Friday, March 19, 2010

Education for Postpartum Depression

I spoke to a friend recently about pregnancy, specifically when and where information is provided. We both agreed that the time right after labor to several weeks after birth is the most formidable time for new parents. In this time parents are plagued by lack of sleep, putting more tension on an already stressful time. Some people are lucky enough to have family and friends present in this time to help the new parents adjust to the daunting task of making life changes for a new addition. What happens for those that do not have the support of friends and family? What happens when parents are not able to deal with the stressors of new parenthood?

The National Institute of Health (NIH) estimates that up to 15% of new mothers have symptoms of postpartum depression (National Institute of Health, 2005). Postpartum depression symptoms can include, but are not limited to feeling: tired, antsy, little motivation, and decreased appetite (National Institute of Health, 2005). All of which can be misconstrued as typical feelings after having a baby. So how can we as educators better identify these signs?

Although we may never aspire to become parents, it is important to support those around us in their sexuality-related endeavors. A good way to look out for a friend or family member is to keep updated about the new family’s adjustments. Let the new parents know there are a number of biological, physical, emotional, and social changes that occur after the birth of a child. If symptoms seem to continue weeks after birth, talk to the person about how you can help. Reassure the new parents that they need not take on everything themselves. Recommend to the new parents that they seek out help from medical professionals, as ignoring can lead to harm of oneself, or the baby. Many treatments are available, and can be very effective. The following resources provide additional information about postpartum depression:

Bodnar, D., Ryan, D., & Smith, J. E. (n.d.). Self-care program for women with postpartum depression and anxiety. Provincial Reproductive Medical Health. Retrieved from

National Institute of Health (2005). Understanding postpartum depression: Common but treatable. News in Health. Retrieved from



  1. Postpartum Depression: Silent Suffering
    The impact of postpartum depression (PPD) can be devastating. I had the opportunity to work with a couple who began to experience PPD about 3 weeks after their child was born. Professionals often treat the symptoms of the female, depression, but rarely has the husband been the focus. Often time’s friends and family members do not recognize the symptoms of depression in both parents. Some mothers and fathers suffer in silence leading friends and family to believe they’re fine. When working with some couples they have experienced feelings of: deep sadness, inadequacy, failure, and intense pressure to succeed and can’t. When working with couples who have experienced these and other various emotions, I refer them.
    These are a few places couples and mothers have found helpful:

  2. It can be an overwhelming feeling to be responsible 24/7 for a helpless infant. It is ironic that at what one expects as a happy time can be equally emotionally devastating. Also, parents don't plan on postpartum depression, but it unfortunately exists. I remember a lot of discussion on the topic when Brooke Shields had her first child and suffered from postpartum psychosis. Tom Cruise had a negative comment about Brooke being medically treated. His statement sparked a myriad of debate.

    As educators, it is important to provide anticipatory guidance and recognize signs of postpartum depression, as well as its potential in any parent and refer appropriately. Some resources are:
    American College of Nurse Midwives
    American College of Ob/Gyn
    La Leche League International


  3. I agree with the need for anticipatory guidance and with the ability to recognize signs. A recent study from NIMH and The University of Rochester Medical Center shows that in a sample population of low income families postpartum depression rates as high as 56% compared to the 15% that is the national average. Three screening tools were used: the Edinburgh Postnatal Depression Scale, the Beck Depression Inventory II and the Postpartum Depression Screening Scale. The purpose of the study was to determine the validity of the scales but the social implications of the findings are remarkable.
    I am hopeful that the recognition of the prevalence of depression in low income mothers and the need to provide medical support for this community will lead to greater medical coverage.

  4. I was really struck by the post about postpartum depression in men. It makes me think that it ties into the belief that men are tough and can handle a "difficult" situation without support.

    Here is a link to some signs to look for in men when working with a family that just had a baby.


  5. The comment about post partum depression also affecting men but being overlooked really struck me. It seems like even the medical society buys into the macho male perspective. I found a website that lists some signs of male postpartum depression which would be good things to look for if working with a family with a new baby.


