What is PPD?
The last thing you want to think about during pregnancy is the possibility that after nine months of anticipation, you'll be too unhappy to enjoy your baby. Yet the truth is that 80 percent of new mothers have severe mood swings, known as baby blues, and 10 percent suffer major postpartum depression (PPD) in the first year.
Traditionally, doctors have blamed PPD on the dramatic drop in hormones that occurs after delivery. But chemistry can't explain everything; otherwise, all new mothers would plummet into depression. According to the latest research, women who suffer from PPD show clear warning signs during pregnancy; many have risk factors, such as a history of depression. "Doctors can detect the most vulnerable women early and prevent the illness before it strikes," says lead researcher Zachary Stowe, M.D., director of the Pregnancy and Postpartum Mood Disorders Program at Emory University, in Atlanta.
"The women with PPD in our study all had symptoms of anxiety or depression during pregnancy," says Dr. Stowe. However, doctors usually ignore these signs. "If a pregnant woman cries frequently, has trouble sleeping, and can't concentrate, everyone assumes that's typical," he adds.
In addition to talking to your doctor about any symptoms of distress that you're experiencing now, the best way to prevent PPD is to have realistic expectations. All new moms must adjust to having less control over their day-to-day lives, but some women find this overwhelming, which leads to anxiety and depression. Some ups and downs are inevitable, but the way you prepare for parenthood now can safeguard your well-being after the baby is born.
Steps to Take
1. Learn to chill out.
Many studies have shown that newborns bond better with calm mothers. New moms who spend at least 15 minutes every other day relaxing- whether by deep breathing, meditating, or soaking in the tub -- cope with the stresses of motherhood better than those who don't, according to Diane Sanford, Ph.D., author of Postpartum Survival Guide (New Harbinger Publications).
In the course for new mothers she teaches in St. Louis, Missouri, Dr. Sanford asks each student to report what she's done to create her "moments of self-preservation." Telling women to take it easy seems to relieve their guilt, Dr. Sanford says -- perhaps because they see it as an assignment instead of an indulgence.
2. Vow to sleep when your baby sleeps.
Everyone has heard the classic adage to nap when the baby naps, but too many women fail to actually heed the advice -- using the downtime instead as a chance to make the bed or write thank-you notes. However, new mothers who are able to make up for lost sleep are less likely to feel depressed, according to a study by Michael O'Hara, Ph.D., of The University of Iowa, in Iowa City. "You may need friends, family members, or hired help to pitch in so you can get the sleep you deserve," says Dr. O'Hara, author of Postpartum Depression: Causes and Consequences (Springer-Verlag).
3. Make time to exercise.
A study of more than 1,000 mothers found that those who exercised before and after the birth of their baby tended to feel better emotionally and were more social than women who didn't. "Taking a brisk walk, getting fresh air, and enjoying nature can improve your outlook," says Karen Rosenthal, Ph.D., a psychologist in Westport, Connecticut. Don't push yourself to do strenuous aerobics, though; this is more about getting your blood flowing than burning calories or tightening your abdominal muscles.
4. Think of motherhood as a career change.
"I often tell couples that parenthood is a job, but it's not 9 to 5; it's 24 hours a day," says Dr. Rosenthal. Most women expect that the first few months of a new job will be stressful, but they often don't anticipate the tensions involved with mothering a newborn. Denise Madison, a New York City mother of twins, said she became much happier once she started telling herself, "My babies are my job" -- and that everything else, including reading the newspaper, could wait.
5. Don't expect to be the perfect parent.
Rest assured, every mom can tell you stories about having left the house with her shirt inside out or having forgotten to put a diaper on her baby after a middle-of-the-night changing. Many women with PPD are perfectionists, notes Joyce A. Venis, a psychiatric nurse and president of Depression After Delivery Inc., a self-help group based in Raritan, New Jersey. "They feel guilty if they can't do everything right and presume that every other mother is doing a better job," she says. "As a result, they impose unrealistic expectations upon themselves." Your goal is not to fulfill some notion of the ideal mother but to be a happy parent.
6. Plan to get plenty of help.
You'll have to delegate chores, let friends bring dinner over, and invite your sister or mother to watch the baby so you can go shopping. "If you feel overwhelmed or resentful, you need to give yourself permission to ask for help rather than wait for others to offer," says Dr. Sanford.
7. Confront your fears.
Have a conversation with your husband in which you each list three things that frighten you about parenthood, suggests Jane Israel Honikman, founder of Postpartum Support International, in Santa Barbara, California. They can be emotional concerns -- such as that the two of you won't have enough time alone -- or practical anxieties about colic or breast-feeding.
8. Be flexible.
You need to be able to go with the flow. "Your morning shower and coffee may not happen until noon," says Dr. Rosenthal. What's more, you should realize that there will be days when taking a shower is the only thing you can check off your to-do list. Rather than panic about how chaotic your life is, try to appreciate its unpredictability -- and throw away that list!
9. Join or start a new-mothers group.
"Isolation breeds anxiety," says Sally Placksin, author of Mothering the New Mother (Newmarket Press). Just knowing that others are experiencing the same mix of joy and frustration will put your mind at ease. "It's also helpful to find a calm, experienced friend who can not only show you how to bathe and burp the baby but who will understand how you're feeling," says Placksin. "You need adult contact," agrees Denise Madison. "When my twins were 4 weeks old, I started feeling sorry for myself. It just became easier to stay home than to get out of the house." One night, despite her reluctance, a neighbor insisted that Madison come to a Christmas party with some neighborhood moms. Listening to others talk -- and having adult conversation -- pulled her out of the doldrums.
10. Remind yourself that the best is yet to come.
Between hormonal swings and all the changes in your life, it will be a challenge to feel confident sometimes -- especially if you assume this is supposed to be the best time of your life. Focus on the light at the end of the tunnel: Soon your baby will settle into a schedule, breast-feeding will be second nature, and your diaper bag will be stocked so you can get out of the house quickly. You have years of best times ahead; don't convince yourself that they need to be the first weeks or months of motherhood.
Copyright ? 1999 Randi Hutter Epstein, M.D. Reprinted with permission from the June 1999 issue of Parents magazine.