7 Facts about Maternal Depression

With depression in the news this week, we wanted to join so many others who are trying to address misinformation about depression and mental health issues. Before I say anything more, I want to say that I am not an expert (in any way) about postpartum depression nor am I qualified to diagnose any mental health condition. But, here are some basic facts that expectant moms, new moms, and loving friends and family should know about maternal depression.

1. Maternal depression does not have a timeline.

We hear most about "postpartum" depression occurring in the early weeks and months after a baby is born. But depression can occur during pregnancy, early in the postpartum period, and after the baby is older. Any mother showing signs of depression needs to seek help and she should not wait to see if she "gets over it."

2. Depression is not the same thing as sadness.

Because "depression" is used so freely to refer to everyday feelings of sadness or low energy, people can be confused and expect that mothers who are depressed must cry everyday. It is important to consult the resources below if you are unsure of what it means to be depressed.

3. Maternal depression is not a choice or something that women can be "strong enough" or "brave enough" to avoid.

For so long, mental health disorders have carried a stigma because they were so poorly understood by those who had no personal experience to draw from. Because there are people who write about "beating" their mental health issues on their own, there can be an expectation that it is a matter of strength or perseverance. Don't believe it and don't wait to get help for yourself or any mother you love.

4. Maternal depression can happen to anyone but is more likely to occur among women with a history of depression.

If you or a mother you love has had a history of depression or other mental health disorders, it is important to have a plan or step in sooner should you become concerned. Having challenges earlier in life does not always mean that you will have a recurrence during or after pregnancy but the risk is high enough that you want get the resources in place so you can get help quickly if you need to. Tell your doctor, get informed, and make a plan.

5. Depressed mothers may not ask for help.

Depression is so disempowering that those who suffer most are least likely to seek help for themselves. If you are concerned about a mom you love, don't assume that you should give up if your offer for help is turned away. Use the resources below to get better informed and strategies to support moms who can't yet see that anything can help them.

6. Treatment takes time and may take multiple efforts.

Every human being is biologically unique. There is no one medication, treatment, therapy, or experience that turns depression on or off. Be prepared that recovery can take time and several different strategies. Any person going through this process needs support by people who are well informed and prepared to make sure that giving up is not an option.

7. Helping moms with depression, can have a huge impact on children's lives.

You may have wondered why the "Secrets of Baby Behavior" has a blog post about maternal depression. It is because there is no doubt that maternal depression can have a terrible impact on babies and young children. In homes where trusted and loving adults are supporting moms who are struggling and making sure that babies and young children get the care they need, many of the negative outcomes can be prevented. Helping families in these situations is not easy but the right support can change children's lives.


Special Note to Moms and Friends and Family: There are excellent online resources for anyone seeking more information about maternal depression (see below), but we think it is really important that you talk to a qualified person if you are worried about yourself or someone else who might have depression. Start with your health care provider, a qualified therapist, or a community helpline. If calling one of these resources seems overwhelming (and that is not strange or being weak) ask a trusted friend or family member to do it for you, but you will need to be close by to verify that you are seeking help.

More is known now about depression and other mood disorders than ever before. Reach out, now.

Mayo Clinic - Basic Information

Office of Women's Health - Answers to Questions

Information for Dads and others supporting mothers at risk

Postpartum Support International - dedicated website and helpline

What New Moms Really Want to Know about the Postpartum Experience

There are a lot of new things to consider when preparing for pregnancy, birth, and the postpartum period.  Today, we will present an article that describes a review of 18 scientific papers and a list of the most important things that mothers want to learn after giving birth.  We have also done a little research of our own to find the answers to these common questions, just in case you were wondering about some of the same things! However, you’ll have to stay tuned for the answers in the next few posts!

Common Questions about the First 3 Days Postpartum

For mothers who have had c-sections, the first 3 days are generally spent in the hospital with access to nurses, lactation consultants (in some cases) and doctors to answer their most pressing questions.  Mothers delivering vaginally, however, may be discharged from the hospital 24 to 48 hours after an uncomplicated birth; it’s not surprising that mothers’ primary concerns centered around their babies’ feeding and care during their first 3 days of life. Mothers asked questions most often about learning how to recognize and treat infant illnesses and how often and how much to feed their infants.

