"A Guide to Postpartum Emotional Difficulties
Common Questions"
Alisa Genovese, MFCC

Many pregnant and new moms have heard about " baby blues". It is common knowledge that at least 80% of new moms experience some form of emotional upset after childbirth. However, what women don't hear about is postpartum emotional difficulties can take many forms: depression and anxiety, panic, mania, obsessive compulsive disorder and psychosis. A woman is more vulnerable to mental illness after childbirth than any other time in her life. There is so little information available to pregnant woman about risk factors and treatment options. How do you know if you are experiencing a postpartum emotional reaction or just "normal baby blues". I hope to answer some common questions and misconceptions.

What is Postpartum Emotional Difficulty?
It is a name given to a wide range of emotional and physiological reactions to the dramatic drop in hormones during labor and delivery. The drop in hormone levels has a direct impact on brain chemistry, predisposing a woman to emotional imbalances. These imbalances can and do self correct in some women, but for others the imbalances continue and worsen. Postpartum emotional disorders are extremely treatable, responding well to education, support, therapy and at times medication. However if left untreated they can continue, worsen and recur. The earlier postpartum depression is treated the faster the recovery rate.

Research has documented that 10 - 20% of new moms continue beyond baby blues to experience some form of postpartum depression and anxiety. Although we know much more today than 10 years ago about emotional problems related to childbirth, it still remains a largely undiagnosed, and under treated condition in women's health. Often women, embarrassed and uneducated about these feelings, fail to ask for help. Studies have shown that education and support in the prenatal and early postpartum period can significantly reduce incidents of postpartum depression and anxiety.

What is the difference between Baby Blues and Postpartum Depression?
Baby blues occur in 50-80% of women within the first 6 weeks postpartum. Feelings of weepiness, anxiety and emotional instability are common. These feelings get increasingly less intense, often resolving themselves by 6 weeks postpartum without assistance. These feelings usually don't significantly effect daily life.

In 10-20% of new moms these feelings continue beyond 6 weeks postpartum and intensify. This should be a red flag.
Woman experience:

This effects not only the women, but other family relationships as well. Women experiencing these feelings often isolate themselves feel guilty, shameful and embarrassed and feel they are to blame.

When and how should I seek help?
My advice is to seek help when symptoms continually increase beyond 6 weeks postpartum over a 2-3 week period and are interfering with daily life. When you feel more bad days than good days and the support of family and friends is not enough. Professional help is very important. Talk to your doctor, therapist, friends. Reach out.

Unfortunately obstetricians, gynecologists, midwives and pediatricians often have minimal training to effectively screen, diagnosis and make appropriate referrals for postpartum depression. Women are often frustrated and discouraged hearing "Just get some rest youâll be fine" or " this is normal, just baby blues". Many women feeling unheard or misunderstood suffer in silence. Know you are not alone and help is available.

How can I feel better?
If you don't get the response you need from your health practitioner don't give up. Here are some steps you can take to feel better.

1. Education: Learning that postpartum reactions are a real disorder, not something caused or brought on themselves, and that they are not alone or to blame. Education helps women gain objectivity, take care of themselves and not get caught in self-blame and shame. I often recommend 2 books: This Isn't What I Expected (1994) by Karen Klieman and Postpartum Survival Guide (1994) by Ann Dunnewold as a place to begin the healing journey.

2. Self-Care: Just like with any other illness, taking care of self needs to become a priority. Learning how to balance the demands of this new life. Getting enough sleep, good nutrition and exercise are all important in feeling better.

3. Support:
A. Therapy: Either individual and/or couple/family therapy helps to sort through the confusion and pain and pick up the pieces. Therapy is effective in helping women grieve losses and unmet expectations such as, a joyful postpartum period, an easy birth, changes in roles and relationships, and loss of autonomy. Therapy help moms feel more in control of their lives again.
B. Support groups: Extremely important to help break the isolation , and gain the needed perspective.
C. Family Support: Family support is essential to healing. Family members need education and understanding about what is happening to their loved one. A husband may also need support coping with the impact on himself and his relationship. This further enables him to understand and support his wife more effectively.

4. Medication: In more severe cases medication can be very effective especially when combined with therapy. One benefit of medication is reduction of insomnia, confusion, indecisiveness and guilt. In recent years antidepressants including Pamalar, Noratriptolin and Zoloft have been proven safe for breastfeeding moms. In my practice I caution breastfeeding moms to choose using any medication carefully as long term data is yet unavailable. I urge women who may benefit from the combination of therapy and medication to consider and weigh the following:

a. Severity of symptoms
b. Individual Preferences
c. Response to other alternative treatments
d. Risk of side effects

5. Alternative treatments: Many women have found natural hormone therapies (i.e., progesterone creams), acupuncture and herbs, and homeopathic medicines to be effective in alleviating symptoms. I have found them successful both alone or in conjunction with medication and psychotherapy.

Alisa Genovese, MA, MFCC is a private practice psychotherapist in Kensington. She has over 10 years experience working with prenatal and postpartum woman and families. She has been studying, lecturing and training in the field of postpartum psychiatric reactions. She currently leads a postpartum depression support group in Berkeley. She is a mother of two and has experienced her own postpartum depression. For more information contact her at (510) 286-7599 or e-mail alisha61@earthlink.net

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