Out Of The Blue

Many new moms are blindsided by postpartum depression. Learn about some lesser-know risk factors and what you can do during pregnancy to minimize them so it doesn't happen to you.

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Until her son was born in 2008, Karen (not her real name) had never suffered from any kind of depression. Her health was good, she liked her job, she was financially secure and her marriage was strong. "My husband and I were very excited about the baby's arrival," says Karen, 31, who lives in Chicago. "I was doing all the normal things to prepare for a baby—getting the nursery ready, planning a last getaway for us as a couple and looking forward to my baby shower."

At 24 weeks, Karen suddenly began hemorrhaging, and her husband rushed her to the hospital. After 10 days on bed rest, she delivered her son via emergency Cesarean section. He weighed less than 2 pounds and would have to spend three months in the hospital. The next weeks were very difficult: While spending as much time as she could with her baby, Karen developed a blood clot in her leg and had to be hospitalized. Her son underwent heart surgery. When she lost her appetite and developed insomnia, Karen chalked it up to stress. But then she started having some scary feelings. "I suddenly was convinced I wasn't fit to be a mother and that my husband and son deserved so much better. I would think about the fact that they might be better off if I left and my husband could find someone better," Karen says.

One day when she drove to the hospital to see her baby, Karen couldn't leave her car. "I was numb and frozen in panic," she recalls. When she finally was able to move, Karen headed for her OB-GYN's office and shared her feelings with a trusted nurse. She was soon diagnosed with postpartum depression (PPD). Although it's known to strike 10 percent to 20 percent of new mothers (see "Facts About PPD," below), the condition is often kept secret because women who develop it feel ashamed or guilty.

Medication and therapy helped Karen feel better. Now, both she and her son are fine. Karen was shocked when she found out she had PPD. After all, she had none of the major risk factors, such as a history of depression before pregnancy or anxiety during it. But like many women, Karen didn't realize that PPD can strike nearly anyone, especially if any of a number of less-common factors applies to them. Some will surprise you. For example, women who have diabetes before becoming pregnant are twice as likely to develop PPD. Women who blame themselves for things that are not their fault or who take rejection very personally are also at greater risk.

Here are 10 other lesser-known risk factors for postpartum depression, along with steps you can take now, while you're still pregnant, to lower your chances of developing it.

Your pregnancy was unplanned.

An unexpected pregnancy can be a huge shock. Even if you choose to go ahead with it, you're more likely than women whose pregnancies were planned to have mixed feelings about becoming a mother—and that ambivalence can affect your emotional health before and after delivery, particularly if you're a glass-half-empty kind of gal, says Sara Rosenquist, Ph.D., a reproductive health psychologist in Chapel Hill, N.C., and author of After the Stork: The Couple's Guide to Preventing and Overcoming Postpartum Depression (New Harbinger).

Prepare yourself: Try not to dwell on the negative aspects of having a child. "We have a choice about what to pay attention to—the positive stuff about this baby or the negative stuff," Rosenquist says. For example, if you're an older mother who thought her diaper-changing days were behind her, think about what great parenting perspective and wisdom your age and experience will give you.

You're having relationship problems.

Couple troubles put an enormous strain on expectant parents. "They increase stress and disappointments," Rosenquist says. "That friction may very well lead to depression."

Prepare yourself: Contrary to the gauzy images we're all bombarded with, research has shown that having a baby increases marital stress rather than decreases it, so get help now from an experienced marital therapist. Working out problems can take time and energy, both of which will be in short supply when your baby arrives. Don't be ashamed to ask friends for referrals—you'll probably be surprised how many of your pals have had couples therapy, Rosenquist says.

You lack support.

You feel all alone—you have an unhelpful partner (or none at all), no close friends nearby, an unsupportive or unavailable family or antagonistic in-laws. This kind of isolation leaves you without the assistance, encouragement and comfort that can help you cope with problems and feel strong.

Prepare yourself: Start building a support system before the baby comes, says PPD researcher Michael O'Hara, Ph.D., a psychology professor at the University of Iowa. Create a village. Nurture new relationships, reach out to old friends, build bridges with estranged family members and join support groups. If you can afford it, get on the phone now and line up a postpartum doula or baby nurse to help after the baby arrives.

Your finances are rocky.

Money struggles are tough at any time, but they weigh especially heavy when you're about to bring a new life into your family. The stress is even greater if you lack adequate health insurance coverage or expect to receive little or no income while you're on maternity leave. "How much financial uncertainty you have in your life is a huge risk factor for postpartum depression," says Rosenquist.

Prepare yourself: Sit down with a financial expert or money-savvy friend who can help you put together a money plan that works. You won't find any magic answers, but you'll probably feel more in control (and less anxious) if you have a solid strategy in place, Rosenquist says. Also, get in-the-know about how to spend less on your baby's needs. Having a baby can cost less when you make smart moves such as asking friends for hand-me-downs, joining a child care co-op, downloading baby-product coupons from such websites as freebabycoupons.com and breastfeeding rather than using formula.

You experience something very stressful.

