This Isn't What I Expected

Notes on healing postpartum depression

Baby Blues or Something More?

How do you know if what you are feeling is really okay?

You've just had a baby. You might be floating around on cloud nine basking in the glow of your new precious gift. Or you may be exhausted, irritable, disappointed and anxious. Or, you might be experiencing some combination of both ends of the spectrum. If this is your first baby, it's hard to know what's "normal."  Is this what other new mothers feel? Am I more nervous, more tired, more worried than other women?

Annie expressed her concern this way:

My mother-in-law said I was overreacting. She said when she had her baby, she just crammed him onto her breast and went along her merry way. She had 4 of them. No help. No complaints. So I must just be a big whiner. Why am I so overwhelmed? This just doesn't feel like me.

If a new mother tells her doctor or her friend or her mother that she's overwhelmed by fatigue, she is likely to hear something such as, of course you are, it's hard to be a mother. Complicating things further, symptoms of postpartum depression can sometimes mimic the blues creating an assortment of emotions that are difficult to discern.  So how do you know what's okay and what's not okay to feel?

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If you read about postpartum emotions, you will discover what appears to be a clear delineation of markers and yet, a closer look at these characteristics shows the potential for misinterpretation. As you can see, some "symptoms" of the blues can mirror some symptoms of depression. Here are some of the common markers:

Postpartum Blues (not considered a disorder):

  • Mood lability
  • Exhaustion, problems sleeping
  • Weepiness
  • Feelings of sadness, anxiety
  • Feeling inadequate
  • Irritability, frustration

Postpartum Depression (1 out of every 7 postaprtum women)

  • Insomnia
  • Mood disturbances
  • Crying
  • Appetite disturbance
  • Peristent Sadness
  • Guilt
  • Excessive anxiety
  • Irritability, anger
  • Scary thoughts
  • Feelings of hopelessness
  • Inability to concentrate
  • Loss of pleasure

Note that some of the feelings associated with normal postpartum adjustment (blues) overlap with those associated with depression. Mood disturbances are difficult to tease out - it's hard to know how bad is too bad, how much is too much?

The important point here is that it is not the feeling itself, rather it is the frequency, intensity and duration of the feeling. For example, all new mothers cry. They are tired, overwhelmed and sleep deprived. This sets up an emotional and physiologic rollercoaster that often results in mommy meltdowns and intermittent expressions of dissatisfaction. So it's not the crying itself that's the indication of anything being wrong. Instead, it's whether the crying is interfering with her ability to get through the day. How much is she crying; how hard is she crying, how long has this been going on, and ultimately, how is it impairing her ability to function? 

As another example, all new mothers are anxious. Did I feed her enough? What is that noise she is making? Is she getting enough or too much sleep? Why is she crying? We expect new mothers to worry. In fact, experts say it can be a healthy expression of the primal fight-or-flight instinct, setting mom up to be in position to protect the baby from perceived danger. In that way, it can be adaptive. However, if worrying becomes excessive, persistent or disproportionate to the circumstance, or, if it interferes with day-to-day performance, it may be problematic.

Keep this in mind. It may not be what you are feeling that is causing a  problem. It is how bad that feeling makes you feel. Put another way, your level of distress is the single best indicator of whether or not something needs to be addressed by your healthcare provider. (Note that in cases of severe depressive episodes, symptoms can distort a woman's perception and she may not be as aware as others are, that something is wrong. But here, we are talking about the difference between normal baby blues and mild postpartum depression.)

Additionally, the time frame is relevant. Baby blues occur during the first week postpartum as a result the dramatic hormonal changes and resolve, without treatment, within the first three weeks postpartum. What this means is simply this: If you are experiencing feelings of sadness, anxiety, worry, irritability, fatigue, etc. and you are more than three weeks postpartum, it is not the baby blues.

You know yourself and your body. You know when you are not feeling like yourself. If you think something is wrong, it probably is. That doesn't mean anything terrible is happening. But if you are worried about the way you are feeling, you are likely to feel better if you bring that to the attention of someone who can help you sort out what is what. 

Trust your instincts.

 

© Karen Kleiman 2011 Postpartumstress.com

Karen Kleiman is founder and director of The Postpartum Stress Center, a treatment and training center for prenatal and postpartum mood and anxiety disorders.

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