Many women go through a few weeks of “baby blues” during the months after childbirth. Estimates vary from 40% to even 70% of all mothers having had such a temporary emotional setback. Usually a combination of very different causes can contribute to this: specific physical after-birth problems such as incontinency or sore nipples, the daily burdens of new responsibility, doubts if you’re an adequate mother, lack of sleep due to the baby’s crying, hormonal changes, sometimes a certain disappointment because actual motherhood turns out to be different from idealized motherhood, and so on.
For some, these fairly natural “baby blues” can worsen and instead of fading away again, will grow into a more persistent postnatal depression. Depending from how exactly you define “postnatal depression”, according to modern research roughly 10% to 15% of all mothers develop a more or less serious depression in the year after giving birth. One of the many things that play a role here, is that a case of simple “baby blues” can get worse by itself: this can happen if you start worrying about it, feeling guilty for not being as completely happy as a good mother is supposed to be.
Postnatal depression was already known thousands of years ago; we can clearly recognize it in some old Greek and Roman stories. Since the 19th century, it has gradually got more attention. Today, there are many websites offering background information on causes, symptoms and therapies. So I will not try to do here what many others have already done better. Just find yourself an informative website, preferably one by a trustworthy non-profit organization. Try for example the Postnatal Depression pages of the British National Health Service.
As you may know I’m not particularly fond of simple online depression tests. I think they are too superficial and often misleading. The standard short 10-question test for postnatal depression is the 1987 Edinburgh Postnatal Depression Scale.
If you really want to, you can do this EPDS test online (select your answers and click “add up score” for a result). Just remember that the outcome, whatever it is, is not a hard fact but only a very rough indication.
If for whatever reason you think you have postnatal depression, you should seek professional help. Without proper attention and treatment, a postnatal depression can take a long time. It will mean a difficult time anyway. But with the right treatment, you will get over it. And although it can be a terrible and maybe even terrifying experience, it is not necessarily dangerous.
In a few exceptional cases, about 0.1% (so only one in a thousand), something can happen that is worse than postnatal depression, and in fact is something different: postnatal psychosis (also known as “puerperal psychosis”). The first one who really systematically discerned this, was the German gynecologist/obstetrician Friedrich Benjamin Osiander. In 1797, he gave an extensive description and analysis of postnatal psychosis in his book Neue Denkwürdigkeiten für Aerzte und Geburtshelfer (“New Memorable Facts for Doctors and Obstetricians”).
Postnatal psychosis can make you not just very depressed, but also very agitated, and often you lose any clear judgment of your own situation. You can get distorted or delusional ideas, start to act in strange or desperate ways. In the most extreme cases you can become a danger to both yourself and your child.
But something like this will happen only to a tiny minority, and within that little group, the group where such a danger really becomes acute, is even smaller. Perhaps, to put things into perspective, will it help to visualize things here a little? In the diagram below, the group with postnatal psychosis is in fact so small that to show it in proportion, we should have made it completely invisible.
Still, in the few cases where it comes to postnatal psychosis, this can end in catastrophe. Some of these cases are so tragic that they get much publicity – and this publicity can make us think such tragedies happen more often than they actually do.
Two examples of high-publicity cases: the one of Melanie Blocker-Stokes, who after she had given birth to a healthy daughter developed delusions, began to behave strangely, and a few months later killed herself. And the much-discussed tragedy of Andrea Yates, who in a postnatal psychosis killed all her five children by drowning them in a bathtub.
Although postnatal psychosis does not happen very often, research indicates that the people who already have a past of depression (especially bipolar disorder) are relatively more vulnerable.
This may (or may not) be illustrated by another high-publicity case. In 1994, Susan Smith drowned her two children (a 3- and a 1-year old) by letting her car, with the children in it, roll into a lake. Just like later with Andrea Yates, there was heated discussion about whether Smith should be seen as a perpetrator, or as a victim.
Because for nine days after her children’s disappearance she’d kept pretending that they had been kidnapped, and because she was in love with a man who didn’t want children, some saw her simply as a devious, scheming, heartless murderess.
On the other hand, others pointed out how very likely it was she had been suffering (and acting) from postnatal psychosis, also in view of her past: her father had committed suicide when she was 6, her stepfather had sexually abused her, and she herself had already made two suicide attempts, at age 13 and 18.
In the end Smith was convicted to life in prison. But still the tragic story of her and her children kept appealing to many, even got something like an emblematic dimension. Do you know the 2008 album Lantana by the wonderful folk singer (country-ish folk singer) Caroline Herring? Her song Paper Gown is directly inspired by this tragedy. In fact, in this song, Herring is trying to give a voice to Susan Smith.
See the official Caroline Herring website for more of her music (she’s really worth a click). – UPDATE: I just found out her site has now gone offline for a redesign, temporarily redirecting to her Facebook page. So maybe you’ll have to try that instead.
Anyway, here she is with Paper Gown, singing about how Susan Smith came to kill her children:
(click the “Play” button – if it does not work, install Flash)
Meanwhile, do you notice how even I could not resist focusing here on this extreme, dramatic, terrible, but relatively rare aspect of postnatal psychosis? While in fact I was planning to focus on the much less rare, but also less spectacular, more drab aspect of postnatal depression?
Common postnatal depression is also a terrible ordeal, sure, but usually it will not lead to suicide or killing your children. With some help and support from others, you will be able to overcome it. So let’s conclude with a few basic tips.
1. Having the “baby blues”: in the first months after childbirth this is fairly normal, and certainly nothing to feel guilty about. Instead of blaming yourself for not living up to expectations, try to pinpoint what specific causes are making you sad or unhappy at times. Talk openly about this with others.
2. If you continue to feel really very unhappy and inadequate for at least several weeks on end, then you should begin to ask yourself if you’re developing a postnatal depression. Ask for advice; do not hesitate to seek professional help. Maybe you need some kind of temporary therapy. Perhaps even, for a while, a little medication: not all antidepressants are incompatible with breastfeeding.
3. If you have had serious depressions in the past, in the form of bipolar disorder or otherwise, then you may run a slightly higher risk than others to develop postnatal psychosis. Even though the risk will still be very small, in this particular case you should ask the people around you expressly and beforehand to keep a close eye on you: just as an extra safety measure.
• footnote 1: For a little more background info, see this Psychology Today article: Moms Who Kill, by Mark Levy (2002).
• footnote 2: Though largely forgotten now, Friedrich Benjamin Osiander (1759-1822) was an interesting man, and not just because of his pioneering role in the recognition of postnatal psychosis.
As a professor he wrote many books; another one of them (1813) was Über den Selbstmord, seine Ursachen, Arten, medicinisch-gerichtliche Untersuchung, und die Mittel gegen denselben. Eine Schrift sowohl für Polizey- und Justitz-Beamte, als für gebildete Aerzte und Wundärzte, für Psychologen und Volkslehrer.
My translation of the title: About Suicide, its Causes, Kinds, Medical-Juridical Investigation, and Means of Prevention. A Book for Police- and Court Officials, trained Doctors and First-Aid Medics, Psychologists and Teachers.
This 1813 book by Osiander is the only one of his works that is online at Google Books: if you can handle German text in the old-fashioned Fraktur script, it makes a fascinating (but occasionally also very moralistic) read.
• footnote 3: Fathers having postnatal depression? Yes it happens, and while not exactly the same, this is beginning to be recognized a little better. But I didn’t want to make this post more complicated than it already is. So, some other time.