Everything you need to know about postpartum depression
Anxiety and depression are the most common mental health disorders during the perinatal period, which encompasses both pregnancy and childbirth. According to data from the 2014 NICE guidelines , revised in February 2020, approximately 12% of women experience depression and 13% experience anxiety at some point during pregnancy. Depression and anxiety also affect between 15% and 20% of women during the first year postpartum.
In general, it is estimated that one in ten mothers will suffer from postpartum depression and, according to data from the World Health Organization (WHO), it can affect one in six women who have given birth.
Why is postpartum depression so rarely discussed?
Unfortunately, the occurrence and presence of mental health problems in pregnant women and those who have given birth has been largely minimized.
Culturally, pregnancy and postpartum have been identified with a time of complete happiness, but evidence shows that pregnancy and postpartum are not protective of mental health; rather, we are facing a time of greater vulnerability.
The social pressure to be happy during this stage of life is immense, and this can lead many women to suffer from postpartum depression in silence. Postpartum depression is sometimes called "smiling depression," precisely because many mothers try to hide their distress for fear of being labeled "bad mothers."
Many of these women already experience symptoms of depression or anxiety during pregnancy, and many do not receive the help they need. Depressive symptoms during pregnancy and postpartum can be experienced with a great deal of guilt, and many women do not share what they are going through with those around them.
Symptoms of postpartum depression
Depression is an illness characterized by intense and persistent feelings of sadness, loss of interest in previously enjoyed activities, sleep and appetite disturbances, and significant difficulty carrying out daily activities, among other symptoms. To be diagnosed with depression, these symptoms must last for more than two weeks.
I'm very sad. Do I have depression?
In the case of postpartum depression, specifically, we find feelings of guilt for not being the mother they expected to be, uncontrollable crying , doubts about their ability to adequately care for their child, feelings of inability to bond emotionally with their daughter or son, as well as feeling completely overwhelmed by the situation. Most cases of postpartum depression appear in the first few weeks after childbirth, but they can appear up to a year postpartum.
Research also shows that mental health disorders during pregnancy and postpartum are associated with pregnancy complications, disruptions in the mother-baby bond, and impaired neurodevelopment in the infant. Therefore, early detection and appropriate treatment of postpartum depression are crucial.
Regarding the care they should receive, it is very important that the woman feels supported and that the care offered to her focuses not only on physical and obstetric aspects, but also on emotional aspects, on how she has adapted to the new situation, and on how she is feeling emotionally.
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Many mothers who come to the mental health center verbalize their feelings: "I feel totally overwhelmed, I feel like I've failed as a mother, I've been waiting so long for this moment and now I can't enjoy it," "I look at my daughter and I feel like I've made a mistake," "My son cries and I just want to run away," "I pick up my daughter and I just want to cry, I just feel sad."
In more severe cases, thoughts of death or even thoughts of harming the child may arise. All these feelings cause great distress and have a significant impact on these women's lives, and are signs that they need help.
It's important to distinguish postpartum depression from the phenomenon known as maternity blues , which affects a significant number of women who have given birth. Maternity blues is characterized by increased sensitivity, crying spells, mild sadness, irritability, and worries about the baby, typically beginning between the second and third day after delivery and lasting no more than 15 days. It usually resolves spontaneously during the first week, and most authors link hormonal changes during the postpartum period to its onset.
Most common risk factors for postpartum depression
The causes of postpartum depression are not fully understood, but we do know that there are biological, sociocultural, and psychological factors that increase the risk of developing it.
- Family and personal history of depression.
- Depression during pregnancy.
- History of premenstrual syndrome.
- Complications during pregnancy and childbirth.
- Prematurity of the baby.
- Lack of social support, both from friends and family.
- Marital problems.
- To live or have lived through situations of abuse or violence.
- Stressful personal situations: having had a traumatic birth, having suffered a loss, having financial or housing problems.
- Having a personality marked by a tendency towards emotional instability, low self-esteem, or perfectionism.
- High and rigid expectations about pregnancy, childbirth and postpartum.
- Excessive worry.
- The tendency towards guilt.
What can you do if you think you have postpartum depression?
- Talk about what's happening to you. It's very important that you share it with someone you trust, ideally your partner.
- Seek professional help together.
- Don't overload yourself with daily tasks, ask for help.
- Take advantage of the time to sleep when the baby is asleep.
- Try to do some physical activity, like going for a walk, getting some fresh air and sunshine.
- Maintain a healthy diet.
- Look for parenting groups in your area. Connecting with other mothers can also be a great support.
Treatment of postpartum depression
It's important to explain to women who suffer from depression, and to their partners, what depression is, to normalize it, and to remove the blame placed on the woman. It's crucial that the partner is deeply involved in raising the child to ensure the mother also has time to rest and doesn't feel alone during this stage of her life.
Psychotherapy is a fundamental part of the treatment. It is a space where, without feeling judged, the mother can speak openly about what she is going through and how she feels, and together, therapeutic goals are formulated to improve her mood, learn to relate more healthily to her baby, establish a good mother-baby bond, and be able to enjoy motherhood.
In some cases, drug treatment will be necessary, but many mothers are reluctant to start drug treatment for fear of possible incompatibility with breastfeeding.
The reality is that several drug treatments are safe during breastfeeding. It's always necessary to weigh the risks and benefits of starting any drug treatment, and it's important to consider the risks of not treating the condition, as this can also have a negative impact.
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