  6. In both educational and clinical settings there are early signs that a woman is at increased risk of suffering with PPD. Some of the biopsychosocial factors include:

    * a history of depression during pregnancy
    * age at time of pregnancy -- the younger you are, the higher the risk
    * ambivalence about the pregnancy
    * children -- the more you have, the more likely you are to be depressed in a subsequent pregnancy
    * having a history of depression or premenstrual dysphoric disorder (PMDD)
    * limited social support
    * living alone
    * marital conflict
    * diet low in omega-3 fats
    * strong/deeply held expectation or attachment to labor & delivery experience.
    * unfinished business with a woman's own mother at time of delivery

    The results of a recently released study indicate that a blood test during the 25th week of pregnancy to evaluate the levels of the hormone pCRH may predict the onset of PPD.

    Some women are given a questionnaire during pregnancy that evaluates the increased risk.

    The increased risk as related to poverty and limited access to health care may be answered by a unique program implemented in Canada where peer-support is offered. Volunteer mothers who suffered with PPD are trained to establish rapport and make connections over the telephone, helping the new mothers through those precious few first weeks. These volunteer moms then become a conduit to the medical community who lose touch with the family once they leave the delivery site.

    Great comment on the risk to the other parent! My experience is that we tend to see this and most other sexuality issues as being the problem of the one person in a partnered situation with the actual medical condition!



    Northup, C. (2006). Women's bodies, women's wisdom. New York, NY: Bantam Books.

  7. I agree that it is important for women to seek help for PPD not only for themselves but for their child(ren) and others involved in their family unit. Something to keep in mind is that there may not be resources available and/or affordable for everyone to seek counseling. There are several support groups that I found online that may aid in comforting those with PPD.

  8. Any type of depression can be devastating, but there is one added cognitive/emotional experience that usually accompanies postpartum depression (PPD), and that is guilt. With guilt, comes anger, and these feelings wear down the mother.
    When a woman is pregnant, she is constantly told what an amazing and joyful experience mothering can be. It is rare for pregnant women to receive precautions on the emotional changes that may occur. Why is this? Perhaps, it’s because people are not educated on PPD.
    Pregnant women are not the only people negatively affected by postpartum depression; therefore, they are not the only people who need to be educated on the subject. The following website is for spouses, family members and friends who want to become more supportive:

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  10. Alicia, thanks for much for posting a blog on this topic. It was truly an eye-opener for me as I knew very little about PPD and didn't realize how prevalent it was. I was surprised to read that 15% or more new mothers experience PPD. Reading that percentage I began to wonder if some women are more at risk than others, and this is what i found:

    The CDC released a report in 2008 which included 52,000 new mothers from 17 states.. the demographics of those more likely to experience PPD or PDS (postpartum depression symptoms) included the follow groups of women:

    - young mothers (teens)
    - mothers with less than 12 years of education,
    - Medicaid patients
    - smokers
    - victims of physical abuse before or during pregnancy
    - women under traumatic or financial stress during pregnancy

    Center for Disease Control and Prevention(2008, April). Prevalence of self-reported postpartum depressive symptoms -17 States, 2004--2005. Morbidity and Mortality Weekly Report retrieved from

    The report also stated that there is a need for education and intervention programs for new mothers. While reading this part of the report I began to think of my sister-in-law who is expecting in May. Although she is not part of the sub-populations listed above, I think it's important that all new mothers receive some education or screen for PPD or PDS. I am also wondering if she will get an information on this topic in her lamaze class.

    Does anyone know if PPD/PDS is being incorporated into lamaze classes? It seems like an opportune time to educate woman on this issue. I'd be interested to read any sources that discussion the curriculum used in a lamaze or "become a parent" type of class.

    Thanks again Alicia for blogging on this topic!

  11. When talking about treating post partum depression it is important to discuss the use of antidepressants and breastfeeding. Antidepressants are commonly prescribed to help treat the depression associated with post partum depression and doctors recommend breastfeeding as a way for mothers to bond with their babies. These two forms of treatment can become contradictory as many new mothers who are taking antidepressants to treat post partum depression are afraid to breastfeed because they are afraid the antidepressants may be harmful to their baby. According to a WedMD article the 156th meeting of the American Psychiatric Association found that most newer antidepressants do not pass through the breast milk. They recommended using SSRI’s to treat postpartum depression. The MGH Center for Women’s Health recommends fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and the tricyclic antidepressants because a lot of research has been conducted on these drugs and breastfeeding. They advise to take precautions with the dosage and to have the baby’s drug level tested if you notice any changes in behavior as the changes may be a result of drug side affects due to a high dosage. Overall the research seems to support the use of antidepressants while breastfeeding which is good news for mothers suffering from post partum depression who want to breastfeed.