puerperium

Taking home a new baby is one of the happiest times in a woman's life. But it also presents both physical and emotional challenges. :

• Get as much rest as possible. You may find that all you can do is eat, sleep, and care for your baby. And that is perfectly okay. You will have spotting or bleeding, like a menstrual period, off and on for up to six weeks.
• You might also have swelling in your legs and feet, feel constipated, have menstrual-like cramping. Even if you are not breastfeeding, you can have milk leaking from your nipples, and your breasts might feel full, tender, or uncomfortable.
• Follow your doctor's instructions on how much activity, like climbing stairs or walking, you can do for the next few weeks.
• Doctors usually recommend that you abstain from sexual intercourse for four to six weeks after birth.

In addition to physical changes, you may feel sad or have the "baby blues." If you are extremely sad or are unable to care for yourself or your baby, you might have a serious condition called postpartum depression.

Dept. of Health and Human Services Office on Women's Health

Depression is more than a feeling of being sad or irritable for a few days. It's a serious mood disorder. As one of the most common mental disorders in the United States, depression can affect how you think, feel, and your everyday life. You may not know why you feel this way, but even basic daily activities such as sleeping, eating, or working may become difficult. Depression often needs long-term treatment but getting help at the earliest sign of a problem can help manage your symptoms.

The most common types of depression are major depression and persistent depressive disorder.

• Major depression symptoms include a depressed mood or a loss of interest. Symptoms affect your daily activities and last for at least two weeks.
• Persistent depressive disorder (also called dysthymia or dysthymic disorder) has less severe depressive symptoms, but they last longer, usually for at least two years.

Other types of depression can include:

• Seasonal affective disorder comes and goes with the seasons. It usually starts in late fall and early winter and goes away during the spring and summer.
• Bipolar disorder is sometimes called manic depression. This mood disorder can cause intense mood swings.
• Depression with symptoms of psychosis is a severe form of depression that also has delusions (false beliefs) or hallucinations (seeing, hearing, or feeling something that isn't there).

There are a variety of things that may cause depression, including genetic, biological, environmental, and psychological factors. Depression can happen at any age and can affect anyone, but it's more common in women. This is often due to the physical and hormonal changes that women have during menstruation, pregnancy, the postpartum period, and menopause. Other mental disorders or chronic medical conditions such as diabetes, cancer, or heart disease may occur with depression. This may make the chronic condition or depression worse.

In some cases, there is no clear cause for depression.

You may be at a higher risk of depression if you have a close relative who has it or another mental health disorder. Going through trauma or stressful life events may raise your risk even more.

Depression doesn't look the same on everyone. The type and number of symptoms of depression can vary and don't always appear like sadness. Depression may affect you differently based on your:

• Age. The symptoms of depression may be different in a child, who may appear more irritable than sad. Teens may act out or have excessive sleepiness. The symptoms for an older adult may not be as obvious as other age groups.
• Sex. Men often show symptoms and coping behaviors differently than women. Rather than sad, men may appear angry or irritable.
• Medical conditions. Some medicines and medical conditions may cause symptoms that look like depression. Chronic conditions may make depression worse.

Symptoms of depression are ongoing and affect your day-to-day life. They can include:

• Feeling sad or "empty"
• Losing interest in favorite activities
• Overeating, or not wanting to eat at all
• Sleeping too much, or not enough
• Feeling very tired
• Feeling hopeless, irritable, anxious, or guilty
• Having aches and pains, headaches, cramps, or digestive problems
• Having thoughts of death or suicide
• Changing moods or behaviors
• Increasing use of alcohol or drugs
• Isolating from family and friends

If you think you have depression, talk to your health care provider or a mental health provider. To be diagnosed with depression, your provider may use many tools:

• A medical history will include asking about your symptoms and family history. To be diagnosed with depression, your symptoms must occur most of the day, nearly every day, for at least two weeks. One of the symptoms must be a depressed mood or a loss of interest in most activities.
• Medical tests may be done to rule out other medical conditions. Certain medicines and medical conditions (such as viruses or thyroid disorders) may cause symptoms like depression.
• A physical exam to make sure another issue isn't causing your symptoms.
• A mental health evaluation by your provider or a mental health provider.

