October 31, 2009

Speaking Her Voice: Perri Shaw Borish

Perri Shaw Borish MSS, LCSW is a clinical social worker in private practice in Philadelphia, PA.  She specializes in working with postpartum depression and anxiety disorders.  For more information about Perri's work and to contact her, please visit her website at http://www.perrishawborish.com/.   

“The only thing that seems eternal and natural in motherhood is ambivalence.” – Jane Lazarre, novelist.

There is a tremendous amount of societal pressure placed on mothers to see the period after the birth of their child as a time of bliss, but for many mothers this is not the case. On the contrary, it is often a time of ambivalence, irritability, anxiety and hopelessness.

“I just want to sleep. I feel terrible and I’m afraid I’m going to drop my baby. Sometimes I imagine my arms may just give out and the baby will fall to the floor. I can’t speak to anyone about this so I pretend that everything is fine but sometimes I wonder if everyone would just be better off if I weren’t here.”

This frame of mind is typical among new mothers I have treated who do not realize that they are suffering from a common and treatable condition. Postpartum depression may appear to be the baby blues at first -- but the signs and symptoms are more intense and longer lasting, eventually interfering with your ability to function.

Postpartum Depression, which affects 15-20% of new mothers, ranges in severity from mild anxiety to major depression. There is a wide range of conditions that are considered postpartum depression but here we will focus on the most common form, that of major depression.

Because patients and caregivers often overlook the symptoms of postpartum depression, it is important that we recognize them. Like other types of non-psychotic major depression, postpartum depression is characterized by: depressed mood, irritability, anxiety and loss of interest in general. Also, women who suffer from postpartum depression often express ambivalence toward their newborn child and commonly have doubts about their ability to care for their child.

How should women suffering from Postpartum Depression be cared for?

Ideally, treatment should begin even before the child is born if a woman is at risk for postpartum depression. She should meet with a therapist to create a wellness plan so that she is prepared once her child arrives.

If a new mother shows symptoms that are associated with postpartum depression, a thorough analysis of her medical history and a physical examination should be undertaken so that medical causes of mood disturbance such as thyroid dysfunction or anemia can be ruled out. Treatment should be based on the severity of the symptoms shown as well as the degree of functional impairment experienced by the new mother.

For cases of mild to moderate depression, non-pharmacologic options such as psychotherapy can be helpful. A good diet and plenty of sleep are essential. Friends and family can lend a hand by offering much-needed emotional support and encouragement and by providing hands-on help in taking care of the baby. It’s important to encourage a new mother to eat a balanced diet and to get sufficient rest which play an important role in her well-being. The human brain needs continuous sleep to recharge.

At night, a loved one can help by bottle-feeding the newborn periodically to enable a new mother to sleep. During the day, a loved one or close friend can take the baby for a walk or hold the baby in order to give the new mother much needed time for herself.

Believing the myth that “new mothers love each and every moment with their babies” can push some mothers to ignore their own needs. When we are depressed it can feel as though the walls are closing in around us. A few minutes of exercise, a short walk outside and a breath of fresh air can go a long way in the recovery process.

When a new mom shows signs of more severe postpartum depression or does not respond to non-psychotropic treatments, antidepressant medications taken along with psychotherapy have been proven to be effective. For nursing mothers, antidepressant medications must be chosen with the safety of the baby in mind - first and foremost. When a mother presents with severe postpartum depression, particularly for patients who are at risk for suicide, inpatient hospitalization may be required.

Recognize the Symptoms and Know What to Do

New mothers and those who surround them should be made aware not only of the symptoms of postpartum depression but also that it is a common and highly treatable condition.

There is no reason for a new mother to suffer in silence and shame. It is imperative that those with symptoms of postpartum depression seek the help of a trained professional in order to develop a game-plan that limits depression and anxiety in favor of the enjoyable aspects of becoming a mother.

I have found that the simple act of talking about feelings often helps to alleviate symptoms in my patients. As a therapist often the most important thing I can do for my patients is to listen to them, encourage them and normalize what a difficult and challenging time this is for new parents. With proper treatment and care, the process of becoming a mother can truly be an exciting time, full of new adventures, growth and a tremendous amount of love.

Resources if you are struggling with Postpartum Depression:

American Psychological Association http://www.apa.org/

Postpartum Support International http://www.postpartum.net/

Center for Postpartum Health http://www.postpartumhealth.com/

Article reprinted with permission by Perri Shaw Borish.  All rights reserved. 

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