Expat Moms at Higher Risk for Postpartum Depression
The majority of mothers experience mood fluctuations after giving birth. While some degree of sadness, irritability and weepiness, colloquially known as baby blues, in the days or weeks immediately following birth is completely normal, there are other, more serious forms of postpartum mood disturbances that respond best to some kind of professional intervention. Postpartum depression (PPD) is a form of clinical depression, and can seriously interfere with a new mother’s ability to take care of herself or her baby. Symptoms may include feelings of sadness, hopelessness, guilt, feeling overwhelmed, extreme irritability or angry outbursts, lack of enjoyment, social withdrawal and sleep disturbances. If these or similar symptoms describe the majority of your days for a stretch of two weeks or more, or if they are interfering with your everyday functioning, it is time to consider getting help.
Who is at risk for postpartum depression?
There are a number of known risk factors that are associated with, but do not necessarily cause, postpartum depression. The three largest risk factors are formula-feeding rather than breastfeeding, a history of depression and cigarette smoking. The effects of these three risk factors can add up. Other, non-additive risk factors include low self-esteem, childcare stress, low socioeconomic status, marital problems, low social support, or having a difficult (colicky or ill) baby.
Of all the risk factors that are associated with PPD, only one has been definitively identified as causing depression, and that is the lack of social support. This is what makes expat moms especially vulnerable.
What’s behind postpartum depression?
In my practice as a psychologist and doula, I work with pregnant women and new mothers regularly. My experience is that even for an otherwise healthy mother, the demands of a new baby in the family can be overwhelming if the experience is not what she expected. Women who do not understand, or underestimate, the demands a new baby will place on them, or who have put off emotionally preparing for the change in lifestyle may be hardest hit, especially if their birth experience or their baby’s temperament is not what they had in mind.
Unrealistic expectations are also a major culprit, especially for first-time mothers. Most often, new mothers underestimate the amount of time and energy a new baby can take up. For example, if you plan to breastfeed, you can expect your little one to spend as much as 12 of the 24 hours in a day nursing, at least in the first 4 to 6 weeks, which means you are stuck on the couch or in bed with a baby attached to you for that long each day. Baby’s on-and-off sleep pattern also means broken sleep for you. Sleep deprivation is a fact of life for new parents and the most realistic solution is to adjust your expectations and your own sleep pattern to match the baby’s, at least in the beginning. Too often, parents struggle against normal baby behavior, which can lead to unnecessary frustration.
Taken together, a demanding nursling and mounting fatigue means new mothers should not be expected, or expect themselves, to be able to take care of anything other than keeping the baby fed and content, and meeting their own basic needs in the first 4 to 6 weeks.
Without social support, without someone to take on the new mother’s previous responsibilities, which may include shopping, cooking, cleaning, working, running errands, taking care of older children, it is very easy for a new mother to become overwhelmed. If a woman does not have realistic expectations of the amount of time and energy a baby can take up, then she is completely unprepared for the massive lifestyle change that a baby brings. This is especially true for first-time mothers, but can also happen when a new baby joins older siblings. She may expect herself to be able to continue her previous life, and symptoms of depression can set in as frustration or even a sense of personal failure pile on top of hormonal fluctuations and sleep deprivation.
If, in addition, you are living in a foreign country where you may or may not speak the language, and where you may or may not have a reliable social support network, these expat hardships can compound the difficulties of the early weeks.
How can you prevent postpartum depression?
The most important thing you can do to prevent postpartum depression is to come up with a realistic plan for the first 4 to 6 weeks of your new baby’s life. What kind of help can you expect? Who can you expect it from? How often can you expect it? If you have family or friends who are willing to help, do not be shy to assign them concrete tasks: ask them to bring you meals, do your grocery shopping, pick up your older kids from school, do a load of laundry, wash the dishes, take the baby for a walk while you take a nap, etc. If all your visitors want to do is cuddle the new baby and keep you from valuable cat naps, consider limiting their access to your home, and definitely consider hiring help. If you cannot afford to hire someone for the whole 4-6 weeks of the childbed period, think about what of your previous responsibilities you could selectively outsource. Grocery shopping can be accomplished online, meals can be delivered to your home, and cleaning ladies or babysitters are not too expensive to hire once a week to lift the load from your shoulders. Although not too widespread in most countries outside the United States, there are also postpartum doulas available. These are women who have experience with small babies, so can help you with basic baby care questions such as feeding, sleeping, clothing, calming, etc. They can also do light housework, run errands or babysit your older children as necessary.
You can also lower your risk of developing postpartum depression by choosing to breastfeed and giving up smoking.
How can postpartum depression be relieved?
The most important thing is to be aware of the risk factors, and ask for help if you suspect that you may have symptoms of postpartum depression. Reach out and ask for help from your spouse, your family, your friends. Insist on being taken seriously, if you feel your symptoms are glossed over. Make sure you get adequate nutrition and attempt to improve your sleep if sleep deprivation is a contributing factor for you. Find opportunities to be social; join a support group or invite people over to your house, take advantage of the Hungarian health visitor system. If you find that none of these things brings relief, seek professional help from your doctor or therapist.
Treatment options for postpartum depression include therapy and medication. Usually, a combination of the two is most effective and brings the fastest relief. Choosing medication does not mean that you need to give up breastfeeding, since there are a number of safe choices for breastfeeding mothers.
Dads can get depressed, too
Although fathers do not experience the hormonal fluctuation involved in the postpartum period, they often share the stresses of the lifestyle change, the sleep deprivation, the added responsibility, and the social isolation. These stressors can lead to depression.
Be vigilant and get help
Above all, do not just settle for feeling depressed. There is relief to be had, and it is within your reach!
Réka Morvay is a Hungarian-American psychologist, doula, childbirth educator and breastfeeding counselor who lives full time in Budapest, Hungary with her husband and two daughters. To see a description of the services she offers, visit http://www.rekamorvay.com/ .