Postpartum Depression: An Important Issue In Women’s Health

Abstract

The purpose of this paper is to educate and inform the audience of a condition known as Postpartum depression (PPD). Throughout this text I will be identifying what exactly PPD is, causes and risk factors associated with PPD, signs and symptoms, complications, diagnosing PPD, prevention, and treatment. Many women don’t seek the help they need during a crisis like PPD because they think their symptoms are relative to expected pregnancy symptoms. It is very important to screen and educate new mothers and to educate family, and friends of the potential risk factors associated with PPD.

Postpartum Depression: Identifying An Important Issue In Women’s Health

When thinking of a newborn baby, what comes to mind? One typically thinks of love, happiness, joyous moments that turn into lifelong memories, and we think of how beautiful a mother’s bond with her baby can be. However, unbeknownst to many, a heavy percentage of women experience something known as Postpartum Depression or PPD. Postpartum depression is a psychological mood disorder that can affect women after they’ve given birth. “Mothers who are diagnosed with postpartum depression can experience feelings of extreme sadness, anxiety, and exhaustion that can make it difficult to complete daily care activities for themselves or for their baby. (National Institute of Mental Health, 2019)

PPD does not occur in one specific population of women. It can happen to any new mother of any age, race, ethnicity, religion, or socioeconomic status. Among the various pregnancy complications that we know of, postpartum depression is one of the most common with as many as 10-15% of women having been diagnosed (Hantsoo, et al. 2014).  While suffering from postpartum depression is undoubtedly difficult, it is important for one to know the signs, symptoms, complications, diagnoses and treatment plan to prevent further complications.

Causes and Risk Factors of PPD

Postpartum Depression has many underlying causes and cannot be narrowed down to one single factor. However, mental and physical changes after birth can definitely make an impact on the manifestation of PPD. Every woman experiences changes in their body after giving birth. However, the body changes come with hormone changes, and the hormones affect each woman differently. After childbirth, a dramatic drop in estrogen and progesterone may contribute to postpartum depression. Other hormones from your thyroid gland also may rapidly decline —which can contribute to feeling tired, sluggish and depressed.

Emotional changes during the postpartum period are also extremely common in new mothers. After being in active labor, a new mother is often extremely fatigued and submerged by all of the vast changes happening in her life. New mothers are often sleep deprived and overwhelmed, which can contribute to feelings of frustration frustration and finding it difficult to deal with even the most simple problems. Women may also feel anxious about their ability to care for their baby, unattractive due to constant bodily changes, and may also feel as though they’ve lost their sense of identity or lost control over their own lives. Any or all of these feelings can contribute to PPD.

Aside from presenting solely emotional and physical symptoms, there are several prequalifying risk factors that may contribute to postpartum depression. Some of which include a history of bipolar disorder, history of postpartum depression with a previous pregnancy, history of depression, history of post traumatic stress disorder, multiple births, difficulty with breast-feeding, financial struggles, a broken support system, spousal/marital issues, and unplanned or unwanted pregnancy.

Signs and Symptoms

PPD can occur a few days after birth or may not present itself until one year postpartum. Potential indicators include feeling sad, hopeless, or immensely overwhelmed, trouble sleeping and eating regularly, feeling guilty and worthless, losing interest in things that you previously enjoyed, withdrawing socially from close family and friends, thoughts of hurting yourself and your baby, and having no interest in your baby. It’s very important to identify and understand risk factors and symptoms of PPD so that the sufferer can receive professional help.

“Postpartum depression may be mistaken for baby blues at first — but the signs and symptoms are more intense and last longer, and may eventually interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin earlier ― during pregnancy ― or later — up to a year after birth” (Mayo Clinic, 2018)

Complications of Postpartum Depression

“Postpartum depression is well-known to have an adverse effect on mothers’ relationships with their children. This has a subsequent impact on child development from early infancy to adolescence and influences emotional, cognitive, and physical development in children” (science daily, 2019). Studies have proven that mothers who suffer from PPD  are more detached, less sensitive, emotionally unavailable, and more critical of their children than mothers who don’t suffer from PPD.

If left untreated, postpartum depression can last for months or even years and can significantly alter the mental and physical relationship between a child and their mother. Women who experience PPD can often find themselves experiencing a health decline, marital discord, strained relationships, suicidal ideation, and a complete disconnect from their baby.

PPD can have life-long effects on a mother-child relationship and can even negatively impact the relationship between a grandmother and grandchild, if the grandmother suffered from PPD with her child. (Hyland 2015). Children who are affected by this illness are shown to have an insecure attachment towards their mothers which can affect their sleep patterns. It can also effect a child’s ability to learn and to deal with regular emotions.

