Over the past few years public awareness has increased dramatically about the prevalence of postpartum depression.
We now understand the postpartum period is a time of great transition and chemical upheaval that puts new mothers at highly increased risk for the development of psychiatric symptoms.
Today, every woman receiving perinatal care in Canada is screened for symptoms of depression and the stigma surrounding it has lessened significantly.
Less attention is paid to other psychiatric conditions commonly triggered during the postpartum period —particularly anxiety disorders such as obsessive compulsive disorder (OCD).
A recent article in the American Journal of Psychiatry suggests postpartum OCD or obsessive-compulsive symptoms are more common than previously thought.
Obsessions are defined as ideas, thoughts, impulses or images that are intrusive and distressing to those experiencing them. In postpartum OCD, these are often thoughts or images of harming the infant. Postpartum obsessions are different from psychosis as the mother will recognize them as bizarre and distressing and understand that they are not rational.
She will have fears of harming her baby but no intention to do it. Women experiencing these symptoms are very unlikely to ever harm their babies.
Compulsions can manifest as active rituals such as excessive checking to ensure the baby has not been harmed or avoidance of feared situations. These are different from healthy maternal behaviours because they often interfere with the ability to care for the infant.
Symptoms like the above are quite common—one study found 87 per cent of women presenting to a perinatal mood disorders clinic had intrusive, obsessive-like thoughts with half of them being clinically significant.
Another study found 57 per cent of women with postpartum depression experienced obsessional thoughts about harming their babies and most had some related checking compulsions.
Treatment for postpartum OCD typically involves a combination of SSRI medication and cognitive-behaviour therapy. Therapy focuses on exposure to feared situations with response prevention.
Education about the nature of obsessive thoughts is also very helpful. Mothers experiencing these symptoms are usually very relieved to learn they are not at elevated risk of aggressive harm to their babies.
Although we are doing a much better job these days in recognizing, treating and supporting mothers experiencing postpartum depression, we should also be screening for symptoms of anxiety and obsessive thinking as they are also quite common during this period.
A child’s birth is a time often filled with great anticipation, excitement and joy as a family welcomes the new little person and is filled with hope about all the possibility inherent in a new life.
Unfortunately, for some mothers this joyful experience can turn into a nightmare when they sink into depression, anxiety or even psychosis.
By now, most people are aware of the existence of postpartum depression—a condition that can affect up to 15 per cent of new mothers. But sadly there are still many who don’t want to talk about it openly. Societal expectations surrounding motherhood often place unspoken pressure on women to bury negative feelings and many don’t seek help even when they need it.
January is postpartum depression awareness month and I thought a fitting time to revisit this important topic.
Pregnancy and the postpartum period are times when women are most vulnerable to develop or relapse into mental illness. Extreme changes in hormone levels can affect brain chemistry as well as most other body systems and often trigger symptoms of depression or anxiety.
Of course the tremendous life change, disrupted sleep and stress of becoming a parent can also increase susceptibility to a mood disorder.
As a result of all of these factors, most women experience mild mood symptoms after giving birth. These can include sadness, weepiness, lack of concentration and moodiness. This is not considered a disorder though because symptoms are mild and subside in a few days.
For those who develop full blown postpartum depression, symptoms can be much more severe and require treatment with either therapy, medication or a combination.
Depression can come on gradually and may begin at any time during pregnancy, immediately following delivery or within the first year of motherhood.
Risk factors include previous postpartum depression, personal or family history of depression or other mental illness, a difficult pregnancy, high levels of stress, depression or anxiety during pregnancy, mood changes while taking birth control or fertility medication or social isolation.
Screening questionnaires and doctor interviews during pregnancy can help to identify those at risk and ensure support systems are in place before a crisis develops.
It is important to note that postpartum depression is an illness. It is not a product of a weak character or the fault of the mother. Counseling, medication and social support are all important factors in treating this condition and with help, depressed mothers recover well and can expect a happy, normal life.
Most important, if you or someone you love is experiencing postpartum depression or anxiety, seek help. Not only will support and treatment help the affected mother, but it can also help to keep children safe and happy. Untreated, maternal depression can have a profound negative effect on family relationships and the healthy development of children. Help is available.
Published Sep 21, 2002 in the North Island Weekender
Shelley, age 30, came to me with Postpartum depression.
She was a first time mom with a six-month old baby and overwhelmed by the experience. She had difficulty with breast feeding to start but finally got the hang of it. She is sleep deprived and unable to find time for herself.
Her husband works out of town so she is finding that she is experiencing not only depression, but anxiety. She feels guilty because she is beginning to resent the needs of the baby and is experiencing lack of interest in the baby, worrying about hurting the baby and lack of concern for herself.
These are the reasons she is now seeking professional help. She wants to avoid antidepressants because she is breast feeding and is concerned about possible risks to the baby.
The majority of women with newborns often experience what is commonly referred to as the “baby blues” which dissipate a few weeks after the baby is born. Postpartum mood disorders are a much more serious form of baby blues that can last for years if left untreated.
Symptoms can include: moodiness, sadness, difficulty sleeping, irritability, appetite changes and concentration problems.
The fix for this mild form is normally lots of rest and more support from the partner and family.
In the case of Shelley, she needed aggressive naturopathic care to get results in order to avoid the use of anti-depressants.
I reviewed the following strategy with her and made her commit to visits with me every two weeks to make sure was progressing well.
1. Secure a good support network. I encouraged her to see a counselor and talked to her about asking for more help from her partner and her close family. She had been afraid to open up about her feelings with her loved ones. I suggested that a counselor could help her with this if she was not feeling safe.
2. Sleep: come up with a strategy where she could get better quality and uninterrupted sleep. This included using homeopathic Rubimeds that help not only with anxiety and depression but also sleep. These remedies are safe with breast feeding.
3. Adrenal support: Pregnancy, delivery and breast feeding play havoc with the stress pathways in the body including the adrenal and thyroid glands. Adrenal support is addressed using the wonderful adaptogenic herb, Siberian Ginseng which is safe during breast feeding. I will have the mother take this herb for months to help with energy, stamina and well being. During pregnancy, moms will feel great because they are benefiting from the babies adrenal function but when they give birth this stops abruptly, contributing to post partum depression.
4. Optimize the thyroid: TSH, T4 and T3 blood tests help me make sure the thyroid is getting the support it needs and I will treat the thyroid before many MD’s will, using effective herbal remedies to start.
5. Covering the basics: Preconception care and prenatal care that I cover with moms before they get pregnant and deliver really helps prevent post partum depression. Basic nutrients help most cases of depression.
6. Hormone balancing: Some women benefit from temporary progesterone supplementation to feel better but this can impact breast feeding so professional assessment is warranted.