Interestingly, there were only minor differences between questions asked by first-time mothers and mothers who had had children before.

For first-time moms, the most universal question on the 1^st day postpartum was how to care for surgical wounds like c-section incisions and episiotomies.  Other common postpartum care questions included combatting postpartum complications, illness, fatigue, and the purpose of uterine massage in the hospital. 

The concerns of mothers who have had a child before were only slightly different.  The most common questions these moms had were the same as the first time mothers’ questions with the additional concern of appropriate maternal physical activity and how to return to their ‘normal’ figures (or weight).

Common Questions beyond the First Days and Weeks Postpartum

By this time, most mothers are back at their own homes, and after having tackled the art of diaper changing and feeding, have a new slew of questions about caring for their baby, themselves, and their new family as a whole. 

In this review, the most important issues to address during the transition from hospital to bringing baby home for both first-time and veteran moms were returning to their prenatal figure, postpartum exercise, “mothering” in general, and meeting the demands of everyone at home.

Understanding Baby Behavior is a universal concern of parents all over the world.  This study found that during their babies’ first few weeks, mothers were concerned about their babies’ behavior, fussiness, need for stimulation, growth and development, and feeding – all things we hope you have learned from our previous posts!  (for a quick refresher on the basics of Baby Behavior, you can review the crying , sleep, states, and cues posts.)  Other, less frequent questions were about support bras, perineal care, and how to deal with older siblings and sibling reactions when the new baby came home.

We know from experience that being aware of common questions can be a relief, helping new parents know that they are not alone in their concerns!  If you haven’t ever stopped to consider any of these questions, don’t worry!  We will be providing the answers to these questions in the next couple of posts!

Reference: Bowman KG. Postpartum Learning Needs. J Obstet Gynecol Neonatal Nurs. 2005 Jul-Aug;34(4):438-43..

More Mommy Science: Days 4 and 5

By Taryn Barrette, RD

Today, we continue our posts about the “Mommy Science” behind the events surrounding Jen B’s postpartum experience with her daughter Charlotte.

In her last post, Jen described her struggles with sleeplessness and breastfeeding during days 4 and 5. Keeping in mind that not all of Jen’s experiences are typical, we’ll share some of the biology lurking in the background.

The Tiredness Continues
In our last mommy science post, we talked about the emotional and physical demands of recovering from a C-section and the onslaught of hormones that induce the “stress response.” Stress causes forgetfulness, irritability, and for Jen B and many other women like her, an alert and awake state – leading to a frustrating inability to sleep. Though these hormones are decreasing on days 4 and 5, the resulting lack of sleep persists through the next few days.

Milk Onset
About 85% of moms ‘feel’ changes in their bodies between 24-72 hours postpartum signalling that their milk supply is increasing (otherwise known as "milk coming in" or "milk onset"). The other 15% feel those changes later (and may need some assistance from the doctor or lactation consultant to get things going). Typically, first time moms feel the increase in milk supply near the end of day 3. Mothers who have already had children often feel the changes at the end of day 2, give or take a few hours. Jen B noted that she felt the changes on day three – which is well within the normal range. Though colostrum (the very important early milk) is already being produced during pregnancy, mothers notice fullness and tightness in their breasts as the milk supply rapidly increases (more than 10 fold) during the first week after the baby has been born. For some mothers, the milk comes in well after the third day (this may happen to some but not all of moms who have had c-sections). In this situation, it is important that both mom and baby are seen by a health care provider. The good news is that for most moms, a delay in milk onset can be addressed with help from the lactation consultant and/or health care provider.

Hungry Babies on Days 4 and 5!
Newborns tend to have the highest number of feeds on days 4 and 5 (we’ll talk more about the science behind this in our next post) and if moms do not expect this increase in feeding, they may think there is something wrong or they may worry that the frequent feeds will go on forever. This added stress combined with fears “doing it wrong” can be very discouraging for new moms, But, this peak in feeding helps mom and baby to get plenty of practice breastfeeding and keeps the mom from being engorged by too much milk when the milk supply is increasing so rapidly. All babies will feed frequently on days 4 and 5 as they become more alert and active. New families need a lot of help during that first week.

