You may be wondering if you have postpartum depression (PPD). Conversations on social media have brought lots of awareness to the topic! It is a surprisingly common condition… 1 in 9 mothers experience some form of postpartum depression. (1,2)
Being a new mother comes with so many questions and uncertainties. It is completely normal to feel scared, unprepared or anxious. Certain experiences, however, can potentially trigger some form of postpartum depression. Below is a list of experiences that could be the cause of postpartum depression.
Strong evidence supports that the experiences listed below (1-8) could contribute to PPD risk: (3,4)
1. History of depression or other mental health issues
2. Low social support
3. Not first pregnancy and/or child
4. Poor postpartum physical health
5. High number of unmet learning needs about the postpartum period
6. Urinary incontinence (loss of bladder control)
7. Problems with breastfeeding
8. Domestic violence or exposure to domestic violence
The following two (9-10) are much less certain and are supported by weaker evidence:
9. High substance use during pregnancy
10. Low socioeconomic status
If you have experienced a number of these things, then perhaps your suspicions about postpartum depression are correct. Below are more details about each topic to better explain how they can predict PPD risk.
1. History of depression or other mental health issues
Research suggests that women who’ve suffered from mental health issues in the past could have a slightly higher chance of developing postpartum depression. Women who suffer from postpartum depression often also showed symptoms during pregnancy. This could be one indicator that you could be experiencing postpartum depression. Mental illness is an unbelievably complex topic, and difficult to understand, but there is some chance you could experience depression as a new mom if you have been depressed in the past. (3,4,5,6)
2. Low social support
Another topic that has strong evidence is that women who feel alone, socially isolated and unsupported may have a higher risk of PPD. Becoming a mother brings many obstacles, and feeling like you’re alone in it and that no one has your back can be terrifying. Being worried is very common, especially when a mom doesn’t have a strong support system, which can make her more susceptible to depression. (3,4,7)
3. Not first pregnancy and/or child
Pregnancy can be scary and stressful, especially if a mother has had more than one pregnancy. Some statistics show that women who are having their second pregnancy may be more predisposed to postpartum depression. Other sources of depression-causing anxiety could stem from a previous pregnancy that was terminated, ended in a miscarriage or resulted in birth trauma. Understandably so, a mother might feel extra nervous about a pregnancy following such difficult experiences. This history can be triggering, and could affect a mother’s mental health when she is reminded of it during later pregnancies. (3,4)
4. Poor postpartum health
A woman’s health can change dramatically after birth—especially after particularly extreme childbirth injuries, or from challenges with mental health. One of the most stressful possibilities during recovery is being readmitted to the hospital. Readmission indicates that there are big problems that need to be solved with professional help. Large issues after birth, like complications of perineum healing naturally cause stress and anxiety. It is for these reasons that poor postpartum health, particularly those health issues that are severe enough to warrant a return to the hospital, can increase a mother’s risk of postpartum depression. (8,3,4)
5. High number of unmet learning needs
Occasionally health professionals will completely neglect to inform a new mother of the transitions she’ll face after childbirth. In this case, a mother who is extremely unaware of the obstacles she will face may be more susceptible to PPD. But remember, it is normal to feel anxious, doubtful and unprepared for childbirth and motherhood. This predicting factor only resembles the most extreme cases. (3)
6. Urinary incontinence (loss of bladder control)
Urinary incontinence is also known as lack of bladder control. You might be familiar with it from pregnancy! It is also a common experience after childbirth, and can present itself as a frequent or severe urge to urinate, a sudden urge after coughing or sneezing, and it can possibly result in an accident. Another form of urinary incontinence is dripping or leaking because the bladder cannot empty completely. Leaking is also common after a vaginal delivery because the bladder and urethra muscles are healing from the act of pushing. Naturally, urinary incontinence can be the source of anxiety and embarrassment despite how common it is. (3)
Lack of control is frustrating! Urinary incontinence has a large impact on new moms everywhere. No one enjoys having urination issues, and the negative feelings it creates is yet another factor that could increase the risk of postpartum depression. (3)
7. Problems with breastfeeding
Having issues with breastfeeding? Most moms do! The feeling of frustration, guilt or even incompetence are completely normal—all moms have doubts about their maternal performance! These sentiments could be one factor that could cause postpartum depression, particularly if you are unable to breastfeed at all. This is a tough experience as a mother who expected to nourish her baby all on her own. You may feel angry and frustrated, but you certainly are not alone! (3)
8. Domestic violence or exposure to domestic violence
Similarly to feeling unsupported, a new mom who is physically abused at home is likely not getting the support she needs. So many changes occur when you have a baby, including hormone changes and frustrating obstacles with being a mother. Feeling unsupported amidst these challenges can increase a mother’s risk of postpartum depression. It is important that a mother feels socially supported, which may help protect her from falling into a depressive period after birth. Mothers are also more at risk of PPD if they have been exposed to domestic violence sometime in the past. (3,9)
9. High substance use during pregnancy
This topic does not have sufficient evidence but may be relevant. Most women know substance use is discouraged during pregnancy. Some studies show that smoking and considerable alcohol intake during pregnancy may elevate a mother’s chance of postpartum depression. (3,4)
10. Low socioeconomic status
This topic is not well supported and has inconsistent evidence, but every mom has the right to make her own decisions about postpartum information!
