The Weeks Following Birth

The time after birth, also known as postpartum, is a time of great emotional, physical, and mental adjustments. Many women find that they are weepy, emotionally rocky, have difficulty sleeping or taking care of their own needs (bathing, getting ready for the day, feeding themselves, etc..). These are all common as families learn to juggle the new responsibilities of parenting, along with adjusting to the needs and schedules of their smallest members.

There are, in layman's terms, 3 different types of mood challenges that can develop in the postpartum period. These three are the Baby Blues, Postpartum Depression, and Postpartum Psychosis (some in the medical community add a fourth - Postpartum PTSD - that can accompany Birth Trauma).

Many women experience the baby blues in the first few days after childbirth, some theorize an upwards of 75% of postpartum women experience some level of the baby blues. Some symptoms of the baby blues include:

• mood swings, including feeling sad, anxious, or overwhelmed
• crying spells
• loss of appetite
• insomnia

The baby blues most often peak within the first few days after birth and go away within a few days or a week. The symptoms are not severe and do not need treatment beyond community and relational support. A postpartum doula can greatly help to alleviate the symptoms of the baby blues.

The symptoms of postpartum depression last longer and are more severe. Postpartum depression can begin anytime within the first year after childbirth, although they often manifest within the first month. Postpartum Depression takes on a number of guises and symptoms and can include:

• the same symptoms of baby blues, but more severe
• disinterest in things that normally bring you joy
• thoughts of hurting yourself or the baby
• not having any interest in the baby

Postpartum depression needs to be treated by a doctor and/or counselor. Some treatments include: community and support groups, homeopathic or herbal remedies, or medications. Postpartum doulas can still be a great asset during this situation and help to transition a woman into motherhood in conjunction with her medical team's efforts.

Postpartum Psychosis is rare. It occurs in about 1 to 4 out of every 1,000 births. It usually begins in the first 2 weeks after childbirth. Women who have bipolar disorder or another mental health problem called schizo-affective disorder have a higher risk for postpartum psychosis. Symptoms may include:

• hallucinations
• confusion
• rapid mood swings
• trying to hurt yourself or your baby

While many women experience some mild mood changes during or after the birth of a child, 15 to 20% of women experience more significant symptoms of depression or anxiety. Please know that with informed care you can prevent a worsening of these symptoms and can fully recover. There is no reason to continue to suffer.

Women of every culture, age, income level and race can develop perinatal mood and anxiety disorders. Symptoms can appear any time during pregnancy and the first 12 months after childbirth. - From PSI

Additionally, about one in ten new fathers will develop postpartum depression, usually during the first six month's of the baby's life, according to a meta-analysis of findings from 43 studies.

The authors pointed out that a "large body of research on maternal depression documents incidence rates between 10% and 30%," but until now mood disorders in fathers have been largely ignored.  Researchers have hypothesized that there were similarities between maternal and paternal depression, but the available data are based on an emerging and inconsistent literature. - New Dad's Also At Risk for Postpartum Depression

This means that the father/partner of the woman who just gave birth cannot be the sole source of watching for postpartum depression.

As a loving friend, partner, or family member, when you visit with the new parents (or your partner) be considering the following:

• Are they feeling sad or depressed?
• Do they seem more irritable or angry with those around them?
• Do they seem to be having difficulty bonding with the baby?
• Do they seem anxious or panicky?
• Are they having problems with eating or sleeping?
• Do they seem unable to take care of themselves (unkempt or not bathed and not caring)?
• Do they mention things like feeling “out of control” or like they are “going crazy”?
• Do they make remarks such as they never should have become a parent?
• Have they mentioned they are worried that they might hurt the baby or themselves?

Any of these symptoms, and many more, could indicate that either of the new parents have a form of perinatal mood or anxiety disorder, such as postpartum depression. Listen online as Dr. Pauline Dillard, , a specialist in postpartum mood disorders, discusses "Postpartum Depression Part I".

If you believe you or someone you care about may be experiencing some level of postpartum mood disorder, take this short test or this online PPD screening tool, which can help you with an initial assessment, but should not take the place of professional care if you believe that you or someone you know is suffering from Postpartum Depression.

HOW CAN I HELP?
This question is so important, especially to the person being asked. As a friend or loved one of the new parent(s), when you ask how you can help, be sure to mean it. This includes, usually, doing mundane things around the house so that the new family unit can spend time recovering. This also means listening, being attentive, and watchful.

Most new families have quite a bit of support from friends, family, and community for the first 1-2 weeks after baby is born. After that time, support drops off, and this is when families need the support the most.

Listen online as Dr. Dillard discusses "Caring for the Postpartum Family" on the Whole Mother show on kpft.org out of Houston.

As parents preparing for a new addition, consider planning for the postpartum period just as diligently as you do the birth. Additional resources for making a postpartum plan are here and here.

• Mom, make sure you have a list of people you can call on to be completely honest with your feelings and thoughts about, someone to help you with housework, and someone who will ask the 'tough questions'.
• Dads/partners you should help make sure there are friends/family/community to help mom when you can't be there, and you should make sure to have a non-judgmental listening ear to be able to talk to as well.
• Consider making a detailed baby care plan, including who will be responsible for what tasks in the first 2 months after baby is born and who each family member can call when they feel overwhelmed or sad.
• A postpartum doula in the area suggests writing down chores that need to be done and putting them in a bowl. When people visit, they must draw a slip from the bowl and complete their chore before they are able to hold the baby.

For additional reading or help:
Afterbirth, After Birth
PSI
Jennifer Mudd Houghtaling PPD Foundation
Postpartum Men
Mother to Mother Postpartum Depression Network
Birth Crisis
TABS - PTSD and traumatic birth support
SOLACE - Birth Trauma support center 
Postpartum Care
Postpartum Depression - a handout on how to support someone working through PPD