When a New Mother Is Depressed
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:
- 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
- Negative birth experience
- 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
- 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.
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.