Some risk factors for developing postpartum depression can be: having a prior history, stressful events during pregnancy or birth, and women with marital difficulties or general lack of social support.
Dr. Ingrid Pincott N.D. Naturopathic Physician, has been practicing since 1985 and can be reached at 250-286-3655 or www.DrPincott.com
Testimony Tuesdays: My Awakening By Jayma DuChene
There are two parts to my testimony. The first part is pretty simple. The second part…. well, it’s anything but simple.
I was raised in a Christ-centered home, with prayer and church consistently in my life. On Christmas Eve, when I was six years old, I felt this longing for something that was not of this world. I was crying and my parents prayed for me, and I accepted Christ into my heart that night. You could say it was the best Christmas present I have ever received.
My testimony doesn’t end there. I do believe that every person who comes to Christ will have a separate “awakening” as a Christian and mine came to me in August of this year. On August 4th, 2012, I passed out for the very first time in my life on the hardwood floor of my kitchen.
Before I go on, I need to fill you in on what led me to the point of passing out.
Shortly before the birth of my second child, my mom told me that my dad was diagnosed with colon cancer. I didn’t even have a relationship with my father at that point in time, so I technically wasn’t hit that hard emotionally with the news. I had already mentally and emotionally removed him from my life. Just writing those words breaks my heart, but that was truth. I was in fact upset, but I think I also had to, more or less bottle it up inside of me. I told myself that I needed to stay as positive as I could, especially for the health and well-being of my unborn daughter.
On April 3rd, God gave me and my husband our second gift of love. I was on cloud 9 hundred with all of the love I was embraced with after I had Natalie. I was also notably given a lot of information at the hospital and from some of my friends about Postpartum depression/anxiety/OCD. I was aware that Postpartum was a real thing, but I was in complete denial with myself and basically said in my head, I have God’s help and will be strong enough to never have to go through that. I also thought, that since I didn’t experience Postpartum with my son, that I would be just fine with this second pregnancy. Ha! Well, when you say things like that to yourself, God usually has to force an attitude adjustment… especially on people who aren’t humble and think they’ve got it all figured out.
2012 has been a year of a lot of huge change and adjustment for me. My family was hit with a wave of health issues all in a short amount of time. As my dad was starting chemo, my mom was diagnosed with melanoma…the worst kind of skin cancer you could have. And then a month later, the very first person in my immediate family died - my Papaul. I love him so much it hurts my heart every time I think about him. He had the warmest smile I’ve ever seen. His death hit me HARD, to say the least…..
So with all the health issues that hit our family, I do have to mention that I still never blamed God or got angry with Him because my faith in Him was slowly getting stronger throughout the whole experience.
Well, aside from the health issues, I was completely consumed with wanting to breast feed my daughter for a full 12 months. Because with my son, I was only able to nurse him for three months and when I went back to work, my milk dried up. To me, that personally made me feel like I was a failure. I have a type “A” personality and perfection is always something in the front of my mind… and to not give him the best nourishment was absolutely devastating to me.
I was 23 when I had my son and 27 when I had my daughter. In those four years between Jake and Natalie, I did do a lot of significant “growing up” spiritually and mentally…. I am still continuing to “grow up” - but I was definitely in a better mind set when I had my second child. I knew that as long as I showed my daughter God’s love, and raised her as the Word instructs, that that would be the best I could give her (and my son). But the devil kept on instilling in my brain that I had to nurse her for 12 months or else I wasn’t “the best mother I could be”. Breast feeding definitely plays with your emotions and hormone levels can be absolutely chaotic. I can say that I went through tiny bits of Postpartum cleaning OCD/anxiety near the end of every month after Natalie was first born (when I would normally have my period). It was as if everything in my house was dirty and I saw every imperfection. I had to clean every single nook and cranny. In my mind, I was failing my children if I didn’t have a constantly clean environment for them. Now that my friends, is POSTPARTUM. A form of it at least. *please note, there are several different kinds of postpartum disorders and the kind I suffered from was internal and basically enhanced my existing weaknesses: OCD cleaning/worrying/depression…. And I never wanted to hurt or was scared of my children. - I can’t even imagine what that kind of postpartum is like…
God talks to us, and if we choose not to listen, sometimes we have to learn the hard way. That’s where passing out on my kitchen floor comes into the picture. I was battling a head cold and had just nursed my daughter in the early morning. After I placed her back in the crib, I took some Tylenol, drank some water, then went back to bed…without eating. I was so tired and not feeling well and eating was the last thing on my mind. As I was shivering in my bed, my four year old son came in and asked for breakfast. It was the weekend and my husband was working the weekend shift at the time (he is in the USAF, so his shift changes every few months). So I walked downstairs with my son and got him a pop-tart and then I just felt so incredibly weird. I immediately tried to shove food - anything I could find that was closest to me - into my mouth. I sat down in my living room and just broke down. I started praying…. and then called my husband. I told him I wasn’t feeling well and that I needed him to come home to take care of the kids while I rested up in bed. He told me he couldn’t. At that moment, I never felt more scared and isolated in my entire life. I was afraid that something was going to happen to me and my kids would be without their mother’s care.
After the call with my husband ended, I stood up, walked into the kitchen again to get some more food from the pantry and as soon as I got to the pantry door, I slithered to the floor with a hard thud. At the same time as I was falling, I said “God help me.”
I don’t think I was out for very long, but I know that when I woke up, I was seeing nothing but white for what seemed like forever. I suddenly realized it was the ceiling, then I looked down and immediately felt a surging pain in my left leg. It was bent the wrong way when I fell. Thankfully I was able to pull myself up and my son wasn’t really aware of what happened. I held onto him and just told him I loved him so much. And he looked at my crying face and said “Mommy, it’ll be ok.” Then I called my dad and told him to pray for me. I then called my husband to come take me to the ER…. He was there in record timing. I had a CAT scan and full physical examination, along with blood work, and everything checked out fine…. I just needed to eat and drink more. Thank the Lord!! That was my first “wake-up call” from God. The wake-up call being…. I needed to take care of myself in order to take care of my family… and that meant no more nursing. After I had stopped nursing completely, my body still wasn’t functioning the way it should. My hormones were still crazy and a month after my fall, I went into a panic attack. I had extremely high anxiety about the world, the upcoming election, friendships, just basically everything would set me off. One night I couldn’t sleep and my whole body was shaking. (Throughout the month prior to this night, I was losing huge amounts of hair on my head, I had lost 20 pounds, and my appetite was basically non-existent) I didn’t know what else to do but tell my husband and pray. I called my doctor as soon as the office opened and got an appointment that day. I was diagnosed with Postpartum depression/anxiety/OCD and also was told that I had an adjustment disorder with all of the change that hit me in the past year. It made sense. I was sort of “out of it” you could say. I felt as if I could feel my skin crawling and I wanted to be out of my body so badly. But I knew that going on the medication my doctor prescribed would [hopefully] help me. Because God made man and helped man develop/discover medicine… so I put my trust in God, and my doctor.
