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Carne's Wellness Corner
Postpartum Depression

Recognizing postpartum depression may come easier to women who have already had a baby than first-time mothers, which means others - providers and family members – need to be on the lookout for typical signs and symptoms of the disease.

"We need to think about postpartum depression (PPD) the same way we think of other complications of pregnancy – such as gestational diabetes, hypertension, or other post-delivery complications," says Margaret Howard, PhD, director of the Day Hospital at Women & Infants Hospital. "All women need to be educated that postpartum depression can occur, and they need to be aware of the symptoms as well as the riskPostpartum Depression factors."

Is this normal?

Women who suffer from PPD may experience various emotions, which one blogger compares to the stages of grief

"I think what we see in postpartum women is a combination of the stages of denial and bargaining," Dr. Howard says. "We particularly see that in women who have never had a postpartum depression. Having a new baby is a major event in a women's life – unlike anything she's ever experienced previously – so for a woman who has just given birth for the first time, it's understandable that she would chalk a lot of her symptoms up to, 'Oh, I just had a baby, and this is all part of it'. Many first-time mothers think it must be a normal part of having a baby."

Accordingly, many women try to make adjustments - getting more sleep or improving their diet – thinking it might go away.

"They keep trying different things to make themselves feel better, all the while saying 'This must be normal,' until something kind of cracks," Dr. Howard says. "A woman might find herself throwing her cell phone across the room or something really uncharacteristic that gets her attention and begins the conversation of, 'Maybe this isn't so normal and maybe there's more to it.'

"We hope women who are truly suffering from postpartum depression come to that conclusion sooner rather than later so they can get treatment. The longer women wait to get treatment for depression, the tendency is for the depression to worsen," she says.

Women who have already given birth with minimal mood disruption are quicker to recognize PPD symptoms. "They do not chalk it up to childbirth, because they've been through it before," Dr. Howard explains. "Typically those are the moms we see sooner because they know something is wrong."

It can also be difficult for moms to admit they are having trouble. "That's why the more that we, as a culture, can talk freely about postpartum depression as yet another complication of child bearing without stigma, the more women will get treated. There's no reason for women to suffer with postpartum depression."

A progressive model

The Day Hospital, opened in 2000, was the first in the nation to treat women in a psychiatric partial-hospital setting while keeping them with their babies. Women receive daily treatment, including group and individual therapy, skills training, relaxation and mindfulness-based therapies, and medication management when necessary. Because it is not an inpatient program, the mothers and babies return home to their families in the evening.

"In the past, women were referred to psychiatric hospitals, but they weren't going to treatment because they didn't want to be separated from their baby," Dr. Howard says. "They may have been breastfeeding, or just didn't want to be away from their babies all day. In a partial-hospital setting, women can go home in the evening and be with the rest of their family and actually practice some of the skills they learned in the treatment program. We felt this model was a little bit more real life."

Cultural changes

In the past decade, the pediatric community has gotten better at recognizing PPD and how it impacts the health of the baby, Dr. Howard says, adding that women may still feel it's a sign of weakness.

"They get those messages both culturally, and some get it in their own home," she notes. "So they internalize it. The end result is that women continue to suffer and not get the help they need. No women should suffer. Having a new baby is hard enough in itself."

Anyone concerned about PPD should seek an evaluation from a professional experienced in treating perinatal mood disorders, or call the Day Hospital at (401) 274-1122, ext. 2870.

-- Pamela Berard

Care New England
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