Chapter 8

Postpartum Disorders Defined

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Like Carol and Paul, most new parents don't expect a debilitating emotional reaction following the birth of their child. After all, having a baby is supposed to be one of the most wonderful times in a couple's life. Even when some difficulties are anticipated because of all the changes that accompany childbirth, the reality of postpartum depression is rarely considered. If it's considered at all, most prospective parents say to themselves, "That won't happen to me!" To complicate matters further, emotional reactions following the birth of a baby are often referred to as postpartum depression. You're probably familiar with the term. People use it for anything from constant tearfulness on the part of a new mom to the rarer phenomenon of new mothers who have homicidal thoughts about their baby.

The more professionals have studied postpartum depression, the more they've concluded that it's not a single, distinct entity. Rather, a full range--or spectrum--of emotional conditions and symptoms appears to be possible in the postpartum period. These feelings and complaints most often take one of several definite patterns. This has led to the identification of related but varied emotional syndromes (sets of symptoms) occurring after childbirth. Postpartum depression, postpartum mania, postpartum panic, postpartum obsessivecompulsive disorder, postpartum post-traumatic stress disorder, and postpartum psychosis are the major patterns that we'll discuss in detail in this chapter.

To understand the range of difficulties women experience after the birth of a baby, the idea of a continuum is helpful. This is illustrated in the following spectrum, which first appeared in chapter four. Chapter four delineated how the spectrum begins with the range of normal adjustment, which includes the baby blues, postpartum exhaustion, and the normal emotions of the postpartum period. When symptoms listed under "Normal Adjustment" intensify, the new mother may have moved into the range of a clinical postpartum episode, such as depression or obsessive-compulsive disorder. The symptoms may be the same, but they are more powerful, more frequent, and/or more overwhelming. This is especially true if you are not getting up and dressed each day or if you are not caring for your baby's needs.

Many women ask, "How do I know when I have moved from 'normal' to a more serious reaction?" The answer is often a question of good versus bad days, manageable versus overwhelming feelings. If you are having more good days than bad days, you are likely still in the range of normal. If the bad feelings and days greatly overwhelm and outnumber the good feelings and/or the good days, then you have likely moved into the range of a postpartum clinical condition. In such situations, women cannot simply pull themselves up by their bootstraps. The situation needs to be dealt with immediately by a healthcare professional who is knowledgeable about postpartum adjustment. If you think you have a postpartum clinical condition, or you know someone who does, use the resource list at the back of this book to find the best local people who can provide you with an evaluation and treatment plan. Chapter ten offers guidance in selecting a therapist.

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© 2010 A. Dunnewold & D. Sanford