources. Our hope is that you understand PPD and are more equipped when PPD enters your life, either directly or indirectly.

Here is the postpartum series. All articles and resources can be found at globaltrellis.com/postpartum.

Part 1: My Story with Postpartum Depression on the Field
Part 2: Postpartum Depression—What it is and What to do about it
Part 3: A Conversation with my Husband about PPD
Part 4: How Organizations Can Support Women Going Through PPD

The idea of where to start with Postpartum Depression (PPD) on the field can be overwhelming, We’ve made three checklists that will break down step-by-step what to be looking for and what you can do. The three checklists are for those who are having a baby, has a teammate who is having a baby, and for those in member care and someone in your organization is having a baby. You’ll be emailed all three checklists, download the one (or ones) you want. Get your checklist here!

Photo by Zach Lucero on Unsplash