What really got me through everything was having an amazing support system and not being introverted… my support system consisted of my parents - whom I had recently mended my relationship with, as well as my forever friend - my next door neighbor. My entire family, friends, pastor, doctor and psychiatrist were all such a blessing from God and really helped me get through my lowest of lows………. And now I feel as though I am the best version of myself. I am bolder in my faith, stronger as an individual, confident in my trust with God, and overall BLESSED.
My life verse still holds true to me….. Romans 8:28 ~ “For ALL things work together for good for those who love God and are called according to His purpose.”
I want to share my story, because I want to help other women who are going through scary moments in their life where they feel they have absolutely no control. THERE IS HOPE….. The hope you have to have to get through your struggle is complete trust and reliance upon God. It can be a scary thing, but it is possible because ALL things are possible with God - and once that trust is learned, you will never be the same. In my blog http://jaymastips.blogspot.com I talk more about what I learned from this experience and the blessings God has given me through the Holy Spirit.
Special Interview with Wendy Isnardi, author of Nobody Told Me...My Battle with Postpartum Depression and Obsessive Compulsive Disorder
PPDA: When did you first realize that you had postpartum depression?
Wendy: About 3 weeks Postpartum is when I realized I was going through PPD.
PPDA: What steps did you take to find help?
Wendy: First I contacted my OBGYN, not much help there, just prescribed me medication i told me I would be fine. I was on a mission to get better so I contacted everyone including my Lamaze Instructor, who in turn introduced me to The Postpartum Resource Center of New York. The Resource Center gave me all the tools I needed to help my recovery.
PPDA: How easy or difficult was it for you to find help? What do you feel there is a need for in terms of PPD?
Wendy: At first it was difficult. I happen to be very fortunate to find the help I needed with competent doctors and therapists treating me. I believe in education all around beginning with your OB and continuing through the hospitals and even pediatricians, who often see the new mother shortly after the birth. People need to recognize and refer PPD as soon as possible, in order to prevent it from spiraling deeper.
PPDA: When did you realize your PPD was not just PPD, but OCD as well?
Wendy: I did not know it was OCD, till I was screened by a truly competent doctor. One who took the time to realize the symptoms, rather than just subscribe to a cookie cutter theory about PPD/OCD. The doctor needs to be truly interested and educated in this form of PPD/OCD.
PPDA: What inspired you to share your story in the form of a book?
Wendy: I had been volunteering for 8 years and helping other women. I felt if I could write a book to go out to those who need the help, rather than just wait for them to look for the help the need. After several CNN interviews and being published in SELF magazine, I thought i may have a story to tell, that might help someone.
PPDA: What are your goals for your book and what are your future plans?
Wendy: I want to reach as many Families in need, supporting anyone who needs it, man, woman, child, sibling, grandparent or otherwise. I dont want to see anyone suffer the way I did. I hope to perhaps write a second book on the dialogues I have had with women from all walks of life, in my phone support. A book with enough variation and experience that i can touch upon as many situations that may relate to the reader.
For more information about Wendy Isnardi and her book please visit: www.nobodytoldmebook.com
The act of standing up and beginning to move the body in any way is a therapeutic experience to say the least. For people who spend a great deal of their day sitting, this is especially true. Walking is wonderful after being in a chair for awhile and equally enjoyable when we need to get out of the house. Stretching the body and moving the limbs is fabulous and true pleasure; Taking those limbs and making them dance is joy and ecstasy itself
I think even still the power of dance is underestimated. Dance is truly in our souls, something we as a species have been doing for thousands of years as a form of movement and expression. We have danced for lovers and to secure mates, we have danced in celebration, we have danced in the face of war. It is the perfect embodiment of art, exercise and passion. And the element of music that generally accompanies dance is a huge part of this too. Even if that element is something as simple as a single drum beat, it is enough to stir in most of us something primal.
Dance for me, has existed my whole life. It has been my friend, my enemy, my obsession and my passion, but most importantly it has always been there for me. When I was bored I would dance, when I was lonely I would dance, when I was inspired I would dance and when I was depressed or anxious I would dance... AND then I would feel JOY.
I have to admit too as I have in a previous blog that I got a little burnt out on dance a few years ago. I had just danced too much and may dealt with a little more than my fair share of dance politics. I just needed a break. I still danced, but not as much and not with as much fervor as I had in previous years. This past year, I have felt my passion and inspiration for dance returning to me and it is wonderful! I found my passion for dance again in a Zumba class of all places. When I go to it, this class just makes me smile and I feel joyful. The music is uplifting, the movements are enjoyable and I feel free to just dance and be me.
I think everyone should experience dance in their lifetime. Whether it is in your living room by yourself, with your spouse at an event, at a dance class or somewhere else, experiencing the power of dance is just as important as seeing the Eiffel Tower.
Dance is not just about exercise, art and passion. Nor is it simply about power and joy. Dance can also be very therapeutic. As a creative outlet it can be a good distraction for someone who is not feeling completely themselves; Dance can even help lift someone out of a depression. Through expression and movement healing and transformation can occur!
Sad Dads: Paternal Postpartum Depression by Pilyoung Kim, MEd, BA and James E. Swain, MD, PhD, FRCPS
Pilyoung Kim, Ms. Kim is from the Department of Human Development, Cornell University, Ithaca, New York;
Corresponding author.ADDRESS CORRESPONDENCE TO— James E. Swain, MD, PhD, FRCPS, Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT 06520-7900; Phone: (203) 785-6973; Fax: (203) 785-7611; E-mail: firstname.lastname@example.org
The postpartum period is associated with many adjustments to fathers that pose risks for depression. Estimates of the prevalence of paternal postpartum depression (PPD) in the first two months postpartum vary in the postpartum period from 4 to 25 percent. Paternal PPD has high comorbidity with maternal PPD and might also be associated with other postpartum psychiatric disorders. Studies so far have only used diagnostic criteria for maternal PPD to investigate paternal PPD, so there is an urgent need to study the validity of these scales for men and develop accurate diagnostic tools for paternal PPD. Paternal PPD has negative impacts on family, including increasing emotional and behavioral problems among their children (either directly or through the mother) and increasing conflicts in the marital relationship. Changes in hormones, including testosterone, estrogen, cortisol, vasopressin, and prolactin, during the postpartum period in fathers may be biological risk factors in paternal PPD. Fathers who have ecological risk factors, such as excessive stress from becoming a parent, lack of social supports for parenting, and feeling excluded from mother-infant bonding, may be more likely to develop paternal PPD. Support from their partner, educational programs, policy for paid paternal leave, as well as consideration of psychiatric care may help fathers cope with stressful experiences during the postpartum period.
