Your Emotions After Delivery
Women‟s Mental Health Initiative
of the Mental Health Association of Greater Houston
THIS PRESENTATION
WILL INCLUDE:
• INTRODUCTION TO POSTPARTUM MENTAL
ILLNESSES
• SIGNS AND SYMPTOMS
• RISK FACTORS
• TREATMENT OPTIONS
• STARTING A SUPPORT GROUP
• RESOURCES
Women and Depression
Estimated that 21% of women vs.
13% of men will experience
depression sometime over the
lifespan
Beyond the Blues: A Guide to Understanding and Treating Prenatal & Postpartum
Depression. Bennett, S., Ph.D. & Indman, P., Ed.D., MFT
Pathophysiology
of depression in women
Fluctuations of estrogen across the
menstrual cycle and at other points in a
women’s reproductive life may disrupt
the balance of the neurotransmitters and
affect a woman’s mood
Why is Postpartum Illness Getting
More Attention these days?
Postpartum tragedies are getting public
attention
More knowledge about postpartum illness
Some destigmatization of mental illness
Increased stress of American life can put
more women at risk
Stress Factors Related to Postpartum
Illness in the U.S.
■ Fragmentation of extended families and communities
■ Isolation of the new mother
■ Childbirth practices and experiences
■ Glamorization of motherhood by commercial interests
■ Silence about the difficulty of life changes
■ Financial constraints of staying home with baby
Psychiatric Hospitalizations for
Women During Postpartum Years
All Admissions 60
50
Admissions Per 40
Month 30
Pregnancy
20
10
-2 Years -1 Year Childbirth +1 Year +2
Psychosis Years
50
Admissions 40
30 Pregnancy
Admissions Per
20
Month 10
-2 Years -1 Year Childbirth +1 Year +2
Years
Kendell RE et al. Br J Psychiatry. 1987;150:662-673
Postpartum Mental Illness Facts
■ Up to 80% of new moms get the “baby
blues”
■ 1 out of 10 of new moms develop
postpartum depression
■ 1 in a 1000 new moms develop
postpartum psychosis
Postpartum depression or
just the “baby blues”?
Baby Blues:
■ Occurs within a few days of the baby‟s
birth and lasts for up to 2 weeks.
■ Usually resolves without professional help.
■ Symptoms are: tearfulness, exhaustion,
anxiety and difficulty sleeping.
■ Support and monitor mothers with “baby
blues.”
In her own words:
■ “As people joked about the baby blues, I
knew their stories were not the same as
mine. None of those people told stories of
hysterical crying jags, refusing to eat, or
inability to speak. “
Postpartum Depression
■ Serious, sometimes life-threatening
condition.
■ Onset occurs within 4-6 weeks after
delivery, but may be recognized
anytime during the first year.
■ During the first month after delivery,
childbearing women have a 3x greater
risk for depression compared to
nonchildbearing women.
Key Signs and Symptoms
■ SLEEP DISTURBANCE may be hallmark
of the illness
■ Excessive worry about the baby
■ Mood swings
■ Loss of appetite
■ Anxiety out of proportion to event
■ GUILT
In her own words:
“The mornings were often the worst for
me. I would usually wake up crying (after
whatever sleep I had been able to get). I
had no desire for the day to begin and felt
I easily could have slept for months. I
had no desire for self-preservation.”
Postpartum Depression (PPD):
Risk Factors
■ Previous episode of depression
■ Severe PMS
■ Depression during pregnancy,
particularly third trimester
■ Prior episode of PPD
■ Family history of depression, anxiety,
&/or bipolar disorder
■ Poor marital support
Postpartum Depression:
Risk Factors (continued)
■ Isolation of mother
■ Increased life stressors such as poverty,
domestic violence, ambivalence about
motherhood, relationship instability
■ Perfectionism in mother
■ Work and financial pressures and changes
■ Lack of maternal self-care and support
How can one differentiate
between the “baby blues” and
depression?
