Mental health postpartum

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This is an article from our “Doctor’s Corner” series, brought to you by Samitivej Hospital. Make sure to read the entire series!

Thankfully women who have recently given birth feel a bit better talking about their mood. In the past, moms who suffered from ‘baby blues’ or ‘post partum depression’ were often ignored or meant to feel guilty. Now we know that many women’s mood will fall after delivery and this is an important subject to talk about with compassion, especially between new mothers and their care providers, husbands/partners, family, and friends. I have had many casual and professional conversations on the subject comparing experiences of what it was like after giving birth and frankly isn’t always such a wonderful a time for everyone.

Postpartum Depression

Brooke Shields and Tom Cruise should be given an award for raising awareness of post partum depression. For those who have forgotten, in 2005 Brooke Shields opened up about having postpartum depression and being treated. Tom Cruise basically stated that Brooke Shields was misinformed on the condition and questioned the use of medication as a treatment option on the “Today Show”. Brooke Shields responded to Tom’s comments really well in an article published in the New York Times. A link to both the transcript from Tom Cruise and the response from Brooke Shields can be found below. (I believe it’s always best to find the original version of the conversations.) The back lash on Tom Cruise was HUDGE and his apology to Brooke Shield was accepted. The end result in my opinion is that women will therefore continue to see Tom Cruise movies, but let’s face it…his Top Gun ‘I melt when you look my way’ days are over.  And Brooke Shield rocks!

So let’s keep the discussion going. What happens when someone has the baby blues or post partum depression? When does it start, what do mom’s say it feels like, what causes it, and what are the treatment options should it happen to you?

Everyone is different of course but baby blues is a mild form of postpartum depression. It hits new mom’s two to four days after delivery and can last up to two weeks. Being irritable, more prone to crying or overly happy, feeling sad, or edgy are common, however it doesn’t get in the way of a mom caring for her new baby. Postpartum depression is different, as the negative feelings creep in over several weeks, beginning between two to three weeks after delivery and lasting up to one year. The feelings when a person suffers from postpartum depression become more severe than those who suffer from baby blues and the mom may find it very difficult to care for her new baby. Feeling constantly exhausted, questioning one’s ability to be a parent, and questioning one’s self-worth are common. Those around the mom may see changes in eating patterns that lead to large weight gain or loss, the mom may speak in a way that is slow, and it may be obvious that she can’t seem to concentrate. The feeling of sadness may even grow to the point where a mom becomes suicidal. One mom described her experience to me as ‘being in a deep hole and I could hear my baby boy crying at the top but I just can’t reach him’. She went on to say that she didn’t want her baby in the hole with her, but her husband had to work, so it was just her and the baby for 10 hours a day.

It’s generally accepted that it’s a combination of factors that leads to postpartum depression, which makes sense. What are some of these factors? All moms undergo a hormone shift after delivery but some women’s hormones fluctuate more than others, some mom’s have financial resources and support systems in the form of friends and family, that others do not. A past history of personal or family mental health conditions or stressful life events that may be happening at the same time can increase a mom’s risk of postpartum depression. In Brooke Shields case her father recently passed away and she was taking hormones to help her conceive and remain pregnant. Although not mentioned in her response in the New York Times, I’m sure being in the public eye for the majority of her life isn’t a piece of cake, and would make any life changing events more stressful.

It’s important to be honest with your health care provider(s) about your risk factors for postpartum depression while you are pregnant. There is nothing wrong with your provider(s) watching your mood a bit more often, or for a bit longer, if you are at risk. An ethical and safe provider will take the time needed to ensure you and your child(ren) are given every opportunity to bond and enjoy each other. The doctors at Samitivej are especially kind and will take the time needed to listen and ask the important questions.

Eating healthy meals, light exercise, linking with other moms who have babies, and letting people help are also a must. It sounds like common sense, but it’s easy for moms to put themselves last when: they are only getting two to three hours of sleep at a time, their hormones are out of whack, there may be money worries, they are experiencing stressful family situations, a pile of laundry and dirty dishes are staring the mom in the face. I like to ask new moms how they plan to take care for not just the baby but themselves postpartum during antenatal visits just to get people thinking, preparing, and remembering they need to take care of themselves as well.

Starting medication is a decision that a mom and her health care provider makes together. A serotonin reuptake inhibitor is generally tried first. According to Spencer, Gonzalez, and Barnhart (2001), Zoloft (also known as Sertraline), is a medication that can be given while breastfeeding, as it has been extensively studied and drug levels in infants have been shown to be minimal. Paxil is also a safer choice. The other medications within this family can cause baby’s to oversleep, be more fussy/colicky, lose weight, and/or stop breastfeeding, so they are generally not prescribed to mothers who wish to continue breastfeeding. For mothers who were on these medications while pregnant and wish to continue post partum, closer monitoring of the infant is needed.

Please keep in mind, all of the medications within this family takes two to four weeks before they start working, and the dosage may need to be increased before real relief is felt. Serotonin is a chemical released in the brain that helps people feel happy and it’s important to start with a low dose and work up, based on how well it’s thought to be helping by the mom (Lloyd, 2010). So please don’t expect to pop a pill and become instantly better. In addition, like most medications, this family of drugs can cause unwanted side effects that your health care provider will talk to you about. The physicians at Samitivej will take the time to explain the benefits and the risks involved so you can make the best decision for you and your baby. No guilt, no stigma, just information and help.

We don’t all have to write a book like Brooke Shields to raise awareness and acceptance of baby blues and postpartum depression. We just need to create an environment where we can talk about it with compassion and a willingness to provide support. I ask that all moms acknowledge that it happens and keep the conversation alive. 10 to 15 percent of new mom’s battle with their mood after delivery, and many of these women overcome baby blues and postpartum depression brilliantly. I and all the wonderful physicians at Samitivej Hospital applaud each mom who finds the strength to make the changes needed in order to care for themselves and their babies, as well as the family and friends who provide the much needed support.

Samitivej Women's Health CenterThis article courtesy of our Medical Publishing Partner Samitivej Women’s Health Center.

References

Lloyd, A. (2010). Selective Serotonin Reuptake Inhibitors. Retrieved from http://www.netdoctor.co.uk/diseases/depression/selectiveserotoninreputakeinhibitors_000147.htm#

Spencer, J. P., Gonzalez, L. S., Barnhart, D. J. (2001). Medications in the Breastfeeding Mother. Retrieved from http://www.aafp.org/afp/2001/0701/p119.html

Shields, B. (2005). War of Words. Retrieved from http://www.nytimes.com/2005/07/01/opinion/01shields.html

Today Entertainment. (2005). I’m Passionate About Life.  Retrieved from http://today.msnbc.msn.com/id/8343367/ns/today-entertainment/t/im-passionate-about-life/

Samitivej Hospital

Samitivej Hospitals are world class international health care facilities located in Bangkok, Thailand.

Fully equipped with the state-of-the-art technologies, our innovative Women's Health Center at Samitivej Sukhumvit Hospital provides comprehensive gynecological and obstetrical service for women of all ages.

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