Belinda looks at her 9-day-old son and feels the tears well up again. She’s surprised at how her moods have swung from joyful to sad and back over and over again since his delivery. “This isn’t how I expected to feel,” she whispers to the soundly sleeping infant in her arms. “I thought I would be so happy once you were finally here.”
Rosa can’t believe her daughter is already 3 months old: a bright-eyed, precocious infant who has gained weight and met many developmental milestones early. Rosa herself has had a much more difficult time since Carmen’s birth, experiencing persistent insomnia, problems eating, and waves of doubt and confusion about her own identity. “I don’t even know who I am anymore. Sometimes I feel like a robot,” she admits. “I go through the motions of caring for the baby, relating to my husband, and doing my job at work, but I don’t feel anything. It’s even hard for me to think sometimes. My mind seems all fogged in.”
Liz has been avoiding her family and friends for almost six weeks because she believes they will see how evil her newborn is. When Liz looks at the baby these days, she’s aware only of how wrinkled and defective Tracey seems compared to other smiling, cooing babies on television. The voices tell her the baby isn’t normal, and that a good mother wouldn’t have brought such a bad child into the world. She knows the voices are right. She knows when they tell her that the baby should never have been born they’re only trying to help her make a decision about what to do next.
Belinda, Rosa and Liz are three of the more than 400,000 American women who will experience a postpartum mood disorder this year. But their illnesses, like many other psychological and medical conditions that are lumped together in popular discussions, have much less in common than is generally believed.
Three Chameleon-Like, Complex Conditions
Cheryl T. Beck, D.N.Sc., professor at the School of Nursing at the University of Connecticut, Storrs, and co-author of Postpartum Depression Screening Scale, describes the psychological disorders that mothers develop following the birth of a child as “chameleon-like” in their complexities and varying presentations.
“These disorders take a different form and have a different shade of emotional coloring for each mother,” Beck explains. “What they share is an onset or diagnosis linked to the birthing experience.”
Beck describes the conditions as the “blues,” postpartum depression and postpartum psychosis.
The “baby blues,” Beck and other experts say, are a common reaction to the birthing experience that occurs hours or days after delivery in up to 85 percent of women. It’s a period of wide mood swings, insomnia, and, at times, uncontrollable weeping sometimes for no apparent reason. Belinda’s experience typifies the “baby blues,” and if her experience is like most new mothers’, she will be emotionally back on her feet and enjoying the challenges of motherhood in two weeks or less.
“Teetering on the Edge”
Postpartum depression, in contrast to the quickly developing and time-limited period of depressed or “blue” affect, occurs in 10 to 13 percent of new mothers, and its appearance may be delayed for several weeks or months after delivery. When it occurs, its effects can be deep and pervasive.
Typically such depressions persist for months after they begin. Rosa’s experience is a common one, but the disorder can take many forms with wide variations in maternal concerns, symptoms, affective responses and behaviors.
In a 1993 article in Nursing Research, Beck described such depressions as “teetering on the edge.” She notes that new mothers experiencing them exhibit at least one, and often many, of the following characteristics, all of them relating to a sense that they have lost control of their lives as they spiral into increasing levels of loneliness and despair after giving birth:
- Feelings of loss of self. Some new mothers feel they no longer know who they are, says Beck. They describe themselves as feeling “like robots,” with no positive feelings or “going through the motions” of living, with no emotional connection to their husbands or other family members, and no sense of identity or purpose.
- Feelings of guilt or shame. New mothers struggling with a burden of guilt or shame may also perceive themselves as bad mothers, incapable of caring for their infant or undeserving of having a child or loving spouse. Beck says some carry a “suffocating burden of fear or guilt at the thought they may harm their infant,” although such thoughts are seldom acted on.
- Overanxious and insecure. New mothers who are overanxious may feel they lack mothering skills and can’t do anything right with their new infants; some are afraid they are losing their minds. They may experience paralyzing bouts of terror and fear.
- Concern about harming self. As the sense of losing control builds, some new mothers may become concerned that they will harm themselves.
- Difficulties eating or sleeping. Achieving pre-pregnancy or pre-delivery levels of food consumption or sleep is often difficult for new mothers, over and above sleep pattern alterations associated with meeting their infant’s care needs. Some mothers cannot sleep even when their infant is asleep and not requiring their care.
- Difficulty thinking. Some depressed new mothers often complain that their thinking is unclear or disconnected. They also report difficulty concentrating, or maintaining a focus on people or activities that were previously pleasurable. “Some women communicate that this feels like ‘the fog is rolling in,'” explains Beck.
- Wide swings in mood or affect. Postpartum depression is like a mood roller coaster for some women, as they swing from the heights of elation and joy to the depths of despair and sadness, at times cycling up and down rapidly and often. They may be more irritable and more easily angered or upset than in the period before pregnancy or delivery.