When a New
Mother Is Depressed
Kathleen A.
Kendall-Tackett
From: LEAVEN, Vol. 32 No. 3, June-July 1996, pp. 35-37
We provide articles
from our publications from previous years for reference for our Leaders and
members. Readers are cautioned to remember that research and medical information
change over time
What can a Leader do to
help when a mother seems depressed?
Many cultures project an
idealized image of life with a new baby: mother appears attractive and
well-rested, baby sleeps contentedly, the living place is spotless.
Yet most of us recognize that this picture is not realistic. A mother
may have little support from her partner or family members. Indeed,
some cultures shift all attention after birth from the mother to the
baby. One popular parenting book describes this as the transformation
from "pregnant princess to postpartum peasant." Is it any
wonder that some mothers who come to us for breastfeeding support are
depressed?
For some, depression strikes
shortly after birth. For others, depression develops when the baby is
three to six months old. A mother may tell you that she is not sleeping
well, that she feels hopeless, that nothing will ever be "normal"
again. As Leaders, we need to know how to respond, as well as how we
can help. Depression can influence how a woman relates to her baby,
even whether she is able to breastfeed.
Framework for Depression
Becoming a mother is a
stressful life event. This seems obvious, but it is frequently overlooked.
Postpartum depression is often seen as a mystery: "She has everything
she could want. Why is she depressed?" Ignoring the obvious stress
of becoming a mother, many researchers look for internal causes, such
as hormonal fluctuations, instead of considering the events taking place
in a woman's life.
Depression is within the
normal range of responses to life stresses. Some women I've spoken
with had so much to cope with, I would have been surprised if they were
not depressed. Far more common than it is thought to be, depression
can negatively affect both mother and baby.
Frequently there is a
discernible cause or group of causes for a woman's depression. Authors
of popular articles often present the cause of postpartum depression
as either hormonal fluctuations or unknown. However, researchers have
so far failed to demonstrate a link between hormonal fluctuations and
depression. In reality, women often have ample reason for being depressed.
One woman I interviewed told me that her depression was caused by hormones.
But as I spoke with her I discovered that she had had a terrible birth
experience, her husband and family were unsupportive, and she was alone
16 hours a day with a baby who cried all the time. Any one of these
could have caused her depression. The combination of all three made
depression seem almost inevitable.
Why Do Mothers Become Depressed?
A broad range of factors
has been linked to postpartum depression:
- fatigue,
- negative birth experience,
- infant characteristics,
- mother's expectations,
- feelings of self-efficacy
and self- esteem,
- mother's level of social
support.
What Causes Depression in
One Woman May Not Affect Another
Fatigue and sleep deprivation.
Sleep deprivation is a fact of life for new mothers. Perhaps because
it is so common, its influence on a mother's emotional state is often
overlooked. I was at a Series Meeting once where a mother of a new baby
asked when the baby would start to sleep through the night. Several
mothers in the Group, not hearing the desperation in her voice, told
her how their children were still not sleeping through the night. Needless
to say, this new mother was not encouraged!
A mother sometimes decides
to wean because she is so fatigued. When working with a new mother,
it is important to take fatigue seriously. This might include helping
her develop strategies for getting more rest, for example, taking baby
into bed with her; encouraging her to be screened for physical problems
such as hypothyroidism, anemia or allergies; suggesting ways to modify
her diet.
One line of research has
demonstrated a link between depression and the amount of complex carbohydrates
a person consumes. Complex carbohydrates, found in foods such as bread,
pasta, rice or potatoes, actually create chemical changes in the brain.
Higher levels of complex carbohydrates are related to reduced levels
of depression.
Negative birth experiences.
The effect of birth experiences on a woman's emotional state is often
underestimated. During labor, a woman is extremely vulnerable emotionally.
Events that take place during those hours have long-range impact. One
study demonstrated that women could accurately remember details of their
first births 20 years after the fact. A negative birth experience has
been shown to affect how a woman feels and how she relates to her baby.
Indeed, a difficult birth can influence whether a woman decides to breastfeed
or to continue breastfeeding once she is home. If a woman has a negative
or troubling birth experience, she needs to be able to talk about it.
A study by Affonso found that women frequently need to resolve troubling
aspects of their birth experiences so they can focus on the present
and care for their babies. Being depressed after a traumatic experience
is normal! Telling mothers this can go a long way toward helping them
heal.
Infant Characteristics.
