Postpartum depression is not a one-size-fits-all illness. In fact, it is only one among a spectrum of postpartum mood and anxiety disorders, including postpartum anxiety, postpartum OCD, postpartum PTSD and postpartum psychosis. Due to awareness created by such organizations as Postpartum Support International, many now understand that women who give birth may experience any one of these disorders at any time in the first 12 months after delivering a baby. But did you know there are several other groups of people who experience symptoms of depression and anxiety around childbirth who don’t fit that exact description or timeframe?
Pregnant women, adoptive mothers, women who experience perinatal loss, women who are breastfeeding and even dads can experience their own unique forms of depression related to childbirth. Here’s more information about each, so that you might be able to recognize someone in distress who needs your support.
Antepartum Depression (Depression During Pregnancy)
Women who are pregnant are just as likely to suffer from depression and anxiety as those who develop it in the postpartum period. They are also just as likely to forgo reaching out for professional help, often because they are afraid of how treatments like medication will affect their unborn babies. Avoiding treatment, however, is not the best choice. Research shows that women who have depression and remain untreated while pregnant are more likely to smoke and drink, more likely to have a pre-term delivery and a low-birth weight baby, and less likely to carefully follow prenatal care recommendations. Untreated depression during pregnancy also puts them at a greater risk for getting postpartum depression.
Just this year, the American College of Obstetricians and Gynecologists and the American Psychiatric Association collaborated together on a set of guidelines for the treatment of depression during pregnancy to help guide both you and your doctor through the decision-making process. There are a variety of effective treatment methods for depression during pregnancy, so don’t avoid asking for help if you need it.
Antepartum Depression Resources:
- Depression During Pregnancy, Parenting.com
- MGH Center for Women’s Mental Health: Psychiatric Disorders During Pregnancy
- ACOG Guidelines on the Treatment of Depression During Pregnancy
- Motherisk: Medications in Pregnancy
Their hormone levels may not be dropping, but mothers of newly adopted children are susceptible to depression as well. It's called post-adoption depression, and its symptoms are similar to that of PPD, including anxiety, sadness, guilt feelings and hopelessness. While there is still almost no research available on post-adoption depression, adoptive parents will tell you that it clearly exists.
A story on post-adoption depression in the December 2009 issue of O the Magazine enumerates some of the reasons why mothers of newly adopted children may experience depression:
"For some parents … the joy of adopting coincides with lingering grief over a lengthy battle with infertility. What's more, conspicuous physical differences between adopted children and their parents or siblings may elicit unwelcome attention from strangers that can intrude upon the bonding experience. Unsolicited input from friends and family—well meaning or not—can also reinforce feelings of inadequacy for newly adoptive parents, who may feel insecure and overwhelmed, particularly if their child has experienced trauma or neglect."
There also may be worries over the feelings of the birth mother, ongoing legal issues like parental rights and about how well the bond-forming process will go with this new addition to the family.
Birth mothers who relinquish their children for adoption can also suffer from depression and anxiety, explains blogger and birth mother Jenna Hatfield at Adoptionblogs.com:
“You do not deserve to suffer with postpartum depression simply because you relinquished your child. You also need to realize that the actual relinquishment of your child does not exempt you from PPD. In fact, the grief and loss associated with relinquishment are hard enough on their own. Then combine the dramatic effect that fluctuating hormones can have on a mother who just delivered a child and it’s amazing that any of us even survive the first few months after birth.”
Post-Adoption Depression Resources for Birth Mothers and Adoptive Mothers:
- Don’t Call Me Mother (Post-Adoption Depression Blog)
- The Chronicles of Munchkinland (Birth Mother Blog)
- Adoption.com’s Depression & Therapy Support Forum
- The Post-Adoption Blues by Karen Foli
Depression and Grief After Miscarriage or Stillbirth
After the loss of a baby, either due to miscarriage or stillbirth, what exactly is it that a mother goes through as she grapples with this devastating experience? Is it grief or is it postpartum depression? Could it be both? Dr. Ruta Nonacs, in her book A Deeper Shade of Blue, explains that women who have suffered loss can develop depression in addition to their grief:
"Though emotional distress in pregnancy loss is normal, some women may develop more persistent or disabling psychological symptoms ... Depression may also complicate the picture. One study found that during the six months following a miscarriage, about 10 percent of women showed signs of depression ... Experiencing a stillbirth or neonatal death probably puts you at even higher risk for depression; one study indicated that a mother's risk for depression after stillbirth is about seven times higher than a woman who has a live birth."
Several of the women who’ve experienced perinatal loss have expressed to me how few resources are available to help them. They don’t know if they should reach out for treatment, or even how long their feelings should last. Again, Dr. Nonacs helps to clarify:
"The symptoms of grief after a miscarriage typically last about six months to a year and do not usually affect your ability to function for a prolonged period of time; however, some women may have a grief reaction that is more intense or more prolonged. When the grieving process seems unbearably intense or seems to persist for a longer period of time, this may be a sign of what is called 'pathological' or unresolved grief, or this may be an indication that depression has complicated the picture."
Nonacs says that depression is never normal, even for those who've had a loss, and it can impede recovery if not treated.
Perinatal Loss Resources:
Dysphoric Milk-Ejection Reflex
Some moms feel just fine all the time emotionally, except right when they're about to breastfeed or are breastfeeding. According to D-MER.org, Dysphoric Milk Ejection Reflex is a newly recognized condition affecting lactating women which causes a surge of negative emotions to occur just before milk release.
Moms with D-MER often experience a hollow feeling or nervous stomach, and a feeling of dread, guilt, anxiety or anger prior to letdown. These symptoms appear right before milk starts to flow, and the feeling usually lasts only around 2 minutes.
- Emotional Letdown Blog
- Opening the Door to Breastfeeding's Best-Kept Secret, Breastfeeding.com
Postnatal Paternal Depression
I found it hard to believe at first that fathers could get postpartum depression. Considering they don’t have the huge hormonal adjustment that women have after having a baby, and considering that initially we all believed it was solely hormones that caused PPD, it didn’t seem possible. I was wrong. As recently reported in the New York Times, we are beginning to learn more about what causes postnatal paternal depression, and who is at risk:
“By far the strongest predictor of paternal postpartum depression is having a depressed partner. In one study, fathers whose partners were also depressed were at nearly two and a half times the normal risk for depression. That was a critical finding, for clinicians tend to assume that men can easily step up to the plate and help fill in for a depressed mother. In fact, they too may be stressed and vulnerable to depression.”
If you are a new dad suffering from symptoms similar to those of postpartum depression, be comforted. You are not alone.
Postnatal Paternal Depression Resources:
- Newsweek: Slouching Toward Fatherhood
- CNN: New Dads Can Get Postpartum Depression Too
- Postpartum Men
- Postpartum Dads Project