Most know that there are many intersecting factors that form one’s socioeconomic status. In relation to new moms, however, there are particular factors that have been researched: education, very young age, amount of support, and income A woman who hasn’t obtained a high school education might experience a heavier financial burden while raising a child, which can increase her stress levels during and after pregnancy and predispose her to PPD. An extremely young mother might also feel overwhelmed and anxious. In many cases, these mothers might not have a partner or family taking some of the pressure off of raising a baby. In these situations, new moms face more challenges, stress and anxiety leaving them more vulnerable to bouts of postpartum depression. (3)
A mother who has a low income might feel anxious about getting by with a little one on the way. It is normal to be worried about life with a baby. Raising a child is expensive! Each year a parent could spend over $10,000 raising a child. Motherhood is challenging, particularly without plenty of resources. This is why socioeconomically low mothers are more likely to be predisposed to postpartum depression. (3)
Conclusion
Many things could influence a mother’s risk of developing postpartum depression—previous experience with mental health issues, feeling socially unsupported, domestic violence postpartum or in the past, anxiety, worry, setbacks during recovery and the ever-so-challenging breastfeeding! With childbirth, there are seemingly countless new experiences and complicated emotions… but every mother deserves to understand the factors that contribute to her postpartum mental health. (3,4)
References
Yeon Lee Ji and Yun Hwang Jong, 2015. A study on postpartum symptoms and their related factors in Korea. Taiwanese Journal of Obstetrics and Gynecology, Volume 54, Issue 4, Pages 355-363
Ko JY, Rockhill KM, Tong VT, Morrow B, Farr SL. Trends in Postpartum Depressive Symptoms — 27 States, 2004, 2008, and 2012. MMWR Morb Mortal Wkly Rep 2017;66:153–158. DOI: http://dx.doi.org/10.15585/mmwr.mm6606a1
Christie A. Lancaster, MD, MS, Katherine J. Gold, MD, MSW, MS, Heather A. Flynn, PhD, Harim Yoo, Sheila M. Marcus, MD, and Matthew M. Davis, MD, MAPP, 2010. Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol. 2010 Jan; 202(1): 5–14. doi: 10.1016/j.ajog.2009.09.007
D. Fisher Sheehan, K. Sit Dorothy, Yang Amy, D. Ciolino Jody, K. Gollan Jackie, L. Wisner Katherine, 2019. Four maternal characteristics determine the 12-month course of chronic severe postpartum depressive symptoms. The anxiety and depression association of America
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Ahmed Asma, Bowen Angela, Xin Feng Cindy, Muhajarine Nazeem, 2019. Trajectories of maternal depressive and anxiety symptoms from pregnancy to five years postpartum and their prenatal predictors. BMC Pregnancy and Childbirth, 19: 26, doi: 10.1186/s12884-019-2177-y
D. Fisher Sheehan, K. Sit Dorothy, Yang Amy, D. Ciolino Jody, K. Gollan Jackie, L. Wisner Katherine, 2019. Four maternal characteristics determine the 12-month course of chronic severe postpartum depressive symptoms. The anxiety and depression association of America
Norhayati M.N., Nik Hazlina N.H., Asrenee A.R., Wan Emilin W.M.A., 2015. Magnitude and risk factors for postpartum symptoms: A literature review. Journal of Affective Disorders, Volume 175, Pages 34-52
Alexandre Faisal-Cury, Paulo Rossi Menezes, Ana Flávia Pires Lucas d’Oliveira, Lilia Blima Schraiber, Claudia S. Lopes, 2012. Temporal Relationship Between Intimate Partner Violence and Postpartum Depression in a Sample of Low Income Women. Maternal and Child Health Journal. September 2013, Volume 17, Issue 7, pp 1297–1303
Image Credit: Women's Health Today
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