Two broad classes of infant characteristics are directly related
to postpartum depression: infant temperament and infant illness. The
infant with a "difficult" or "high-need" temperament
is of particular interest. These infants cry frequently, are slow to
accept new experiences and do not engage in regular routines. Some parents
may incorrectly attribute baby's fussy behavior to breastfeeding and
decide to try formula instead.
One study found a direct
causal link between infants with difficult temperaments and postpartum
depression in their mothers. The authors hypothesized that the behavior
of these infants diminishes their mother's feelings of self-efficacy
and makes them feel helpless.
Another factor related to
postpartum depression is the effect of infant illness, prematurity or
disability on a mother's emotional state. Not surprisingly, infant illness
has been directly linked to postpartum depression; the higher the risk
for the infant, the greater the depression in the mother. Again, a mother
may feel she has no control and is powerless to help her baby; she may
feel others are more qualified. She may also be extremely anxious about
her infant and experience anticipatory grieving.
A Leader can help a mother
work toward resolving her feelings and feel an attachment to her infant.
We can do this by emphasizing mother's importance to her baby and by
giving her practical assistance with pumping, milk storage and later
breastfeeding. The mother can do something for her baby that no one
else can. Chances are she will need to hear that.
Lack of Social Support.
A woman who has good support is much less likely to become depressed.
Research studies have demonstrated that support from the woman's partner,
both emotional and practical, significantly reduces her risk of postpartum
depression.
A woman's family of origin
can either be a significant source of support or a source of frustration
and discouragement. If she was raised in an abusive, alcoholic or otherwise
dysfunctional home, she may be concerned about her ability to raise
her own children. She may long to turn to her own mother for help. Sadly,
such women may find that when they try to turn to family members for
support and encouragement, their families behave as dysfunctionally
as they always have and are unable to provide support.
The support of peer networks
is very important. Anthropologists Stern and Kruckman noted that there
are many cultures in which postpartum depression, even transient postpartum
blues, is virtually nonexistent. This is in stark contrast to western
culture where the blues are so common (50 to 85% of new mothers), we
assume they are inevitable.
Stern and Kruckman have analyzed
the protective elements of these non-Western cultures. In particular,
they note that cultures in which there is low incidence of postpartum
depression employ many elaborate rituals after a woman has given birth.
These rituals serve several functions:
- giving a woman time to
recuperate,
- offering a woman respite
from daily activities,
- recognizing a woman's
status as a new mother.
In at least one of these
cultures, well-wishers give presents to the mother and a special "stepping
out" ceremony takes place within a few weeks of her giving birth.
In cultures where this special care is lacking, LLL Leaders and members
can serve a vital role by providing encouragement and much-needed peer
support.
What Can Leaders Do to Help?
If you suspect that a mother
is depressed, don't be afraid to gently discuss it with her or provide
information from the Group Library. She may be too embarrassed to bring
it up herself; the social stigma and isolation she feels add to her
distress. While thousands of new mothers experience postpartum depression
every year, she may feel she is the only one.
- Talk about the factors
that could contribute to her depression. Many mothers I've spoken
with do not connect some aspects of their lives, such as an unsupportive
husband or a crying baby, to how they feel. Talk to the mother about
the factors that may be related to how she is feeling but let her
decide which ones are relevant.
- Talk about the importance
of taking care of herself physically. There is a link between
a mother's physical well-being and her emotional health. Talk with
her about the importance of adequate rest and good nutrition. Brainstorm
ideas. Moderate exercise can also help her feel better. Perhaps you
can offer suggestions to help her include some physical activity,
such as taking the baby for a walk outdoors.
- Help the mother gain
confidence in her abilities. This is what LLL does best! When
we support and encourage mothers to trust their mothering instincts,
they gain confidence. Many mothers find that their depression lifts
as they start to feel more confident in their mothering abilities.
- Recognize the limitations
of your role. Although there is much you can do to help mothers
who are depressed, some mothers need professional help. While you
can be empathetic and helpful, this does not take the place of psychotherapy
and/or medication, especially when a mother is so severely depressed
that she may be suicidal. A referral to a professional in your community
or to an outside organization is often the most supportive thing you
can do. I offer this information to every mother I speak with as it
is often difficult for me to tell how serious the situation is.
- Recognize that Leaders
are not immune to depression. Sometimes a Leader may find herself
suddenly overwhelmed by a fussy baby even though her older children
had been easy. Leaders may become so busy caring for their children,
their husbands and their Groups that they fail to take care of themselves.
