Postpartum Depression is a Mental Health Issue

Ultrasounds, pregnancy announcements, gender reveal parties, baby showers and childbirth classes—the events and celebrations centered around a new baby bring immeasurable joy to many expectant mothers. Yet, for 1 in 8 women in the United States, according to the U.S. Centers for Disease Control and Prevention, that joy may soon disappear after she delivers her baby and be quickly replaced by feelings of overwhelm, helplessness and mental distress.

“Having a baby is a life-changing event,” said Melissa Acevedo, M.D., an obstetrician and gynecologist affiliated with South Miami Hospital, part of Baptist Health. “A mother’s sense of self is turned upside down in the days and weeks following delivery.”

Melissa Acevedo, M.D., an obstetrician and gynecologist affiliated with South Miami Hospital.

Dr. Acevedo points to hormonal changes, a lack of sleep because of babies’ often erratic sleep patterns and new family or relationship dynamics as primary causes of distress for women in the early days following the birth of their child. Most women soon learn how to cope with these stressors and manage their new role. But, she says, for some women, disturbing feelings can mount and remain for two weeks or longer past delivery. That’s when postpartum depression is often diagnosed.

Mental Health Screenings

To help with that diagnosis that can often be difficult because women are ashamed to talk about their feelings, Dr. Acevedo begins having conversations about mental and emotional well-being at regular checkups during the pregnancy.

“If a woman has been a gynecology patient of mine, I usually have a baseline of her mental well-being from her annual checkups,” Dr. Acevedo said. “Once she becomes pregnant, or when I begin seeing an obstetrics patient at her regular office visits, we start asking more pregnancy-specific questions to be able to note any relevant changes.” The screening includes questions such as:

• Was this a planned pregnancy?
• How are you sleeping?
• Have you experienced any appetite changes?
• Have your interpersonal relationships with your spouse, partner or other family members changed?

“We ask these questions to remove the stigma,” Dr. Acevedo said. “The more women feel comfortable talking about their mental health, the better chance we have of recognizing a potential problem. We’re going to keep asking these questions at each office visit to be sure the woman is OK.”

Following childbirth, Dr. Acevedo continues these conversations with her patients at their post-delivery checkups. She asks them about their sleep, changes in appetite, the amount of support they have from their loved ones and friends and whether they have had any thoughts about hurting themselves or the baby.

Symptoms of Postpartum Depression

“We parse out any symptoms, the severity of those symptoms and how those symptoms are affecting their lives, their relationships and their ability to bond with their new baby,” she said. “Telltale signs that postpartum depression is present is that these symptoms are severe, last longer than two weeks following delivery and affect quality of life.”

Dr. Acevedo says that “baby blues,” which are often feared to be postpartum depression, resolve within the first two weeks after childbirth and are less severe than symptoms of postpartum depression. Here are common symptoms of postpartum depression:

• Crying and sadness.
• Changes in sleep patterns resulting from a racing mind or persistent urges to check on the baby.
• Eating too much or too little.
• Not being able to bond with the baby.
• Not wanting to do activities that were previously enjoyable.
• Changes to interpersonal relationships.
• Having thoughts of suicide or wanting to harm the baby.

Postpartum Depression and the NICU

For mothers who must leave their babies in the Neonatal Intensive Care Unit, postpartum depression can be especially challenging, Dr. Acevedo says. The mother of a NICU baby herself, Dr. Acevedo acknowledges a higher risk of postpartum depression in this population of moms.

“These women can feel completely inadequate and have tremendous guilt for not being able to care for their baby,” she said. Thankfully, NICUs, like the ones at South Miami Hospital and Baptist Children’s Hospital, take proactive steps to support these women and help them bond with their babies. When safe to do so, mothers are encouraged to feed and care for their babies in the hospital. They also promote kangaroo care, or skin-to-skin contact, which has been shown to strengthen the mother-baby bond.

“The nurses and doctors in our NICU at South Miami Hospital support these moms and remind them that they are most important to their baby’s care,” Dr. Acevedo said.   

Treating Postpartum Depression

If Dr. Acevedo uncovers any indications of postpartum depression in her patients, she recommends treatment, starting with a mental health counselor or therapist.

“These professionals can help retrain the brain to cope with and overcome anxiety and guilt associated with the depression,” she said. “They offer an outlet for the mom and also give them coping skills.”

Additionally, Dr. Acevedo may prescribe medications, such as antidepressants, that are safe for mothers who nurse their babies. She also recommends local support groups for mothers of newborns. Her office partners with a local chapter of Mammha to help women with postpartum depression find local resources like therapists and support groups and helps make and track appointments for the mom.

With treatment and support, mothers overcome their postpartum depression and their babies and their relationship with them thrive.

“It’s vital for us to put aside the stigma associated with postpartum depression by openly talking about it and pointing women to available and effective treatments,” Dr. Acevedo said. “Having postpartum depression doesn’t make someone a bad mom. We need to educate women about this real mental health issue, so they can seek the treatment they need without shame.”