Why is Mom So Blue? Postpartum Depression in a Family Context

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Elizabeth just couldn't understand herself. She had waited for this her whole life. When she was little, she had a whole nursery set up for her "baby" (a doll she had been given by her grandmother), and she would spend hours taking care of her. She loved to change her clothes, give her a bath, rock her to sleep, and do every other thing mommies do with their babies. She would dream of the day she could do those things with her own, real-life baby. So now that she could, why was it so hard? Why wasn't she finding any joy in living her dream? To make matters worse, her husband couldn't understand her either. He would get frustrated when he would come home from work only to find her still in her pajamas. The house was a mess, the baby wasn't happy, and Elizabeth didn't seem to be doing anything anymore. This was her only job, so what was the matter with her?

Elizabeth was suffering from postpartum depression (PPD), an illness that affects around 19 percent of childbearing women at some point in their life.1 Women who suffer from PPD feel confused, afraid, and alone during a time that could be joyful. The Family: A Proclamation to the World teaches us that "in the premortal realm, spirit sons and daughters knew and worshiped God as their Eternal Father and accepted His plan by which His children could obtain a physical body and gain earthly experience" (¶ 3). Much of this earthly experience involves pain and hardship. Postpartum depression is one of the more misunderstood earthly experiences that women have. While many have heard of PPD and its devastating effects on the family, few have been educated about what it is and how it can be treated. Because of this, many women feel that they suffer alone and in silence.5 The family can and should be a woman's best resource during this difficult period. However, family members cannot provide the necessary support unless they understand what the illness is and how it affects them. In this review, we will learn what PPD is, how it affects the family, and how the family can recover from its effects together.

The Cycle of PPD

A family can be seen as a system, with individuals in the family influencing one another. According to this perspective, one family member's experiences affect everyone else in the family, and visa-versa. This creates a continuous cycle of change in the family. Because of this, PPD causes quite a stir in family life. It makes a mother's whole world turn upside down, and her changed feelings and behaviors influence the way her family members feel and act.6 Families who are aware of this cycle can be proactive in changing a possible family disaster into an opportunity for growth and connection.

She's Not Just Feeling Blue

Nearly all women have a period of sadness, called the Baby Blues, following the birth of a child. It is important that family members understand the difference between Baby Blues and PPD so they can avoid letting depression go untreated. Following is a comparison of the Baby Blues and Postpartum Depression.1,5,9,10

 

The Baby Blues

Postpartum Depression

Onset:

3 days following childbirth

Sometime during the 1st year after childbirth

Symptoms:

-         Anger

-         Irritability

-         Extra sensitive

-         Mood swings

-         Sadness

-         Crying

-         Anxiety

-         Elation (sometimes)

-         Increased irritability

-         Anger

-         Withdrawal from family and friends

-         Feelings of guilt and shame

-         Difficulty concentrating

-         Lack of interest or pleasure

-         Insomnia or hypersomnia

-         Suicidal thoughts

-         Desire to harm herself or the baby*

*A woman suffering from PPD still understands that her desires to harm herself or her baby are wrong. If she feels that she should harm herself or the baby, or if she acts on those feelings, she may be suffering from postpartum psychosis, a condition requiring immediate medical attention.

Recovery

Resolves itself in 7-10 days

May take several months to resolve.

Lifestyle changes, therapy, and medication aid in the recovery process.

 

Family members who are aware of PPD can help prevent silent suffering by calling attention to the symptoms of PPD and seeking help for them immediately. Husbands can mention what they see happening, counsel with their wives about possible solutions, and take the initiative in seeking treatment from a healthcare professional. If this is not the first baby, other children can also get involved. They often spend more time with Mom, and may notice that something is not right. They can mention their concern to one or both parents.

"When Mama ain't happy, ain't nobody happy"

You might have heard the silly phrase before, "When Mama ain't happy, ain't nobody happy." While it is often used jokingly, there may be some truth to it, especially in this case. When a mother suffers from PPD, joyful feelings are extinct, or if she's lucky, they're rare. The way she feels affects the way she behaves, and the family can begin to feel the same way.

Postpartum depression can have a profound impact on the infant, the spouse, and the marriage. Mothers with PPD have difficulty interacting with their infants. As a result, they are often less playful and attentive than others their age.10 They are also at risk of having behavioral problems through childhood.1 Fathers, influenced by their wife's feelings about her relationship with the baby, also have difficulty interacting with their infants.6 They, too, can become depressed.2 Symptoms of depression can cause stress in the marital relationship, leading to a decrease in marital satisfaction.8

Lend a Hand

One of the most important ways to prevent PPD is to offer social support. Social support is any type of help provided by friends and family in a time of need. Women who receive practical support (financial aid, meals, childcare, etc.) after the birth of a child are much less likely to suffer from PPD.12 Family members can work to prevent PPD by providing practical support prior to the arrival of the baby, and continuing to help after the baby is born. The father can look into ways he can be home more following the baby's arrival, such as changing his work schedule or taking time off work completely for a little while (many businesses offer maternity and paternity leave). He can also plan ahead for ways he can help when he is at home, and can solicit the help of extended family members as well, if any are nearby. One way he could do this it to create a schedule before the birth for who is going to help and when they will do so during the first several weeks of the baby's life. This would not only ensure that the mother receives the support she needs, but would also strengthen the marriage relationship as the husband serves his wife selflessly. If social support can help to prevent PPD, it can also help with its treatment. It is never too late to lend a hand.

Treatment

A family provides needed support by strengthening the mother as she receives treatment for PPD. The three types of treatment for PPD are lifestyle changes, psychotherapy, and medication. These can be combined or used separately to aid in recovery. A woman suffering with PPD should create a treatment plan under the direction of a healthcare professional and with the help of her spouse and other family members.5 Below are ways that families can make lifestyle changes together to support Mom in the treatment process.

