A Discussion on Postpartem Depression
I want to discuss a very serious and very human problem that affects many women and it affects many families. I am not entering this discussion from the point of view of one who has experience it first hand as a medical issue, nor as a medical expert, but as one who has known someone who had it, one who didn’t have the ability to cry out to someone and it became too late. That very real condition is Postpartum Depression. It is very important for men to understand it as well as women, as often they are the ones with the first opportunity to make a real difference and save that life.
Quite a few years ago, while in elementary and high school, I had a classmate Linda who was everything a parent could ever want in a daughter. Her parents had three daughters and she was the middle one. She always had very good grades and she was very delicately pretty without being ‘drop dead gorgeous’. She was very popular although she wasn’t one of the loud, boisterous girls that often make the popularity polls. She was on the ‘homecoming float’ meaning she had been nominated to be homecoming queen, but was a runner up. She was honestly sweet and kind to everyone even if they weren’t in ‘her crowd’. As a high school girl, neatness was very important to me and I saw her as a role model. I could never figure out how she could look like she had just stepped out of the shower even at 3:00 PM, but she did.
After we graduated, she like many young girls then, decided she was in love with a popular young man who was 4-5 years older than us in school. He used his initials rather than a first name and no one ever knew his real first name, so we called him RC and joked that he liked Royal Crown Colas. By virtue of the age difference, RC had already finished college when we finished high school and he had become a school teacher. He was a very nice young man although I always thought his older brother was ‘cuter’ as he had the nice olive skin that so attracted me. But, nevertheless, RC was a very nice man and was sure to be a great husband and father.
A couple of years later, Linda and RC were the proud new parents of a healthy baby boy. Everyone talked about what a perfect couple they were … and they did make a lovely couple and from all indications, they were very happy together. They waited several years before having their second child. In fact, they waited until the older child was in kindergarten or first grade and she became pregnant again. It certainly seemed they were happy with the news of the pending new arrival. Then, they had a lovely baby girl.
From everything I heard later (and it was the talk of the town) the childbirth was normal and now the family was virtually perfect…. you know, the ‘boy for you and a girl for me’ that the song was written about. When the baby was about two weeks old things fell apart. It was said later that Linda kept worrying that the baby had some sort of birth defect or ‘something wrong with it’. There was no reason for her to worry and the doctor assured her that the baby was ‘perfect’, but the mother was obsessed and worried constantly that there was something they may not be telling her or something they hadn’t found. Since the baby appeared ‘perfect’ and the first child had been ‘perfect’, her family told her to ‘stop worrying. It will be alright.’ Old women tried to figure out why she was so insistent that ‘something was wrong with the baby’, but none could ‘make sense of it’. There was enough concern that her father who was the Chief of Police in this small town, always stopped by her house on his way to work to see his daughter and begin thinking of ways to spoil his new granddaughter.
According to the Women’s Health Organization
Postpartum psychiatric illness is typically divided into three categories: (1) postpartum blues (2) postpartum depression and (3) postpartum psychosis. It may be useful to conceptualize these disorders as existing along a continuum, where postpartum blues is the mildest and postpartum psychosis the most severe form of postpartum psychiatric illness.
It appears that about 50 to 85% of women experience postpartum blues during the first few weeks after delivery. Given how common this type of mood disturbance is, it may be more accurate to consider the blues as a normal experience following childbirth rather than a psychiatric illness.
On the morning that Linda’s obsession shocked everyone in her sphere of friends and acquaintances, RC had already left for school and was going to take the son to his school on the way, leaving Linda who was now well enough to care for the young baby. She knew that her father would come by shortly to see them, but she apparently couldn’t take it anymore and the worst happened. She took her own life but left the baby untouched knowing that her father would soon take care of it. It was a Police Chief’s worst nightmare and left a small town in shock. No one could understand why and in their ignorance some ‘speculated’ about why. No one knew what the doctor meant when he said she suffered from Postpartum Depression. Again, tongues wagged with people saying ‘we all get depressed sometimes, but that’s no reason to kill yourself’. But they didn’t understand. Postpartum Depression is a serious illness and one that must be closely watched to prevent such tragedies.
Again the Women’s Health Organization
Postpartum psychosis is the most severe form of postpartum psychiatric illness. It is a rare event that occurs in approximately 1 to 2 per 1000 women after childbirth. Its presentation is often dramatic, with onset of symptoms as early as the first 48 to 72 hours after delivery. The majority of women with puerperal psychosis develop symptoms within the first two postpartum weeks.
It appears that in most cases, postpartum psychosis represents an episode of bipolar illness; the symptoms of puerperal psychosis most closely resemble those of a rapidly evolving manic (or mixed) episode. The earliest signs are restlessness, irritability, and insomnia. Women with this disorder exhibit a rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behavior. Delusional beliefs are common and often center on the infant. Auditory hallucinations that instruct the mother to harm herself or her infant may also occur. Risk for infanticide, as well as suicide, is significant in this population.
The postpartum period is characterized by a rapid shift in the hormonal environment. Within the first 48 hours after delivery, estrogen and progesterone concentrations fall dramatically. As these gonadal steroids modulate neurotransmitter systems involved in the regulation of mood, many investigators have proposed a role for these hormonal shirts in the emergence of postpartum affective illness. While it appears that there is no consistent correlation between serum levels of estrogen, progesterone, cortisol, or thyroid hormones and the occurrence of postpartum mood disturbance, some investigators hypothesize that there is a subgroup of women who are particularly sensitive to the hormonal changes that take place after delivery. This population of women may be more vulnerable to PPD and to other hormonally driven mood disturbances, such as those occurring during the premenstrual phase of the menstrual cycle or during the perimenopause.
I think some of these traumatic illnesses that are so personally devastating and so disruptive to families can drop off the radar unless we keep bringing them to the forefront. I also think it is important for us to remember the abundance of very serious illnesses that must be recognized and understood as we discuss the possibility of Healthcare. Women like Linda need doctors who quickly recognize the condition and have the ability and flexibility to treat her immediately. They also unknowingly depend on their husbands and families to advocate for them as they are unable to do it for themselves. There are many Lindas in the world. As you can see from the list below, the economy may also causes stress to women in their most vulnerable time. I also worry that many of them will not receive the treatment they need during this economic downturn.
All women are vulnerable to postpartum depression, regardless of age, marital status, education level, or socioeconomic status. While it is impossible to predict who will develop PPD, certain risk factors for PPD have been identified, including:
Previous episode of PPD
Depression during pregnancy
History of depression or bipolar disorder
Recent stressful life events
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