What are "The Baby Blues"?

By Lois V. Nightingale, Ph.D.

You had so looked forward to this joyous time in your life-your baby's birth, all the friends and family surrounding you, your dream to begin building your own family now a realityso why are you so unhappy?

Don't be alarmed. You're probably suffering from a common form of postpartum depression, or what your grandmother called "the Baby Blues". It usually begins on or around the third day after delivery and lasts about 10 to 14 days. The noticeable symptoms are crying for no apparent reason, irritability and dysphoria (feeling down).

Postpartum depression (PPD) strikes indiscriminately, having little to do with the mother's personality. All types of women can suffer from this commonly ignore problem, many never knowing that help is available.

The probable cause for the baby blues is the rapid drop in progesterone levels that occurs in every woman's body after giving birth. Progesterone levels drop from a high of 40 times their highest level during a regular menstrual cycle to levels so low they are almost undetectable in the blood. This dramatic change can have a tremendous impact on the emotions of a new mother.

Approximately 50 to 80 percent of all new mothers (whether they are delivering their first or tenth child) suffer from the baby blues. Although it can be upsetting not to be the perfect picture of a joyous mommy, the baby blues seem to disappear on their own. Most women get through the experience fairly well with the support and reassurance of family and friends.

If you are experiencing this type of PPD it is important for you to feel supported by those around you now. You need to be mothered, as well as your baby! Reassurance that this difficult time will pass and that you are loved and cared for can be very comforting.

Lack of sleep-a problem nearly all new mothers experience-can make the baby blues much worse. Make getting enough rest and sleep a high priority. It is also essential to eat well and regularly. If you are tired you may forget to eat and consequently suffer from periods of low blood sugar, which in turn lowers your frustration tolerance and your body's ability to absorb any new hormones you may be producing.

Extreme Symptoms

Approximately 10 to 15 percent of new mothers who experience the baby blues may develop a deeper level of postpartum depression characterized by several of the following symptoms:

• Difficulty making decisions
• Feelings of inadequacy
• Fear of being left alone
• Fantasies of disaster
• Feelings of not wanting the baby
• Desire to leave the family
• Panic attacks
• Fear and anxiety
• Feeling out of control
• Non-interest in previously pleasurable activities
• Inability to sleep
• Nightmares

Some of these symptoms, in mild forms, are normal adaptations to motherhood. If, however, they are persistent or extreme, they indicate a need for treatment.

This deeper level of postpartum depression usually begins within the first six to eight weeks after delivery but may appear any time in the first year postpartum. If the onset of your symptoms is later than two months after giving birth, they may sneak up on you, and you may not even identify the problem as depression until the symptoms are overwhelming. In fact, your husband or friends may notice it first.

A very small number of new mothers, about one or two in a thousand, develop very severe symptoms, usually in the first few days after birth, that turn into postpartum psychosis. In these rare cases a mother loses touch with reality and has delusions or hallucinations and severe anxiety. She may be a danger to herself or the baby. It is very important that any new mother with this type of symptom receive medical help immediately.

As was previously mentioned, drastically changing hormone levels after birth are thought to be the responsible factor in PPD. While this is most likely true, hormone treatments have been met with mixed results, and fathers and adoptive mothers have also been reported to have symptoms resembling postpartum depression. It would appear that in most cases a combination of factors is responsible.

Some of the factors that may place a woman at higher risk for PPD include:

• A family history of PPD
• Other major depressive episodes
• A history of hormonal problems such as PMS
• Marital tension, feeling unsupported by partner
• Being used to spending majority of time outside the home
• Husband away from home a great deal
• Death of her own parent in childhood or adolescence
• Medications

Positive Steps to Take

The most important thing to remember if you find yourself suffering from PPD is that it is not your fault. You are not a "bad" or incompetent mother. You have not done something "wrong". You are not going crazy and there is help available!

There are several things that you and those close to you can do to help. First, you must rest. Mother yourself and spend time with your baby. Find other people to take care of the housework, meals, other children, laundry, pets, etc. Your most important job is recovering and bonding with your new baby.

If breast-feeding is possible, it is a wonderful way for you to increase the level of Prolactin (a calming hormone) in your body. While breast-feeding can delay the production of Progesterone and Estrogen as your menstrual cycles return, Prolactin can help alleviate depression and facilitate a feeling of closeness with your baby. If you are having problems breast-feeding there are lactation consultants available and organizations such as La Leche League.

Try to avoid fixed or rigid scheduling of your baby; go with the flow. Avoid over-exertion and get lots of rest.

Eat balanced meals throughout the day. Stay away from caffeine, alcohol and smoking. Eat a small portion of complex carbohydrates (Mom used to call these "starchy foods") such as; bread, pasta, crackers, cereal, potatoes. Start eating theses small portions within a half-hour after waking and then every three hours while awake.

Don't isolate yourself or keep your feelings inside. Get outside for some light exercise (with your doctor's permission) everyday. Find other new mothers to talk to---local parenting publications or your pediatrician's office can provide you with lists of support groups. Find a safe person with whom you can express your conflicting emotions. Someone who will accept you just the way you are right now. You can also try keeping a journal.

Make the most of the time you have to rest. Learn relaxation techniques or use the ones you learned in childbirth classes. Rest, meditate or sleep whenever the baby sleeps.

You might also try thinking back to past adversities and remembering the skills and networks you used to get through those difficult times. New mother support groups can be especially beneficial.

Medical Breakthroughs

New medical information is now available about the treatment of PPD. This illness has even recently made its way into the Diagnostic and Statistical Manual for Psychologists and Psychiatrists. This means that the psychiatric community and insurance companies now recognize PPD as a real illness.

Katharina Dalton, M.D. in London, has reported great success in treating PPD and helping new mothers at high risk avoid PPD by using natural progesterone at the time of delivery. Other antidepressants are also widely used to treat this form of depression. Other well-known clinics are helping new mothers get enough sleep in the first two weeks after giving birth, thus avoiding most PPD symptoms.

Many advances have also been made in alternative forms of medicine, such as herbal remedies, holistic, Homeopathic and Chinese medicines. Many people are familiar with St. John's Wort and other natural herbs to treat depression. But it is important to always check with your doctor before taking any medication, especially if you are breast-feeding.

Many advances have been made in the diagnosis and treatment of PPD. With therapy and medication, nearly all forms of this illness are treatable. It is unnecessary for you to suffer untreated from PPD. Whether your symptoms are severe or just a case of the baby blues, remember, you are not alone and help is available.

© 1998 Lois V. Nightingale, Clinical Psychologist, director of the Nightingale Center.