Keywords: fathers/psychology, father-child relations, male, depressive disorders/complications, child development, postpartum depression
Postpartum depression (PPD) typically has been perceived as a problem limited to women with newborn babies and has not included men. Indeed, research accumulated over the past 50 years has focused on the biological and environmental features associated with maternal PPD and the increasingly clear deleterious impact on child development.1,2 However, fathers also experience significant changes in life after childbirth, many of which are similar to the experiences mothers. Fathers must also adjust to an array of new and demanding roles and tasks during the early postpartum period. This critically depends on the level and quality of cooperation between the mother and father. Clearly, the postnatal experience poses many challenges to men's as well as women's lives and mental health,3,4 and the timing and details of paternal PPD are just recently beginning to be recognized and studied.5–7 Studies suggest that paternal PPD has significant prevalence and impact on a father's positive support for both mother and baby during the first postpartum year. Recent media attention on the father's mental health during the postnatal year has also increased public awareness of this issue.8,9
Given the growing body of literature on paternal PPD, we have set out to review current understandings and discuss future research directions. This will help us to improve clinical insight, not only for improving fathers' mental health, but also for helping the family, including their partners and infants, have a better quality of life. The paper will review diagnostic criteria and characteristics of the paternal PPD and its impact on infants' and partners' lives. The paper will also posit biological and ecological risk factors for the paternal PPD and make suggestions for prevention and intervention. Last, the paper will discuss questions for further research. Please see Figure 1 for an overview of paternal PPD, including risk factors and outcomes.
Diagnosis. Remarkably, there is not yet one single official set of diagnostic criteria for paternal postpartum depression. Thus, paternal PPD has been defined in various ways. In research thus far, paternal PPD had been assessed by using measures developed for maternal PPD. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), maternal PPD is defined as a major depressive episode with onset occurring within four weeks of delivery.10 Depressive episodes include depressed or sad mood, marked loss of interest in virtually all activities, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or guilt, diminished ability to think or concentrate, and recurrent thoughts of death.10 A diagnosis of a DSM-IV major depressive episode requires that five of these symptoms be present during a two-week period, and that at least one of the symptoms is either depressed or sad mood or a markedly diminished interest or pleasure in all or almost all activities.10 However, these diagnostic criteria have been defined only for maternal postpartum depression. The validation of similar criteria for paternal PPD as a diagnosis tool will be crucial as considering differences in risk factors for fathers and mothers. For example, there are findings suggesting that PPD develops more slowly and gradually over the more protracted course of a full year postpartum among men.11 Thus, this diagnostic criterion—onset of episodes within one month postpartum—may not be appropriate for diagnosing paternal postpartum depression.
In research on maternal PPD, the Edinburgh Postnatal Depression Scale (EPDS)12 has been widely used. It was first developed for assessing maternal postpartum depression, and it also has been most widely used in paternal PPD studies.6 It consists of 10 self-report items, eight addressing depressive symptoms (e.g., sadness, self-blame) and two inquiring about anxiety symptoms (e.g., feeling worried or anxious and feeling scared or panicky). Responses are scored 0, 1, 2, or 3 according to increased severity of the symptom. The period 6 to 12 weeks after childbirth is often used to assess postnatal depression, but many studies used the EPDS for later postpartum mood evaluation extend up to 12 months postpartum. Cut-off scores for depression vary from 9 to 13 points out of a maximum of 30. The EPDS has been well validated for woman in the US and non-English speaking populations in other countries12,13 and it has been validated for men as well.14 Other self-report measures that PPD studies rely on are Beck Depression Inventory (BDI),15,16 General Health Questionnaire (GHQ),17 and the Center for Epidemiological Studies-Depression (CES-D).18
Some early studies used an unstructured or structured interview, such as the Schedule of Affective Disorders and Schizophrenia (SADS)19 and the Structured Clinical Interview for DSM-II-R (SCID).20 The studies using the structured or unstructured interview often had small sample sizes drawn from limited populations. Although the findings thus far may not yet be applied to the general population, the qualitative interviews plus quantitative self-report measures do support the idea that paternal PPD may be a real and serious diagnostic entity.11
Many of the recent paternal PPD studies have relied on self-report measures of depressive symptoms, often using cut-off scores to establish a diagnosis of depression for women. The cut-off scores for men still need to be validated for different measures. There has been only one study examining the validation of the EPDS for men. The findings from the study suggest that the cut-off score to best identify fathers who were depressed and/or anxious is 5 to 6, which was two points lower than the cut-off score for mothers.14 Because lower cutoff scores are often used to diagnose minor PPD for women,21 there may have been underestimations of the significance of paternal PPD. Indeed, men may be considered to be less expressive about their feelings than women, thus, fathers are like to score lower in self-report questionnaires, such as the EPDS, than mothers even though they might experience a same levels of depression.14 Thus, the development of measures and validation of cut-off scores for paternal PPD are important for more sensitive and accurate diagnosis and efficient treatments and interventions.
Prevalence. Estimates of fathers' depression during the first postpartum year among US community-based samples vary from four percent (at 8 weeks, EPDS≥12)6 to 25.5 percent (at 4 weeks, CES-D≥16).22 Considering most of the studies have a relatively small number of samples, the Ramchandani and his colleagues' finding6 is important because of its large sample size (12,884 fathers).23 Internationally, the rate of paternal PPD ranges from 1.2 percent (at 6 weeks, EPDS≥13, in Ireland)24 to 11.9 % (at 6–12 weeks, BDI≥10, in Brazil).25 The wide range of estimates of paternal PPD may be related to the use of different measures, different cut-off scores, different timing of assessment between studies, as well as social, cultural, and economic differences. The characteristics of different samples might be also associated with different rates of depression. For instance, first-time fathers report higher levels of anxiety during the early postpartum period.26,27
Course. Paternal PPD tends to develop more gradually than maternal PPD. Longitudinal studies suggest that the rate of depression during the prenatal period decreases shortly after childbirth, but increases over the course of the first year. For instance, 4.8 percent of first-time fathers met criteria for depression during pregnancy and 4.8 percent of fathers were depressed at three months postpartum, but 23.8 percent of fathers were depressed at 12 months postnatal.28 A percentage (5.3%) of first-time fathers were screened positively for depression prenatally, and the rate decreased to 2.8 percent at six weeks postnatally, but increased again to 4.7 percent at 12 months postnatally.11 However, there are findings suggesting that the rate of paternal PPD is fairly consistent throughout the postpartum period. Deater-Deckard and his colleagues28 found that 3.5 percent of men during pregnancy and 3.3 percent at eight weeks were depressed. In another study, 4.5 percent of first-time fathers were depressed and the rate was steady at four percent throughout three, six, and 12 months postpartum.33
Correlates with maternal postpartum depression. Most of the data on paternal PPD come from studies originally designed for investigating maternal PPD. In all of these studies, depression in one partner was significantly correlated with depression in the other.22,29,31,32 In community samples, 32.6 to 47 percent of couples included at least one parent who experienced elevated depressive symptoms during the first two months postpartum.22,33 Moreover, it has been shown that nearly 60 percent of couples had at least one partner who was depressed either late in pregnancy or after the birth of their child.33
Maternal depression has consistently been found to be the most important risk factor for depression in fathers, both prenatally and postnatally.29,31,34,37–40 The incidence rate of paternal depression among men whose partners are having postpartum depression ranges from 24 to 50 percent.3,6 Further, Matthey and his colleagues11 found that fathers whose partners also has postpartum depression have a 2.5 times higher risk to be depressed themselves at six weeks postnatal compared to fathers whose partners don't have depression.
