Postpartum Blues and Depression are on the Rise - ChildBirth During a Pandemic
Updated: Jul 17, 2020
Just had a baby and overwhelmed by feelings of blues, guilt, sadness or anger? You aren't alone. Now in the middle of a pandemic, women are reporting more signs of blues or clinical depression after birth. If you are childbearing or a practitioner in the birth world, postpartum depression is a serious disorder that requires our collective awareness and education to support women through these dark times. Here is why:
Most women experience some form of mood fluctuations, or baby blues, during the first few weeks after their newborn arrives. A reported 85 % of new mothers may experience mood swings, crying, irritability and sadness during the first 2 weeks postpartum. The dramatic decrease in hormones that naturally occur following the birth of the placenta, along with the ensuing lack of sleep that a newborn brings, the new role changes, any prior history of premenstrual syndrome or depression and / or lack of a strong social network can all impact or exacerbate the emotional and physiological experience often leading to the blues.
Postpartum Depression (PPD) is a serious and longer lasting condition classified by the Diagnostic and Statistical Manual -V (DSM) as a mood disorder. Its origins can begin in the pre-pregnant period, during the pregnancy or last throughout the first year after birth. In order to diagnose PPD, symptoms must occur during the first 4-6 weeks postpartum but the clinical course can last up to 12 months following birth before it is considered under a wider lens as clinical postpartum depression.
Causal factors for PPD include physiological, genetic, environmental and psychosocial signals. The expected drop in hormones, sleep deprivation, prior underlying comorbidities such as thyroid disorder or diabetes, prior history of mild or minor depression, Premenstrual Dysphoric Disorder, prior history of major clinical depression, prior history of postpartum psychosis, history of trauma or abuse, lack of family support or a social network, lower socioeconomic status, ethnicity, inherent practitioner bias and institutional discrimination and racism within healthcare are all components of this serious and complicated pathology.
Symptoms and outcomes differ depending on each person. The impact can range from a mild interference in the ability to carry out the activities of new or returning motherhood to the more detrimental impact on mother, baby and her family. Without proper treatment, maternal risks include breastfeeding issues such as low milk supply and mastitis, interference in recovery after birth, relational issues with family members, substance abuse, prolonged depression, psychosis and suicide (8, 9).
The profound impact on children include both physical impairment and cognitive and behavioral affects.
"The risks to children of untreated depressed mothers (compared to mothers without PPD) include problems such as poor cognitive functioning, behavioral inhibition, emotional maladjustment, violent behavior, externalizing disorders, and psychiatric and medical disorders in adolescence" (8).
Prevalence & Statistical Issues
Prior to Covid-19 pandemic, incidence rates in the United States (US) ranged from 3 % to 10%, while rates for PPD worldwide are a reported 10% of the population. Countless studies, referred to in the enclosed reference list, point to much higher rates for the risk of PPD and site at least 1 in 7 US women will have some form of PPD in their first year postpartum. The occurrence in communities of color along with communities who lack access to adequate care however, may even be higher. Women often under-report symptoms until the clinical course is advanced and studies have shown practitioners can be dismissive of a mothers experience as just "par for the course". New mothers often feel ashamed or embarrassed they aren’t “embracing” new motherhood and social media has exacerbated this false narrative of what new motherhood should look like. Many women don’t report their inability to emotionally or physically carry out the duties of caretaker for their newborn for fear of judgement or even legal retribution. This is especially significant in communities of color where discrimination can impact a woman's trust in medical care workers. They often fear child protective services might be called if they discuss their experience. The incidence of PPD can be higher in certain ethnicities but they are less likely to receive vital treatment. Lack of adequate education and lower socioeconomic backgrounds regardless of ethnicity also play a role in women who seek care. Lastly, healthcare insurance carries responsibility in the barriers women face as many practitioners lack the adequate time necessary to address the issues, citing an inability to bill insurance for their added time during postpartum visits. Medical and midwifery schools and residency programs in general ill prepare practitioners in addressing the clinical course of PPD or how to adopt management or fee for service protocols when addressing these issues.
Although no new studies have completed trials since the beginning of the pandemic, both postpartum blues and PPD are on the rise due to the added stress and isolation the world is now facing. Domestic violence is also on the rise which is a significant risk factor in PPD.
According to the American College of Nurse Midwives, clinical identifiers include:
● Loss of appetite
● Fear that you will hurt yourself or your baby
● Feeling guilty
● Feelings of anxiousness, panic or insecurity
● Feeling overwhelmed
● Crying a lot
● Feeling like you are not normal or real anymore
● Difficulty sleeping—you can’t sleep, even when the baby is sleeping
● Angry; feeling like you might explode
● Feeling lonely
● Can’t make decisions
● Inability to concentrate or focus
● Thinking the baby might be better off without you
Fortunately there are a few simple tools that any practitioner can incorporate into their practice to screen for PPD and should be used regardless of identified risk factors. The Edinburgh Postnatal Depression Scale should be given to expecting mothers at every visit during their last few weeks of pregnancy during this pandemic and at every visit during the first 6 weeks after delivery. As a practitioner, I am even more aware of those with added risk factors with the knowledge that the isolation experienced during this time in history is risk alone. The sooner practitioners can identify its occurrence, the better the outcome for mother, baby and family. In addition, all practitioners should begin to discuss depression as a risk during the first and last month of prenatal visits as a way to normalize and ease discomfort around it. Through clear and repeated unbiased education, expecting mothers have the added benefit of not being shocked or in denial if it occurs. Open dialogue and the provision of more time during visits can help gain trust between patient and practitioner and thus reduce the risk of disclosing their experience. Creating a solid support system is one tool in helping to decrease the severity or even its occurrence. Practitioners should carry an active list of mental health support in their clients areas that have worked with that particular community, carry insurance and are affordable.
Once PPD is identified, women should receive adequate support with a variety of ways that may or may not include medical treatment. We can begin to address individual needs through providing multiple follow up tele-health or in-office visits until resolved. Initial support during the pandemic might also include the social support system by suggesting family members drop food and groceries off during the first 6 weeks along with registering in postpartum zoom chat groups for new mothers. Support them in signing up for weekly attendance regardless of the platform. Addressing their daily habits of living is vital as well. A clean nutritious diet, supplements, light movement, hydration and adequate sleep can all aid in a mother’s physiological recovery and thus decrease her risk factors.
Until the pandemic, postpartum doula's served women in their homes. This network of care has helped in countless ways including lowering the risk of depression and the longevity of the clinical course. Doula's and Ayurvedic postpartum care can still be provided through zoom calls, food preparation, check in calls and in person visits using protective gear. Haven't heard about Ayurvedic Postpartum care before? Check out Ayurvedic Mama's on IG and FB for more information about the benefits and healing with Ayurvedic postpartum care.
If you or anyone you know is experiencing depression - seek help now. Call your practitioner and for more information, please see my reference page below
For more information or support, feel free to reach out to me at LisaArshawsky.com or firstname.lastname@example.org