Ask Dr. Pat

Dr. Pat Consults: New Mothers and Postpartum Depression—When It’s More Than Baby Blues

Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly Medical Monday” column for Women’s Voices for Change.  (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

This week, Dr. Pat has asked Megan Riddle, M.D./Ph.D.— a psychiatry resident at the University of Washington and a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional M.D.-Ph.D. Program—to address the concerns of a woman who suffered from postpartum depression when she gave birth; she is worried that her daughter, who is pregnant, may have the same experience.

380747913_c73873a0d1_oImage by Ozan Ozan via Flickr (Creative Commons License)

Dear Dr. Pat:

My daughter—I’ll call her Emily—is 32 years old and 6 months pregnant with her first child. My husband and I are very excited, since this will be our first grandchild, but I am also worried. Emily is my only child. When I was younger, my husband and I had always planned to have a big family, but I had a very difficult time after giving birth to Emily. I was tearful for months after her delivery, and so overwhelmed that I was barely able to function. She was a very good baby, sleeping through the night at a young age, but I found myself lying in bed awake for hours, worrying about her and feeling as if I would never be a good parent. Thankfully, my husband was very supportive and I was able to get through that dark period, but it did affect our decision not to have more children.

I realize now that I had a severe case of the baby blues. I have not discussed this with my daughter; I did not want her to feel that she was somehow to blame, or that I did not want to be a mother. Now, though, I find myself holding my breath, worrying that she will go through the same thing. She seems to be doing well at this point in her pregnancy, but I wonder: Should I discuss this with her? Is she at greater risk? What signs should I be looking for?

Thank you,

Marianne

 

Dr. Riddle Responds:

Dear Marianne:

Congratulations on expecting your first grandchild. I can understand your concerns; it sounds as if you had a very difficult time after the birth of your daughter. The birth of a child, particularly a first child, is filled with excitement and anxiety. Society expects us to be blissfully happy after welcoming home the new baby, but the reality is far more complex. When our life does not live up to the Hallmark card images of peaceful mother and happy baby, the experience is further complicated by a sense of shame and guilt.

The time around childbirth is associated with significant changes physically, emotionally, and socially, all of which can contribute to the development of mental health issues. These can range from fairly mild and self-limiting—responsive to support and watchful waiting—to severe and life-threatening, necessitating hospitalization. It is important for new mothers and their families to be aware of the mental health concerns that can arise, because early interventions lead to the best outcomes for all involved.

Many factors are likely to contribute to the mental health issues that can arise in this period.   During pregnancy and after delivery, a woman’s body goes through significant hormonal fluctuations. Just as monthly menstrual cycles and the hormonal changes of menopause can send your mood reeling, so can the hormonal changes associated with childbearing.   In fact, having severe mood symptoms related to your monthly cycle increases your risk for developing depression around the time of childbirth.

Social factors also contribute; those experiencing stressful life events, social isolation, or relationship issues with their spouse are at greater risk. Other risk factors include having had a previous episode of depression or other mental illness or having a family history of mental illness. Therefore, women need to talk to their obstetricians about their mental health history. Because we know that genetics do play a role as well, it is important for your daughter to know that you struggled with mood symptoms after delivery; this will enable her to share this information with her physician.

Next page: The difference between postpartum blues and postpartum depression.

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