Comorbidity. Although there are few studies existing on this topic, the high comorbidity of postpartum depression with other psychiatric disorders has been found among men. The most common psychiatric disorders co-occurring with depression during postpartum period are anxiety and obsessive compulsive disorder (OCD). Studies investigating fathers' experience during the transition to parenthood found that around 10 percent of fathers reported a significant elevation of anxiety levels.7,36,38 In a study by Matthey and colleagues7 with 356 fathers, the chance to have a depression was increased by 30 to 100 percent for men when they have anxiety problems. As for mothers, it has been suggested that fathers experience preoccupations akin to those of obsessive compulsive disorder39 during an initial critical period of ‘engrossment’ with the infant in which all other concerns and realities assume a lesser role in day to day life.40 This may include the usual thoughts and activities that contribute to mental health. In a prospective longitudinal study of 82 parents, the course of early preoccupations has been shown to peak around the time of delivery.41 Although fathers and mothers displayed a similar time course, the degree of preoccupation was significantly less for fathers. For example, at two weeks after delivery, mothers of normal infants, on average, reported spending nearly 14 hours per day focused exclusively on the infant, while father reported spending approximately half that amount of time. The mental content of these preoccupations includes thoughts of reciprocity and unity with the infant, as well as thoughts about the perfection of the infant. Further, 73 percent of mothers and 66 percent of fathers reported having the thought that their baby was ‘perfect’ at three months of age.41 These idealizing thoughts may be especially important in the establishment of psychological resiliency and the perception of self-efficacy during this time of stress and reorganized priorities. As such, their absence may be an indication of problematic early bonding. These parental preoccupations also include anxious, intrusive thoughts about the infant. In the few studies done so far, it was found that 95 percent of mothers and 80 percent of fathers experienced recurrent thoughts about the possibility of something bad happening to their babies at eight months of gestation. In the weeks following delivery, this percentage declined only slightly to 80 and 73 percent for mothers and fathers, respectively, and at three months these figures were unchanged.41,42 After delivery and on returning home, most frequently cited concerns related to feeding the baby, the baby's crying, adequacy as a new parent, and baby's wellbeing.41 Such thoughts are more commonly reported among parents of very sick preterm infants, infants with serious congenital disorders or malformations, or infants with serious birth complications.41 Parents also endorse fantasies or worries that they may in some way inadvertently harm their infant, for example, by dropping the baby in a time of exhaustion or frustration or even ignoring or injuring the baby.
Perhaps these intrusive thoughts of injuring the child can beset some at-risk new fathers and lead to postpartum obsessive compulsive disorder and/or depression. Indeed, depression and anxiety during the postpartum year can also be correlated with OCD. Typical symptoms of postpartum OCD include intrusive thoughts (such as harming their infant) and/or compulsive behaviors (such as checking babies).43 In the literature on maternal postpartum depression, 41 percent of mothers with major depression reported unwanted intrusive thoughts of harming their infant, compared to only seven percent of nondepressed mothers.44 Although Abramowitz and his colleagues45 did not find a significant association between severity of intrusions and depressive symptoms among fathers, it might be that such disturbing thoughts are not easily disclosed and need to be asked directly. In the same study, around 45 percent of men reported worries about whether their babies would be suffocated, around 25 percent of men reported worries about doing intentional harm to babies, and around three percent of the men reported worries about losing their babies. Fathers also often report a range of somatic symptoms and psychological problems related to the postpartum period, such as more fatigue, irritability, nervousness, and restlessness36,46 that likely influence the risk for depression.
These findings suggest that having one psychiatric disorder makes fathers more vulnerable to the other psychiatric disorders. Moreover, the presence of multiple comorbid psychiatric disorders might have cumulative or multiplicative detrimental effects on men's coping skills during the postpartum period. Questions, such as whether certain risk factors are particularly common across different psychiatric disorders and whether the severity of depressed symptoms are associated with the presence of other disorders, are waiting to be answered. Future studies are required to understand the full range of normal and abnormal adjustments to becoming a father coupled with possible comorbidities of other psychological problems that will clarify appropriate interventions for our understanding of fathers who suffer from paternal PPD—especially as it appears increasingly clear that paternal PPD has many detrimental effects on the family.
