- The experience of bringing home a new baby can be overwhelming.
- Some parents may feel the need for some guidance in basic baby care and parenting, while others may have some serious issues of concern.
- The Public Health Nurse can identify any concerns that have not been found during the hospital stay.
- The postpartum home visit is an opportunity to help families make the transition from hospital to home, with a new baby successful.
- It provides the family an opportunity to discuss any concerns with a professional in their own home, in a relaxed and informal manner.
 The Public Health Nurse can also provide the family with a link to the information, services and supports they require supporting their baby's development. - The nurse can also help the family and mother with any new baby issues they might have.
Postpartum Depression or "Baby Blues"?
- More than 70% of new mothers feel a little depressed after birth – it is normal to cry for no reason, to feel anxious, frightened, and sad.
- “The baby blues” happen within a couple of days after the birth.
- You may feel
- Happy, then sad the next minute
- Very tired, then get a burst of energy
- Have trouble sleeping
- Have trouble making decisions
- Confident, then insecure
- As though you will never get your old life or your old body back
- As if you have no interest in sex
- It may be linked to changing hormones, and may also come from feelings of loss because the baby is no longer inside you.
- These feelings may last for hours or days – for most women, they go away within 2 weeks without treatment.
- Reach out to your partner, family and friends for support.
- If the baby blues seem to be getting worse instead of better, or if they last more than 2 weeks, you may be moving into postpartum depression.
- Postpartum depression lasts longer, involves more intense emotions, and often requires counseling and treatment.
- Postpartum depression can occur after any birth not just the first. About 10% of women who give birth develop postpartum depression.
- Many new mothers are surprised at how fragile, alone and overwhelmed they feel after the birth of a child. Their feelings do not seem to match their expectations.
- If not recognized and treated, Postpartum Depression may become worse or may last longer than it needs to.
When to Suspect Postpartum Depression:
 Signs of postpartum depression:
- My baby blues have not gone away after 2 weeks
- I don’t feel like my usual self
- I have strong feelings of sadness or guilt
- I often feel very anxious or worried
- I have strong feelings of hopelessness or helplessness
- I cannot sleep, even when I am tired
- I sleep all the time, even when my baby is awake
- I cannot eat, even when I am hungry
- I cannot eat because I am never hungry, or because I feel sick
- I worry about the baby too much; I’m obsessed with the baby
- I do not worry about the baby at all; it’s almost like I don’t care
- I am having anxiety or panic attacks
- I feel angry toward the baby
- I think about hurting my baby, or myself
- Talk to your health care provider about your feelings. It is not your fault – they will understand and be able to help you
Some Reasons for Postpartum Depression:
- Some women appear to have a higher risk of postpartum depression.
- Risks for developing postpartum depression include
- Women who have had postpartum depression before
- Women with a psychiatric history
- Recent stressful events, such as loss of a loved one, family illness or moving to a new city
- There is no evidence that postpartum depression is related to age or number of previous children
- Lack of a supportive partner may be a major factor
- In rare cases - about 1 - 3 in every 1,000 births - the mother will develop a more severe mental illness or psychosis
- Women with a personal or family history of manic depression (bipolar disorder) or schizophrenia appear to be at increased risk for such disorders
- It is not always known why some women become depressed after childbirth and others do not.
- Postpartum depression is likely to result from a combination of physical, environmental, and psychological.
- For each woman, the combination of factors that cause it are unique, because no two women have the same biological makeup or life experiences.
- This may explain why some women develop postpartum depression and others do not.
- It may also explain why a woman who may cope well with the pressures and responsibilities of everyday life may find the stress of a new baby hard to handle.
Physical factors:
- Levels of the female hormones estrogen and progesterone drop sharply in the hours after childbirth.
- These decreases may trigger depression, just as much smaller hormonal changes can cause mood swings and tension before menstrual periods.
- Because some women are more sensitive to these changes than others, they may be more prone to having postpartum blues or depression.
- Thyroid levels may also drop sharply after birth – this can produce symptoms that mimic depression, such as mood swings, severe agitation, fatigue, insomnia (trouble sleeping) and tension.
- Many women feel exhausted after labour and delivery. It can take two weeks for a woman to regain her normal strength and stamina.
- If a woman has had a Caesarean birth, recovering from this major surgery can take even longer.
 Also new mothers seldom get the kind of rest they need. In the hospital, sleep is interrupted by visitors, hospital routine and the baby's feedings. At home, the feedings and care continue around the clock, along with the usual household tasks. - This fatigue and lack of sleep can go on for months and be a major reason for depression.
Environmental factors:
- Stress
- Feeling alone
- Lack of support from partner, family and friends
- The steady support of a mother's partner is especially important to her throughout pregnancy and in the weeks and months after birth.
- If a woman is single, divorced or separated, or living far away from her family, support may be scarce or lacking.
- This may make her feel alone, overwhelmed, overworked and unloved.
- Breastfeeding problems can make a new mother feel inadequate and depressed.