Newborn Challenges
Despite the fact that bringing home her newborn was a new experience, Jen B was confident that her training and experience would make breastfeeding and understanding her baby’s needs easy. Unfortunately, Charlotte didn’t get that memorandum. Charlotte’s early cues were confusing and her attempts to latch resulted in fussy frustration or sleep when she should have been eating. As Jen B became more overwhelmed, the hospital staff was able to step in at the right time and support her efforts to keep breastfeeding.

Next time: We’ll get back to the Baby Science of that tough first week!

And Baby Makes Three - Part 5: The Rocky Road to Becoming A Mother

In this extended series of posts, we've looked closely at the importance of parents' relationships in babies lives. We've talked about the changes that new babies bring to couples' lives and how dads experience the transition. To end this series, we'll take a look at women's experiences in becoming mothers. Given that there are literally hundreds of studies about moms, we can't possibly do a good job in covering them all. Instead, we'll focus on some of the most common key findings.

The Realities of Recovery

While many mothers in the studies learned about childbirth by taking classes or asking questions, few moms were ready for those first few days home from the hospital. Muscles ache, stitches hurt, exhaustion sets in, and going to the bathroom becomes something to dread. Some moms are also dealing with nausea, incision pain, nasty headaches, and wild mood swings. Don't be surprised if you feel very emotional during those first few days, it is common for new moms to feel that way, but if you feel out of control of those emotions, you should talk to your doctor.

Feeling the Weight of Responsibility

Many new moms feel that they are responsible for the bulk of the baby care and still expected to meet everyone else's needs too - partners, other kids, friends, family and pets! The weight of all that responsibility can be overwhelming. It is interesting that many of the moms in the studies asked their health care providers how to manage all the responsibility rather than how to get more support. Secrets readers know that we think all moms should ask for help from family and friends so that they can get the time they need for their own physical recovery and to connect with their babies. Even the most independent and organized mom can't multitask enough to make those exhausting first few weeks easy; moms need help. It would be better for moms to use their organizational abilities to make a nice chore chart to share with helpful friends and family. These days, so many moms think they'll be able to go back to their regular routines in a short time - unfortunately, babies can't cooperate with any of moms' plans until they are older.

Dealing with the Fear

Babies are so tiny and they look so fragile, many mothers are worried that they'll make a mistake and somehow hurt their babies. They worry that they won't know if they don't have enough milk, or what to do if their baby gets sick, or if anything else is wrong. Since most new moms find themselves on an emotional roller coaster, the fear that they feel can be extreme. Some mothers question their ability to cope with it all and aren't reassured by their partners telling them "You'll be fine." Anxiety can be a tough thing; new mothers may need to talk about their fears with professionals they trust. Moms in the studies felt better if they knew they could call their health care providers or the one of the hospital nurses whenever they had questions.

A New Normal

I really don't know if anyone can be prepared adequately for life with a newborn. Routines, relationships, and day-to-day activities will need to be replaced with a "new normal" that won't ever be the same as before the baby came along. Many of the moms in the studies wanted to get back to their "normal" lives but they realized fairly soon that wasn't going to happen. Part of their transition to motherhood involved their acceptance of the "new normal."

The idea that you will never go back to what life was like before baby may sound intimidating to those of you still awaiting your special day but we can reassure you that the "new normal" will (eventually)be even better than the old one. Even though both my children are adults, my life is not like it was before they were born and I am thankful for that everyday. While I don't miss the fatigue or the scarier moments, I have thousands of precious memories that I wouldn't trade for anything. We hope that this series has helped shed some light on the challenges of the transition to parenthood. The transition is a rough and rocky road but the rewards are worth the ride. Be sure get some help at home! Help won't make it easy but support from family and friends will make a huge difference, to mom, to dad, and to baby.

Next time: Back to Basics!

References

Barnes et al. Learning about babies: what new mothers want to know. J Perinatal Educ. 2008; 17:3:33-41.

Forster et al. The early postpartum period:Exploring women's views, expectations, and experiences of care using focus groups in Victoria, Australia. BMC Pregnancy and Childbirth. 2008; 8:27.