In her own words:
“ As I lay on the floor staring vacantly while
my husband begged me to eat, I had
enough wherewithal left to realize that my
situation was beyond the baby blues. ”
If a woman is more than two weeks
postpartum and still feels tearful and
sad, you should have greater concern
that IT IS NOT JUST THE BLUES!
■ Other warning signs:
– The woman is having difficulty performing daily
activities.
– The woman has a generally BLANK expression
and does not talk as much as she used to.
– The woman is thinking about death or suicide.
What to do if you are
concerned?
■ Ask questions in an open,
nonjudgmental way.
■ Ask the new mother if she is able to
sleep when the baby sleeps?
In her own words:
“ I, for one, was terrified that if I admitted
how bad I felt that someone might take my
newborn daughter away from me. “
What to do if you are
concerned?
■ If a woman talks about symptoms of
depression, she should be evaluated by a
healthcare professional as soon as
possible.
■ It is crucial to ensure the safety of the
woman AND her baby.
Postpartum Obsessive Compulsive
Disorder (OCD) and Anxiety
■ Common and often co morbid with
depression
■ Intrusive thoughts or “images” of
harming baby or something harmful
happening
■ Distressing and incapacitating
■ Afraid to be alone with the baby
In her own words:
■ “My heart and mind were racing. I was
sweaty all the time. I had no appetite at
all. The nights blurred with the days even
though my husband and I were taking
turns with nighttime feedings. I would be
awake all night even if it wasn't my turn.”
Postpartum Obsessive-Compulsive
Disorder (OCD)
“ Many other women I would talk to would
have such „normal‟ worries. I would only
insinuate that my worries were much
worse. How could I tell people about the
horrific images that pop into my head?
The paralyzing fears and images I had of
stabbing my baby or sexually abusing
him…”
Postpartum Psychosis
■ Occurs in 1 in 1000 deliveries
■ 50% of women will later be diagnosed
with bipolar disorder
■ Recurrence rate extremely high with more
severe episodes common
■ Onset fairly rapid, within 3 days to one
week
In her own words:
“It is hard to describe to someone who has
not been there what it feels like to slip
away from everything you thought you
knew.”
Postpartum Psychosis
■ Symptoms revolve around the infant.
■ Agitation and anxiety, disorganized
behavior, confusion.
■ Delusion(s) about the infant.
■ Hearing voices or seeing things that are
not there.
■ Thoughts about hurting herself or the
baby.
Risk Factors
■ History of depression in self or family
■ History of postpartum illness
■ Psychosocial factors: poor social support,
adverse life events, marital instability,
ambivalence about motherhood
■ Perfectionistic personality style
Case Management
■ Identify women at risk
■ Psychiatric referral prior to delivery
■ Follow-up within 2 weeks after delivery
■ Distribute postpartum depression
brochure
■ Screen with Edinburgh scale
■ Provide resources
Treatment
What women need medically, mentally
& emotionally for optimum recovery.
Anyone can guide them to a path of recovery!
Anyone can connect
moms to treatment!
OB/GYN
Nurse or Midwife
Pediatrician
Lactation Specialist
Faith Community Member
Family Member
Doula
Social Worker Women will talk to the
person with whom they
Phone Volunteer feel most comfortable!
Social Service Provider
Treatment
■ Anti-depressant and/or anti-anxiety meds
■ Interpersonal psychotherapy:
dealing with loss and role change
■ Additional support
Therapeutic Intervention
Clinical Social Workers LCSW
Psychologists PhD
Marriage and Family Therapists LMFT
Licensed Counselors LPC
Psychiatrists MD
Acute Interventions
■ Mother MUST get uninterrupted sleep
(at least 2 nights for 4-6 hours)
■ Recruit ANYONE to help
■ Recommend that someone else feed the
infant at night
Hospitalization
■ Necessary for suicidal patients
■ Any evidence of psychosis
– Should be treated as a medical emergency!