Change Your Lifestyle

  • Sleep. Lack of sleep is a common complaint among all parents of newborn babies, but it is especially problematic for women with PPD. Women are more likely to suffer from PPD if they get less than four hours of sleep between the hours of midnight and 6 am, and nap less than one hour during the day.7 Following are some ideas for ways immediate and extended family members can make more time for Mom to sleep:5
    • Maintain a positive attitude about Mom's need for extra sleep
    • Establish quiet hours for naptime
    • Care for the baby between feedings
    • Do household chores
    • Make meals
    • Run errands
  • Exercise. It is important for Mom's physical and mental health to be exercising regularly. Many doctors are prescribing exercise in conjunction with other treatments for PPD. Physically, exercise helps keep all of the body's functions working properly. It also releases endorphins in the brain, which contribute to a happier mood. Mentally, exercise can help a new mother feel more in control of her life, and empowered to take steps toward recovery.5 Women suffering from PPD are often encouraged to exercise in groups so that they can enjoy much needed social interaction as they work to stay physically fit.3

Like extra sleep, exercise is difficult to fit into a new mother's schedule without concerted effort. Families can make time for Mom to exercise by doing some of the things suggested to help her get more sleep. Couples and families can also participate in physical exercise together, providing time for the family to strengthen their connection while also meeting the physical needs of the mother who struggles with PPD. Consider planning a family outing once a week that involves some physical activity. A bike ride with the baby in a baby seat, a walk around the neighborhood, or even a playful game of hopscotch can relieve stress and bring laughter to the family dealing with PPD.

  • New thought patterns. Patterns of negative thought can perpetuate symptoms of depression. For example, a common negative thought pattern that contributes to depression is the "mental filter"5 (p. 85). We are using a mental filter when we focus on only the negative aspects of a situation and ignore the positive. If you are accustomed to thinking this way, the following thought might ring familiar to you: "I can't get anything done anymore. The sink is full of dishes, the floor hasn't been swept for a week, and we ate frozen pizza for dinner again tonight." Consider replacing it with one more like this: "I might not do as many chores as I used to do, but I'm doing the best I can. I got dinner on the table, I changed and fed the baby whenever she needed it, and I even showered today!" Focusing on the things that did go right can relieve some of the stress and negativity that accompanies thoughts of what didn't.

Negative thought patterns are often perpetuated in the home by negative attitudes and expressions used by family members. Families can work together to create positive thought patterns in their homes by speaking positively and encouraging one another to choose a new way of thinking when negative thoughts creep in. For example, if Billy started to complain about having frozen pizza for dinner again, his brother could kindly remind him that they are choosing positive thoughts, and say something like, "I'm sure glad we're having dinner as a family tonight." Families offer support to the mother by not only encouraging her to change her thoughts but committing to do so along with her.

When family members take an active role in the process of treating postpartum depression, they are not only helping Mom recover but are buffering the negative effects of PPD on the whole family. They are helping the entire family recover through their efforts. If you believe you or someone you love suffers from postpartum depression, take action now. Discuss your concerns with a trusted family member, and seek the advice of a healthcare professional.

Suggested Reading & Further Resources

Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression, by Shoshana S. Bennett and Pec Indman

The Postpartum Husband:  Practical Solutions for living with Postpartum Depression, by Karen R. Kleiman

When Baby Brings the Blues: Solutions for Postpartum Depression, by Ariel Dalfen

The Great Marriage Tune-Up Book, by Jeffry H. Larson, Ph.D.

Written by Amy M. Scoville, Research Assistant, and edited by Stephen F. Duncan, professor in the School of Family Life, Brigham Young University.

References

  1. Beck, C. T. (2006). Postpartum depression: It isn't just the blues. The American Journal of Nursing, 106(5), 40-50.
  2. Bielawska-Batorowicz, E., & Kossakowska-Petrycka, K. (2006). Depressive mood in men after the birth of their offspring in relation to a partner's depression, social support, fathers' personality and prenatal expectations. Journal of Reproductive and Infant Psychology, 24(1), 21-29.
  3. Currie, J. L., & Develin, E. (2002). Stroll your way to well-being: A survey of the perceived benefits, barriers, community support, and stigma associated with pram walking groups designed for new mothers, Sydney, Australia. Health Care for Women International, 23, 882-893.
  4. Daley, A., Jolly, K., & MacArthur, C. (2009). The effectiveness of exercise in the management of post-natal depression: Systematic review and meta-analysis. Family Practice, 26, 154-162.
  5. Dalfen, A. (2009). When baby brings the blues: Solutions for postpartum depression. Mississauga, Ont.: J. Wiley & Sons Canada.
  6. Goodman, J.H. (2008). Influences of maternal postpartum depression on fathers and on father-infant interaction. Infant Mental Health Journal, 29(6)624-643.
  7. Goyal, D., Gay, C., & Lee, K. (2009). Fragmented sleep is more strongly correlated with depressive symptoms than infant temperament at three months. Archive of Women's Mental Health, 12, 229-237.
  8. Larson, J. H. (2003). The great marriage tune-up book. San Francisco, CA: Jossey-Bass.
  9. Mayo Clinic (2008). Postpartum depression
  10. O'Hara, M. W. (2009). Postpartum depression: What we know. Journal of Clinical Psychology, 65, 1258-1269.
  11. Seyfried, L. S., & Marcus, S. M. (2003). Postpartum mood disorders. International Review of Psychiatry, 15, 231-242.
  12. Xie, R., He, G., Koszycki, D., Walker, M., & Wen, S. W. (2009). Prenatal social support, postnatal social support, and postpartum depression. Annals of Epidemiology, 19, 637-643.