Coping with Postpartum Depression
Rosha Forman shares signs of postpartum depression, if it's different than the baby blues, how common it is, and when you should talk to your healthcare provider.
Rosha Forman, CNM
Rosha Forman, CNM is a midwife at Boston Medical Center and Assistant Professor of Obstetrics & Gynecology at the Boston University School of Medicine. She has a special interest in breastfeeding support and supporting women in their choices for birth. She serves as the Director of Community Health Centers for the OBGYN department and is the Associate Director of the midwifery service.
Melanie Cole (Host): Being a new mom is so exciting, but it presents it’s own challenges and in those first days and weeks after childbirth, a new mother goes through such a variety of emotions. She may also experience difficult feelings, including sadness. My guest today is Rosha Forman. She’s a midwife at Boston Medical Center and an Assistant Professor of Obstetrics and Gynecology at the Boston University School of Medicine. Rosha, thank you for being with us today. I remember a lot of those feelings right after I had my first child, and it’s such a wonderful time, but some women it’s a little tougher than others. Tell us a little bit about postpartum mood disorders and how prevalent they are.
Rosha Forman (Guest): Well it’s a pleasure to be here. Women feel lots of different things after giving birth and some of them are totally normal and some of them do go into what we call postpartum mood disorders. So the first thing that sometimes happens to women, more than 50% of women is postpartum blues, and this is sort of what people experience the first one to two weeks after birth when you have this enormous hormone shifts and women feel really strong emotions, extreme happiness and can be really tired and tearful and sad as well. I like to say to women sometimes you might find yourself crying for no reason or crying at commercials, and this is actually a totally normal part of the transition to motherhood; however, if these feelings of sadness or not feeling like yourself last longer than two to four weeks, you start worrying that it’s postpartum depression and postpartum depression happens in around 10% to 20% of women and then in very, very rare cases you can have postpartum psychosis which happens in 1 in 1,000 women where people can hallucinate and really have other disturbing thoughts.
Host: Wow, and it really is a prevalent problem, and thank you for describing the difference between the baby blues and actually postpartum. So who is at risk for postpartum depression? Is there a screening tool? Is it hormone related? Do we know why it even happens?
Rosha: Yeah, those are great questions. So everybody’s at risk for postpartum depression because it can happen to 1 in 10 or 2 in 10 women, so that’s a lot. There are certain things that increase your risk of postpartum depression. So if we know that a woman has had depression that has been treated by medication or anxiety or posttraumatic stress disorder in the past, then we know that a woman is at higher risk for postpartum depression. You know, there’s also theories about why postpartum depression happens, and it’s certainly related to this big hormonal shift and different things can trigger the feelings of depression.
Host: So how do we know? What are the symptoms that would separate that difference between just those normal hormones and emotions that we’re all going through to something that’s really more serious? Is it something you would recognize in yourself or is it something that your loved ones would recognize?
Rosha: Yeah I think your loved ones would recognize. We recommend a postpartum depression screening tool. So there’s two that people use often. The one we use here at Boston Medical Center is called the Edinburgh Postpartum Depression Screening Tool and you should be getting this after having a baby at your two week visit, your six week visit, and a lot of times you’re getting it also at the pediatric visit where the pediatricians are screening and making sure that the mom doesn’t have postpartum depression. What you would notice in yourself is really not feeling like yourself emotionally. So other than just the normal fatigue of the sleep deprivation, you’re having trouble getting out of bed, not wanting to do the things you normally like to do. So not finding pleasure in things that used to give you pleasure, finding yourself crying very often, feeling overly worried about things that maybe your loved ones don’t think you should be as worried about. So those are all signs of postpartum depression and anxiety.
Host: And then how is it treated? What are some treatment options? And before we get into medication, are there some non-medicational interventions that get tried first?
Rosha: Yeah, there’s definitely – you know, once a women has been diagnosed with postpartum depression, we have her see either a social worker or one of our perinatal psychiatrists and you can get just counseling and have a space to go talk about your feelings, have some coping strategies to get through a really tough time. The evidence shows that treatment is most effective when there’s very small amount of medication or less than small amount of medication and counseling together. So when you start medication, you start a very, very small dose and try that for a couple weeks and then they slowly increase the dose, but support groups can help. Going to therapy can help. You know your midwife or doctor may give you other ways to cope with it, like increasing exercising and trying to focus on your sleep can also help, but people with postpartum depression really do need therapy and medication.
