Often tabooed, underestimated and still under-served: postpartum depression. A topic that unfortunately still receives too little attention and consideration in society. Pregnancy is already a great challenge for both the female body and soul. Emotionally processing birth is the next big psychological task that mothers will face. Sometimes, however, the emotional balance gets out of whack. Not every mother who has given birth to a child can be unreservedly happy about it. Between 10-20% of mothers develop depression, which is called “postpartum depression” (PPD) because of its temporal connection to birth. In other words, 1 in 5 women develop postpartum depression, and most cases go undetected. However, since there is very little research on the topic, the number of people affected is probably even higher. Australian researchers concluded that 33%, or 1 in 3 women, suffer from traumatic childbirth and exhibit symptoms of PPD (Creedy DK. 2000).
What characterizes postpartum depression?
Postpartum depression is a serious condition and not a trifle. It is a depressive disorder that develops within four to six weeks after delivery. Symptoms are varied and range from depressed mood, lack of interests, bleakness, loss of appetite, increased fatigability, feelings of worthlessness and guilt, inner emptiness and hopelessness, and decreased concentration, to suicidal thoughts and actions. To be diagnosed with PPD, five of these symptoms must be present for at least two weeks. PPD is not the same as the so-called “baby blues”, which occurs in 25-50% of all women who have recently given birth and also disappears on their own. The latter is milder in course and characterized by symptoms such as weepiness, 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 hospital, so it is often not recognized at all or only very late. In addition, new mothers often conceal their symptoms out of shame, fear and guilt. Particularly apathy and ambivalent feelings towards the child often lead to massive feelings of guilt, because mothers do not even know that they are suffering from depression. A broad education and information of the population would promote understanding and acceptance of the disease. In the general population, however, postpartum depression is still not taken seriously enough, because unconditional motherly love and joy for the baby are simply assumed. For some mothers, however, a bond with this little creature that is suddenly “there” must first be established. In addition, there are hormonal changes, sleep deprivation and the sudden great responsibility towards the newborn. It is not uncommon for those affected to care for their baby correctly, but apathetically, like a doll. The consequences for the infant can be behavioral problems, attachment disorders, and disturbances in emotional and cognitive development. Especially the close social environment such as life partners, relatives and aftercare midwives must pay increased attention to signs of postpartum depression in the first weeks. After all, if PPD is not treated, serious complications can arise in the mother and child, which in the worst case can even lead to suicide or extended suicide.
How does postpartum depression develop?
Neurochemical, hormonal, and psychosocial factors are thought to be involved in the development of PPD. On the physical level, hormonal changes in the female body, and here especially the drastic drop in progesterone and estrogen levels, are held responsible for the low mood leading to PPD. But other factors can also play a role, such as a general feeling of helplessness in the face of the great responsibility towards the newborn, the new role as a mother in itself, hypothyroidism, states of exhaustion or a traumatic birth, often accompanied by a high level of obstetric intervention.
Risk factors
The most important risk factor for PPD is considered to be increased vulnerability of the mother due to a history of depressive (pre)illness or other mental illnesses. In addition, traumatic experiences and neglect in the mother’s own childhood, stress during pregnancy, traumatic experience of childbirth, biological triggers, little or no social support, and low partnership satisfaction are discussed. In contrast, educational level, sex of the child, or breastfeeding do not seem to influence postpartum depression.
How is postpartum depression treated?
Unlike baby blues, there is an absolute need for therapy for PPD. Treatment of PPD can vary according to the severity and preferences of the affected woman. Increasingly, the focus is on therapy for the frequently disturbed mother-child relationship. In addition, therapy includes both psychotherapy and drug therapy, and in urgent cases, inpatient hospitalization is required. A broad education and information of the population would also promote understanding and acceptance of the disease. If you are affected by postpartum depression (or also by baby blues) or have friends who seem to be psychologically unwell after childbirth, please don’t hesitate and talk about it with your partner, friends, postpartum midwife, doctors or psychologists and get advice and help!
Here you can get additional information and help:
Schatten und Licht e.V., Support group for women with postpartum depression and postpartum psychosis
References
Bürmann/ Siggeman C. 2014. Postpartale Depression. Kompetenz Zentrum NRW. Frauen und Gesundheit
Creedy DK et al. 2000. Childbirth and the development of acute trauma symptoms: incidence and contributing factors. Birth;27(2):104-11.
https://www.aerzteblatt.de/archiv/54466/Postpartale-Depression-Vom-Tief-nach-der-Geburt , Access 13.8.2019
https://www.stiftung-gesundheitswissen.de/wissen/wochenbettdepression/hintergrund, Access 13.8.2019
https://postpartaledepression.jimdo.com/, Access 12.8.2019
https://lansinoh.de/baby-blues-und-wochenbettdepression/, Access 12.8.2019