Some Leaders feel they need to be "perfect" or to have all
the answers. When they encounter difficulties, these Leaders feel
cut off from sources of support because they are embarrassed to admit
that they are having problems. Leaders deserve the same care that
mothers in the Group do. If you find yourself suddenly overwhelmed,
you might need to curtail some activities, take a leave, and/or get
more help and support.
Providing support for new
mothers is well worth our efforts. By nurturing women during this vulnerable
time, we help them be the most effective mothers they can be.
Incredible as it seems,
our [Western] culture, with its emphasis on education, has left young
adults entirely unprepared to face the practical realities of parenting.
And this may be the most important job they will ever hold. So, for
those of us who are comfortable and happy in the work of parenting,
we can serve the future of humanity through our humble sharing of
our skills and our love for children and families. Salle Webber, Doula
Causes of postpartum depression
Physiological factors
- Pain
- Fatigue
- Negative birth experience
Psychosocial factors
- Lack of social support
- Mother's attributional
style (optimistic vs. pessimistic)
- Low socioeconomic status
- Dysfunctional or abusive
family of origin
- Mother's feelings of self-esteem,
self-efficacy or her expectations of herself and her infant
Infant characteristics
- Difficult temperament
- Premature, ill or disabled
Treatment options available
for postpartum depression
- Moderate exercise
- Diet high in complex
carbohydrates
- Increased rest Increased
social support
- Psychotherapy (for example,
cognitive-behavioral therapy)
- Antidepressant medications
Organizations that work
with new mothers
C/SEC (Cesarean/Support,
Education, Concern) 22 Forest Rd. Framingham, MA 01701 (508) 877-8266
Depression After Delivery,
National P.O. Box 1282 Morrisville, PA 19067 (215) 295-3994
Federation for Children with
Special Needs 95 Berkeley St., Suite 104 Boston, MA 02116 (617) 482-2915
Parents Anonymous, National
520 S. Lafayette Park Pl., Suite 316 Los Angeles, CA 90057 (213) 388-6685
(800) 421-0353
Ed. Note: Leaders in outside
the US should search out appropriate groups for referral.
LLLI Resources
Doyle, Denise. Postpartum
Depression. LEAVEN Jul/Aug 1993, 53. THE BREASTFEEDING ANSWER BOOK,
1991, 204-207.
THE WOMANLY ART OF BREASTFEEDING,
1991, 13, 88-89.
Group Library Books
Dunnewold, Ann and Diane
G. Sanford, Postpartum survival guide. Oakland, CA: New Harbinger
Publications, Inc., 1994.
Sears, Martha and William.
25 things every new mother should know. Boston: Harvard Common
Press, 1995.
Sears, William. The fussy
baby. New York: Penguin, 1989.
For Further Reading
Affonso, D.D. "Missing
pieces" a study of postpartum feelings. Birth Fam J, 4,
1977, 159-64.
Blumberg, N.L. Effects of
neonatal risk, maternal attitude and cognitive style on early postpartum
adjustment. J Abnormal Psychol, 89,1980,139-50.
Campbell, S.B., Cohn, J.F.,
Flanagan, C., Popper, S., Meyers, T. Course and correlates of postpartum
depression during the transition to parenthood. Dev Psychopathol,
4, 1992, 29-47.
Cutrona, C.E., Troutman,
B.R. Social support, infant temperament, and parenting self-efficacy:
a mediational model of postpartum depression. Child Dev, 57,1986,1507-18.
Kendall-Tackett, K.A., with
Kantor, G.K. Postpartum depression: a comprehensive approach for
nurses. Newbury Park, CA: Sage, 1983.
O'Hara, M.W. Social support,
life events, and depression during pregnancy and the puerperium. Arch
Gen Psychiatr, 43, 1986, 569-73.
Simkin, P. Just another day
in a woman's life? Part II: Nature and consistency of women's long-term
memories of their first birth experiences. Birth, 19,1992, 64-81.
Stern, G., & Kruckman,
L. Multi-disciplinary perspectives on postpartum depression: An anthropological
critique. Soc Sci Med, 17, 1983, 1027-41
Webber, S. Postpartum nurturance.
The Doula, 1992, 18.
Wurtman, R.J., Wurtman, J.J.
Carbohydrates and depression. Sci Am January 1989, 68-75.
Page last edited Sun Oct 14 09:31:27 UTC 2007.
