Maternal mental health: understanding postpartum mood disorders

The struggles of motherhood are often not expressed widely, and understood even less. We hear of postpartum depression, but many have little knowledge about the disorder. A Baylor College of Medicine expert weighs in on maternal mental health.

A mother with a newborn child.
A mother with a newborn child.

Postpartum depression is a cluster of symptoms that develop during pregnancy or the postpartum period. It consists of symptoms of depression, such as low mood, difficulty motivating yourself and change in energy level. Other mood disorders can be exacerbated through the pregnancy process, and these are compounded by lack of sleep, the shifting of roles and transitions mothers endure after childbirth.

Providers offer a specialized screening tool, the Edinburgh Postnatal Depression Scale (EPDS), at specific intervals of the postpartum period to understand which mothers may benefit from additional evaluation, assessment and support. When depressive symptoms exceed normal difficulty, doctors can differentiate between baby blues and postpartum depression. Baby blues consists of mild, time limited symptoms that resolve within a few weeks postpartum and don’t impact functioning.

“Women dealing with postpartum depression have more severe, prolonged symptoms of depression. While many women develop symptoms during pregnancy or shortly after delivery, women can develop symptoms of postpartum depression up to a year postpartum. Many women develop postpartum depression and don’t receive the appropriate treatment, which can lead to symptoms that persist beyond the postpartum period,” said Dr. Elisabeth Netherton, clinical assistant professor of psychiatry and behavioral sciences at Baylor and regional medical director for Texas at MindPath Health.

Postpartum mood disorders, which can include depression, anxiety and even psychosis, heavily impact babies and can delay a strong connection between a mother and her child. Depression can get in the way of mothers feeling present with their baby and can lead to long-term negative outcomes for both the mother and baby. Babies can become more vulnerable to emotional disturbances, and their nutrition may suffer. Babies whose mothers are depressed can experiences challenges with attachment, which can affect their relationships with others as they grow older. Women also can experience trauma during deliveries, which is associated with postpartum depression and can affect her ability to bond with the baby.

“One of the most important pieces for women postpartum is having appropriate support. Social support is crucial,” Netherton said. “Many mothers don’t feel an automatic bond with their baby, so I would suggest talking to girlfriends if possible, because many women don’t feel that bond, and it’s not abnormal.”

A combination of medication and therapy can be beneficial to mothers. Although many hold the misconception that women who are breastfeeding or pregnant cannot take medication, medications often are needed during pregnancy to help mothers stay well; women planning pregnancy or struggling with symptoms postpartum should discuss their care with a medical provider to learn more about medication options. Mothers also can engage in interpersonal therapy, which focuses on coping with role changes. Shifting to motherhood is an immense change, and interpersonal therapy allows mothers to understand their new roles. Normalizing the experiences of new motherhood and sharing challenges can be one of the most helpful aspects of therapy.

Whether a mother has a history of depression or not, postpartum depression can occur in anyone. Certain groups of women may be more prone to the disorder. The biggest risk is women who have previously experienced depression, specifically, women who have a history of postpartum depression, prenatal depression or a family history of postpartum depression. Psychiatrists often want to follow women with these risk factors more closely to ensure they are well supported. Other at-risk women include women who have less social support, women who have lower social resources, women in violent relationships, women suffering from PTSD, women with a first-time pregnancy and women who are younger.

Women need adequate assistance during the postpartum period. There is a common mentality across the country that mothers should be able to manage everything during the postpartum period in terms of physical appearance and taking care of the baby independently.

“There is a concept that women six to eight weeks postpartum should be back at work and fully functioning while taking care of the baby without difficulty. Culturally, we need a radical shift. Women needing extra assistance postpartum is normal and acceptable,” Netherton said.

Other common misconceptions surrounding pregnancy and childcare can be damaging to new mothers. Common myths surround baby’s sleep, breastfeeding versus bottle feeding versus formula, baby’s weight, mother’s weight, and going back to work versus staying home with the baby. Netherton reminds that there are varying methods of raising a child, and not one perfect approach.

By Homa Shalchi

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