After Baby is Born: Postpartum Depression and Relationships

Between 10% and 20% of new mothers experience postpartum depression.

From the WebMD Archives

When Tina Merritt gave birth to her son Graham six years ago, she expected what all new mothers expect: a joyous experience getting to know her baby. Instead, she found that she was terrified of her own child.

“I came home and I cried for hours straight. I was afraid that somebody would leave me alone with this baby that I had no clue how to take care of,” she recalls.

Stricken with the fear that she would be an incompetent mother, Merritt went back to work when Graham was 6 weeks old, ceding most of the baby’s care to her husband and the grandparents.

“It wasn’t that I didn’t want to take care of him -- I just thought they were better at it,” she says. “I felt like I couldn’t do it right. My husband knew something was wrong, and he picked up the pieces. He just thought, OK, I need to step up to the plate and be a responsible husband.”

Merritt, who now lives in southern California, wouldn’t learn the truth until her son was more than 2 years old: she was suffering from postpartum depression (PPD). Between 10% and 20% of women who have recently given birth experience PPD, but like Merritt, more than half of them go undiagnosed.

Recognizing Postpartum Depression

Postpartum depression is very different from the “baby blues,” a heightened emotional state that can hit 80% or more of new moms in the first days after the baby is born. Baby blues usually ebbs within a couple of weeks.

True postpartum depression is actually part of a constellation of conditions that experts call “perinatal mood disorders.” These mood disorders involve more than just feeling depressed, and they can occur during pregnancy as well as afterward.

How can you tell if you have a perinatal mood disorder? Here are six signs:

  • Eating and sleeping disturbances: You haven’t eaten in two days because you’re just not hungry, or you can’t stop eating. You sleep all the time, or you can’t sleep even when you have the chance.
  • Anxiety: Your mind races with fears and worries and you just can’t shut it off.
  • Feelings of guilt and shame: You have the sense that you’re “not doing this right,” that you’re a bad mother.Anger and irritability.
  • Uncontrollable thoughts of harm coming to the baby.
  • Just not feeling “like yourself.”

These symptoms usually appear within the first three months after the baby is born, and peak around the four-month mark. But, as with Tina Merritt, they can go on for years if undiagnosed and untreated.

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Overwhelming Anxiety and Stress in a Relationship

Merritt says she barely remembers the first year or so of her son’s life. “I can’t remember his first steps. I can’t remember the first time he ate solid food. It’s all a blur. I was able to take care of him, but I was in a complete fog,” she says.

The crippling, overwhelming anxiety made it difficult for Merritt to become close to her baby, something she says she still feels guilty about.

The mother-baby relationship isn’t the only relationship affected by perinatal mood disorders. Merritt and her husband were lucky -- their marriage survived the strain of her withdrawal, until an emergency brought them into counseling when Graham was 2 1/2. But many couples don’t survive a bout with perinatal mood disorders.

“There’s a very high rate of divorce in the first year after having a baby,” says Birdie Gunyon Meyer, RN, coordinator of the Perinatal Mood Disorders Program at Clarian Health in Indianapolis, Ind., and the president of Postpartum Support International.

“Even when there is no mood disorder, having a baby is very stressful on a relationship. Then, if she gets postpartum depression and anxiety, it’s that much worse,” Gunyon tells WebMD. “Men say things like, ‘I was disappointed. I was doing my part and she wasn’t pulling her weight. She was very depressed and anxious, and I had to take care of a new baby and my wife.’”

Postpartum Depression Is a Family Illness

Men can also get postpartum depression, Meyer says, noting that an estimated 10% of new fathers experience the condition.

PPD is a family illness, says Karen Kleiman, MSW, LSW, director of the Postpartum Stress Center, which has locations in Pennsylvania and New Jersey. And, it can affect your relationship for years to come.

“It is so isolating and self-absorbing for moms, that we often forget that dad is a big player here. I see a lot of couples who struggle with this and get through it, but at the other end, they are still angry and unforgiving,” Kleiman says. “I know women who 10 years later have said ‘I will never forgive you for not being there for me,’ and the husband replies, ‘I didn’t know what to do, you were shut down and wouldn’t talk to me and weren’t treating me well.’”

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Treating Perinatal Mood Disorders

If you think you have a perinatal mood disorder, one of the most important things you can do when seeking treatment is to involve your partner.

“As soon as I’m seeing someone, I want to get the husband and baby in as well, to see what impact it’s having on the family, and to give him the opportunity to talk about his frustrations and show him how he can support her,” Kleinman says.

The good news, Meyer says, is this: you’re not alone, and there is help -- for both of you. But you have to reach out for it. You can start by contacting Postpartum Support International at 800-944-4773 for referrals to resources in your area. Men may want to check out an online resource called the Postpartum Dads Project at http://postpartumdadsproject.org/.

What will happen when you reach out for counseling and treatment? There are multiple options for treating perinatal mood disorders.

  • Medication. Many women who experience perinatal mood disorders, like Tina Merritt, find significant relief from antidepressant medication. Women who want to breastfeed should talk with their doctor about the best antidepressants for their situation.
  • Counseling and group therapy. Counselors can help you with specific techniques for dealing with your particular symptoms, such as relaxation techniques for women who often feel anxious, and “thought-stopping” for obsessive negative thoughts.
  • Establishing a support system. Friends help, especially other new mothers who have empathy for what you’re going through.
  • Lifestyle interventions. Improving nutrition and getting sufficient sleep can lessen symptoms.

And, couples must remember to care for one another while in treatment for postpartum depression.

“Stress so easily turns into ‘You’re not taking care of me, so the hell with you.’ This is not going to get you what you need,” Kleiman says. “Tend to your relationship. Embrace it. Take care of each other. One of the best ways to meet your own needs is to take care of your partner’s needs. It makes them feel better, and it enables them to do a better job taking care of you.”

WebMD Feature

Sources

SOURCES:

Tina Merritt, San Bernardino, Calif.

Birdie Gunyon Meyer, RN, coordinator, Perinatal Mood Disorders Program, Clarian Health, Indianapolis, Ind., and president, Postpartum Support International.

Karen Kleiman, MSW, LSW, director, Postpartum Stress Center, Rosemont, Pa., and Voorhees, N.J.

Gjerdingen D, The Journal of the American Board of Family Medicine 20 (3): pp 280-288, 2007.

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