Within the last few weeks, pre and post partem depression is in the news, first for women. At the end of January 2016, the United States Preventive Services Task Force issued new recommendations that women should be screened during pregnancy and after childbirth for depression. New findings show that as many as half the cases of depression that were previously thought to occur within a few weeks of childbirth actually occur during pregnancy and can arise any time within a year after a child is born. The numbers are greater than previously thought and up to 20% of women develop mild to serious symptoms of depression, and it is not only with the first birth, but can be a subsequent birth, or every pregnancy. Some of the news media put the percentages even higher.
Yes, hormones surge during pregnancy and plummet after pregnancy, but the experts say that the likely cause of maternal depression is an interplay of genes, stress, and hormones. We grandmas know how hard it is to care for a dependent newborn in the non stop 24/7 commitment required, when one has just given birth, is trying to breastfeed, with sleep deprivation and exhaustion. See post on breastfeeding and working women.
See post on breastfeeding pressure and how we grandmas can help.
It is so stressful to care for a newborn, and a totally different life for both parents, recognizing that life as was before is gone forever. Depression is not unexpected, and can affect ability to care for the child, and, according to the experts, can affect the child’s emotional well-being, social behavior and cognitive skills.
Then, just about a week after the first news appeared, in the New York Times, on February 2, 2016, Nicholas Bakalar, reported on “Depression and Preterm Birth,” emphasizing the effect on the entire household. The concern for depression is not only for the mother, but also for the father, based on a study from Sweden. It seems that diagnoses of depression in either the mother or the father can increase the risk of preterm birth. The quote from Dr. Anders Hjern, the senior author of the study is telling:
“Having a mentally healthy and supportive father who can provide a favorable environment for his partner is also good for the baby. And maternity care interventions should also include the father. Sometimes the father is forgotten.”
This Grandma offered the parents of her grandchildren a baby nurse as a baby gift. Yes, it is a luxury they cannot afford, and if we can afford the gift, even for a few days or even just a night nurse, this is a gift for the baby’s well being as well as both parents’ well being. The baby nurse trains the parents as well as cares for the newborn, and helps the family adjust to their new life together. See previous post which gives all the reasons why a baby nurse is the best baby gift for your new grandchild.
The post also gives tips on how we grandmas can be most helpful to the new baby and new parents. This Grandma tried to come before the baby was born and stayed to take care of the parents, not the baby. The parents need coddling and need to be fed! Then, this Grandma leaves home cooked meals in the refrigerator and freezer, and leaves the baby nurse to train the newborn and the parents. After the baby nurse leaves, this Grandma waits a bit, so the parents have time to re-stress, and then returns to assist again for a time. Now, I know that this plan may be one that helps both parents with what is a monumental life passage event in a way to minimize the potential for depression in either the mother or the father. The benefit to grandma is more than you can imagine—we know temperament and personality appear at birth and we get to know the new person who is our new grandchild—when we are not stressed and just experiencing the unbelievable joy of the newborn.
There is something more we grandmas can do now that we know depression is the most common complication of childbearing to provide for the safety and well being of our new grandchild, and may happen well after the birth of the baby. There is a common screening method for depression that consists of ten questions. This Edinburgh Postnatal Depression Scale is considered ‘self-rating” as an effective and efficient way to identify persons at risk for depression, although originally designed for pregnant women or women who have just given birth. We grandmas can know the scale, keep it handy, and by asking seeming innocuous questions, can identify the risk for depression in the mother or father even before they recognize it. It seems that the person who is depressed may be the last one to recognize he or she is depressed and we grandmas may be the first to recognize the symptoms.
Here is the Edinburgh Postnatal Depression Scale, requiring an answer that comes closest to how the person (self-rating) felt in the previous seven days:
1. I have been able to laugh and see the funny side of things.
*As much as I always could
*Not quite so much now
* Definitely not so much now
*Not at all
We grandmas can crack jokes, make light of things, and see the response. We can rate those we know and hold dear.
2. I have looked forward with enjoyment to things.
*As much as I ever did
*Rather less than I used to
*less than I used to
* Hardly at all
Again, we grandmas can plan or participate in fun activities, and see the response. We can rate those we know and hold dear.
3. I have blamed myself unnecessarily when things went wrong.
*Yes, most of the time
*Yes, some of the time
* Not very often
*No, never
By keeping those we know and hold dear close to us, calling and visiting, we can listen and rate them. The rest of the questions require us to do the same, listen, watch, pay attention.
4. I have been anxious or worried for no good reason.
*No not at all
* Hardly ever
*Yes, sometimes
*Yes, very often
5. I have felt scared or panicky for no very good reason.
*Yes, quite a lot
*Yes, sometimes
*No, not much
*No, not at all
6. Things have been getting on top of me.
*Yes, most of the time I haven’t been able to cope at all
*Yes, sometimes I haven’t been coping as well as usual
*No, most of the time I have coped quite well
*No, I have been coping as well as ever
7. I have been so unhappy that I have had difficulty sleeping.
*Yes, most of the time
* Yes, sometimes
* Not very often
*No, not at all
8. have felt sad or miserable.
*Yes, most of the time
*Yes, sometimes
*Not very often
*No, not at all
9. I have been so unhappy that I have been crying.
*Yes, most of the time
*Yes, quite often
*Only occasionally
*No, never
The last question is most troublesome, and thoughts of suicide, intense worry, may involve thoughts of harming the baby as well. These require immediate action.
10. The thought of harming myself has occurred to me.
* Yes, quite often
*Sometimes
*Hardly ever
* Never
A score of 10 to 30 signifies depression. Take the test yourself here.
So, what do we grandmas do if we identify the signs of depression? It is always best to deal with the parent who is our child, as they are more receptive to our interventions, most of the time. But, prospective and new parents may not be receptive at all to intervention into their attempts to consolidate themselves as a new family. Leaving a link to or a copy of the Edinburg Postnatal Depression Scale may be too obvious but here is the link that has a host of information on the same website. The important information is that there is treatment for the parents, and there should be intervention for them to get the treatment they need, for the baby’s best interest. There is behavioral therapy and antidepressants that can be prescribed during and after pregnancy, although there is some controversy about prescribing antidepressants to pregnant women.
Grandma can mention that there is always stress and worry with a newborn and that there is help and suggest they talk to the obstetrician or pediatrician. The doctor can be the one to recommend mental health professionals experienced in treating maternal and paternal depression issues. There is an organization, Postpartum Support International, with resources for providers, experts, and support groups around the United States.
Postpartum Support International is a wealth of information, including additional risk factors and descriptions we grandmas can consider:
A personal or family history of depression, anxiety, or postpartum depression
Premenstrual dysphoric disorder (PMDD or PMS)
Inadequate support in caring for the baby
Financial stress
Marital stress
Complications in pregnancy, birth or breastfeeding
A major recent life event: loss, house move, job loss
Mothers of multiples
Mothers whose infants are in Neonatal Intensive Care (NICU)
Mothers who’ve gone through infertility treatments
Women with a thyroid imbalance
Women with any form of diabetes (type 1, type 2 or gestational)
And we grandmas can help with a few of the above. We can provide support, personally or financially within our means, in caring for the baby, the finances, and the stress upon the relationship of the new parents, especially if we identify risk factors. And, we can be proactive if we identify risk factors pre-birth, and suggest the prospective parents seek support earlier than they would have on their own.
Yes, having a new born can be overwhelming. Yes, there are professionals who can help. But, as family, we are the first defense, to protect our defenseless newborn grandchild, even before we have the overwhelming joy of holding the baby in our arms.
Joy,
Mema
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