Written by Pamela Lim,  https://joyfulparenting.sg

The birth of a baby can start a variety of powerful emotions, from excitement and joy to fear and anxiety. Depression can also be a result in something you might not expect.

This is such an important topic that is not often talked about. Did you know that maternal depression is the number one complication of childbirth and pregnancy and sadly the most under-diagnosed? 

Most moms may experience postpartum "baby blues" after childbirth, which is common and it includes mood swings, crying spells, anxiety and difficulty sleeping. Baby blues usually begin within the first few days after delivery and may last for up to two weeks.

Some new moms may experience a more severe condition known as postpartum depression. Sometimes it's called peripartum depression because it can start during pregnancy and continue after childbirth. Rarely, an extreme mood disorder called postpartum psychosis also may develop after childbirth.

1 in 6 women who are affected mostly suffer in silence. Some sources state that up to 25% of new moms have postpartum depression. Did you know that dads, partners and adoptive parents can also suffer from postpartum mood and anxiety disorders too?  

Postpartum depression is not a character flaw or a weakness. Sometimes it's simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms and help you bond with your baby.

If you are experiencing symptoms, the most important thing to remember is that you are not alone and no one is immune to it!  It doesn't matter your age, income, where you are from, your nationality or your education level. There is no shame in it and you did not cause it either. But it's important to get help.  

Getting help is better for you and better for the baby. A baby's brain is developing rapidly and studies show that if a mom is severely depressed, it can affect the long term health of her child.  That’s why it’s so important to promptly get the support and the treatments that work best for you.

Perinatal mood and anxiety disorders can manifest in many ways and can occur anytime from conception through two years after delivery.

The symptoms are different for everyone and you can't tell by just looking at someone whether they are suffering or not. More often, women and men do not recognize the symptoms they are having.

I have been working with moms with postnatal mood disorders and depression for over 15 years and I have been educating in my childbirth education workshops on how mental illness can affects families.

The brain is an organ like any other organ in the body, and sometimes it doesn't work 100%. Sometimes the body gets imbalanced and needs help re-aligning. It's no different if someone has heart disease or a liver disorder or rheumatoid arthritis.  

Let’s get clear on what postpartum depression is and isn't. The first thing to identify when it comes to looking for signs of postpartum depression that is in any sort of noticeable and concerning change in personality, mood and behaviour. These may come and go or they may be chronic and long-lasting.

Often our society and the media confuses the Baby Blues and Postpartum Psychosis with Postpartum Depression. They are not the same.

The Baby Blues
80 - 90% of new moms experience the baby blues. Mood swings after the birth are not uncommon.  The baby blues show up around day 2 - 3 after the baby is born and lasts about 2 weeks. There is a big shift hormonally once the baby is born and most moms notice the difference. All of a sudden the new baby high wears off and the exhaustion kicks in. Symptoms can be mild or not, but are temporary as the body re-adjusts.

Signs:

• Feeling overwhelmed
• Restlessness
• Poor concentration
• Sadness
• Tearfulness
• Exhaustion
• Hypo-manic (decreased need for sleep, irritable, feeling energetic, racing thoughts, super-talkative) 
• Resolves on its own after a couple of weeks with good nutrition, rest and support. 
• If your symptoms last longer than two weeks you might be dealing with more than just the baby blues. 

Postpartum Depression
1 in 7 Moms and 1 in 10 Dads suffer from postpartum depression.  In order to be diagnosed with postpartum depression, a person must exhibit 5 or more of the following symptoms and the symptoms must last for more than 2 weeks:

• Depressed mood-tearfulness, hopelessness, and feeling empty inside, with or without severe anxiety.
• Loss of pleasure in either all or almost all of your daily activities.
• Appetite and weight change-usually a drop in appetite and weight but sometimes the opposite.
• Problems with sleep-usually trouble with sleeping, even when your baby is sleeping.
• Noticeable change in how you walk and talk-usually restlessness, but sometimes sluggishness.
• Extreme fatigue or loss of energy.
• Feelings of worthlessness or guilt, with no reasonable cause.
• Difficulty concentrating and making decisions.
• Thoughts about death or suicide. Some women with PPD have fleeting, frightening thoughts of harming their babies. These thoughts tend to be fearful thoughts, rather than urges to harm.

