Postpartum Depression and Caring for Your Baby **LONG**

Taken from: http://www.kidshealth.org/parent/pregnancy_newborn/home/ppd_baby.html

**some partner talk**

The morning sickness, the weight gain, and the hours of labor are all finally over - and you're now the proud mother of a beautiful baby. Friends and family have been surrounding you, offering their heartfelt congratulations and expressing their joy at the sight of your new little bundle. So how can it be that you're feeling so unhappy and overwhelmed?

Feeling depressed after giving birth is not uncommon. In fact, about one in 10 women experience an often undiagnosed condition called postpartum depression (PPD) after childbirth.

What Is PPD?
There are three forms of depression that can occur after giving birth: the "baby blues," PPD, and postpartum psychosis.

Many new mothers experience the baby blues, which are characterized by:

mild sadness
tearfulness
anxiety
irritability, often for no clear reason
fluctuating moods
increased sensitivity
fatigue

The baby blues typically peak 3 to 5 days after delivery and can last a few hours or days; usually, however, they resolve within about 10 days after childbirth. Although for most women the blues are short-lived, some researchers believe that women who experience these symptoms have an increased risk for PPD, a more severe form of depression later in the postpartum period. One study found that of women who were diagnosed with PPD 6 weeks after delivery, two thirds had the baby blues.

PPD refers to a major depressive episode that occurs usually about 4 weeks after delivery. PPD isn't a special kind of depression; the only aspect that makes PPD a "unique" depression is that it occurs around the time of childbirth. How long it lasts is different for every woman - some women feel better in a few weeks, whereas others may feel depressed for months. Most women with PPD have symptoms for more than 6 months, and if untreated, 25% of patients are still depressed a year later. Women who have a history of depression may have PPD even longer.

New fathers also may experience PPD, although it's more common in stepfathers. Fathers are more likely to experience PPD if they are:

with a partner who's depressed
ending their relationship with the mother
unemployed
poorly educated
socially isolated
under severe stress
in a physically aggressive relationship with the new mother

PPD should also be differentiated from postpartum psychosis, the most severe form of postnatal depression, which affects about 0.1% to 0.2% of women. Although it's rare, this condition is extremely serious, disabling, and often requires hospitalization. Women with postpartum psychosis have delusions and hallucinations that often focus on hurting themselves or their babies. They need immediate medical care.

What Causes PPD?
Experts disagree about what causes PPD - and depression in general. The leading theories about the cause of major depression focus on the brain chemicals serotonin, norepinephrine, epinephrine, and dopamine. Some researchers have proposed that changes in the levels of these chemicals in specific parts of the brain can trigger depression.

In addition, hormonal imbalances may be a biological factor contributing to the development of PPD. Estrogen and progesterone levels fall by 90% to 95% in the first 48 hours after delivery. Recent evidence points to estrogen's importance in regulating memory, cognition, and mood - and estrogen has also been shown to have a strong effect on brain function. However, no direct link between estrogen levels and PPD has been established. Both low pre-delivery levels and high postpartum levels of estrogen have been reported in depressed women. Although estrogen and progesterone levels drop in all women before delivery, not all women develop PPD, so these hormones appear not to be entirely responsible for the condition.

Also, changing levels of the hormones cortisol (a stress hormone) and prolactin (a hormone that stimulates breast milk production) have been implicated but not confirmed in the development of PPD.

To date, then, there's no one, clearly defined cause of PPD. Contributing factors include both chemical and psychological changes arising from pregnancy and childbirth, as well as the mother's environment, which most likely combine to influence a new mother's psychological state.

Do You Have PPD?
Although you need a doctor to diagnose PPD, you or your partner may be able to recognize some of the warning signs and symptoms to help decide if you need medical attention. Although the experiences of women who have PPD vary considerably, symptoms generally include several of the following:

Feelings:

persistent low mood
inadequacy, failure, hopelessness, or helplessness
exhaustion, emptiness, sadness, or tearfulness
guilt, shame, or worthlessness
confusion, anxiety, or panic
fear of harming the baby
fear of being alone or going out

Behaviors:

lack of interest or pleasure in usual activities
insomnia, excessive sleep, or nightmares
not eating or overeating
agitation
decreased energy or motivation
withdrawal from social events or contact with other people
poor self-care or personal hygiene
inability to cope with routine tasks

Thoughts:

inability to think clearly or make decisions
lack of concentration or poor memory
fantasy of running away from all responsibilities
fear of being rejected by partner
obsessing about harming the baby or oneself
Again, every woman's experience with PPD is unique, so don't try to compare yourself with someone else to determine if you may have the disorder.

