Perinatal Depression: Not Just the 'Baby Blues'

While being pregnant is most often characterized as a happy, feel-good time for a mother-to-be, it can also be a time of stress and despair for some. Changes to a woman’s body with accompanying aches and pains, shifting family dynamics, and physiological changes causing hormonal imbalances all can take a toll.

According to the American College of Obstetricians and Gynecologists (ACOG), perinatal depression – which is defined as depression during or just after pregnancy – affects as many as one in seven women in the U.S.

“The prevalence of perinatal depression is very significant and can be quite scary,” says Jason James, M.D., chief of obstetrics and gynecology at Baptist Hospital of Miami. “As obstetricians, it’s our job and obligation to properly screen, evaluate and treat patients effectively.”

“Baby Blues” or Depression?

Dr. James says it’s important to differentiate between clinical postpartum depression and the “baby blues,” a term often used when referring to a woman experiencing crying, sadness and other depressive symptoms after having a baby. Perinatal depression can occur at any time during and after pregnancy and can have seriously negative effects on mom, baby and the family.

“Moments of feeling overwhelmed or sad during the first few days or weeks after having a baby are typically categorized as ‘postpartum blues’,” he said. “It’s when these feelings worsen or last for weeks it can mean clinical depression that needs intervention and treatment.”

In general, the first six weeks after a baby is born is considered the postpartum time period, says Dr. James. Significant hormonal changes to help foster breastfeeding can affect the brain’s neurotransmitters that regulate mood. The time it takes a woman’s hormones to revert back to pre-pregnancy levels depends on many different factors, Dr. James says, including how easy or difficult breastfeeding is, sleep deprivation and lack of social support.

“Postpartum depression can happen any time within the first year after giving birth,” he said. “Since the first postpartum doctor’s visit for women who deliver vaginally typically occurs at six weeks, they may not be evaluated for mood disorders in a timely manner. It’s important to include proper screening for depression and other mood disorders as part of well-baby care, since a mother’s mood also affects baby’s health and well being.”

Screening for Perinatal Depression

Current protocol for detecting perinatal depression includes a risk assessment for patients at least once during, and once after, pregnancy using a standard screening tool composed of questions that evaluate a patient’s mood, sleeping and eating habits, and social support systems. Postpartum screening is a standard of care for maternity patients at Baptist Hospital, South Miami Hospital’s Center for Women & Infants, Homestead Hospital and West Kendall Baptist Hospital.

According to perinatal depression screening recommendations recently released by ACOG, factors that increase a woman’s risk for depression during pregnancy include stress, being single and a history of depression or another mood disorder, such as anxiety. After baby is born, factors that increase a mother’s risk of postpartum depression include a traumatic birth experience, lack of social support, a sick baby and breastfeeding problems.

Dr. James says the recently released ACOG opinion is a positive step in the movement to raise awareness of the benefits of screening for perinatal depression.

“By screening for depression during and after pregnancy, we’ve had many successes in identifying patients who need help,” said Dr. James. “Proactively identifying anxiety and other stressors that can accompany pregnancy allows us to detect mood disorders and avoid potentially dangerous situations that can affect mom and baby, alike.”