Fighting Postpartum Blues: It's Harder With Two Than One
by Dr. Susan S. Bartell
Many women experience postpartum reactions after giving birth. The baby blues and Postpartum Depression are terms with which you're probably quite familiar, and postpartum psychosis is the most serious form of emotional upheaval that women may experience after giving birth. This article describes the signs and symptoms of minor and serious difficulties in postpartum adjustment. It then gives you suggestions for how to handle the emotional upheaval when you have not only a new baby, but also an older child (or children) to care for.
Approximately 80% of all women suffer from the baby blues after giving birth, so there is a good chance that you experienced it after your first birth and will experience it again after subsequent births. On the other hand, since every pregnancy and birth is different, you may have experiences the second (or third, or fourth!) time around that are very different from your first birth. Furthermore, having older children to care for may cause additional stress for you, making you somewhat more susceptible to all forms of postpartum difficulties. The baby blues, which is related to changes in hormone levels after delivery, typically occurs within the first few days after giving birth. It can last a day or as long as a week to ten days before resolving naturally.
The baby blues is characterized by one or more of the following:
- Feelings of sadness
- Crying more than usual
- Feeling overwhelmed
The best way to get yourself and your children through this emotional period is to request as much help as possible.
- Since emotional instability of all kinds can be connected to sleep deprivation, ask your partner, family and friends to take the baby and older children for short periods to allow you to nap.
- Also, spending time with older children, while someone else cares for the baby, can sometimes provide a welcome break. For example, playing a board game or having a tea party can be fun when all you've been doing is changing diapers and nursing.
- Take time to relax in the bath or have a cup of tea.
- While you may be feeling bad, it's important not to take it out on your older child by seeming impatient, angry or dismissive. Your older child, who is going through his or her own adjustment to the baby, may interpret it as you not wanting him or her around anymore now that there is a new baby at home.
- If your older child is over two years and has noticed you crying, you may need to explain that you are not upset or angry with him or the baby. Explain that you are tired and getting used to having another baby. Reassure your child that you will be fine. If your child seems particularly distressed, it may be a good idea to try not to cry in front of him.
- Most importantly, don't be ashamed to share your feelings with your partner. Feeling sad, anxious or weepy does not make you a bad mother and being able to talk about it can help you feel less overwhelmed.
- Usually the Baby Blues does not require any kind of formal intervention. However, if your symptoms persist for longer than a couple of weeks, you may have Postpartum Depression, which you shouldn't ignore.
Anywhere from ten to thirty percent of women suffers with postpartum depression (PPD). It can occur at any time during the first year after giving birth, but typically occurs within the first few months.
There are several risk factors for PPD:
- PPD or significant baby blues during an earlier pregnancy can increase the risk for PPD.
- Women who have a personal or family history of non-pregnancy related depression, are also more likely to suffer from PPD.
- Women who have an unsupportive spouse or poor support network are more prone to PPD.
- Women who experience chronic marital problems such as fighting, or separation or divorce, are more prone to PPD.
- Financial difficulties, problems with older children, having babies very close together, or other life stressors can increase the risk for PPD.
- Health concerns or problems with the new baby can increase the risk for PPD.
In addition to the symptoms associated with baby blues, the signs of PPD can also include any one or more of the following:
- Feelings of hopelessness
- Feelings of despair
- Difficulties with concentration or memory
- Feelings of worthlessness and guilt
- Overconcern for the baby
Lack of interest in the baby
- Fears of hurting the baby
- Thoughts about hurting or killing oneself
- Feeling like you're "going crazy" or there's "something wrong" with you or that you're "out of control"
Because mothers often worry that there is something seriously wrong with them or that someone might take away their baby, they are afraid to tell their partner or doctor if they start to have symptoms of PPD. However, PPD is treatable but only if you ask for help. So, it is very important, for you, for your new baby and for your other children, that you ask for help if you feel any of the above symptoms. A mother who suffers with PPD, without getting help, harms not only herself, but potentially her baby and older children too.
Here are some suggestions for handling PPD:
- See your doctor or midwife. If your symptoms are severe you may temporarily require medical intervention (such as antidepressants) to help you through this traumatic period. However, be sure to tell your doctor or midwife if you are nursing because this may affect which medications you can safely take.
- Sleep as often as possible. Sleep deprivation can cause and exacerbate symptoms of depression.
- If necessary, get counseling. A therapist can help you cope with the stresses and conflicts in your life that may be impacting on your emotional state.
- Eat healthily because your body needs good fuel to help it function as optimally as possible.
- Exercise has been shown time and time again to physiologically alleviate the symptoms of depression, sometimes as well as medication.
- Talk to your partner about what you're going through. If you're not going through this alone, you don't need to act as if you are. Sharing your feelings and fears can help you feel a bit better.
- Don't waste energy feeling guilty. This is not your fault!
- Your older child will sense the changes in you and may become worried. If your PPD impacts greatly on them, such as requiring you to have other people take care of them, try and explain that you will be feeling better as soon as possible and that right now you need some help to take care of them and the baby.
- Encourage your child to share his or her feelings with you, especially if he or she seems to be upset about changes in you or in the family.
- Be careful not to blame the baby for your PPD. Older children may become angry with the baby for "making mommy feel bad," and harbor negative feelings long after you are feeling better.
Postpartum psychosis is the most severe form of postpartum reaction. Luckily, it is also very uncommon. The symptoms of postpartum psychosis include all of those seen in PPD, but are much more severe. Postpartum psychosis also includes one or more of the following:
- Severe agitation
- Strange feelings
- Strange behaviors
- Significant trouble sleeping
- Extreme Confusion
- Excessive Energy
- Paranoia or Suspiciousness
If you, your partner, a family member or friend seems to be experiencing any of the above symptoms, it is imperative that you speak to a doctor or midwife immediately. A mother who suffers from Postpartum Psychosis may unknowingly present a danger to her new baby and other children. This is because it is likely that her judgement will be impaired and her ability to parent adequately will be significantly diminished.
A Word for Fathers
In all cases of PPD and postpartum psychosis, there is an extra burden placed on the father, of caring for the children as well as caring for the mother. Fathers who endure this stress should not be embarrassed to ask for help from other family members, friends or therapists. In most cases a father will have to continue working while taking on the extra stress of caring for a legitimately ill wife, a new baby and any other older children. Postpartum illness burdens any family excessively, and asking for help, whether personal or professional, should not be seen by fathers, as a weakness in any way.
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