- New mothers need not feel guilty if they cannot breast feed or if they decide to stop. The baby can be well nourished with formula.
- Your partner can help with some of the feedings freeing you to have more time for yourself or for rest.
Psychological Aspects:
- Feelings of doubt about pregnancy are very common.
- The pregnancy may be unwanted or unplanned.
- Even for a planned, wanted pregnancy, nine months may not be enough time for a woman and her partner to adjust to the responsibilities of having a baby.
- Sometimes a woman becomes pregnant in the hopes that the baby will bring back her partner who left. When this does not happen she may feel abandoned, angry, guilty and inadequate.
- The baby may come early, forcing unexpected, stressful changes in home and work routines.
- If the baby is born with a birth defect, it may be even harder for the parents to adjust.
- Mixed feelings sometimes arise from a woman's personal history.
- If a new mother lost her own mother early or had a poor relationship with her, she may be unsure about her feelings toward her new baby. She may fear that caring for the child will lead to pain, disappointment or loss.
- Feelings of loss are very common after childbirth and can also contribute to depression. The loss can take many forms: loss of freedom, along with feelings of being trapped and tied down; loss of an old identity as one who is taken care of, or the one who is always in control; loss of your old body and feelings of sexual attractiveness.
The Role of Myths
- The more a woman has idealized motherhood, the more likely she may be to feel disappointed, disillusioned and depressed as she faces the reality of day-to-day mothering.
- 3 myths about motherhood are common:
 Myth #1: Motherhood is Instinctive
- First-time mothers often believe that they should automatically know how to care for a newborn.
- New mothers need to learn mothering skills just as they learn any other important life skill. It takes time and patience. It takes reading child care books, watching experienced child care givers and talking with experienced mothers.
- Confidence usually grows as a mother's skills grow.
- Mothers may also believe that they must feel a certain way toward their newborn or they are not "maternal".
- Some women feel very little for their infants at first. Mother love, like mothering skills, is not automatic.
- Bonding usually takes days or even weeks. When these special feelings of motherhood - protectiveness, warmth, delight - begin to emerge, they need to be nurtured.
Myth #2: The Perfect Baby
- Most women have fantasies and dreams about what their newborn will look like.
- When the baby arrives, mothers have to realize that their newborn may not match the baby of their dreams.
- Babies have distinct personalities right from birth. Some infants are simply easier to care for. Others are fussy, colicky and not easily soothed or comforted.
- Adjusting to the baby may be demanding and difficult and may add to feelings of inadequacy and depression.
Myth #3: The Perfect Mother
- For many women, striving for perfection is a never-ending and destructive goal.
- If a mother thinks she is not living up to this ideal, whether it is her own or that of her friends or parents, she may suffer from intense feelings of inadequacy or failure.
- In reality, no mother is perfect.
- It is not true that every woman can "have it all".
- Most women find juggling a new baby with household duties, other children, and a job or career to be extremely demanding. They often feel this way even with a lot of emotional and financial support.
What You Can Do
- Do not try to do everything.
- Ask for help from family and friends, especially if you already have children.
- Try to nap when the baby naps.
- If possible, have your partner help with the feedings during the night.
- Shower and dress each day and take special care of yourself.
- Get out of the house a little each day. Get a babysitter or take the baby with you.
- Go for a walk, meet with a friend, exchange notes with other new mothers.
- Be sure you spend time with your partner. Tell them how you feel. Often just talking things out with someone you trust can provide relief.
- Blues that do not go away after a few weeks may be a sign of a more serious depression.
- If your feelings do not lessen after a few weeks and begin to interfere with your functioning, contact your health care provider. Tell them about your feelings, including any fears you might have about neglecting or hurting your child.
- Your doctor can refer you to counsellors (psychiatrists, psychologists, psychiatric nurse specialists or social workers) who specialize in treating depression.
- There are hotlines and support groups that may be helpful for women with postpartum depression. See For more information below.
- Sometimes medication may be prescribed along with counselling.
- If you are breastfeeding your baby, be sure to talk with your doctor about any side effects of medication.
- In some cases of severe depression or psychosis, a mother may need to be hospitalized until she can resume normal care of herself and her child.
- During these difficult weeks and months, you will have to learn how to nurture yourself as well as your family.
- Small, daily things can make a big difference...things like taking time for yourself, getting out of the house, reaching out to family and friends, doing only what is needed and letting the rest go.
Finally...
- Many new mothers have periods of sadness, fear, anger and anxiety after childbirth.
- It is important to remember that these feelings are quite common. They do not mean that you are a failure as a woman or as a mother, or that you are mentally ill. They do mean that you and your body are adjusting to the many changes that follow the birth of a child.
- If the baby blues do not go away after a week or two, you may be suffering from postpartum depression. T
- Talk with your health care provider who can refer you to counselling and treatment.
- Even if your depression is severe, treatment is available to help you return to normal as soon as possible.
For more information:
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