The death of a family member or friend, a divorce, a major injury or medical diagnosis, a job layoff or even a move to a new home can raise anyone's depression risk for about a year. But the added challenges of pregnancy, delivery and parenting an infant during that period may push you over the edge, according to Maria Muzik, M.D., an assistant professor at the University of Michigan Health System and an expert in women's reproductive mental health issues.

Prepare yourself: If possible, avoid making big life changes, such as moving, during pregnancy and the postpartum period, Muzik says. If you can't, alleviate the physical and emotional strain by using such stress-reduction techniques as meditation, visualization, moderate exercise and prenatal yoga. Get plenty of rest and pay special attention to carving out time to relax and spend time with loved ones. If you've experienced a loss, get help coping by asking friends for extra emotional support or by talking with a therapist or grief counselor.

You're a perfectionist.

"Perfectionism is a risk factor for postpartum depression," says Kim Zittel, Ph.D., M.S.W., an assistant professor in the social work department at Buffalo State College in New York and author of Postpartum Mood Disorders: A Guide for Medical, Mental Health, and Other Support Providers (NASW Press). A perfectionist may have completely unrealistic expectations, picturing herself as the perfect mother, her partner as a model father and their baby as an absolute angel. But when reality hits, Zittel says, she can be thrown off her axis and start blaming herself for the normal problems that inevitably arise. "Pregnancy and birth can be out-of-control experiences," Muzik explains. "Having rigid expectations and being a perfectionist may be a risk for a more difficult transition."

Prepare yourself: First, identify some of your perfectionist expectations about parenting. Then use visualization to give yourself a reality check about them and envision good-enough alternatives. For example, say you plan to deliver your baby naturally. Picture an intervention-filled delivery that is exactly what you don't want, Zittel suggests. Then, visualize that you and your baby are just fine even though delivery didn't go quite the way you expected it. "Recognize that you will have to lower your standards and adjust to the baby rather than expect the baby to live up to your standards," O'Hara says.

You will be making a major job change.

"Role transition can be very stressful," Muzik says. Whether you're quitting your job to be a stay-at-home mother, swapping a high-powered career for a lower-status position or choosing to work from home instead of commuting to the office, a big change in your role can cause emotional upheaval or depression. Women who go back to work when they'd rather stay home are also vulnerable to depression, Muzik adds.

Prepare yourself: Spend some time visualizing—and planning for—the difficulties of the transition, Zittel suggests. For example, if you're quitting work to stay at home with your baby, acknowledge that there will be days when you will feel lonely because you'll be stuck in the house with a crying infant. Make connections now with other stay-at-home moms so you can get together for coffee or walks. If you're downgrading to the slow lane in your career for a while, focus on how this will benefit you and your baby rather than on its potential negative effect on your professional life, Zittel says. Plan to maintain relationships with influential co-workers so you can hop back into the fast lane when your baby is older.

You generally feel stressed and anxious.

Do you worry more than most people? Are you stressed by situations that don't ruffle your friends? Have your anxiety levels been increasing during pregnancy? Your tendency to fret may mean that postpartum stresses and anxieties will affect you more deeply than other new mothers, according to Zittel.

Prepare yourself: Acknowledge your tensions, discuss them with your partner and recognize that you'll need an extra dose of support after your baby is born. Make plans now for lots of assistance from your partner, friends, family or hired help during the first weeks postpartum to allow you to rest and recharge your emotional batteries. If anxiety worsens, talk with your doctor, Zittel advises—some antidepressant and anti-anxiety medications are safe during pregnancy and can prevent things from getting worse.

When Dads Get Down.

A study published last year in the Journal of the American Medical Association reported that 10.4 percent of new fathers develop "paternal depression" sometime during their partners' pregnancies or their babies' first year of life. That's about twice the rate of depression among men in the general population. The study also found that new fathers are more likely to be depressed if their partners have PPD. Symptoms are similar to those women experience—feelings of sadness, loss of interest in enjoyable activities, irritability, anger, changes in weight or eating patterns and sleep problems.

Facts about PPD

  • Seventy percent to 80 percent of women feel somewhat sad, afraid or anxious starting about two or three days after giving birth. But these feelings usually go away in a few days. If the "baby blues" become intense or don't go away within a week, it may be postpartum depression.
  • PPD can occur at any time but most commonly begins one to three weeks after delivery.
  • Symptoms of PPD include anger, irritability, crying for no reason, appetite changes, anxiety attacks, sleep problems, trouble bonding with your baby, questioning your ability to be a mother, upsetting thoughts and fear that you may hurt yourself or your baby.
  • Doctors treat PPD with talk therapy and/or antidepressant medications that are safe for nursing mothers.
  • In rare cases, PPD develops into a much more dangerous condition known as postpartum psychosis.

Catch it early If you suspect you may have PPD, contact your doctor or midwife right away. Early treatment can prevent it from getting worse or from lasting a long time. If untreated, PPD can continue for months or years. Postpartum Support International provides more information about recognizing PPD, along with contact information for local support groups and other resources. Visit its website, postpartum.net, or call 800-944-4773.

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