Caroline Brown, DEd, WHNP, IBCLC

The birth of a baby is a significant event. A new baby brings both joy and challenges to the family. Changes in mood associated with childbearing and childbirth present a problem within the family system that can yield long lasting effects. Research has shown that depression negatively impacts maternal infant attachment during the first year (Beck, 1992; Kaplan et al, 1999). Depressed mothers demonstrated less affection, reduced responsiveness, and withdrawal. The infants were found to be fussier and less interactive than infants with non-depressed mothers. A range of mood disorders associated with childbearing has been described in the literature including the baby blues, postpartum depression, postpartum anxiety/panic disorders, and postpartum psychosis.

Baby Blues
Many mothers experience blues, an emotional let down following the birth. The incidence of postpartum blues varies in the literature from 30%-80% (Beck et al, 1992; Kendall-Tackett & Kantor, 1993). It usually starts a few days after birth, peaks on day four to five, lifting ten to fourteen days after birth. Symptoms can include anxiety, mood swings, confusion, negative feelings for the infant, altered sleep patterns, irritability, and crying.
A research study by Beck and associates (1992) explored the experience of blues and depression in primiparous mothers finding that those women experiencing the blues were at higher risk for developing postpartum depression. The women in this study experienced a peak in blues symptoms on the 5th postpartum day. The researchers suggested screening for postpartum blues and continued follow-up for those women with blues symptoms. With subsequent research Beck (1998) has further developed a screening tool for use with childbearing women.

Beyond the Baby Blues: Postpartum Depression
Postpartum depression (PPD) is different from the baby blues and can develop with any pregnancy. The onset of symptoms occurs within the initial weeks after the birth and can continue, if untreated, for a year (Dalton & Holton, 2001). The incidence of postpartum depression is 10%-25% with variation in expression of depressive symptomatology (Beck, 1993; 1998; Kendall-Tackett & Kantor, 1993). The symptoms include:

1. Changes in sleep patterns, i.e. waking early in the morning, difficulty falling and staying asleep, extreme fatigue, and not feeling rested.
2. Changes in eating habits, i.e. forgetting meals, changes in appetite, either increase or decrease, or substance abuse.
3. Changes in energy level, i.e. feeling sluggish, irritable, and physical aches and pains.
4. Changes in thinking, i.e. difficulty concentrating, over- or underconcern for baby, loss of interest in life and pleasure activities, decrease in libido, suicidal thoughts, fear of hurting the baby.
5. Changes in feelings, i.e. moodiness, sadness, crying, anger, feeling hopeless or helpless.

Postpartum psychosis occurs in 1-2 women in 1000 (Kendall-Tackett, 1993). The onset of symptoms can occur between 2 to 8 weeks postpartum with duration depending on diagnosis and treatment. Symptoms include altered activity, delusions, hallucinations, marked mood swings, depression or mania, and confusion (Kendall-Tackett & Kantor, 1993).

continued on page 3