Call your doctor immediately if:

you have symptoms of PPD and are experiencing additional life changes, such as divorce, a job change, or a move
your symptoms worsen or do not improve after 2 weeks
you have suicidal urges
you fear harming your baby

Are You at Risk for PPD?
You can determine if you are at a higher risk for developing PPD by understanding the risk factors. One or more of the following factors may increase stress and lead to depression during the postpartum period:

previous PPD
lack of support from one's partner, family, or friends
family history of depression
labor/delivery complications for mother or baby
premature or late delivery
being separated from the baby
difficulties with the baby (health, temperament, feeding, or sleeping problems)
severe premenstrual syndrome (PMS)
marital problems
preexisting psychological disorder

Diagnosing and Treating PPD
It can be difficult for some women to admit, or to recognize, that they have these kinds of negative feelings or thoughts, and it's quite common for all new parents to feel overwhelmed and question their parenting skills from time to time. So when well-meaning friends and family members keep stressing how wonderful it must be to have a new baby in the family, new mothers may be even less inclined to admit that their lives are less than charmed. It may be hard to talk about, but if you think you have PPD, it's important to be honest about your feelings and thoughts and discuss them openly with your doctor. Or if you know a woman you think may have PPD, gently suggest that she seek help from her doctor. This may be difficult to do, but in cases where the mother's or the baby's health may be in danger, it's crucial.

Some of the symptoms of PPD - especially sleep problems, weight fluctuations, low energy, and difficulty concentrating - occur normally after childbirth. To distinguish between normal feelings and behaviors following pregnancy and childbirth from those that might signal PPD, however, at least five of the symptoms of PPD must be present during a 2-week period. Also, at least one of the symptoms must be either depressed mood or a significantly diminished interest or pleasure in nearly all activities.

After considering your history and symptoms carefully, your doctor will be able to diagnose your condition and treat it appropriately.

As in other types of depression, early identification and treatment are the keys to successful therapy. Treatment of depression involves three phases: acute treatment (which lasts 6 to 12 weeks) aimed at eliminating or alleviating symptoms; continuation treatment (which lasts 4 to 9 months) aimed at stabilization and recovery; and maintenance treatment aimed at preventing recurrence in women with a history of PPD.

PPD may be treated with medications (usually antidepressants), counseling, or a combination of both. Drug treatment may be necessary for women with more severe or chronic symptoms, prior episodes of PPD, or a family history of depression. Psychotherapy may be used for women with severe depression, chronic psychosocial problems, an inadequate response to medication, or a coexisting personality disorder.

If your doctor gives you a prescription, he or she will monitor you for any side effects and your response to the medication. Keep in mind that it typically takes several weeks before most people begin to notice a benefit from antidepressant medications. If you're breast-feeding, your doctor will also make sure that the medication you're taking will not affect your baby's health.

With support from friends and family and proper medical attention, a woman with mild symptoms of PPD will usually feel better in 3 to 6 months. If symptoms are severe or a mother cannot care for herself or her baby, hospitalization may be necessary.

Caring for Your Baby
One of the most troubling consequences of PPD is its effect on a new mother's ability to care for her baby. Mothers with PPD often feel helpless or inadequate and withdraw from their responsibilities. They may not have as much interest in caring for their baby, and this may contribute to feelings of guilt or low self-esteem.

As difficult as it may be, it's important for you to think not only about how PPD affects you but also how it may be affecting your infant. There may be times when you're able to respond positively to your infant's needs, but there may be times when you're not. During those times when you are unresponsive, your baby will likely try harder to get your attention. For example, infants need comfort and reassurance when they're upset. But if you're feeling upset yourself - or tired, or angry, or depressed - you may not be able to recognize your child's needs, let alone respond to them.

