The rapid changes in hormone levels after delivery can be expected to cause some minor problems for new mothers. In addition sleep deprivation can cause behavioral changes. 50 80% of women will have a few days of weepiness or up-and-down emotions following delivery which resolves by day 12. 20% of women with postpartum blues develop postpartum depression (PPD) that becomes overwhelming. Fortunately only 0.1-0.2% will develop postpartum psychosis. (Suri and Burt 67,70,72).

Sometimes repeated calls to the hospital or doctors' office or a friend for help with seemingly small problems can be indicative postpartum depression. Some mothers seem quite calm over the telephone and it is difficult to decide if she is overly concerned or if she needs help in another area. Ask the mother how she feels. Is she getting enough sleep, nourishment and support? Ask her how dad is dealing with the new baby. Sometimes the simplest questions result in a flood of tears.

Unfortunately many health care professionals and parents fail to recognize the signs and symptoms of postpartum depression. Women with histories of prior depression, panic disorder, obsessive compulsive disorder, marital problems, premature delivery, premenstrual syndrome and a history of prior PPD are at highest risk for developing PPD. One article describes post traumatic stress disorder as a complication of infertility treatment (Bartlik et al). In some women symptoms of postpartum depression may not appear until weaning. If left untreated, postpartum depression can last for months or years. It can ruin families and relationships and cause developmental problems for the infant.

If the following symptoms are present, mother should be referred to a specialist in postpartum depression immediately:

• Depression/ "Baby Blues" last longer than 2 weeks after delivery (mood swings, anxiety, insomnia).
• Loss of appetite or unable to care for herself or the baby.
• Obsessive preoccupation with the health of the baby, excessively worried that baby is ill.
• Suicidal ideation or thoughts of harming the baby or herself (Requires EMERGENCY attention).
• Signs of panic disorders; fear of being alone, fear of leaving the home, fear of public places.

 In all cases of apparent postpartum depression, thyroid function should be tested (Suri and Burt 71). There is a false perception that women cannot take medication for depression when breastfeeding. Women are often told that they must wean to be treated. Unfortunately weaning can deepen the depression and precipitate a crisis. Medications can be used in the breastfeeding woman, with careful consideration of the drug's properties. Generally speaking, more data is available for older drug compounds verses newer medications.

Copyright Marie Davis, RN,  IBCLC 1999 
Revised Wed, Nov 8, 2006

[references]

[index]