Diagnosing PPD

Understanding that postpartum depression is not only a very serious risk to the mother but also her child, it is very important for those involved in their care to be properly educated and informed of the potential risk factors and signs associated with PPD so that a proper diagnoses can be formed. Screening women for PPD can help to identify who is experiencing the effects of this illness, and it also helps catch symptoms early to help improve outcomes of the mother and child. While extremely severe cases are easily identified and treated, more moderate forms are passed off as “baby blues” or normal outcomes of pregnancy and can lead to detrimental outcomes for the mother and baby (Hyland 2015).

“The American College of Obstetricians and Gynecologists has recognized PPD screening as an important part of postpartum care. This is evident as studies show that up to an alarming 50% of PPD cases go undetected and only 49% of mothers who felt severely depressed get help” (Hyland 2015). In order to more accurately identify those at risk for postpartum depression, a model entitled The Postpartum Depression Predictive Inventory (PDPI) was created and has been used in the United States of America, Canada, and Iceland. The checklist contains 8 risk factors that can help identify the likelihood of a mother developing PPD. The risk factors associated include

In addition to the PDPI, the Edinburgh Postnatal Depression Scale (EPDS) was created for screening postpartum women in outpatient, home visiting settings, or at the 6 –8 week postpartum examination. It has been utilized within many populations including U.S. women and Spanish speaking women in other countries. Spanish women are at higher risk for postpartum depression due to lack of insurance and no access to healthcare. Among the two scales, the EPDS is used more frequently (Hyland 2015).

Prevention and Treatment

Most pregnant women receive routine pregnancy care throughout the gestational period which makes it easier for providers to identify and recognize early symptoms. It is very important not only for physicians, but also for women to become educated on the signs, symptoms, and risk factors associated with PPD. “Early identification of women who may be at risk for PPD aids in the prevention and reduction of depressive symptoms” (Hyland 2019).

History of depression and other psychological disorders should be shared with a provider as early into the pregnancy as possible. Many women feel as though the manifestations they experience are part of a normal pregnancy and ignore their feelings. It is absolutely imperative for physicians to recognize the early signs and risk factors of PPD so that they may conduct follow up care and interventions to combat PPD. Since postpartum depression is one of the most common postpartum complications, women who are tested positive for PPD should be treated as soon as possible.

When dealing with such a devastating condition, one may feel alone and lost. However, there are plenty of treatment options available to help depressed women cope. Many women go through postpartum depression and as a result, there are various support groups for counseling and sharing experiences with people of similar conditions. Cognitive behavioral therapy and pyschoeducation are two other alternatives in which women can learn about the effects of PPD and learn how to cope and redirect their emotions with a certified professional (Mayo Clinic 2019).

Aside from therapy and support groups, medication is another method to combat and treat postpartum depression. Medications such as Sertraline, Fluoxetine, and Paroxetine (among many others) can be used to treat depression, anxiety, and other symptoms as well as ease the discomfort of such symptoms. If medication is not an option then there are other holistic ways of dealing with PPD. Meditation, yoga, breathing exercises, and herbal remedies such as St. John’s Wort can provide ease and comfort to some patients.

Treatment options are dependent upon many factors. Some of which include severity of PPD, what the patient and physician are both comfortable with, whether the mother will be breastfeeding, and medical history of the patient. It’s always important to seek treatment and communicate with a provider about any negative feelings and what treatment options would be most comfortable for the patient to try. If after all available treatments fail, the patient should be re-evaluated.

While suffering from an illness like postpartum depression is difficult, it is important for one to know the signs, symptoms, complications, diagnoses and treatment plan to prevent further. PPD can affect any woman, at any time within the first year of giving birth to a child. Although it isn’t specific to one population, there are certain factors that contribute to a higher risk of development. Postpartum depression can interfere with the mothers ability to care for and bond with her child. Treatment options are vast and easily accessible with a proper diagnoses from a provider.

References:

• Hantsoo, Liisa, et al. “A Randomized, Placebo-Controlled, Double-Blind Trial of Sertraline for Postpartum Depression.” SpringerLink, Springer Berlin Heidelberg, 31 Oct. 2014, link.springer.com/article/10.1007/s00213-013-3316-1.
• Hyland, Kristina. “Postpartum Depression Research Paper.” LinkedIn SlideShare, 15 Nov. 2015, www.slideshare.net/KristinaHyland/postpartum-depression-research-paper-55121451.
• National Institute of Mental Health, www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtmlTables.
• “Postnatal Depression Has Life-Long Impact on Mother-Child Relations.” ScienceDaily, ScienceDaily, 20 Feb. 2018, www.sciencedaily.com/releases/2018/02/180220122917.htm.
• “Postpartum Depression.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 1 Sept. 2018, www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617.