Postpartum Psychosis
Develops during the first 3 weeks after childbirth. Often the media portrays postpartum psychosis as postpartum depression. They are not the same.

According to PostpartumDepression.org Postpartum psychosis symptoms include:

• Experiencing hallucinations of things or sounds that aren’t there
• Becoming delusional with paranoid, suspicious or irrational beliefs
• Exhibiting extremely agitated or even violent behaviour
• Becoming easily confused or disoriented
• Obsessing over the baby
• Being extremely fearful or anxious
• Displaying bizarre behaviours that are uncharacteristic of the individual
• Extreme and rapid mood swings
• Refusing to eat or sleep
• Taking self-harming actions
• Suicidal thoughts
• Suicidal attempts
• Thoughts of harming or killing her baby

Postpartum psychosis is an emergency requiring immediate medical treatment. If you have any psychotic symptoms, seek emergency help immediately. Until you tell your doctor and get treatment, you are at high risk of suddenly harming yourself or your baby.

RED FLAG Warnings to look out for:
A few red flags that you should be aware of when it comes to postpartum depression and/or the mood and anxiety disorders. You can't always tell 100% if someone is symptomatic or not. 

A mom who always looks "too good" and has the perfect looking baby. It can be an over compensation for their feelings of irritability, OCD and/or anxiety. Think of those Facebook and Instagram moms with the perfect life, who always look perfect and their kids always look perfect. I see a lot of those moms and I always wonder how they are "really" doing.

A mom who keeps saying:

• "I just don't feel like myself".
• "I don't know what to do".  
• It can be her way of saying "HELP ME!".  

The feeling of Anger and Rage - these feeling are more common than not. She just feels very angry all the time or a lot of the time. If she can't take care of herself or the baby or can't get out of bed - get help immediately.

Risk Factors or Root Causes for Postpartum Mood and Anxiety Disorders:

There are many, so just know that someone can be dealing with one or more of the following:

• History of depression or mood disorder
• Family history of depression or mood disorder
• History of PMS
• Medical problems (for example, hypothyroidism, severe nausea and vomiting in pregnancy, or a pregnancy-related medical problem)
• Blood sugar problems, including both hypoglycaemia and elevated blood sugar
• A traumatic pregnancy or birth experience
• History of a pregnancy loss or loss of a child
• Unhealthy relationship with partner
• Not enough support from partner, family, work or social support
• Financial issues (money, job stress, living situation)
• High stress levels
• Lack of movement
• Lack of sunshine
• Poor sleep and not enough sleep
• A pregnancy that was not planned, you feel ambivalent  
• Teen pregnancy
• Military service (partner)
• Domestic violence (often increases during pregnancy and postpartum period)
• Nutritional deficiencies, protein, omega-3 fats, iron, vitamin D, B12, to name a few.  (1, 2)
• History of substance abuse
• Food sensitivities or gut dysbiosis (unhealthy changes in the gut flora or microbiome)
• Inflammation
• Thyroid issues 

It’s true that having a baby is incredibly demanding physically, and at the same time, we’re going through a tremendous amount of personal, psychological, emotional, and social adjustment. But exhaustion, feeling down, difficulty losing weight, intense struggle to produce enough breast milk, and hair loss aren’t always just a normal part of having had a baby. They can also be tell-tale signs of hypothyroidism.

What helps?

• Understanding the role of inflammation and gut health
• Ripples- (sleep, nutrition, omega 3's, walk, baby break, adult time, liquids, and laughter)
• Breastfeeding
• Meditation & Gratitude
• Medical tests
• Clinical Psychotherapy / Hypnotherapy and support groups
• Medication

Postpartum Depression and mood disorders can be Challenging, But You Are Not Alone

Postpartum depression and mood disorders can be a difficult illness that can leave new mothers feeling hopeless and alone. It can be hard to see the light at the end of the tunnel when postpartum depression has taken over, but it is important to remember that recovery is possible. 

With the right support and treatment, many women are able to heal and feel better. There is hope for you and healing is possible. If you are struggling, please reach out for help. You are not alone.

Joyful Parenting Helpline: 6488 0286

Whatsapp Pamela: 9271 3335