Now nine months of waiting and childbirth have passed - all the hardest things are behind us. You have the best, most beautiful and fragrant baby in your arms, and finally the boundless happiness of motherhood, about which your friends have talked so much, should come. But for some reason this doesn’t happen. If, in addition, you feel melancholy, deep fatigue, devastation - perhaps we are talking about postpartum depression.
There is no need to be afraid of these words: they do not mean that you are a bad mother or are not prepared enough for a new life. Postpartum depression is a common condition experienced by many women, including celebrities and “perfect mothers” on social media. According to WHO, postpartum depression occurs in approximately 25% of new mothers. Interestingly, it also happens to new dads. According to a 2012 survey conducted by the American Medical Association (AMA), about 10% of fathers after giving birth feel low energy, irritability, and sadness - classic symptoms of postpartum depression. The main thing that both parents need to do is to correctly identify their condition and help each other cope with it.
Signs of postpartum depression
Postpartum depression is often confused with the “baby blues” - the blues that affects 70% of new mothers. It is characterized by mood swings, causeless tears, a feeling of helplessness, and constant fatigue. All this is understandable: serious hormonal changes have occurred in the body, the amount of sleep has sharply decreased, and the number of worries has increased. Usually, after a month or two, the mother gets used to the new state, the hormonal storm subsides and the emotional background returns to normal. But if the blues do not go away after 8–10 weeks and only intensify, and apathy, depression, and reluctance to care for the baby are added to the sensations, perhaps we are talking about postpartum depression. Usually it develops gradually, but sometimes it hits a young mother like an avalanche literally in one day. Here are the symptoms that give reason to seriously think about your well-being:
- Migraine;
- Digestive disorder;
- Skin itching;
- Insomnia;
- Neuralgia;
- Nightmares;
- Unexplained mood changes;
- Frequent tears;
- Problems communicating with your own child, lack of interest in him;
- Reluctance to contact relatives and friends;
- General loss of strength;
- Feeling that you are a bad mother and cannot cope;
- Feelings of worthlessness, shame, guilt;
- Inability to concentrate on anything and make decisions;
- Memory impairment;
- Panic attacks;
- A latent desire to harm yourself or a child.
Every mother who has discovered these alarming symptoms in herself will involuntarily ask the question: why did this happen to me?
Bad mood, sleep and appetite disturbances, irritability, fatigue... Women in the postpartum period often encounter such symptoms. However, only a few seek help. They believe that love for a child will allow them to cope with all difficulties - and they are mistaken. In an interview with MV, myths about the boundless joy of motherhood are dispelled by the deputy head of the department of forensic psychiatric examinations of the State Committee for Forensic Examinations in the Minsk Region - state medical forensic psychiatrist Tatyana Semenova.
Tatyana Semenova, deputy head of the department of forensic psychiatric examinations of the State Committee for Forensic Examinations in the Minsk Region - state medical forensic psychiatrist. Tatyana Sergeevna, what mental problems does a woman face after giving birth to a child?
In the first 3–5 days, approximately half of women develop postpartum blues (postpartum melancholy, baby blues), which is detected in only 3% of cases. It’s just that many women don’t seek help: they feel uncomfortable or don’t understand what’s happening to them. Their mood fluctuates, they feel irritable, tired, sleep poorly, worry for no reason and cry.
Typically, postpartum blues develops against the background of a sharp decrease in female sex hormones - estrogen and progesterone. The sodium level may change, causing fluid retention and intercellular edema in the brain tissue, and the transmission of nerve impulses is disrupted. Mental tension and stress play a role: unwanted pregnancy, lack of support or poor social status.
Postpartum blues lasts up to a week and does not require medication. Enough to rest and talk to a therapist about your worries and fears.
But why are postpartum blues dangerous? Sometimes postpartum depression or postpartum psychosis develops against their background.
For what other reasons does a woman become depressed after childbirth?
It's impossible to say for sure. Usually this is a combination of factors: social - level of education, marital status, relationship with husband, income, age; biological - history of PMS, excess weight after childbirth; obstetrics - first birth, complications, time of discharge from the hospital; psychological - antenatal depression, level of self-esteem, ambivalent attitude towards pregnancy. Sometimes even the gender of the child influences it, that is, when the parents’ expectations are not met.
