Stress and Pregnancy: What about post-partum?

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This week, Dr. G has written about the lack of clarity in the pregnancy/stress research, the findings that are more consistent, and he gave some hints about how mothers can reduce stress. But, even though many parents are relieved after the birth of their healthy child, the stress doesn't disappear in the post-partum period. Probably everyone reading this has heard of post-partum (or perinatal) depression (PPD). Although some research has estimated the rates of PPD at 10-20% of women post-delivery, a closer look at the statistics indicates that there is a high degree of variability between and within countries. Lee & Chung in 2007 estimated that rates varied between 0.5% to over 60% depending on the population. Mothers with PPD may experience a number of symptoms, many of which overlap with Major Depressive Disorder:

  • Sad mood, crying, and tearfulness
  • Lack of enjoyment
  • Low energy
  • Insomnia or hypersomnia
  • Change in appetite
  • Concentration problems
  • Feelings of helplessness and/or inadequacy

For some mothers, PPD interferes with the development of their bond with their infant; they may feel emotionally detached from their baby or from other family members. Mothers may also lose their temper with the baby, and in some cases, they may wish to harm their infant. This anger and irritability sometimes surprises new moms, who may have expected to feel sad rather than irritable and short-tempered. An article on the Baby Ready blog described one mother's experience that was later identified as PPD:

Do I feel depressed? Not exactly. Do I sit and weep inconsolably? Who has time? So, how do I feel? Angry. Ridiculously, illogically, uncontrollably angry. I am irritable, impatient, and resentful. Then I feel guilty, which makes me feel angry all over again.

Researchers have examined possible treatments to prevent PPD, but the complex biological, psychological, social and cultural factors that contribute to the depression make it difficult to develop an effective treatment plan in the prenatal period. It might be helpful for mothers to be aware that the biggest predictor of PPD is a previous experience of depression.

Even though it's difficult to prevent the development of PPD, research suggests that it's important to address it as early as possible when it occurs. Lognitudinal studies suggest that PPD is associated with an impairment of parenting skills; maternal withdrawal might be of particular concern. However, the actual effects of these difficulties on the baby's development appears to be quite small. At any rate, therapeutic intervention, similar to treatment that is used for other kinds of depressive episodes, has been found to be effective in addressing PPD as well. Mothers should talk to their partners and other family members, and should try to be willing to accept support. It doesn't necessarily require a therapist to reduce these symptoms, and friends or family members can be valuable resources.

Although moms are typically the focus of research and treatment when it comes to PPD, fathers also experience considerable stressors in the weeks and months after the birth of the baby. Lee and Chung cite research suggesting that 5 to 24% of fathers suffer from depressive symptoms in the early postnatal period; there is a 40 to 50% chance that partners of mothers who suffer from PPD will also experience depression. One study found that paternal depression can interfere with the mother's recovery from PPD!

What should parents remember about PPD? Here are a few important tidbits from the research:

  • Mothers' experience of PPD may vary - they don't necessarily need to be crying all the time to be depressed.
  • PPD can interfere with a mother's parenting skills and with the developing bond with the baby, but the impact of this on the child seems to be small.
  • Fathers also experience an increased risk for depressive symptoms in the weeks after the baby is born.
  • The support of family and friends is important, but when the symptoms are severe, professional help may be warranted!

You can find Lee and Chung's study here (that issue has a few articles about PPD). The study about paternal support is here.

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Note: Posts on Family Anatomy are for information only. If you need to talk to someone about family or mental health issues, you can get a referral from your family doctor.