Originally posted January 10, 2014.
A recent study about finding a link between postpartum depression and fear of childbirth has been getting a lot of press. The press I read reported the study showed a prevalence of .03% of postpartum depression. I felt like the public was being fed bits and pieces of the study, so I read the whole article and wanted to bring out a few key facts.
The researchers, led by lead study author Dr. Sari Raisanen, an epidemiologist and visiting scholar at Emory University in Atlanta, reviewed retrospective data from 511,422 births from 2000 – 2010 in Finland.
First off, the clinician in me had a hard time with the first line of the study. It starts out by saying that “Postpartum depression encompasses disorders ranging in severity from baby blues to postpartum psychosis….” Ok, sorry. Postpartum psychosis is not a variant of postpartum depression. Please let’s stop perpetuating this confusing information. One of the main risk factors for postpartum psychosis is a personal history of bipolar disorder or a familial history of a psychiatric diagnosis of schizophrenia, not a history of major depressive disorder.
Let me just say I absolutely respect the scholarship of the authors. I mean, DSM-V doesn’t have the diagnoses of the postpartum psychiatric disorders finely defined. There’s definitely a lack of consensus about the distinctions in the perinatal psychiatric illnesses.
But, clinically, here in the US, there’s a well-developed Maternal Mental Health specialty. We clinicians in the US, who work in this specialty field, have come to a consensus that there are distinct groupings of perinatal psychiatric mental illness, as defined on the Postpartum Support International Website. And take a look at Cheryl Beck’s and Jeanne Driscoll’s work, please. And then go on to read more at the Massachusetts Hospital’s Center for Women Health to read about Women’s Postpartum Psychiatric Disorders. You can read my book, BirthTouch® Pocket Guide to Perinatal Mental Illness for Childbirth Educators
I could go on and on about this….ok, well.
Ok, once the clinician in me got past that first line, the next statistic that struck me was that the researchers stated the “…overall rate for diagnosed postpartum depression was found to be .03%, a similar rate in the United States…”
.03% ?? What?
It’s widely disseminated that the rate for postpartum depression is between 15 and 20% worldwide. Hmm, what’s that all about then?
Ok, so the thing is, the researchers used only those women who were diagnosed by a physician with postpartum depression. And most of those women were actually hospitalized. So, this is not the actual rate of occurrence of postpartum depression, it’s only the women who reported it to their medical doctors and then were diagnosed with major depression and also were probably hospitalized for it, after they gave birth. A small subset of women, if you ask me. I see many women who are depressed who don’t wish to consult with their doctor, even if I encourage them to do so.
Ok. So on to the study’s conclusions.
Two-thirds of the PPD cases diagnosed were in women with a personal history of depression
One-third of the PPD cases diagnosed were in women with no personal history of depression
Prenatal fear of childbirth increased the likelihood of postpartum depression by fivefold and threefold, respectively in the above groups
The researchers found these other factors to contribute to major postpartum depression:
cesarean section
pre-term birth
smoking
low socioeconomic status
single status
gestational diabetes (possibly due to a pro-inflammatory state)
Anxiety and stress are cousins to depression; they are often the precursors to depression. The stress response depletes us hormonally and emotionally, leading to burn-out and depression, so it’s not surprising that fear and anxiety during pregnancy set the body up for depression after delivery.
And yet, fears and anxieties of childbirth vary widely within individuals. From true generalized anxiety disorder to nagging fears.
It’s important to go to a professional to get a clear clinical picture of your situation, to receive the proper treatment which may be an integrative approach of medications and holistic treatments.
There are a lot of evidence- based techniques that can effectively to support a woman prenatally to help manage her fears.
Clinically, the best tools for managing anxiety build up the relaxation response:
Building up a daily practice of 20 minutes of relaxation and awareness practices, there are numerous holistic therapies to choose from…
Interpersonal psychotherapy is a proven method of processing emotions and learning new behavioral skills
Vitamin “T” – touch – inexpensive if done at home with a partner – just ten minutes a day is a proven way to reduce feelings of isolation, depression, anxiety
Aroma therapeutic remedies are gaining clinical support for positive effects on the neuro-endocrine system, as a gentle supportive self-care
Good nutrition and rest is important to maintain your physical and mental health, which are intertwined
If you can spare ten – twenty minutes a day, you can contribute to managing your fears and anxieties about childbirth.
BirthTouch® Childbirth Education is my private childbirth education series, designed to focus you as an individual, the woman and her partner, and your emotions about pregnancy, birth and your transition to parenthood.
Chock full of proven holistic and integrative methods, we spend a series of four two and a half hour sessions together. We use expressive art, guided imagery, positive psychology, Vitamin T and aroma therapeutics to address and soothe fears, bolster confidence, build up the relaxation response and support balance.
In women who have underlying anxieties, the stress response is constantly being primed at non-verbal levels. Processing fears and building up the relaxation response interrupts the stress feedback system and soothes feelings of anxiety.
So, be aware of the power of addressing and releasing fears during pregnancy, it helps you come into a state of trust and confidence, helps you live consciously, and helps you manage your emotions on your terms.
It might be hard to think about fitting self-care in, but think of it as taking positive steps in your life to take a break and become educated about your body and your emotions.