Stress associated with caring for a baby and increased workload plays a big role. The woman begins to worry: I can’t cope, I can’t do anything. She had seen enough of happy mothers on social networks and hoped: I, too, would immediately love my child just as much, and I wouldn’t have any problems. In reality, everything is not so simple. Love is formed over time, when you take care of your baby and constantly communicate with him.
Postpartum depression often develops in perfectionists. Wash the floors every day, cook breakfast, lunch and dinner, play sports... Such women have many demands on themselves, and the baby dictates his own conditions. A woman ceases to live up to her ideas about an ideal wife, mother, and she begins to develop feelings of guilt, shame... She is convinced of her inadequacy. At the same time, there is such an attitude: when the child sleeps, the mother should also sleep, and not wipe off the dust again.
What makes it difficult to diagnose postpartum depression?
Women are ashamed to complain, because what they hear from relatives is: you’re just lazy, we used to give birth in the field, and here you are in some kind of bad mood and other nonsense. Moreover, what is the attitude in society towards mental disorders? If you get registered, the child will be taken away...
Some go to the general practitioner with complaints of numbness and tingling in the extremities, rapid heartbeat, breathing problems, headaches, that is, with somatic manifestations that mask postpartum depression.
How does this disorder manifest itself mentally?
Postpartum depression has a triad of symptoms characteristic of all depression - low mood, decreased or loss of the ability to enjoy what previously brought joy, and increased fatigue. The woman sleeps poorly, feels powerless, melancholy, guilt, sadness, emptiness, causeless anxiety, obsessive fear of harming the baby, and is overly worried about his health.
Suicidal thoughts and even plans may arise. Postpartum extended suicides occur when both the child and the mother die. In addition, there are attempts to cause harm that are not recorded. For example, leaving a child alone for a long time, not feeding him, leaving while bathing and returning 15 minutes later... Accidents also mask postpartum depression. At the same time, the woman repeatedly told her family about her condition, but they did not pay attention. For them, the main thing is how the child feels.
You can't let the situation take its course. It is important that both the woman and her husband and relatives know that such conditions exist, that this is a mental disorder that needs to be treated. It is necessary to talk about this along with breastfeeding classes.
In ICD-10, postpartum depression refers to mild mental and behavioral disorders of the postpartum period. This is a fairly persistent condition that develops in the first 2–3 months after the birth of the child. Untreated emotional disturbances can persist for a year, two or more. The woman does not realize that this is an illness, she thinks: I’ll sleep and everything will go away. But at this time, negative thoughts and fatigue accumulate.
Does the mother's emotional state affect the baby?
If a woman is depressed, then, firstly, defects in care and nutrition arise, for example, refusal to breastfeed. Secondly, defects in communication, education and teaching. The mother does not take the baby in her arms or talk to him, which is why his speech does not develop. Emotional disturbances in the mother make it difficult for the child to form emotional attachment, which can subsequently affect his psycho-emotional development.
If before the age of one year the disharmony of interaction is manifested in a child by frequent colds and nighttime sleep disturbances, then at the age of 12–14 years - by significant cognitive deficits, emotional and behavioral disorders. Such children do not understand how to show their love.
How is postpartum depression treated?
Antidepressants and cognitive behavioral psychotherapy. Treatment lasts from 6 to 16 weeks. A psychotherapist or psychiatrist observes the patient, talks to her, explains how to behave, how to take care of herself.
Discussing the problem on a forum with other mothers will not help. Instead of reading social networks, it is better to sleep or exercise. Your figure will get toned and your mood will improve. You definitely need to devote time to yourself: take a relaxing bath, get a manicure, do breathing exercises, take a walk alone or meet with a friend. When you start doing things for yourself, your self-esteem increases. A calm mother will calm the baby faster. And when a woman is nervous, it is better for her not to approach the child: he senses her mood very well.
You don't have to take on everything. There is no shame in asking your family, husband, or friends for help. You can agree with your partner to take on some of the housework, or set aside money for cleaning services.
If you are comfortable sleeping with your child, sleep with your child. Only mom decides what is more convenient for her.
It’s important to talk to your partner: I feel bad, how are you feeling? I feel like I'm not coping.
One cannot ignore the words of a woman-mother that it would be better if there was no child, if she herself died.
How can a GP diagnose postpartum depression?
It is based on a carefully collected anamnesis. Typically, general practitioners begin examining a woman who has given birth not by asking how she is feeling, but by measuring her blood pressure and temperature. Even a short conversation with the patient is very important, because the doctor is not a relative to whom the woman is ashamed to admit that she cannot cope.
