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Continued from page 1 Some mothers experienced anxiety to an extreme, including panic symptoms following birth. Symptoms include anxiety, rapid breathing/hyperventilation, rapid heart rate, body temperature changes, chest pain, shakiness, or dizziness. This phenomenon is not as well described in the literature.
Contributing Factors Research has not demonstrated a clear etiology of mood disorders associated with childbearing. Many factors have been identified as contributing to the development of postpartum affective disorders. Biochemical changes resulting from dramatic alterations in hormones following birth are a contributing factor (Kendall-Tackett & Kantor, 1993). Social isolation has been identified as a contributing factor (Ray & Hodnett, 2002; Stern & Kruckman, 1983). Many women in Western culture, and those displaced from their country of origin, can be faced with social isolation. The relationship of the woman with her partner has been identified as a strong influence on the woman's emotional state (Fisher et al, 2002). Birth experiences, which are perceived in a negative way by women, can contribute to women's depressive symptoms. Traumatic births result in physical sequelae for women, feelings of failure or inadequacy, feelings or mistrust or betrayal, and helplessness or powerlessness. Medical complications during pregnancy were found more likely to develop into depressive symptoms (Burger et al, 1993).
Self-esteem, cognitive style, and psychiatric history influence the way a woman perceives her life and copes with challenging events. Life events, separate from childbirth, can have an additive effect thus reducing a woman's overall coping ability.
Finally, the temperament of the infant brings with it a separate set of variables to consider (Cutrona &Troutman, 1986). Infants who cry excessively can wear on a new mother's ability to cope and leave her feeling like a failure. Beck (1998; 2002) found eight factors which were significantly related to the development of postnatal depression. These factors included prenatal depression, history of depression, social support, marital satisfaction, life stress, childcare stress, and maternity blues. Bozoky and Corwin (2002) found fatigue to be predictive of postpartum depression.
Consideration for Lactation Consultants The lactation consultant should be alert to cues new mothers offer in the early postpartum period. Concerns expressed by women should not be minimized but explored and evaluated. Knowledge of the woman's past experiences, as well as her current birth experience and existing social support networks, can give insight into early family transitions.
Useful strategies for women experiencing mood disorders in pregnancy and following birth have been demonstrated in research (Ray & Hodnett, 2002). Early detection and management are essential to minimize the potential long-term consequences to the woman and her family. Treatment typically involves a combination of medication, psychotherapy, and support group. Social support networks within the woman's domain can mediate some of the stressors and challenges pregnancy and early child rearing can bring. Social support has demonstrated some positive outcomes for women with depression (Kendall-Tackett & Kantor, 1993; Ray & Hodnett, 2002). The use of morning light therapy has been applied to the treatment of depression during pregnancy yielding a positive effect (Oren et al, 2002). Pharmacologic treatment of postnatal depression has increased in recent years and is considered to yield more good than harm, which may result from failure to treat (Hale & Ilett, 2002; Hoffbrand et al, 2002).
Postpartum mood disorders can be treated with early detection and management. The lactation consultant is optimally positioned to make a difference in the outcomes of women developing postpartum affective disorders.
Additional Information: Internet: Depression after delivery: www.depressionafterdelivery.com
The National Women's Health Information Center:
www.4women.gov/faq/postpartum.html
Postpartum Support International: www.chssiup.edu/postpartum
Medline Plus: www.nlm.nih.gov/medlineplus/postpartumdepression.html
The Postpartum stress center: www.postpartumstress.com
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Books: Beyond the Blues: Prenatal and Postpartum Depression by Shoshana Bennet and Pec Indman Shouldn't I Be Happy? Emotional Problems of Pregnant and Postpartum Women by Shalila Misri This Isn't What I Expected by Karen Kleiman and Valerie Raskin The New Mother Syndrome by Carol Dix Depression after Childbirth by Katharina Dalton Postpartum Depression and Child Development by Lynne Murray Postpartum Depression: Every Woman's Guide to Diagnosis, Treatment and Prevention by Sharon Roan Rebounding from Childbirth: Toward Emotional Recovery by Lynn Madsen When Words Are Not Enough: The Women's Prescription for Depression and Anxiety by Valerie Raskin Postpartum Survival Guide by Ann Dunnewold and Diane Sanford I Wish Someone Had Told Me: A Realistic Guide to Early Motherhood by Nina Barnett References:
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