Postpartum depression

Often stigmatized, underestimated, and still underserved: postpartum depression. It is an issue that, unfortunately, still receives too little attention and recognition in society at large. Pregnancy itself is a major challenge for both the female body and the mind. Coming to terms with the birth emotionally is the next major psychological challenge mothers will face. Sometimes, however, their emotional balance can be thrown off course. Not every mother who has given birth is able to rejoice in it unreservedly. Between 10–20% of mothers develop depression, which is referred to as “postpartum depression” (PPD) or postpartum depression due to its temporal association with childbirth. In other words, one in five women develops postpartum depression, and most cases go undetected. However, since there is very little research on the subject, the number of women affected is likely even higher. Australian researchers concluded that 33%, or one in three women, experiences a traumatic birth and exhibits symptoms of PPD (Creedy DK. 2000).

What are the characteristics of postpartum depression?

Postpartum depression is a serious condition and not something to be taken lightly. It is a depressive disorder that develops within four to six weeks after childbirth. The symptoms are varied and range from a depressed mood, loss of interest, withdrawal from others, loss of appetite, increased fatigue, feelings of worthlessness and guilt, inner emptiness and hopelessness, and difficulty concentrating, all the way to suicidal thoughts and actions. To diagnose PPD, five of these symptoms must be present for at least two weeks. PPD should not be confused with the so-called “baby blues,” which occurs in 25–50% of all new mothers after childbirth and resolves on its own. The baby blues is milder in nature and characterized by symptoms such as tearfulness, sadness, and depressive moods.

Why does postpartum depression often go undetected?

The symptoms of PPD usually do not appear until after discharge from the maternity ward, which is why it is often not recognized at all or only very late. In addition, new mothers often conceal their symptoms out of shame, fear, and feelings of guilt. In particular, apathy and ambivalent feelings toward the child often lead to intense feelings of guilt, because the mothers are unaware that they are suffering from depression. Widespread public education and information would promote understanding and acceptance of the condition. However, postpartum depression is still not taken seriously enough by the general public, as unconditional maternal love and joy over the baby are simply taken for granted. For some mothers, however, a bond with this tiny creature that has suddenly “appeared” must first be established. Added to this are hormonal changes, sleep deprivation, and the sudden, overwhelming responsibility toward the newborn. It is not uncommon for those affected to care for their baby correctly but without emotion, as if it were a doll. The consequences for the infant can include behavioral problems, attachment disorders, and disturbances in emotional and cognitive development. The immediate social circle—such as partners, family members, and postpartum midwives—must be particularly vigilant for signs of postpartum depression during the first few weeks. If PPD is left untreated, serious complications can arise for both mother and child, which in the worst-case scenario can even lead to suicide or extended suicide.

What causes postpartum depression?

Neurochemical, hormonal, and psychosocial factors are believed to play a role in the development of PPD. On a physical level, hormonal changes in a woman’s body—particularly the drastic drop in progesterone and estrogen levels—are believed to be responsible for low mood and, in some cases, PPD. However, other factors can also play a role, such as a general sense of helplessness in the face of the immense responsibility toward the newborn, the new role of motherhood itself, hypothyroidism, exhaustion, or a traumatic birth, often accompanied by a high degree of obstetric interventions.

Risk Factors

The most significant risk factor for PPD is considered to be the mother’s increased vulnerability due to a history of depression or other mental health conditions. In addition, traumatic experiences and neglect during one’s own childhood, stress during pregnancy, a traumatic birth experience, biological triggers, little or no social support, and low relationship satisfaction are also discussed. Educational level, the child’s gender, and breastfeeding, on the other hand, do not appear to have any influence on postpartum depression.

How is postpartum depression treated?

Unlike the “baby blues,” PPD absolutely requires treatment. Treatment for PPD can vary depending on the severity of the condition and the preferences of the affected woman. Increasing emphasis is being placed on addressing the often-strained mother-child relationship. In addition, treatment includes both psychotherapy and medication; in urgent cases, inpatient hospitalization may be necessary. Widespread public education and information would also promote understanding and acceptance of the condition. If you are experiencing postpartum depression (or the “baby blues”) or know friends who seem to be struggling emotionally after giving birth, please don’t hesitate to talk to your partner, friends, your postpartum midwife, doctors, or psychologists about it, and seek advice and help!

Here you can find additional information and help

Shadow and Light, Inc., Support group for women with postpartum depression and postpartum psychosis

German Depression Support

Social psychiatric services or pregnancy counseling centers near you. The social workers and psychologists who work there are bound by confidentiality.

References

Bürmann/ Siggeman, C. 2014. Postpartum Depression. Competence Center NRW. Women and Health
Creedy DK et al. 2000. Childbirth and the development of acute trauma symptoms: incidence and contributing factors. Birth;27(2):104-11.

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