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Deep in the trenches of newborn parenting, I confessed to family and friends that I had crippling mom guilt and persistent feelings of inadequacy. Some nodded in recognition, while others brushed it off as “the ups and downs of parenting.” But my emotions wouldn’t ease up. It was my second high-risk pregnancy and difficult birth. I spent weeks in the neonatal intensive care unit (NICU), and experienced early struggles with feeding…….Continue reading…
Source: Parents
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Critics:
Postpartum blues, also known as baby blues and maternity blues, is a very common but self-limited condition that begins shortly after childbirth and can present with a variety of symptoms such as mood swings, irritability, and tearfulness. Mothers may experience negative mood symptoms mixed with intense periods of joy. Up to 85% of new mothers are affected by postpartum blues, with symptoms starting within a few days after childbirth and lasting up to two weeks in duration.
Treatment is supportive, including ensuring adequate sleep and emotional support. If symptoms are severe enough to affect daily functioning or last longer than two weeks, the individual should be evaluated for related postpartum psychiatric conditions, such as postpartum depression and postpartum anxiety. It is unclear whether the condition can be prevented, however education and reassurance are important to help alleviate patient distress.
Symptoms of postpartum blues can vary significantly from one individual to another, and from one pregnancy to the next. Many symptoms of postpartum blues overlap both with normal symptoms experienced by new parents and with postpartum depression. Individuals with postpartum blues have symptoms that are milder and less disruptive to their daily functioning compared to those with postpartum depression. Symptoms of postpartum blues include, but are not limited to:
- Tearfulness or crying “for no reason”
- Mood swings
- Irritability
- Anxiety
- Questioning one’s ability to care for the baby
- Difficulty making choices
- Loss of appetite
- Fatigue
- Difficulty sleeping
- Difficulty concentrating
- Negative mood symptoms interspersed with positive symptoms
Postpartum blues may last a few days up to two weeks. If symptoms last more than two weeks, evaluation for postpartum depression is recommended by the American Psychiatric Association. The causes of postpartum blues have not been clearly established. Most hypotheses regarding the etiology of postpartum blues and postpartum depression center on the intersection of the significant biological and psychosocial changes that occur with childbirth.
Pregnancy and postpartum are significant life events that increase a woman’s vulnerability for postpartum blues. Even with a planned pregnancy, it is normal to have feelings of doubt or regret, and it takes time to adjust to having a newborn. Feelings commonly reported by new parents and lifestyle changes that may contribute to developing early postpartum mood symptoms include:
- Fatigue after labor and delivery
- Caring for a newborn that requires 24/7 attention
- Sleep deprivation
- Lack of support from family and friends
- Marital or relationship strain
- Changes in home and work routines
- Financial stress
- Unrealistic expectations of self
- Societal or cultural pressure to “bounce back” quickly after pregnancy and childbirth
- Overwhelmed and questioning ability to care for baby
- Anger, loss, or guilt, especially for parents of premature or sick infants
Most risk factors studied have not clearly and consistently demonstrated an association with postpartum blues. These include sociodemographic factors, such as age and marital status, and obstetric factors, such as delivery complications or low birth weight. Factors most consistently shown to be predictive of postpartum blues are personal and family history of depression.
This is of particular interest given of the bidirectional relationship between postpartum blues and postpartum depression: a history of postpartum depression appears to be a risk factor for developing postpartum blues, and postpartum blues confers a higher risk of developing subsequent postpartum depression.
Symptoms of anxiety and irritability are often predominant in the presentation of postpartum blues. However, compared to postpartum anxiety, symptoms of postpartum blues are less severe, resolve on their own, and last fewer than two weeks. Postpartum depression and postpartum blues may be indistinguishable when symptoms first begin.
However, symptoms of postpartum blues are less severe, resolve on their own, and last fewer than two weeks. Mothers who experience severe postpartum blues appear to be at increased risk of developing depression. Although both conditions can cause periods of high and low moods, the mood swings in postpartum psychosis are significantly more severe and may include mania, hallucinations, and delusions.
Postpartum psychosis is a rare condition, affecting 1-2 per 1000 women. Postpartum psychosis is classified as a psychiatric emergency and requires hospital admission. Given the mixed evidence regarding causes of postpartum blues, it is unclear whether prevention strategies would be effective in decreasing the risk of developing this condition.
However, educating women during pregnancy about postpartum blues may help to prepare them for these symptoms that are often unexpected and concerning in the setting of excitement and anticipation of a new baby. Mothers who develop postpartum blues often have significant shame or guilt for feelings of anxiety or depression during a time that is expected to be joyful. It is important to reassure new parents that low mood symptoms after childbirth are common and transient.
Obstetric providers may recommend that patients and their families prepare ahead of time to ensure the mother will have adequate support and rest after the delivery. Additionally, they should provide education and resources to family and friends about red flags of more severe perinatal psychiatric conditions that may develop, such as postpartum depression and postpartum psychosis.
Most mothers who develop postpartum blues experience complete resolution of symptoms by two weeks. However, a number of prospective studies have identified more severe postpartum blues as an independent risk factor for developing subsequent postpartum depression. More research is necessary to fully elucidate the association between postpartum blues and postpartum depression. Postpartum blues is a very common condition, affecting around 50–80% of new mothers based on most sources.
However, estimates of prevalence vary greatly in the literature, from 26 to 85%, depending on the criteria used. Precise rates are difficult to obtain given lack of standardized diagnostic criteria, inconsistency of presentation to medical care, and methodological limitations of retrospective reporting of symptoms.
Evidence demonstrates that postpartum blues exists across a variety of countries and cultures, however there is considerable heterogeneity in reported prevalence rates. For instance, reports of prevalence of postpartum blues in the literature vary from 15% in Japan to 60% in Iran. Underreporting of symptoms due to cultural norms and expectations may be one explanation for this heterogeneity.
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