Recognising and coping with postpartum depression
Especially during the first days after a birth, the idyllic image of a contented baby and joyful mother is often far from reality. Many new mothers are irritable and prone to crying spells, a condition known colloquially as the "baby blues."
Between 10 and 15 percent of them are still unhappy after several weeks, feel little for their newborn and have trouble sleeping. These could be symptoms of postpartum depression.
"During their fertile years, women are general at a higher risk of depression than men; the number of depressed mothers is not much higher than that of childless women," noted Anita Riecher-Roessler, chief physician at the Psychiatric University Polyclinic of the University Psychiatric Clinics in Basel, Switzerland.
Riecher-Roessler has written a book on mental illnesses during pregnancy and breastfeeding.
"Depression or another mental illness in mothers has greater consequences because it can impair the bond with the child," she says.
It is important for a baby's development that the mother react appropriately to the baby's needs.
"Baby blues typically last just a few days to two weeks. Some women don't have them at all. They can, however, lead to depression, which isn't always easy to recognize," said Brigitte Ramsauer, a psychologist at the University Medical Centre Hamburg-Eppendorf in Germany.
Midwives can play a key role in detecting the symptoms of postpartum depression. "We have the advantage of visiting the women in their homes and spending more time with them," said Dagmar Weimer, a psychologist and midwife in the Bavarian community of Kleinostheim.
Weimer said there was a condition in between the baby blues and long-term depression that she calls "puerperal crisis," from the Latin word puerperium: the approximate six-week period lasting from childbirth to the return of normal uterine size.
"The first six to eight weeks after delivery may be marked by anxiety and lethargy, which can - but does not always - become depression," pointed out Weimer, who said it was important that new mothers get help.
"I draw up a self-help plan with the women," with the top priority being sufficient sleep, for example, after which the women can consider what tasks their partner or a relative can assume.
Weimer refers women unable to say what would help them - an alarm signal - to a nearby psychologist or psychiatrist. Pregnancy counselling centres and support groups can also be helpful, she said.
At the North Baden Psychiatric Centre in the German city of Wiesloch, new mothers are admitted with their baby for six to eight weeks of in-patient treatment. The fathers and other important relatives are involved as well.
"Along with psychotherapeutic and medicinal treatment of the women, we work primarily on the relationship between the mother and child," said Christiane Hornstein, head of the centre's mother-child project.
When a postpartum mental health disorder is treated, the chances of recovery are excellent, according to Riecher-Roessler. Psychotherapy is often sufficient, she said, adding that antidepressants can help in serious cases.
She said that women should consider the advantages of stopping breastfeeding.
"For example, the partner can bottle-feed the baby at night to let the woman sleep through, which is very important if she's depressed," Riecher-Roessler said. The better a mother feels, the better she can interact with her baby.