How is your sleep and appetite? Have you gained a lot of excess weight? Are you breastfeeding and if not, why? What are your family relationships like? Do your family help you? Here is a minimum set of questions that a general practitioner or other specialist can ask to understand a woman’s condition. The Edinburgh Postnatal Depression Scale will help diagnose .
Does it happen that men get depressed?
Yes, because they also have expectations. The birth of a child is associated with joy and happiness. But at the same time, men understand: the wife will always be tired and dissatisfied, will wear a robe, and will not cook as often and deliciously. Changes occur in sexual relationships. It turns out that the child is to blame for everything. There is also less money. The husband begins to think: I don’t earn enough, I’m a bad father.
Initially, fathers do not experience as much love for the baby as mothers do. For them, this is a child who screams endlessly and takes away his wife’s attention. They think: why was all this necessary? Men begin to treat children differently when they start doing something on their own - holding a spoon, playing with a car... They are touched when they are called dad.
Sometimes, for a man to get out of a depressed state, it’s enough just to talk to him. But, in essence, this is a time that needs to be lived through.
What kind of phenomenon is pregnancy in men?
This is couvade syndrome, when a man, usually of an infantile nature, begins to experience the same sensations as his pregnant wife. He feels nauseous, he is just as irritable, capricious, and his belly may even grow. He sleeps poorly and complains of loss of appetite. It happens that the wife is taken away for childbirth, and at this time the man has a picture of an acute abdomen. Doctors cannot understand what is the reason. And if you don’t collect a proper medical history, it’s unlikely that you’ll be able to solve the problem correctly.
How common is postpartum psychosis and how does it manifest?
There have been no extensive epidemiological studies in Belarus over the past ten years. According to literature data, 1–2 cases per thousand births were registered in our country. The diagnosis is made 2–3 months after birth. It has a persistent course and lasts 60–75 days.
In the development of postpartum psychosis, a genetic predisposition to mental disorders is key. Plus fluctuations in female sex hormones. Many psychoses develop against the background of sleep deprivation and postpartum depression.
The clinical picture is dominated by visual and auditory hallucinations. Manic ideas arise that someone wants to harm the child or that he is sick. A woman in such a state is sure that by killing, she is saving him. Often she decides to die with the baby.
Postpartum psychosis requires hospitalization and medication. Unfortunately, it can become a trigger for the development of schizophrenic or affective disorder.
Share cases from your practice.
Forensic psychiatrists and forensic psychologists are faced with situations where the mother killed the baby or committed suicide (often attempted suicide) or extended suicide.
For example, a story where a woman in a state of postpartum psychosis threw two children out of a window from the 9th floor. Unfortunately, one of them died. A woman with a higher education, she was in her second marriage, in which she gave birth to three children. In her first marriage she had a son. After giving birth, the mother’s condition changed - from depressive depression to delight, and there was insomnia. She felt like she couldn't cope. She complained to her family that she felt bad, asked them to take care of the children and give her some rest. But no one paid attention to the requests. The woman developed psychosis: she heard voices that ordered the children to be killed. When she thought she heard the killers' footsteps on the stairs, she decided to save her sons by throwing them out of the window. Then, with her youngest child in her arms, she woke up her eldest son (it was at night) and asked him to help her jump out of the window...
Do you have any children? How did you survive the postpartum period?
I have a 14 year old daughter and suffered postpartum blues. The reason for this was a caesarean section, during which I lost a lot of blood. In addition, my stitch hurt: I refused pain relief because I was breastfeeding. I had a low mood, tearfulness, thoughts that I could not cope with the child, that he was not eating well. I asked the doctor to take the baby so I could get some sleep. The next day I felt much better, and they gave me my daughter.
What advice do you have for couples who have become parents or are just planning children?
Be prepared for the fact that a child is not only happiness, but also worries. Don’t try to live on an A in the first months after the baby is born. Ask your family for help, take time to relax, pay attention to yourself and your partner and remember: everything will be fine.
Photo by expert Tatyana Stolyarova, MV.
Causes of postpartum depression
The mechanism of postpartum depression is not well understood. According to scientists, its development is influenced by many different reasons, from genetic predisposition to recent emigration. Women of all ages and classes are susceptible to this condition, and it is impossible to completely protect yourself. But there are some factors moms should take into account that have been proven to increase the chances of postpartum depression:
Some researchers claim that breastfeeding helps reduce the risk of postpartum depression.