Impact on Family
The transition to become a new parent is a stressful experience for both men and women. Gjerdingen and Carter26 found that fathers and mothers both reported decreasing marital satisfaction due to the lack of supports and unstable mental states during the first six months after a child was born. The father's anxiety and depression may even translate into violent behaviors toward his partner. Among mothers in the postpartum period, an alarming one-fourth reported violence from their partners with 69 percent being the first occurrence.47 Given the importance of the partner's psychological support as a protective factor for postpartum depression,3 the low supports from fathers who experience PPD may cause a mother to become more vulnerable to stress and psychopathology.48
The poor mental health of the partner of a father with PPD might also affect an infant's development. In fact, the high comorbidity rate between maternal and paternal PPD (from 24 to 50%) suggests a high chance for an infant to be in a situation where both parents are depressed. An infant's development is more severely disrupted when both parents are depressed than when only one parent is depressed.5 The protective role of paternal care may become more important when a mother is depressed. One study shows that responsive care provided by the father can actually buffer an infant from being negatively influenced by the maternal PPD during development.49
In contrast to a large body of literature on maternal care and child development, the relationship between quality of paternal care and child development alone has been less well documented. However, an increasing number of recent studies suggest that fathers exhibit capabilities to interact with their infants almost as well as mothers.50–52 The quality of the paternal care is clearly important for a child's cognitive, emotional, and social development during the first years and likely beyond.6,53
For each infant, the first year is a critical period of forming basic biological and behavioral regulatory patterns through interactions with primary caregivers.54 An infant's heightened levels of the stress hormone cortisol resulting from unresponsive or chaotic parenting, can hamper normal brain growth and self-regulatory ability in the early life.55 Also, a chronic elevation of basal cortisol levels affects an infant's physiological growth and immune system.56 For example, negative interactions between a depressed parent and infant might interrupt the maturation of the infant's orbitofrontal cortex, which plays an important role in cognitive and emotional regulation throughout life.57
The first year is also an important time for an infant and parents to establish a secure attachment. Depressed parents tend to exhibit negative emotions and helplessness, which can influence their interactions with the infant. For instance, depressed mothers exhibit more irritability, apathy, and hostility to their infants.58 Remarkably, parenting styles of depressed fathers have not yet been studied in great detail. Some findings suggest the link between irresponsive and unaffectionate parenting of both mothers and fathers make infants and the development of insecure attachments.59 An insecure attachment between a depressed mother and her child can cause the child to develop emotional and behavioral problems as well as increase the risk of psychopathology.58 Similarly, one might expect that a father who experienced PPD might fail to build a secure attachment with his infant child, which in turn may have similar negative effects on the infant's development. The effects of the paternal PPD on an infant seem to interact with maternal mood and may indeed be long-term. A recent study found that children with fathers experiencing postpartum depression tend to exhibit greater behavioral problems, such as conduct problems or hyperactivity.6 Such negative impacts of paternal PPD on behavioral regulation were found to be stronger among boys than girls.6 In another study, paternal depression during the first year postpartum was shown to aggravate the negative impact of maternal depression on children's development only when a father interacts with an infant for medium to high amount of time.60 Finally, in an attempt to address the long-term outcomes, one recent study showed that paternal major depression was associated with lower psychosocial functioning, elevated suicidal ideation and attempt rates in sons in young adulthood, and depression in daughters.61
Further, paternal PPD is a risk factor for child maltreatment and infanticide. According to the literature on maternal PPD literature, one of the greatest risk factors for a child to be a victim of maltreatment and infanticide is mother's depression.62 Thus, it is conceivable that a depressed father in an unstable mental state may expose his infant child to a greater risk of such unfortunate events.
Biological Risk Factors
There is very little research on biological factors for paternal PPD despite a large body of literature on maternal PPD and how it is associated with the levels of hormones, such as estrogen, oxytocin, or prolactin, to understand a biological mechanism of mood dysregulation during the postpartum period.2 Based on the existing knowledge of maternal PPD, we conjecture that PPD experienced by a father might be caused by hormonal changes occurring during his partner's pregnancy and postnatal period. We will propose several biological factors for the onset and development of the paternal PPD.
First, paternal PPD might be related to changes in his testosterone level, which decreases over time during his partner's pregnancy and postpartum period.63,64 Testosterone levels started to decrease at least a few months before the childbirth and maintain low levels for several months after the childbirth among most of fathers.65 Several researchers suggest that such decrease leads to lower aggression, better concentration in parenting, and stronger attachment with the infant.65,66 Fathers who have lower testosterone levels expressed more sympathy and need to respond when they heard infants' cry.61 Interestingly, recent studies on older men show a significant correlation between low testosterone levels and depression.67 Men aged 45 to 60 who are clinically depressed also exhibit lower testosterone levels than normal men.68
Further studies are needed to show whether such correlations can be extrapolated to all fathers during the postpartum period and if they might be part of an excessive adjustment. If proven, testosterone levels might contribute to a biological explanation of paternal PPD and even point toward a means of testing and prevention.
Second, paternal PPD might be related to lower levels of estrogen. Among men, the estrogen level begins to increase during the last month of his partner's pregnancy until the early postpartum period.69 Given findings on the relation between increased levels of estrogen and maternal behaviors,70 the increase in estrogen in a father might enhance more active parenting behaviors after the birth of his child. Fleming and colleagues63 also found that the more involved the father is in parenting, the higher the level his estrogen is compared to other fathers. In rats, increased numbers of estrogen receptors in brain areas important for parental behaviors, including the medial preoptic area, are associated with parental experience with pups.71 Perhaps then dysregulation of paternal estrogen may disturb paternal behaviors and constitute another important risk factor for any depressed mood in fathers.
Third, paternal PPD might be related to lower levels of cortisol, a hormone that regulates the physiological responses to stressful events.72 High cortisol levels are generally associated with high stress levels. However, for a mother, during the early postpartum period, high cortisol levels are associated with increased sensitivity toward her infant73 and with less depressed mood.74 Thus, the lower levels of cortisol among certain fathers might be related to difficulties in father-infant bonding and associated depressed mood.
Fourth, paternal PPD might be related to low vasopressin levels, which increase after the birth of the child in a way analogous to the oxytocin level of the mother.75 Based on research in prairie voles, vasopressin appears to play an important role in enhancing the development of parent-infant bonding for fathers.76 A recent primate study reported on marmoset fathers, which are noted for their extensive involvement in parenting, particularly early postpartum period with behaviors such as carrying, protecting, and feeding their offspring.77 These paternal behaviors during the first month of the infant's life are associated with a rapid increase of vasopressin receptors in the prefrontal cortex of the brain. This particular brain area is important for planning and organizing appropriate parental behavior.78 Perhaps then, human fathers with low levels of vasopressin may have difficulties with parenting behaviors and so again be more vulnerable to depression.
Fifth, paternal PPD might be related to changes in prolactin levels. Prolactin is important for the onset and maintenance of parental behaviors.64 Prolactin levels in men rise during pregnancy and continue to rise during the first postnatal year.64 High prolactin levels are related to greater responses to infant stimuli among new fathers.64 Thus, a lower prolactin level could cause a father to experience difficulties in adapting to parenthood and thus exhibit more negative moods.
Ecological Risk Factors
An ecological model can provide a perspective to understand how different levels of environment, such as family, community, work, society and culture, interact and influence an individual's development.79 New demands and responsibilities during the postpartum period often cause major changes in a father's life. Thus, it is important to understand how stress factors in a father's environment affect the development of depression during the postpartum period.
Fathers often experience more difficulties in developing emotional bonds with their children than mothers, who tend to develop an attachment almost immediately after a child is born. The father-infant bond appears to develop more gradually over the first two months postpartum.80 Before then, fathers have more difficulties than mothers with emotional bonding with their infants.81 The relative slow development of attachment might be related to the father's feeling of helplessness and depression for the first few postpartum months.