PPD can have long-term effects on a child's emotional growth, especially if the condition goes untreated or lasts for a long time. Children of depressed mothers often have a difficult time expressing their feelings and participating in social activities. Some may have learned to keep their feelings locked inside and often feel like outcasts or loners. Children who are raised by depressed mothers will commonly show one or more of the following characteristics:

temperamental patterns of negative mood
poor adaptability to change
poor academic performance and intellectual ability
difficulty associating with peers
inability to achieve secure attachment
trouble with school due to attention wandering, restlessness, and misconduct
major depression or anxiety disorder

Although some mothers with PPD may passively ignore their children's needs, other women may become violent or aggressive. They may lose control and use physical punishment to discipline their infants.

If you find yourself feeling overwhelmed with anger or frustration, here are some strategies you can use to control yourself and not take your feelings out on your baby or family:

relaxation - Deep breathing and relaxing imagery can help calm down angry feelings.
cognitive restructuring - When you're angry, try replacing exaggerated or overly dramatic thoughts with more rational ones.
problem solving - Instead of trying to deny or ignore your anger, focus on how you're handling it.
communication - The first thing to do if you're angry at your baby or a family member is to slow down and think through your possible responses. Don't say or do the first thing that comes into your head; focus on what is beneath your anger and talk through your emotions.
humor - Have the courage to laugh at yourself occasionally.

Maintaining the mother-baby bond during your depression is essential. Here are some things you can do to strengthen that bond:

Nurse frequently, as often as every 2 or 3 hours, in a quiet place where you won't be interrupted. Relax and enjoy holding your infant, and try to make eye contact. The same suggestions apply to bottle-feeding your baby, although the frequency of feedings may differ depending on your infant's needs.
Provide a quiet place for your baby to rest, and try to rest when your baby does. Sleep is important for both of you.
Hold and talk softly to your infant often. Keep your baby dry, warm, and fed.
Involve others - your partner, family members, and friends - in caring for the baby.
If you have other children, know that they may be upset because of all the attention you must give to your new baby. Take time to be with each child individually and to let them know that you love them. Encourage older children to help care for or play with the new baby.
Go outside with your baby. A change of scenery and the fresh air may do you and your baby a lot of good.
If you're feeling lonely, angry, frustrated, or tired, leave your baby with someone you trust and take some time for yourself. Don't feel guilty - you may be more likely to upset the new baby or your other children when you are upset, so taking some time for yourself is the best thing for everyone.

Nurturing Yourself
If you have given birth recently and are experiencing any of the symptoms of PPD, don't think that you just have to grin and bear it. Here are some things you can do that other mothers with PPD have found helpful:

Find someone to talk to about your feelings. Talking with other mothers - and knowing that you're not alone - can help keep things in perspective.
Set aside time to be with your partner to relax and talk about the changes in your lives. Be open about your feelings and worries.
Let friends and family members help you with child care, household chores, and errands.
Find time to do something for yourself, even if it's only 15 minutes a day. Try reading, doing something creative, taking a bath, or meditating - anything that you enjoy.
To fight fatigue and depression, you need your rest. You may not be able to get 8 consecutive hours of sleep, but try to sleep whenever your baby naps.
Exercise, even if it's just walking around the block a few times. The increased metabolism and change of scenery can improve your frame of mind and health.
Eat a variety of whole grains, fruits, vegetables, and lean meat or fish. Stay away from caffeine, alcohol, and sugar.
Keep a journal. Write down your feelings and emotions as a way of releasing them. Once you begin to feel better, you can go back and reread your journal to see your progress.
Even if you can only accomplish one goal per day, this is a step in the right direction. There may be days when you can't get anything done - and that's normal for many parents!
Remember that it's OK to feel overwhelmed. Having a baby means many changes, and it can take some time to adjust to parenthood.

Although your partner may try, he or she can't fix your problems. All your partner can do is be there for you. You'll have to do the hard work yourself, but your partner's support is essential to your recovery. Here are a few things he or she can do for you:

listen to and validate your feelings
avoid criticizing or judging
be patient
give you some breaks from housework and child care responsibilities
support your decision to seek help
talk to your doctor or therapist to understand what you're going through

Getting Help
You don't have to deal with PPD alone. There's lots of help out there. It's natural to turn to family and friends first - especially for help with baby care - but there are other things you can do to help yourself. Ask your doctor or contact your local hospital for help in finding support groups in your area.

Reviewed by: Jack Guida, MD
Date reviewed: September 2000