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The term “postpartum depression” refers to depressive episodes following childbirth. These can occur after the birth of any child, not just the first. Depressive episodes can even follow a miscarriage or termination of a pregnancy. According to the Office on Women’s Health of the U.S. Department of Health and Human Services, there is a wide range in the severity of the symptoms.

Many women experience postpartum blues, or baby blues, characterized by mild sadness, anxiety, irritability, fluctuating moods, and fatigue. These blues are considered normal and are short-lived, resolving themselves without medical help within about ten days after childbirth.

However, the American College of Obstetricians and Gynecologists estimates that in 1 out of 10 new mothers, these feelings escalate and go beyond the first few days. They can even appear several months after the birth. This may be full-fledged postpartum depression, in which the feelings of sadness, anxiety, or despair are so intense that the new mother has trouble coping with her daily tasks.

Additionally, between 1 and 3 new mothers in every 1,000 suffer from an even more severe form of depression called postpartum psychosis, in which the mother has delusions or hallucinations that often focus on hurting herself or her baby. This latter condition requires immediate medical attention.

What causes Postartum Depression?

Causes

While not all causes of PPD are known, several factors have been identified.
Prenatal depression, i.e., during pregnancy
Low self esteem
Childcare stress
Prenatal anxiety
Life stress
Low social support
Poor marital relationship
History of previous depression
Infant temperament problems/colic
Maternity blues
Single parent
Low socioeconomic status
Unplanned/unwanted pregnancy

There is no single clearly defined cause of postpartum depression. Both physical and emotional factors seem to be involved. One physical factor may be that in the first 24 to 48 hours after delivery, estrogen and progesterone levels drop sharply, to a point lower than before conception, creating an abrupt change in the physiological state of the body. This may trigger depression in much the same way as mood swings and tension are triggered before menstrual periods. The level of hormones produced by the thyroid may also drop after childbirth. This could result in symptoms that mimic depression. For these reasons researchers are calling PPD a “biochemical and hormonal disorder.”

Interestingly, one medical newsletter suggests that postpartum depression may be caused by a nutritional imbalance, perhaps a B-complex deficiency.

Fatigue and lack of sleep can also play a role. Says Dr. Steven I. Altchuler, a psychiatrist at Mayo Clinic in Minnesota, U.S.A.: “In the period shortly after childbirth, lack of energy and an inability to sleep may make minor problems seem much more major. Some women might be frustrated to find that they have difficulty coping with things that they had handled well before delivery, without the baby blues, and with a full night’s sleep.” Emotional factors such as an unplanned pregnancy, a premature birth, loss of freedom, concern about attractiveness, and lack of support can also add to depression.

Additionally, there are several common myths about being a mother that can contribute to a woman’s feeling depressed and feeling that she is a failure. These include the idea that motherhood skills are instinctive, that bonding should be immediate, that the baby will be perfect and never fussy, and that the new mother should be perfect. In real life this is not the case. Mothering skills need to be learned, bonding often takes time, some babies are easier to care for than others, and no mother is perfect or a supermum.