By Joy Davy, MS, LCPC, NCC, licensed professional counselor specializing in perinatal mood disorders, www.joydavy.com.

The joy of motherhood is the subject of much art and idealistic images. Our expectation that the arrival of a baby is a time of peace and pure bliss is enforced by the culture. Certainly for many mothers, the months of carrying a precious new life and bringing a brand new person into the world are experiences unparalleled in satisfaction and happiness. Of course, even the most exhilarated mother has her moments of feeling overwhelmed, intimidated by the formidable job ahead, and just plain physically exhausted. Overall, though, new motherhood is expected to be a wonderful time, and it often is. However, a significant number of mothers experience mood disorders, ranging from the relatively mild “baby blues” to far more serious and persistent conditions that require treatment.

The Baby Blues

The baby blues is a very common transitory experience of tearfulness, irritability, overwhelmed feelings and mood swings. More than half of all mothers pass through this phase during the first two weeks after childbirth. For the baby blues, no treatment is needed unless the depression appears to be extreme. If the new mother is breastfeeding on demand, using no bottles or pacifiers, with the baby having continuous access to the breast, her hormones are likely to be at a euphoric level that seems to offer some measure of protection against the the baby blues and the clinical illness postpartum depression, although there is no sure guarantee. The baby blues will pass untreated. Postpartum depression, however, is another matter entirely and requires professional attention.

Postpartum Depression and Perinatal Depression

The term “postpartum depression,” which refers to depression after childbirth, is being replaced by the wider term “perinatal depression,” which includes depression both during pregnancy and after childbirth. Women who are depressed during pregnancy are at risk of being depressed after the birth, as well, and ideally should seek help when the symptoms of depression are felt. Perinatal depression is recognized by its duration and severity. A mother who continues to be depressed after her baby is 3 weeks old should be assessed for postpartum depression, as by that time her hormones should have settled down. Symptoms of perinatal depression include:

· Depressed mood, tearfulness, hopelessness and feeling empty inside, with or without severe anxiety

· Loss of pleasure in either all or almost all daily activities

· Appetite and weight change

· Sleep problems, such as trouble with sleeping even when baby is sleeping

· Either restlessness or sluggishness

· Extreme fatigue or loss of energy

· Feelings of worthlessness or guilt, with no reasonable cause

· Difficulty concentrating and making decisions

· Thoughts or fears about death, suicide or hurting the baby

Perinatal Anxiety

Some mothers begin to be overly concerned about cleanliness during pregnancy or after the birth. They may spend an inordinate amount of time cleaning and scrubbing, to the point of having little time for anything else. Other people may notice that the items being cleaned are already clean or that the mother’s hands are raw from constant scrubbing. This is an example of obsessive compulsive disorder, which is one form of anxiety.

Some mothers begin to worry much more than ever before, to the point of having this constant worry interfere with their daily functioning. Some mothers may be horrified by thoughts that they cannot stop; these thoughts may concern hurting the baby. These are some examples of anxiety, which can begin for the first time during pregnancy or after childbirth, or it can be a returning problem that the mother experienced earlier in her life. In any case, counseling can help her manage her symptoms of worry.

Perinatal Bipolar Disorder

A woman may develop bipolar disorder during this time of shifting hormones. This may begin as a severe depression but then cycle into feelings of euphoria and mania, accompanied by insomnia and extreme feelings of excitement, happiness and confidence. She may be reckless of safety or make rash decisions during these times. Bipolar disorder requires both counseling and medication, but people who have this challenge can lead very satisfying lives. The most important thing is staying on medication prescribed by a psychiatrist.

Post Traumatic Stress Disorder Following Childbirth

Birth should be a natural event. However, it can be overwhelming or terrifying to a woman, especially if something goes wrong or if there is extensive medical intervention combined with a lack of emotional support. Post traumatic stress disorder (PTSD) is a condition usually associated with combat veterans or victims of domestic violence, but it can also affect new mothers. PTSD is caused by feelings of horror or extreme fear and the perception that one (or a loved one) is in danger of dying or being severely injured. Not all people in such a situation develop PTSD; some are more vulnerable to this condition than others. A woman is more likely to develop PTSD if she has an emergency Cesarean, a very long labor, a lot of blood loss, or a high level of pain. Symptoms of PTSD include:

· Re-experiencing the event again and again; flashbacks, nightmares, intrusive thoughts, being upset by the memory of the event

· Avoiding reminders of the event (which could include avoiding the baby); feeling emotionally numb

· Irritability, difficulty concentrating, difficulty falling or staying asleep, an exaggerated startle response (for example, jumping when surprised by a sound)

Perinatal Psychosis

Perinatal psychosis is the rarest of perinatal mood disorders, but it does occasionally occur.  Psychosis is a loss of contact with reality, thus the mother may have visual hallucinations (seeing things that other people do not see) or, more commonly, auditory hallucinations (hearing voices). Psychosis may also cause delusions, which are bizarre false beliefs, such as the belief that one is possessed by demons or that one’s thoughts are being read by passersby on the street. The mother who is experiencing these distressing symptoms needs immediate emergency care at a hospital. There are medications which can usually get these symptoms under control quickly.

In Conclusion

In many cases, counseling with a therapist who is well-versed in perinatal mood disorders will be enough to bring the mother to health again. In some cases, medication prescribed by a psychiatrist will be necessary. When medication is necessary, the utmost care should be taken to consider the risks and benefits to both mother and baby. These disorders may pose a danger to the mother and baby, and for that reason it is important to have an open mind when weighing decisions concerning medication.

Mothers struggling with mood disorders need and deserve help and support. If you or a mother you know is struggling with sad thoughts, extreme anxiousness, mood swings or other emotional difficulties, please remember that there is no need to go through this alone. It is vital for the mother and her whole family that her symptoms be attended to and that she be restored to balance. Professional help is available and can make all the difference in the world.