Three Critical
Components to Recovery
Medical Intervention
Therapeutic Intervention Social Support
Recovery
■ Most women fully recover from
postpartum mental illness
■ May take several weeks to stabilize on
correct medication
■ Most cases of depression improve with
both medication and psychotherapy
Prevention
Assist at-risk mothers in developing a treatment
and support plan before birth of baby
Educate the community about postpartum mental illness
Encourage use of screening tools during pregnancy
Give pregnant mothers information and resources
Encourage mothers to get help sooner rather than later
Resources for New Mothers:
Herself
“The Well-Mom Checklist”
– Gives structure to lives that feel out of control
– Reminds new mothers to attend to themselves
– Reviews the basic tenants of self-care: food, sleep, exercise,
emotional health
– Easy to review if one is feeling badly—gives some thought to
feelings
The Well Mom Checklist
■ Have I eaten enough nutritious food today?
■ Have I slept at least 5 hours, or taken a nap?
■ Have I bathed or showered today?
■ Have I exercised at least 10 minutes today?
■ Have I had at least 10 minutes of quiet time for reflection and renewal
today?
■ Have I let myself laugh today?
■ Have I let others help me today?
■ Have I kissed my baby and told him/her “I love you” today?
■ Have I talked to at least one adult today about how I„m doing today
(not just about the baby)?
■ Have I forgiven myself for mistakes today?
Copyright Sherry J. Duson, 2001
Review Existing Support Systems
■ Immediate: spouse, partner, parents, close family and friends
■ Extended communities: neighbors, churches, schools, co-workers, other
moms, professional services
■ Local professional resources:
– Psychotherapists, psychiatrists, doulas, lactation consultants
– PPD Support Groups
■ Paid support: night nurses, nannies, Mother‟s Day Out programs
■ Local & National resources: Mental Health Association of Greater
Houston, Postpartum Support International
How to Start a Support Group
• Find a consistent place and time
• Have a regular facilitator
• Allow for babies, spouses, other
family members
• Make it free or low cost
• Provide information about illness,
resources
• Practice good group skills
• Work to get word out to as many
places as possible
Support Group Skills
Set ground rules for:
• Confidentiality
• Supportive listening, not advice giving
• Give attention to speaker
• Share in talking time - watch for common
themes, common dominators
• Allow for silence and not sharing
• Hand out information and resources
Support Group Skills
• Go around circle for introductions, have
each person explain why she‟s here
• Allow each person to tell her story without
interruptions (birth stories as well as PPD
stories)
• Ask for feedback from the group
• Ask who might have a question for the
group, or introduce a topic to be discussed
Support Group Skills
• When group time is ending, ask what are
the particular challenges each is facing
this week
• Ask if they want feedback from the group
• Discuss plans for increasing self-care or
seeking treatment
• Encourage each group member towards
wellness
Screening Tools
■ Edinburgh Postnatal Depression Scale
(EPDS) (1987) -- Distribute freely with
citation
■ Postpartum Depression Screening Scale
(PDSS) (2001); Available from: Western
Psychological Services, 12031 Wilshire
Blvd., Los Angeles, CA 90025-1251 or
#1-800-648-8857
Assessing using
the EPDS
Edinburgh Postnatal Depression Screening
10-question screening tool introduced in 1987 by Cox et al.
Validity and reliability has been well-established.
Translated into 20 languages.
Easy to use. Easy to score.
A score of 12 or greater indicates depression.
Postpartum Support International
(PSI) Message
■ You are not alone
■ It is not your fault
■ You will get better
Resources
■ Mental Health Association of Greater Houston,
www.mhahouston.org
■ Houston Area Postpartum Illness website,
www.houstonpostpartum.com
■ National organization -- Postpartum Support
International, www.postpartum.org
■ Therapists and psychiatrists who specialize in or are
familiar with postpartum illnesses
■ Pregnancy and Postpartum Depression Support Groups
■ Develop at-home support plan
Women’s Mental
Health Initiative of the
Mental Health
Association of Greater
Houston
By phone:
713-523-8963 (Main Line)
713-522-5161 (Information & Referral)
On the web:
www.mhahouston.org