- You have previously been diagnosed with depression;
- There is a history of depression or mental illness in your family;
- You have always had severe premenstrual syndrome;
- You had a problematic pregnancy;
- While expecting your baby, you experienced a lot of stress;
- The child has health problems;
- You have difficulty breastfeeding;
- You are unhappy with your relationship with your husband;
- You have no close friends;
- You have financial problems;
- The pregnancy was unplanned.
Sleep disturbances can prolong postpartum depression, so it's important to get some rest whenever possible. Even a ten-minute nap will help you feel better.
Unfortunately, young mothers are often embarrassed by their condition or consider it a variant of the norm and do not seek help, although they obviously need it. But if you discover three or more symptoms of postpartum depression and they do not go away within 4 to 6 weeks, you should contact a specialist. If your own good health is not enough motivation, think about your baby: he really needs a calm and caring mother.
How long does it last?
The diagnosis of postnatal depression is established when characteristic symptoms appear in the first 4-6 months after birth. Foreign classifiers increase the diagnostic period to 1 year. The probability of disease relapse is 1:3-4 cases.
In mild cases, the episode lasts up to 2-3 weeks - “postpartum blues”, that is, transient depression. The clinical picture is mild and does not require massive pharmacological intervention. It is relieved with the help of psychotherapeutic influence.
More severe variants of mental disorders involve long-lasting symptoms with individual timing. Patients may remain ill for months or even years. The recurrent course of the disease indicates the formation of recurrent depressive disorder (F33).
Professional help
A good way to combat postpartum depression is psychotherapy sessions. They help a woman increase her self-esteem, stimulate her to communicate with her baby, and restore interest in life. A specialist will tell you how to properly relax and take care of yourself, for example, recommend art therapy, meditation or yoga. Close relatives of the young mother are often invited to sessions, because without their support, healing is impossible.
In some cases, medication may be required, and this is not something to be afraid of. If you consulted a doctor, it only means that you are a thinking mother who cares about her well-being. First, you will need to take some tests - for example, a lack of thyroid hormones or estrogen can aggravate a depressive state. The doctor will adjust your hormonal levels and prescribe treatment with antidepressants. Many women are reluctant to take these medications for fear of addiction or the need to wean their baby. It is important to know that there are now mild medications that are compatible with breastfeeding, and the course of therapy usually lasts only a few weeks.
Ask your doctor to check the drug prescribed to you for compatibility with breastfeeding.
Self-care
How can you help yourself cope with depression? Rest, rest and rest again as much as possible. Nature itself took care of this, because for the first few months the child sleeps a lot, and the mother can relax with him. Give yourself time to establish contact with your baby: carry him in your arms more often, kiss him, hug him, and breastfeed him. This helps to overcome the feeling of alienation if it appears. In the first weeks after birth, minimize visits from friends and family and focus on yourself and your newborn.
Get enough sleep and eat well, especially if you are breastfeeding: you need all the microelements and vitamins. Treat yourself to tasty and healthy food, because buckwheat and crackers do not contribute to a good mood. It is ideal if someone can help you with everyday life: go grocery shopping, cook food, clean the house.
6 tips to prevent postpartum depression:
- Surround yourself only with beautiful things, choose those news sources and information channels that do not carry negativity, listen to good music. Try not to read bad books, watch horror films, or go to online forums where children’s problems and illnesses are discussed;
- Don't burden yourself with all sorts of things. At the moment, the main thing is the child, and for him there is nothing more important than a happy and satisfied mother. Cleaning and work can easily wait;
- Don't believe everything "good mothers" say on social media. In fact, there is no ideal, and photographs on the Internet do not convey the true state of affairs. You don’t have to look up to them, because you don’t know how they really live;
- Add light and air! Walk more often in the morning and during the day, ventilate the apartment, do not sit in the dark. You can buy a beautiful new lamp or set of candles for your home;
- Avoid communicating with those who do not support you, accuse you, or are generally unpleasant to you. You can choose your social circle yourself: leave only good people in it;
- Find an ally - someone you can talk to about your condition and who will definitely support you. For example, this could be a friend who also went through postpartum depression and understands exactly how you feel.
Remember that you and your baby come first now. By any means you need to achieve harmony with yourself and start enjoying motherhood. The postpartum period is the best time to learn to love yourself. Believe me, this will benefit not only the newborn, but the whole family.