Depression may need long-term treatment. Most treatments include medicines and/or psychotherapy (talk therapy):

• Medicines such as antidepressants may help control your symptoms. You may need to try several medicines to find which works best for you. Medicine may take time to work and can have side effects. Don't stop taking your medicine without first talking with your provider. Contact your provider if you have any concerns about side effects from the medicine.
• Psychotherapy (talk therapy) under the care of a mental health provider can help you recognize and change troubling emotions, thoughts, and behaviors. This may be done one-on-one or in a group setting. It can give you and your family support, education, skills, and coping strategies.
• Light therapy has been shown to be effective for seasonal affective disorder (SAD).
• Other treatments options may be considered if treatment isn't working or if depression is severe. These may include:
  • Electroconvulsive therapy (ECT) is a brain stimulation procedure that uses a mild electric current when you are under general anesthesia. ECT is most often used for severe depression that is not getting better with other treatments.
  • Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation procedure that uses magnetic waves to relieve depression. It's not as powerful as ECT, but with rTMS, you don't need anesthesia. It also has a low risk of negative effects on your memory and thinking.

Most cases of depression can't be prevented, but healthy lifestyle changes can have long-term benefits for your mental health. These can include:

• Getting regular exercise
• Having a consistent sleep schedule
• Controlling stress

If you, or someone you love is depressed, see your provider or a mental health provider. It's important to get treatment at the earliest sign of a problem.

If you or someone you know has thoughts of hurting themselves or attempting suicide, get help right away. If it is an emergency, dial 911.

NIH: National Institute of Mental Health

Having a baby can be exciting, but it can also be stressful and bring many strong emotions. During the postpartum period, which is the time after you give birth, you may have mood swings, crying spells, or feel anxious. These feelings are common and are often called the postpartum "baby blues". The baby blues usually go away within a few days to a week.

If your symptoms are more severe and last longer than two weeks, you may have postpartum depression.

Postpartum depression is a common but serious mood disorder that can begin anytime within the first year after childbirth. Without treatment, symptoms may make it hard to care for your baby or manage daily tasks.

The exact cause is unknown, but postpartum depression likely results from a combination of factors, including:

• Sudden changes in hormone levels after pregnancy
• Physical changes, such as dropping thyroid hormone levels
• Lifestyle factors, such as fatigue, lack of sleep, limited support, or recent stressful events

Anyone can develop postpartum depression after childbirth. You might be at higher risk if you:

• Have a history of depression, bipolar disorder, or a family health history of these conditions
• Had a multiple birth (twins, triplets, or more)
• Gave birth while in your teens
• Had health problems during pregnancy
• Had preterm labor or other complications during childbirth
• Have a baby with special needs
• Have ever experienced domestic violence
• Are dealing with financial stress
• Had an unplanned pregnancy

Postpartum depression symptoms are more intense and last longer than the baby blues.

Symptoms may include:

• Feeling sad or empty most of the time
• Eating too much or too little
• Sleeping too much or too little
• Crying more than usual or for no clear reason
• Feeling unusually angry
• Pulling away from family and friends
• Feeling worried or anxious often
• Feeling little or no interest in your baby
• Constant doubts about your ability to care for your baby
• Thinking of harming yourself or your baby

If you have thoughts about suicide, or hurting yourself or your baby get help right away:

• Call 911 or go to your local emergency room
• Contact a crisis hotline. In the United States, you can reach the National Suicide and Crisis Lifeline at any time:
  • Call or text 988
  • Chat online with Lifeline Chat
  • TTY users: Use your preferred relay service or dial 711 then 988
• Veterans can contact the Veterans Crisis Line:
  • Call 988, then press 1
  • Text 838255
  • Chat online
• Call your mental health provider or other health care provider
• Reach out to a loved one or close friend

If these symptoms begin during pregnancy and continue after childbirth, it's called perinatal depression. Without treatment, it can affect bonding with your baby and may contribute to feeding or sleeping problems.

Very rarely, a new mother may develop postpartum psychosis, a medical emergency. Symptoms may include confusion, hallucinations (seeing or hearing things that aren't real), or dangerous behaviors. Call 911 or go to the nearest emergency room right away if this happens.

Your provider may diagnose postpartum depression using:

• Screening questions or questionnaires, such as those about your mood, sleep, and thoughts.
• A clinical evaluation based on your symptoms.
• Blood tests, if needed, to check for physical conditions such as thyroid disorders, that can cause or worsen depression.

If you think you have postpartum depression, talk with your provider. Treatments may include:

• Medicines, including antidepressants
• Talk therapy (counseling)

Tell your provider if you are breastfeeding so they can choose the safest treatment options.

Along with these treatment options, there are things you can do at home that may help you feel better, such as:

• Asking for help with caring for the baby and household chores
• Taking time for yourself
• Getting physical activity, such as walking
• Resting when the baby rests

You may be able to lower your risk for postpartum depression by:

• Talking with your provider during pregnancy about any history of depression
• Completing recommended screening questionnaires during pregnancy and after birth
• Getting support from family, friends, or support groups
• Attending early Physical changes so symptoms can be found and treated as soon as possible

Dept. of Health and Human Services Office on Women's Health