Postpartum Tips & Info from the "Deliver Me" Doctors

1. What is the difference between postpartum blues and depression?
Postpartum blues or the "baby blues" is a transient period of depressive mood, tearfulness, anxiety, irritation and restlessness. It can start 2-3 days after delivery and last up to 4 weeks.

Postpartum depression is defined as intense feelings of sadness, anxiety, or despair in the post-partum period that interfere with the mother's ability to function and that do not resolve. It can result in serious harm to the mother or the infant.

Criteria for diagnosing PPD requires one of the following:
Depressed mood for most days for at least 2 weeks

Or

Anhedonia (loss of pleasure or interest in usual activities)

PLUS 4 of the symptoms below (or 3 from below if both above are present):

• Weight loss or decreased/loss of appetite
• Insomnia or hypersomnia
• Psychomotor retardation/agitation
• Fatigue or loss of energy
• Feelings of worthlessness or excessive guilt
• Decreased ability to concentrate
• Recurrent thoughts of death, suicidal ideation, or attempted suicide

2. Is post partum depression always dramatic and severe? Including ill-feelings towards the baby?
Post-partum depression may definitely cause ill feelings towards the baby and towards the mother herself. It may present as dramatic and severe, but not always overtly obvious, especially if the mother is hiding her feelings or ashamed to share her feelings.

3. How common is post-partum depression?
Post-partum blues occurs in about 50 to 80 percent of women in the post-partum period. Post-partum depression occurs in about 10 to 15 percent of women in the post-partum period. Up to 50 percent of the women with PPD may continue to have their symptoms at the end of the first year after delivery.

4. Is it underdiagnosed? If so, why?
Post-partum depression is often underdiagnosed because:

• Many women feel ashamed and afraid to talk about their feelings with their family, friends, or doctors. The lack of interest in their baby, the sadness, and the inability to cope with “motherhood” may make a new mother feel that they are not good mothers.
• The diagnosis may be missed unless the doctor specifically and routinely questions the new mother about her mood as new mothers may not volunteer the information.
• Family members and friends may mistake PPD for normal part of adjusting to motherhood.

5. Are some women pre-disposed to PPD?
Yes, some women are predisposed to PPD.  The risk factors include young age, multiple life stresses, divorce and previous history of depression.  However, only about 40 percent of women with PPD will have one of these risk factors.

6. What are some treatments, even for breastfeeding moms?
The treatment includes the combination of therapy and medications.  The therapy is used to confront any underlying stresses, and the medications alter brain chemistry.  These are in the form of anti-depressants and most can be taken safely with breast feeding.

7. Are there any common misconceptions about PPD?
The most common misconception is that the symptoms of PPD are just a normal part of the adjustment to motherhood.  

8. What advice can you give to family members who are concerned about PPD?

• If you think your partner, sister or daughter seems to have postpartum depression, ask to help.  She may be afraid to express what she is feeling.  If it goes untreated or is ignored it can have serious consequences to the patient or infant.  
• Do not make the family member feel bad or abnormal if she is having these feelings.  Just because you (her mother, sister, grandmother) didn't experience this doesn't mean that other women don't, or it is abnormal.  
• If a family member is experiencing postpartum depression talk to her.  Have her express her feelings.  Give her a break to do something just for herself.
• Give her a much needed sleep break.  If this means having different family members come in the middle of night to take shifts so the tired mom can sleep.  Sleep deprivation exacerbates the feeling of depression and exhaustion.

9. If a woman suffers from PPD after a pregnancy, can you pre-treat her during subsequent pregnancies?

We do not recommend pretreating the mom just because she had depression in a previous pregnancy.  Every pregnancy and every baby is different.  The first time can be so overwhelming that the Mom may be more prone to depression.  With experience, she may not feel so overwhelmed and may have a less chance of depression in the subsequent pregnancy.

What we do recommend to women that have had preexisting depression prior to pregnancy or a history of postpartum depression is to contact their provider early on if symptoms are developing.  We then have the patient come in for an appointment and offer therapy, and medication if necessary.

10. What are some steps for a healthy post-partum recovery?

• Get as much rest as possible.
• Sleep when the baby sleeps.
• Have someone take a shift in the middle of the night so you can a few hours of interrupted sleep.
• Walk outside, fresh air and movement are amazing for one's mood.
• Exercise, meditate, read a book, listen to music all by yourself even if it is just for ten minutes.
• Eat a well balanced diet.
• Drink a lot of water.
• This period will end, the baby will grow and will sleep, your life will return to normal.

Tune in to Deliver Me, Tuesdays at 10 pm ET/PT on Discovery Health.