One of the factors that may make parenting difficult for many fathers is the absence of a good role model. In recent years, we see a dramatic increase in society's expectation for fathers to have greater involvement in parenting, yet many fathers report that they did not learn appropriate parenting skills from their own fathers or other male seniors.82 Competence in parenting among fathers is significantly associated with the father's sense of mastery in his role and family functioning.83 The lack of understanding of what is expected of a father might cause anxiety, especially the first-time fathers, and lead to a greater risk of paternal PPD.30
Lack of rewards in parenting might also contribute to the development of paternal PPD. Fathers report positive feedbacks, such as smiles from their infants, as the most significant reward in parenting.80 However, a father's lack of experience in parenting and fewer hours with an infant may tend to make interactions more distressing for the infant. Fathers also report being isolated from mother-infant bonding and feeling jealous about their partners' dominance in spending intimate time with babies, especially through breastfeeding.3 Interestingly, fathers may report feelings of jealousy toward their babies because the babies occupy a great amount of their partner's attention.84
Furthermore, the stress from the relationship with their partners might influence fathers' moods during the postpartum period. Because of sudden life changes, marital relationships often are threatened during the early postnatal period time.80 Fathers report increased dissatisfaction with their relationships with their partners, including lack of intimacy85 and the partner's loss of interest in sexual relationship.30 Some studies found that the quality of relationship not only with their partners but also with their in-laws, especially mothers-in-law, can influence fathers' involvement in parenting.50
In marital relationships, fathers' parenting stress during the postpartum period can be further complicated by the differences in and perceptions of distinct gender roles of fathers and mothers. The emphasis on the man's role as the breadwinner may be increased due to the increased financial burdens after the birth of the child, and, in turn, may prevent fathers from being more involved in parenting. A greater feeling of failure in performance in both work and sex as a part of the emphasized male gender role is significantly related to psychological distress among fathers.86
Prevention and Intervention
For fathers, different types of support may ease the transition process to fatherhood during the postpartum period. The most effective supports likely come from their partners because paternal PPD is closely related to partners' mental health and their relationship with the fathers. More encouragement from a mother and active discussion in each couple as they await and prepare for their baby may help the father's involvement in parenting and ease the stress as a new father. Mothers sharing parenting roles with fathers may also lower fathers' feelings of isolation from the relationship between mother-infant, as well as difficult feelings, such as jealousy toward the infant. Furthermore, support and acknowledgement from other family members about the father's role and understanding the difficulties the fathers may encounter may have a positive effect on fathers.
Educational programs in the community help fathers understand their expected roles. Findings suggest that a program for PPD mothers and their partners is more effective then a program with PPD mothers alone.87 For the same reason, a program for both PPD fathers and mothers could be more effective to alleviate paternal PPD. In addition, because anxiety and depressed mood might start during the partner's pregnancy, earlier intervention for both parents would be more effective before the symptoms become serious.
Support from society, such as paid paternity leave, would help fathers adapt to changes during the postpartum period. The US has no policy for paid paternity or maternity leave.88 Globally, there are 45 countries with policies for paid paternity leave or parental leave (leave used as maternity or paternity leave), and 27 countries guarantee paid paternity leave. In the case of Finland, 68 percent of fathers use a three-week leave with part pay.89 Policy for paternity leave in Sweden has experienced changes to encourage fathers to exercise their right to paternal leave.78 “Father's quota” allocates 30 days among 450 days of parental leave for paternal leave. This means if fathers do not use 30 days for paternal leave, the days of parental leave will be lost. In addition to ‘Father’s quota,' fathers in Sweden have 10 days of paternity leave and allowance to take care of their families at home. This parental leave can be used any time until a child becomes 18 months old. There is accumulating evidence that there are benefits to child outcomes of positive paternity leave. For example, Feldman and colleagues90 showed that longer paternal leave is associated with a more positive attitude toward parenting. On the other hand, the shorter paternal leave is associated with low quality of child care and less adaptation at work among fathers.
Lack of understanding and lack of a supportive network for new fathers is common.28 Traditionally, fathers have been largely recognized only as support providers for their partners. However, given a recent increase in fathers' involvement in parenting, proper supports from the society that focus on the active roles of fathers would help new fathers ease their stress in the early postpartum period. For instance, encouraging fathers to seek help from health professionals for complete assessments and consideration of psychotherapy or antidepressants might significantly improve their family health.
Suggestions for future research. Paternal postpartum depression has only been studied by a small number of researchers, so it is not surprising that there is a long list of questions yet to be addressed.
Because the existing studies focus heavily on Caucasian, middle-class, married fathers, we have a serious lack of understanding about depression of fathers of different cultural and socioeconomic backgrounds. It is important to identify at-risk groups of fathers for paternal PPD, such as fathers with lower incomes, fathers of very young or old age, or ethnic minority background. It is also important to study fathers in non-traditional settings, such as stay-at-home fathers, nonbiological fathers (e.g., stepfathers) or single fathers, in order to understand unique risk factors that may increase the risk for paternal PPD. Furthermore, we need to further investigate risk factors not only in fathers but also in their families, such as physical or mental health status with their partner or infant.
Besides the homogeneous samples in paternal PPD studies, the single time point observation limits our understanding of the long-term effects of postpartum depression. Because the experience of fathers changes in the course of the first postpartum year, we need a prospective study, with multiple sampling points, that allows follow-up of fathers at risk starting from their partners' pregnancies. The study would provide much information about the developmental course of paternal postpartum depression. Longitudinal studies would help us understand the long-term effects of paternal PPD on fathers' lives as well as on their families, including development of their children. Conducting international and cross-cultural studies would determine if there are similarities and differences in paternal PPD in different cultures and countries. It would provide us with a better picture to develop more accurate diagnostic tools and treatment programs for fathers with different backgrounds.
Most of the studies on paternal PPD have been done by using self-report questionnaires. Studies on hormonal and physiological changes during the postpartum period among fathers would provide information on biological factors of depression and biological mechanisms of father-infant attachment. In addition, brain imaging studies of paternal PPD will enrich our understanding of different brain circuits and neurohormonal systems that govern the processes of parenting in health and, in particular, among fathers with PPD.91
Pilyoung Kim, Ms. Kim is from the Department of Human Development, Cornell University, Ithaca, New York;
James E. Swain, Dr. Swain is from the Child Study Center, Yale University School of Medicine, New Haven, Connecticut;
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Articles from Psychiatry (Edgmont) are provided here courtesy of
Matrix Medical Communications
Have you ever said to yourself, “I’ll eat when I have a minute” or “I want to shed the extra pregnancy pounds so missing a meal here and there isn’t a big deal”? Both of these thought processes can lead you down the opposite path you intend on going and leave you feeling more frustrated and unsatisfied than when you started.
While, eating healthy during pregnancy is important to help your baby grow and develop, good nutrition should still be of concern after your baby is born.
It took me a little time after having my children to learn how to balance looking after myself with caring for a baby.
One thing I quickly realized was to let go of the expectation that each meal I ate needed to be gourmet. Instead, meals just need to be balanced and nutritious. Most important, they will be better than no meal at all!
