Congratulations - you've just given birth to a "little bundle of joy!" Everyone wants to believe that being pregnant and giving birth changes a woman instantaneously into a kind, nurturing, patient person called Mommy. But for many women, the birth of a baby may be a distressing time fraught with a wide range of emotions including sadness, anxiety and confusion. Sometimes, these feelings can be an indication of postpartum depression (PPD). PPD does not mean that you are "going crazy", are a bad mother or are to blame. You are not alone and there is help and treatment.

Feelings After Birth

• The "Baby Blues"
  The baby blues are a very common reaction after giving birth, with up to sixty per cent of women experiencing them. Symptoms usually start three to four days after delivery and last several days, or sometimes as long as two weeks. If you have the baby blues, you may experience mood swings, going from feeling happy one minute to crying the next. Other symptoms include feeling a little "depressed", having trouble concentrating, loss of appetite, irritability and lack of confidence. This condition is a minor disorder and is considered a normal part of early motherhood. Usually, it does not require any treatment and will disappear on its own within a short time.

• Postpartum Depression
  Postpartum depression (PPD) affects approximately ten to twenty per cent of new mothers. Its onset can begin days, weeks or sometimes even months after delivery. Depression that occurs within the first six months of childbirth may be PPD and should be assessed by a physician or qualified mental health practitioner. PPD is different from the "baby blues" as it lasts for a longer period of time, can feel overwhelming and debilitating and can prevent daily functioning.

• Postpartum Psychosis
  Postpartum psychosis is a rare disorder that affects approximately one out of every thousand women who give birth. It normally occurs within the first two weeks of childbirth and is marked by exaggerated symptoms such as insomnia, hallucinations, hyperactivity/mania, rapid speech, paranoia, extreme confusion, agitation and depression. Postpartum psychosis is a serious condition that requires immediate medical attention or hospitalization.

Symptoms of Postpartum Depression

Though each woman's experience of PPD is different, women may experience many of the symptoms listed below, ranging from mild to severe.

• Insomnia and exhaustion
• Changes in appetite and weight loss
• Difficulty concentrating or making decisions
• Feeling restless, irritable or anxious (may experience anxiety/panic attacks)
• Persistent sadness, increased or uncontrollable crying
• Loss of interest in pleasurable activities (including sex)
• Feelings of despair, worthlessness and hopelessness
• Feelings of guilt and being a "bad mother"
• Lack of interest in the baby
• Feeling that life isn't worth living and thoughts of harming yourself
• Fears of harming your baby

Causes of Postpartum Depression

The exact causes of postpartum depression are not known. Current research points to several factors that may contribute to or "trigger" PPD.

• Physiological Changes- Almost immediately after birth, there is a rapid change in hormone levels (eg, a decrease in estrogen and progesterone). It is thought that these hormone changes may produce chemical changes in the brain and play a part in causing depression.

• Physical Exhaustion- The physical drain from giving birth and the sleep deprivation that comes from having a newborn can significantly impact a mother's mood and ability to cope and may contribute to the emergence of PPD.

• Sociological Factors- Being a new mother can be emotionally gratifying but in our society there is also a lot of pressure put on new mothers to be "supermoms." Mothers are expected to know intuitively how to be a great parent. Sometimes, this can lead to feelings of guilt, inadequacy and isolation. Feeling overwhelmed by all the new responsibilities and expectations may trigger PPD.

Other Risk Factors

There are several additional factors that may put a woman at risk of developing PPD. Even though these factors do not necessarily cause PPD, it is important to be aware of them so that if you are "at risk" you can put some coping and support mechanisms in place before the birth of your child, potentially preventing PPD from developing.

• Previous or family history of depression
• Previous postpartum depression
• Severe PMS
• Early childhood trauma or a history of abuse
• A difficult marriage or unsupportive partner, family or friends
• Unplanned pregnancy
• Obstetrical complications
• Major life changes or stressful life events during the pregnancy or after the birth (e.g., job loss, relocation, death in the family)

Treatment for Postpartum Depression

Treatment for PPD can take a number of forms and like its symptoms will be very individual. You need to find out what works for you and sometimes this can take a bit of time and experimentation. A typical treatment plan may include:

1. Creating a supportive environment for the new mother: enlisting the support of family, friends, relatives and homecare workers to assist you as you transition to your new role.
2. Self-Care: proper nutrition and exercise
3. Counselling: support from a qualified mental health practitioner
4. Support groups: self-help and community groups that provide education and emotional support for women experiencing PPD
5. Medication- the use of anti-depressants may help alleviate symptoms

No matter what treatment approach is taken, it is important to remember that you did not cause your postpartum depression and its symptoms are temporary and treatable!

Tips for Coping with Postpartum Depression

• REST! Avoid getting over-tired or exhausted. Plan times when you can rest and if possible nap when your baby naps. Get help from family and friends who can look after the baby while you get some sleep.

• Talk to your doctor about how you are feeling. He or she may offer emotional support or medications that can help. Be sure to check with your doctor before starting any medicines (herbal or artificial), especially if you are breastfeeding.

• Find some time to do something for yourself everyday, even if it is only for 15 minutes. Go for a walk, take a bath, read, meditate.

• Maintain open, honest communication with your partner and try to arrange shared responsibility for the household chores and the baby so you do not become overburdened.

• Ask for help. You are not expected to be "supermom." Be honest about what you can handle and let others know what you need.

• Eat well. Do not skip meals. Eat nutritious, balanced meals and try to avoid high sugar and high fat junk food.

• Avoid all alcohol and recreational drugs.

• Keep a journal or diary as a way of expressing how you feel and "let it all out."

• Take one day at a time. Focus on the goals for the day. Even if you can only get one thing done, this is a step in the right direction. Try to be patient, gentle and forgiving with yourself.

• Find a PPD support group in your area. This can be a resource for practical information or just a place to express yourself. You will feel less alone being around others who understand and share what you are experiencing.

• Build a support network that includes family, friends or a counsellor with whom you can talk about your feelings, fears and concerns.

• Remember that it is OK to feel overwhelmed - almost every new mother does! It does not mean that you are a failure as a mother. Having a child is a major life event and one that can bring with it a lot of stress and anxiety. It is a learning process and it will get easier.