When ‘Baby Blues’ Is Something More Serious

Dirty diapers, washing an endless supply of bottles, and taking tons of photos of that precious little creature that keeps you up all night. That’s what I recall of the three months on family leave taking care of a newborn. 

But what if you’re not thrilled to be a new mom? What if you can’t shake this sad feeling during a time you envisioned life would be so perfect?

And when are your bad feelings not just “baby blues,” but postpartum depression?

To learn more, I sat down with Dr. June Ching, a board-certified clinical psychologist, who is past president of the Hawaii Psychological Association and former chief psychologist at Kapiolani Medical Center for Women & Children.

According to Dr. Ching, it’s common to experience baby blues. Feeling stressed, sad, frustrated, tired or anxious after having a baby is natural – and usually doesn’t require treatment. However, if your symptoms last more than several weeks, or are so pronounced that “you lose pleasure or interest in things you used to enjoy, have an unusual change in sleeping or eating habits, feel anxious, guilty or worthless, cry uncontrollably for long periods of time, experience excessive mood swings, or have a lack of bonding with your baby,” it is recommended that you get help for a more serious mood disorder – postpartum depression.

Severe troubling signs include any thoughts of hurting the baby or oneself. “If you have any scary thoughts about hurting yourself or harming your baby, please seek immediate attention,” she said. And if in doubt, it’s a good idea to err on the side of caution.

Dr. Ching added that it’s important all moms have a support system.

“It’s easy for moms to get overwhelmed after giving birth,” Dr. Ching said, “so getting sufficient rest and sleep is necessary, along with letting go of less important responsibilities.”

Mothers also need to give themselves a break, speak up when they are struggling, and turn to family members, friends and others for help. Society expects new parents to be having the happiest time of their lives. If the reality is different, mothers are reluctant to report having symptoms, Ching said. New moms also might have trouble asking for emotional help because they consider it to be a sign of failure.

Are there risk factors for postpartum depression?

Dr. Ching: Statistically, around 10-15 percent of women will experience post-partum depression. It can appear days or even months after delivering a baby. While the causes are not well understood, a number of factors have been cited as being associated with the development of post-partum depression. One risk indicator is if you were already suffering from depression or anxiety during your pregnancy, or if you have had any history of depressive episodes.

Other risk factors include: a particularly difficult or high-risk pregnancy, or having a baby with special needs such as preterm birth, medical complications or illness. Other considerations involve having an extremely challenging baby who is difficult to comfort, acute emotional stressors such as the recent loss of a loved one, severe marital discord, major financial or employment problems, and isolation with lack of an adequate support system after childbirth.

What should loved ones look for, and how can they support a mom if they believe something’s wrong?

Dr. Ching: Loved ones need to know they play a major part in assisting a new mom. Everyone in the family should help out and provide support in any way they can. Men can also be susceptible to depression, as a new baby requires transitions for all the family members. If you were a couple for a long time and now mom is always attending to a needy new baby that dramatically changes the family dynamics. A new baby means lots of shifts and redefining of relationships.

For dads, any way you can help will be appreciated. They can tend to meals, share with household chores, offer to take care of baby so mom has breaks, and arrange for her to have self-care time to exercise or spend time with family and friends. Most importantly, provide a listening ear to how the mom is feeling and doing. If she is having a difficult time and experiencing depressive symptoms, encourage her to seek assistance.

If I’m a new mother and I think I may have a problem, where should I go for help?

Dr. Ching: You will likely have a post-partum checkup with your obstetrician. Inform your doctor if you are experiencing any problems. Your obstetrician or primary care doctor should be responsive and listen to your physical as well as emotional symptoms. They can rule out possible physiological reasons for post-partum depression and refer you to see a licensed mental health professional, such as a psychologist, if they think something might be wrong. You can also seek out psychotherapy on your own. Early intervention is the key to establishing a correct diagnosis and implementing an effective intervention.

Why do some women get post-partum depression while others don’t?

Dr. Ching: While the exact causes of postpartum depression are not clearly understood, we know that certain factors are associated with increased risk of susceptibility. During pregnancy and after giving birth, a mom’s hormones fluctuate and it can take a while for her estrogen and progesterone levels to regain their balance. Other factors mentioned include a previous experience with or a family history of depression, birth related trauma, child care stressors, prenatal anxiety, lack of social support, difficult infant temperament, and marital instability.

How is post-partum depression treated?

Dr. Ching: Psychotherapy is very effective in treating post-partum depression. A medication evaluation referral might also be made. Part of the intervention is to provide sufficient rest and sleep for the new mom, increase partner support and give added assistance with childcare and household responsibilities.

Psychologists can provide a safe, supportive environment for the new mom to discuss her concerns with someone who understands. She will be encouraged to express her thoughts and feelings and can learn effective coping skills to deal with the post-partum parenting stressors in her life.

Some women enjoy support groups because it gives them a chance to hear from others who are also going through similar circumstances.

How long can postpartum depression last?

Dr. Ching: It can last several months to a year, but depends on the severity of the condition — mild, moderate, or severe symptoms — and whether the patient has the resources to get help. Preventive education and early intervention matters.

That’s why it’s important to raise awareness about this condition. It’s vital that midwives, doctors, partners and family members inquire about how moms are doing, and validate the range of feelings and experiences that come with having a new baby. Most importantly, moms need to know that they should always reach out and get help if needed. It’s an investment in their well-being and the quality of their mother-child relationship.