Having an action plan makes this easier and will help you focus, give you purpose and build your confidence. Use these key tips to help you get started and keep you healthy:
Start your day off right by eating breakfast. Studies show a breakfast containing higher fiber carbohydrates along with 14 grams of protein leaves you feeling satisfied. Protein helps minimize fluctuations in blood sugar after your meal time, making you feeling fuller longer.
Eat balanced meals
To help steady your blood sugar levels, as well as your appetite and cravings, always eat a meal containing all four food groups. Each food group has something different to offer, so eating them together will help you meet your daily nutrient needs and make you feel more satisfied.
As you know, eating regularly will optimize your energy and your mood throughout the day, as well as help minimize overeating at any one meal. Ideally I recommend eating approximately every 2-3 hours when possible, as this gives your body the fuel it needs throughout the day.
If you skip breakfast and have an unbalanced lunch I guarantee you will overeat at supper and your cravings will also kick in. All of a sudden your best intentions for controlling what you eat have disappeared.
Your fluid intake can affect your energy level, breast milk production, your mood and your overall health, so it’s important to make sure you are keeping well hydrated. Your fluid requirements are 1.5-2 L daily (6-8 cups) daily.
“Fluid” includes all hydrating beverages: water, milk, juice (limit to 1 cup per day), herbal tea, decaffeinated coffee.
Stock up on fast and healthy options
Keep quick and simple foods on hand so you always have something you can grab in a hurry.
Protein choices: nut butters, canned tuna, canned salmon, rotisserie chicken, cheese strings, eggs, hummus, edamame, canned beans and lentils
Grains: soft tortilla wraps, whole wheat bread/buns, pita, bagels, whole grain crackers, homemade muffins, individual oatmeal packages, whole grain cereal (5g of fiber per serving)
Fruit: frozen berries, in season fresh fruit, fruit canned in juice, unsweetened applesauce
Vegetables: in-season fresh vegetables, fresh spinach in a bag, frozen vegetables, a vegetable tray with grape tomatoes, carrots, cucumbers and snap peas. (Try some low fat taziki to dip)
Dairy: milk-white or chocolate, yogurt, milk alternatives
Pick one item from each group and you will have a well balanced meal.
Staying active is very important for your overall health. Incorporate some form of physical activity into your daily routine to help balance out your hormone levels and your mood. It will also help you build/maintain muscle, manage your weight, regulate your bowels and give purpose to your day!
The miracle that is childbirth is laden with joy, triumph and love, this is the romantic idea that speaks truth but does not tell the whole story, as with most things in life there must be balance. This new life created and welcomed brings with it new love and joys as well as new responsibility and adjustments. Many believe that our difficulties play a large role in helping us enjoy our triumphs. In postpartum depression this balance is tipped making it difficult to find the beauty in motherhood.
The postpartum period is a time of huge change and extreme demands which tax every part of a woman; her physical body, relationships, sex life, spirituality, career life, finances, social life and emotions. This is a time in a women’s life when everything changes, it is not like any other major event in her life, it is bigger than a new home, a new job, a new partner or marriage; none of these events impact every single aspect of a women’s life. Having a baby does. Physically a woman’s body is shifting back to accommodating one set of organs once again. Her hormones are in flux as her body recovers from pregnancy and birth and shifts to accommodate a seemingly ever increasing demand for breast milk. During all this physical change, women are sleep deprived as they are adjusting to their new baby’s sleeping and feeding patterns. Romantic relationships are altered as a relationship of two now involves three and sexual relations often require more planning. This time in a woman’s life often also brings about re-evaluation of spiritual meanings and convictions as they reflect on their pregnancy and birth of their child. Between these thoughts are thoughts of adjusting to life as a mother and how they feel about taking time away from their career and how this will affect their family financially and otherwise. Women alter their social life, finding more child friendly activities and often are introduced to a new social network. There are new questions and concerns about the baby and motherhood, the question on every woman’s mind is “is this normal?” Finally, her emotions dealing with all these changes in combination with the new hormone soup circulating her body, all have huge effects on how a woman feels.
Does all of this leave you feeling overwhelmed? The point I am trying to make, is that it is natural for any woman to feel overwhelmed at this time in her life. This is a time when balance must be actively sought out. So, what does it mean if you feel that this has landed you in a position that you are concerned about postpartum depression? It means that your body is demanding help. Let me also elaborate on what this does NOT mean. It does not mean that you have done something wrong or that you are inadequate in anyway. It does not mean that you are unfit to be a mother. It does not mean that you will feel this way forever. It simply means that you need to care for yourself. Every woman during this time needs help; it is no different for you. What does “help” mean? It means ANYTHING you feel you need. This is where your social network comes in large or small, family or friends, your network need only be supportive and loving. Do not hesitate to ask for help! If you feel you do not have a social network, please join a mother’s group or support group (see the resources section of the PPDA website). In today’s society people are feeling more and more disconnected, the birth of a child traditionally brought communities together, so that all could marvel in the miracle of new life. Unfortunately, this seems to be slipping as our lives become busier and busier. This does not mean that this is the way it should be, there are movements to bring the group back for women, PDDA is just one example of this. Help also means talking to a primary care physician an MD or ND (Naturopathic Doctor). If you think you may be suffering from postpartum depression it is very important you tell your doctor, they are there to help you. Know that your psychological health is just as important as any other system in your body; would you ignore a broken bone? If you are not comfortable with your doctor, find one you are comfortable with, I suggest you ask your friends about their MD or ND, or consider bringing a friend or your husband in with you for this conversation with your physician.
From a naturopathic perspective one must address the root cause of the postpartum depression; this will vary from individual to individual. There are specific areas that need to be addressed with any woman suffering with post partum depression; for example, proper nutrition is essential. We have all heard the adage you are what you eat, this is quite literally true; our food is broken down, absorbed and used to create new building blocks for our body. During pregnancy and breast feeding the mother is not only providing this support for her own body but also for that of her growing child; studies have shown links between particular nutritional deficiencies and postpartum depression. During this time of high stress, substances that add to the body burden such as alcohol, cigarettes, caffeine and refined sugars should be avoided as they will only further contribute to the body’s stress. Also imperative is mental/ emotional support, this can come in a variety of forms from herbal supplements to acupuncture, counseling, or physical therapies to help release issues a mother is holding in her body. One of the beautiful things about naturopathic medicine is that we have so many different ways to address most any health concern; it offers a real benefit in being able to individually tailor treatments to a patients specific needs. I would recommend that a mother struggling with postpartum depression be seen by a team of health professionals who are all in communication with each other, so that her issues can be addressed from more than one perspective. Ultimately, the message here is that all women need help during the postpartum period, if you know or believe you may have postpartum depression this is essential, this is not a time to ignore your needs. Know that you are not alone, you can make a change and that there is help.