The baby blues – When does it start, when will it end?

TONI was the first one from her group of friends to have a baby. She was 20 years old, and her pregnancy was unplanned. She suspected that her boyfriend of two years was cheating on her, as he had become less interested in sex since she started showing. After she gave birth, her friends rallied around her and brought gifts for the baby. Within a few weeks, though, they went back to their normal lives. They partied without her, started new jobs, migrated, continued college, and dated new people. By this time she was sure her boyfriend had someone else, and he hardly visited. She was constantly criticised by her relatives that she was holding the baby wrong, not feeding him enough, feeding him too often, and even not putting on his diapers properly. Her baby cried constantly, even when nothing seemed to be wrong. She felt clueless and alone.

Michonne just had her second daughter and felt confident that she was ready for anything. She soon realised, though, that this baby was different from her first. She cried a lot more, and Michonne just didn’t feel as if she was bonding with this one. Though she had no doubts that she loved her child, there were times when she felt like she wanted to throw her into a wall for her to stop crying. She tried to breastfeed exclusively to facilitate a bond, but she got annoyed when the baby wasn’t latching properly or sucked too hard on her nipple. She lacked sleep, and was not interested in sex with her children’s father. They had not been intimate since she was in her second trimester. She didn’t love him anymore, and felt as if she was settling.

Kadie did not expect to get pregnant a third time, since she and her husband were separated. He had new family in another parish and she hated him. She wanted to have an abortion but could not go through with it at the last minute. Her husband, though he had coerced her into having sex, claimed the child was not his. By the time she gave birth to her daughter, she was basically a single mom of three. Her boys started acting out from not having their father around, and her family gossiped about her for having another child for a man who did not want her. She felt tired all the time, and did not leave her house unless she absolutely had to. She loved her daughter, but she felt too stressed to take care of her. She felt as if she was ruined.

These three women told All Woman that they knew that they suffered from postpartum depression (PPD), though none of them ever revealed their concerns to their doctors at their visits. They all read about the ‘baby blues’ and that it was common to feel overwhelmed shortly after having a baby, and that it would go away on its own after a few days or weeks. But these women didn’t feel better with time; they felt progressively worse. They wondered when the depression was going to end.

Internist Dr Samantha Nicholson-Spence says that in some women, the feelings associated with PPD will go away spontaneously, but others will require treatment.

“If it goes away within two weeks, it doesn’t meet the criteria to be considered as postpartum depression,” she said. “It can take a month, two months, six months… whatever it takes to get over it.”

Dr Nicholson-Spence said that by definition, PPD can strike anywhere in the year following childbirth, and in some cases even before the baby is born.

“It tends to start in the third trimester in a lot of women, and then it becomes more florid after the birth of the baby. It’s more common up to the first five months after the birth of the baby.”

She said the symptoms are similar to those of depression, such as constant sadness, tearfulness, difficulty sleeping, fatigue, and disinterest in things that once interested the woman.

“But because it’s related to a baby, you find that there are other features, such as an obsessive preoccupation with the health of the baby, or the opposite, where the mother may not care about the baby’s well-being at all, such as not wanting to feed the baby, or not responding when the baby cries,” she explained. “She may also not care for herself, such as not bathing or keeping up her appearance, and not being interested in sex or her spouse.”

While postpartum depression can strike any mother, Dr Nicholson-Spence noted that women without much social support are more at risk of becoming depressed.

“For example, if there is no father around, or your mother [or an experienced relative] is not there to help you, you might have a problem,” she said. “Also if it’s twins, or a higher multiple pregnancy, or you have older children in the home, especially if those children are toddlers… That is a lot of stress, and if you don’t have help it is easy for you to become depressed.”

She added: “If you already have had depression in the past, or even premenstrual dysphoric disorder (depression symptoms just before menstruation), if you can’t provide for yourself and the child, if you didn’t want the pregnancy in the first place, or if there is a history of abuse; those things also predispose you to having postpartum depression.”

While the ‘baby blues’ mimics PPD, Dr Nicholson-Spence says it doesn’t last very long and its symptoms are milder than those of PPD. She urged women who feel as if their symptoms are getting worse or that they might hurt themselves or their babies to seek help as untreated PPD can develop into a more serious condition.

“Things can be so bad where you go into postpartum psychosis, where you start hearing voices and seeing things,” she warned. “The voices may tell you that you are a worthless mom, or that you should kill yourself or your baby.”