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A Look Into Postpartum Depression

posted Feb 14, 2016, 11:31 AM by Carolyn Honea, IBCLC, CLC   [ updated Mar 2, 2016, 5:03 AM ]
This month's blog is a guest post by Davidson area Licensed Professional Counselor Associate, Jennie Bower Kologe. I asked her to write about postpartum depression, since it is a common topic I encounter in lactation counseling. Sometimes breastfeeding difficulties intertwine with emotional difficulties, and it takes the right team approach to help mother and baby be happy and healthy.


She described it as a muted darkness.

As I sat across from her in my office chair, a new client, only a few months postpartum with her first child, opened up to me about the darkness she felt since becoming a mom. “Things just seem – muted. I feel dull. I’m so tired. I know I’m supposed to be filled with glee all the time that she’s healthy and all mine and everything. But I’m just annoyed at her when it’s 3 AM and she’s awake again. And I’m a little…” She stopped. She looked down, wringing the Kleenex in her hands. I prompted her with a gentle question,

“Are you having thoughts that are scaring you?”1 Her eyes filled with tears. I knew the answer must be yes.

Postpartum depression (PPD). One therapist called it a feeling of “falling forever,”2 being immersed in anxiety and in a sense of total loss of control with the feeling that it won’t change: I will never get better. I don’t feel the way I’m supposed to feel about baby. I am alone. There’s something wrong with me. Somewhere between 10 to 20% of mothers suffer from PPD.3 That’s a sizable hunk of mothers who are not feeling that “new mommy glow,” but are wrestling, often alone, with ambivalence toward their new little one; they are anxious and irritable, struggling with feelings of depression, guilt, panic, and helplessness. Sometimes PPD sufferers even have intrusive or suicidal thoughts.

The women suffering from postpartum may not be who you think they are, either. A 2006 study found that certain characteristics like perfectionism may contribute to the development of depression in new moms.4 These aren’t couch-surfers. They are women who expect a lot of themselves and who suddenly find that their inner world is working against them. Their thoughts seem out of control: In a study of 100 depressed mothers, 41% of these women reported thoughts of wanting to harm their infants.5  

The problem is many women who are suffering from PPD don’t really come to the table, so to speak, with what’s going on. One therapist said that women in her clinic for PPD reported that they were least likely to disclose these feelings of depression to their pediatrician.6 There’s an innate fear there that those feelings of inadequacy and darkness are going to be subject to critical evaluation and affect the thing that they are most afraid of losing and harming – their newborn baby.

And as internal as the PPD struggle is, mom is not the only one who suffers. In couples where the woman is diagnosed with PPD, both partners report dissatisfaction within the marriage. Even further, the depressive feelings of the mother can impact and influence the father’s perception of the newborn itself. 7

Kind of eye-opening, huh? As a therapist and a mom, I would encourage you with these three things:

 TALK IT OUT


Studies show that certain types of counseling can be a valuable resource in “significantly reducing the symptoms of post partum depression.”8 Cognitive-Behavioral Therapy (CBT) specifically has proven to be effective with eliminating PPD symptoms and works with challenging negative thoughts about yourself or your situations in order to in turn alter mood or behavior patterns. A CBT therapist would work with you through “talk” therapy as you might imagine: Meeting one-on-one with a counselor as an unbiased, calm third-party to hear those thoughts and feelings in a safe, non-judgmental setting. If you have been mildly depressed during pregnancy itself or if you have had PPD with previous pregnancy, your risk increases. Let these words encourage you to seek help where you can. Finding a counselor in your area is easy: Talk to your obstetrician about therapists he or she may recommend or check out therapists in your area who specialize in PPD or depression on Psychologytoday.com.

BREASTFEEDING AND MEDICATION


A major concern, ironically, for women not wanting to seek help is that they don’t want it to affect the baby. Perhaps the fear is that admitting there’s an issue puts a risk of separation from baby. Or, the false dichotomy is made that it either needs to be treatment for mom or breastfeeding for baby. But when PPD becomes such an inhibitor to your daily life that you feel you are making compromising decisions for your baby or when your thoughts reach levels of suicidality (meaning, thoughts or attempts of suicide), it is extremely important to seek help and speak to your doctor or your therapist about medication. While most antidepressants are secreted into breast milk, studies show that “no antidepressant has been associated with serious adverse events in baby.”9 With the growing body of data on the incredible benefits of breastfeeding for both mom and baby, the (seemingly risky) step of speaking up to your doctor or therapist about breastfeeding-safe medication for PPD is an important one to take in order to maintain breastfeeding goals while also taking care of mom’s emotional health too. If you are being treated medically for PPD, talk with your Lactation Consultant (LC) and your doctor about what’s best for continuing to breastfeed for both you and baby.

BAD DAYS HAPPEN
 

As a therapist and a woman who tends toward perfectionism, I loved what fellow therapist Karen Kleiman said on the process of healing: Bad days will happen. Understand that walking out of PPD is a process. There are good days and there are bad days. Allowing yourself the process of healing is important to the journey itself. Because of the mixed feelings and blurred lines, your spouse may not be the number one support at this time. And that’s OK too. Let yourself journey through the deepness of emotions with a trusted listener.

If you or someone you know may be struggling with feelings of depression or anxiety to a degree that has begun to impair their normal ability to function within four weeks postpartum, I would encourage you to seek help. There was a light in her darkness for my new patient in the form of therapy. And there is a light in your darkness too. 
 
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Jennie Bower Kologe is a Licensed Professional Counselor Associate in the Davidson, NC area.

Further Reading
Signs of Postpartum Depression

1 I drew heavily on Karen Kleiman’s work, Therapy and the Postpartum Woman: Notes on Healing Postpartum Depression for Clinicians and the Women Who Seek Their Help when writing this post. This question, drawn from Kleiman, is a simple, but barrier-breaking step into the postpartum woman’s world.  

2 D.W. Winnicott, The maturational processes and the facilitating environment, (New York: International Universities Press, 1965), 57. 

3 R. Kumar, and K.M. Robson, “A prospective study of emotional disorders in childbearing women,” British Journal of Psychiatry, 144 (January 1984):35–47.

 L. Hawley, M. Ho, D. Zuroff, &  S. Blatt , “The relationship of perfectionism, depression, and therapeutic alliance during treatment for depression: Latent difference score analysis,” Journal of Consulting and Clinical Psychology 74, no. 5 (2006): 930-942. 

K.D. Jennings, S. Ross, S. Popper, & M. Elmore, “Thoughts of harming infants in depressed and nondepressed mothers,” Journal of Affective Disorders 54, no. 1-2 (July 1999): 21-28. 

6 Karen Kleiman, Therapy and the Postpartum Woman: Notes on Healing Postpartum Depression for Clinicians and the Women Who Seek Their Help (New York: The Taylor and Francis Group, 2009), 101.  

 J. Ventura, & M. Stevenson, “Relations of mothers’ and fathers’ reports of infant temperament, parents’ psychological functioning, and family characteristics,” Merrill-Palmer Quarterly, 32: 275-289. 

 L. Appleby, R. Warner, A. Whitton, & B. Faragher, “A controlled study of fluxoetine and cognitive-behavior counseling in the treatment of postnatal depression,” British Medical Journal, 314 (1997): 932-936. 

S. Misiri & X. Kostaras, “Benefits and risks to mother and infant of drug treatment for postnatal depression,” Drug Safety 25, no 13 (2002): 903-911.