Host: And another worry that I think that many new mothers that have this issue might be worried about is those medications and nursing and breast feeding. Can they be passed to the baby through breast milk? Is this a concern?
Rosha: No, I wouldn’t be concerned about this. A very, very tiny amount of antidepressant is passed through breast milk and it’s not enough to cause any effect or changes to the baby’s brain or affect the baby’s mood or the baby’s neurological development. So we definitely encourage women with postpartum depression to think about starting a medication because postpartum depression can also have negative effects on the baby. If you’re not feeling like yourself, if you’re not able to you know bond and interact with your baby with lots of smiles, that also has an effect on the baby. So it’s not really a zero sum game of medication has risk and depression doesn’t have risk. Postpartum depression can effect not just the women but her baby and the whole family. So we take it really seriously and we encourage women to get treatment and to do therapy if they can make the time for that.
Host: Rosha do you think that some women hesitate to seek treatment because they’re worried about a stigma? What do you want friends and family to know about offering help and support? Helping with the baby, and the laundry – it’s so overwhelming. It can really send women into a tizzy. What do you want family members to know and do you think there still is a stigma?
Rosha: When I discharge a new family from the hospital, the advice that I give is for the first two weeks, your only job is to feed yourself and to feed your baby. I encourage women to stay in their pajamas because if you start putting on your regular clothes, people are going to expect you to go about your activities of normal living like getting up and cooking and doing laundry and doing all those household tasks, but if you stay in your pajamas, then people recognize this is really a time for rest and for bonding and for just being a new family and welcoming that new baby. I think the rest of – you know women have different levels of support in their lives, and some women don’t have that support from family or friends, but I encourage women to ask for help. People want to help when you have a new baby. They want to come over. They want to meet that baby. So I say if you – if someone wants to come visit and meet that baby, then ask them to do something like a load of dishes, or put in a load of laundry because people want to help, they just don’t always know the way. So if you can encourage them to help with all those household tasks, that can be great. And yes, I’m sure there’s a stigma and that’s why we make it a routine to screen women every time she presents to care after having a baby. So it is very normal to have postpartum depression. Again, that statistics of one or two in 10 women, that’s a really high percentage, so lots of women have postpartum depression and I definitely believe that the more we talk about it, the more women talk to each other, the less of a stigma there will be around postpartum depression, and the faster women will feel comfortable seeking help.
Host: I’m so glad you said that and it is something that could be concerning when family members might discount it and say, oh you know its just normal hormones you’ll get over it, and so I’m glad that you pointed out that it’s really important and that screening tool. So then as we wrap up, I would like you to give your best advice for what women can do to take better care of themselves as they’re a new mother at the same time and what support is available to help cope with this through Boston Medical Center?
Rosha: So you know I think women can definitely take care of themselves, but if someone does start having postpartum depression, I just want to point out that it is nothing that the woman did wrong. This is a disease that happens to a lot of moms after having a baby. So the best thing that you can do is to recognize and then to acknowledge that you really aren’t feeling like your normal self and you’re not finding as much joy as you used to find in the things you normally like to do, and then to go to your midwife, your doctor, your nurse practioner, and be very honest about how you’re feeling, because at Boston Medical Center, we have a fantastic social worker in our OB/GYN Clinics, there’s social workers in the family medicine clinics, and we have a wonderful perinatal psychiatry service with specialists that can prescribe medicine and can also just prescribe counseling. So at BMC if you share with your provider that you’re not feeling well emotionally, there are lots of people that you can meet with that day of your appointment to get help. My best advice is to acknowledge how you’re feeling to try to get as much sleep as you can to ask for help from all different people, even people you’re not used to asking for help, so that they can hold the baby while you take a little bit of a nap. But if you’re really not feeling well emotionally, definitely share that with your provider because there’s lots of stuff we can do to help.
Host: Thank you so much Rosha, it’s really important information for women and the people that love them to hear because it can be such an exciting time, but it also can be quite overwhelming, thank you for sharing your expertise today. This is Boston MedTalks with Boston Medical Center. For more information on postpartum depression, you can go to bmc.org/obgyn, that’s bmc.org/obgyn. I’m Melanie Cole.