Expectant Mother's Guide:

Coping with Prenatal & Postpartum Depression

Becoming a parent is one of the most remarkable and life-changing events a person will ever experience. But, for better or worse, pregnancy, childbirth and raising children dramatically changes the parents' life.

Women can be particularly vulnerable to depression after giving birth, when hormonal and physical changes — added to the new responsibility of caring for a newborn — can be overwhelming. It takes a little time for them, as well as their husbands, to adapt. Childbirth can precipitate a depressive episode, both before and after delivery of the baby.

Following the birth of the baby, up to 80 percent of new mothers experience a brief episode of the "baby blues." Baby blues is a transient condition that occurs within 3 - 10 days following childbirth. For women who have a strong emotional support system, the baby blues will vanish.

But 12 to 16 percent of new mothers will develop Postpartum Depression (PPD), also called Post-Natal Depression (PND), a much more serious depressive condition for which active treatment and emotional support are required.

PPD occurs within one month to one year following the birth of the baby, and can develop gradually or suddenly.

Postpartum Depression symptoms may include:

  • Total loss of enjoyment in life, or anhedonia
  • Feelings of helplessness and despair
  • Abnormal maternal attitudes, which can vary widely from disinterest and fear of being alone with the baby, to obsessiveness with the baby's well-being and even over-intrusiveness that doesn't allow the baby to properly rest.
  • At the extreme, postpartum episodes (depression, mania or mixed episodes) can include psychotic or delusional behavior, which can lead to increased risk of suicide, and serious injury or death for the baby.

Consider the story of Brook Shields, whose 2005 book Down Came the Rain detailed her battle with Postpartum Depression, which ultimately included some psychotic symptoms.

At first I thought what I was feeling was just exhaustion, but with it came an overriding sense of panic that I had never felt before. Rowan kept crying and I suddenly began to fear the moment when Chris would bring her back to me. I started to experience a sick sensation in my stomach; it was as if a vice was tightening around my chest. Instead of the nervous anxiety that accompanies panic, a feeling of quiet devastation overcame me. I hardly moved. Sitting on my bed, I let out a deep, slow gutteral wail. I wasn't simply emotional or weepy like I had been told I might be. This was something different. This was sadness of a shockingly different magnitude. It felt as if it would never go away.

It's important for women who are considering having more children to be aware of conditions that increase the risk of PPD:

  • Women who have had prior Mood Disorder, such as Major Depressive Episodes or Mania
  • Women who experience anxiety and depression symptoms during pregnancy, as well as the baby blues
  • Women with a family history of Mood Disorder
  • Lack of support from family and friends
  • Marriage or money problems
  • Additional stressful life events

If you feel that you are experiencing symptoms of post-partum depression, contact your doctor or meet with a therapist so your level of depression can be assessed. It may be that therapy and strengthening your support network will be enough to help you move out of the depression. Depending on the level of severity of the depression, you may need to consider using psychotropic medication.

There are many nutritional and natural things you can try along with therapy before considering any type of psychotropic medication. Massage can be very helpful in relaxing your body physically as well as emotionally. Acupuncture has also proven to be helpful. Both massage and acupuncture have been proven to provide some relief for depression, depending on the patient. Natural remedies that could help and are safe during pregnancy and breastfeeding include B vitamin supplements along with Fish Oils. You can experiment with the dosages to see what is helpful for you. Exercise and good nutrition are also critical in helping with mood issues.

Don't beat yourself up. Depression is not your fault. And do everything you can to support yourself during this trying time. Rest as much as possible and try to sleep when the baby is sleeping. Ask people for help. Talk about your feelings with others so you don't feel isolated. Limit stress as much as possible. There is hope and things will get better.

Depression During Pregnancy

On any list of the most life-changing events, pregnancy is at or near the top for most women. There's the obvious change of bringing a new child into the world and the effect that has on one's family, career, emotional and financial life. But the changes during pregnancy are equally significant. Clearly, there are biological and physiological changes. These are the most obvious. These physiological changes in hormones and body chemistry have a different effect on every woman. Similarly, external factors such as marital satisfaction, supportive friendships, medical care, and overall health also play a role in how each woman responds to pregnancy. People often don't talk about the startling statistics of depression during pregnancy, known as Antenatal Depression. In Australia, for example, Antenatal Depression affects 10 percent of all pregnant women.

In many women, the combination of inner and outer circumstances lead to stress and subsequent emotional responses that most have never experienced before, or at least not as intensely or regularly. For some it looks like emotional numbness, others have subtle feelings of depression, for others it's crying and loneliness, and others struggle just to get out of bed. If you're a woman experiencing these symptoms and not sure what to do about it, there is hope for you.

The first thing you can do is ask for help. This could be from a licensed professional, but could also be from your doctor, spouse, or friend. Social support is one of the most important factors in alleviating depression. Tell someone what you are feeling - be brutally honest. Find someone who is safe to talk to about all the strange feelings coming up about yourself, your baby, and the changes taking place in your life.

Some of the feelings that many are uncomfortable talking about are:

  • Feeling regret about getting pregnant
  • Wishing life could go back to the way it was
  • Fear that you will not be a good mother
  • Fear that you or the baby will die in childbirth
  • Resentment towards the baby for taking away the intimacy in your marriage
  • Anger towards the baby for draining you

Talking about these feelings is the first step towards getting better. You will feel relief to verbalize these feelings rather than suppressing them, and will also find that many of these feelings are normal and most women are feeling them to some degree. A good therapist will be able to guide and direct you to deal with the issues at hand along with underlying issues. Often, issues from childhood resurface during pregnancy because the attachment issues get triggered. A professional can help you navigate these territories and find healing and restoration. Acknowledging and getting help for depression before the baby is born is the best thing for you and for your baby. Mothers who have depression during pregnancy have a higher rate of postpartum depression. But if you act early and treat it during pregnancy, you will have a higher chance of health after the baby is born.

Do you suspect that someone you care about is depressed? This checklist can help you recognize the warning signs of depression.


©2009 Maria Lloyd, LMFT MFC38399. All worldwide rights reserved.
Maria Lloyd is a Licensed Marriage and Family Therapist located in the Silicon Valley area— San Jose / Santa Clara County, California. Maria provides individual counseling for women for: depression and stress management, post-partum depression, anxiety and panic disorders, bipolar disorder, interpersonal relationship issues, self and identity issues, co-dependency, anger management, and managing grief and loss.