Post-partum depression affects about 1 in 7 American women after giving birth
By Deborah Jeanne Sergeant
We recently spoke about postpartum depression with Christine Kowaleski, a doctor of nurse practitioner and reproductive psychiatric nurse practitioner at Crouse Family Support Program. Kowaleski is also the co-chairwoman for the New York chapter of Postpartum Depression Support International.
In Good Health (IGH): How can you tell the difference between ‘baby blues,’ and post-partum depression?
Christine Kowaleksi (CK): Baby blues occurs in the first two weeks. Usually, the mom is a little weepy, stressed, a little nervous about taking care of the baby, but overall functioning. Postpartum depression sets in usually around the third week. Moms are feeling a little robotic, not like themselves. They have a little anxiety that turns into panic. They’re not able to sleep sometimes. We expect people to have weepiness with a big hormone fluctuation. Even if they’re on medication it doesn’t stop that weepiness and feeling overwhelmed. But it changes with the lack of sleep. The thing is there’s more research on organic brain changes during pregnancy. Part of our brain that’s the fight or flight center, the amygdala, is larger. The hippocampus changes as well. They feel like they’re in a fog and call it “Mom brain.” They can’t concentrate. They don’t know what way they’re going and forget things. It can cause extreme anxiety for high-functioning moms. They think they’re going crazy and wonder if they’ll ever get their brain back. It’s not commonly discussed in OB offices.
IGH: What are some of the causes of postpartum depression?
CK: There’s social media pressure and influence of society on these moms. They see moms who are breastfeeding for a year or are successful. La Leche League and lactation consultants can help. But sometimes it’s not in the cards if the latch isn’t good and the baby has a small jaw. Moms who have this plan of snuggling with the baby and breastfeeding, but can’t, can feel devastated. I worked as a NICU NP for 25 years. Preemie babies need breastmilk. And full-term babies, often formula is fine. I don’t go against recommendations but if it becomes a mental health issue for the mom, it’s fine. Everything has to be weighed.
IGH: Do previous mental health issues raise risk for postpartum depression?
CK: Yes. We do a number of screenings on each new mom, including past mental health history and her family’s. If she’s prone to depression and anxiety, and now she has this responsibility, there’s much higher increased risk. If one of my moms scores 4-plus on her adverse childhood experience assessment, it puts her higher at risk, like did you have a depressed parent, an alcoholic parent? Her mental health will affect that baby’s future far more than many things pushed on parents, like a bottle of formula now and then. Her mental health is just as important as physical health during pregnancy and postpartum.
IGH: What can help moms reduce risk of postpartum depression?
CK: The family should help. When they have a baby shower, start a doula fund. They’re great in the first week or two postpartum to get mom acclimated. Many have their first babies in their 30s and they’ve been successful in their careers and school but now they want to be No. 1 mom. But there’s no book. Do not be judgmental if breastfeeding doesn’t work. Support her however the baby gets nourishment. Giving her a break to nap is wonderful. Moms want reassurance that they can do this. Remind them that postpartum depression doesn’t last forever. Look at their life like a yardstick and this is a quarter of an inch. At the time they’re going through it, it feels all-consuming and they’ll never have their life back again. It’s helpful for them to hear from seasoned mothers that it does change. One day you’ll be walking into pre-K, and then you’ll be like me with grandkids. They don’t stay in that crib forever.
I cannot stress enough the importance of mental health checks during pregnancy and postpartum. Some moms say, “Five of my friends were pregnant at the same time and they were all doing great.” But how do you know that?
IGH: How are postpartum depression and postpartum psychosis different?
CK: Postpartum psychosis is feeling out of touch with reality. Sometimes, the moms will see and hear things others don’t. It’s a feeling you might hurt yourself or your baby. There’s hopelessness and total despair. Certain thoughts are connected with postpartum psychosis and anxiety. They’re very common, like “I can’t drive over a bridge” or “I might fall down the stairs” for fear of hurting the baby That’s not, postpartum psychosis is more like “I saw the dog go out, but the dog is here.” Or “I talked with that person earlier today but didn’t.” It’s an intrusive thought. It gets to the point where they’re afraid and they can’t control these intrusive thoughts.
IGH: How would a provider recognize postpartum depression?
CK: We developed a “Point of Entry to Care” booklet available at Crouse for doctors. It’s about how to screen. These are not diagnostic but screening tools. We can garner so much more information in an hour at our first visit. If they go to a talk therapist, the therapist might say “Tell me about your childhood…” or something and it takes much longer.
IGH: What is the biggest misconception about postpartum depression?
CK: That it happens only to “certain people.” It crosses all lines of our culture. There’s nobody who’s immune. Postpartum Depression Support International says, “It’s not your fault and you’re not alone.”
IGH: What is the treatment protocol for postpartum depression?
CK: Not all of our treatment plans include pharmacology. For some moms not in full-blown postpartum depression, but struggling with anxiety, we can have a treatment plan that includes sleep. Each parent takes a five-hour shift. If mom can get five hours of sleep, she can get REM sleep. We promote eating protein four times a day to keep blood sugar level to protect them from cortisol, which causes anxiety. They need to trust another person with the baby to get a break. Self-care is vital. We have support groups. Being with others and feeling like they’re not the only one. We don’t do it like a six-week class. Then everyone’s on the same treatment. An open support group, there are moms there who are better.