Who’s at risk for postpartum depression?The question of who gets postpartum depression “is a little bit controversial,” said Dr. James Kappenman, obstetrician-gynecologist at Sanford Health in Fargo.
By: Pamela Knudson, Grand Forks Herald
The question of who gets postpartum depression “is a little bit controversial,” said Dr. James Kappenman, obstetrician-gynecologist at Sanford Health in Fargo.
“Certain women are predisposed to hormonal fluctuation — the dramatic drop-off in estrogen and progesterone levels after pregnancy — that may be tied to postpartum depression.
In a recent interview, he cited one study that analyzed the effect of a certain medication that causes a decrease in estrogen and progesterone, hormones that are produced by the ovaries. The study revealed a higher reoccurrence of postpartum depression in women who were prescribed the drug than in women who weren’t, he said.
But were the results because of a certain population that was studied, or the genetic make–up of the women who were studied? he said. “That’s not clear.”
Research is on-going in this area, he said.
“Ethical issues related to studying pregnant women, and concerns about subjecting her and her fetus to medications, make these kinds of studies ethically challenging,” he said. Because of these concerns, most of the data has to be collected after-the-fact.
Postpartum depression typically happens after the first baby, he said. “Having your first baby can put you at higher risk,” simply because becoming a parent is one of the significant life changes that can trigger depression.
A prior event can also increase your risk.
“If you had postpartum depression in a past pregnancy, you’re more likely to have it recur in a future pregnancy,” Kappenman said.
Also, women at the extremes of the child-bearing-years spectrum are also at risk for postpartum depression because those pregnancies may be “more difficult and stressful,” he said, especially if they are unexpected — such by teenagers or women who thought child-bearing was behind them.
Research has also revealed that women who breastfeed have lower rates of postpartum depression, he said. And more studies are confirming that skin-to-skin contact between mother and baby immediately after birth helps with intimacy and bonding which can reduce the threat of postpartum depression.
In severe cases, depressive symptoms can reach the level of postpartum psychosis, although “fortunately, it’s very rare,” he said. “Maybe .1 or .2 percent of women who’ve delivered” have these symptoms.
“It can be a challenge to identify,” he said. “Oftentimes (patients) are unaware of symptoms. We have to depend on close family members or friends (to report them). Or the patient may tell (their health care provider) that they’re doing strange things.”
Such patients may have delusions of hearing or seeing things that aren’t present, he said.
“If you feel you don’t have interest or motivation to do things you normally find enjoyable, or you have recurring thoughts of doing harm to your baby, see your (health care) provider right away,” he said.
At Sanford, the goal of the OB-GYN department is to encourage patients who may be at risk for postpartum depression to come in and talk with someone or get help, he said. “We want your baby to be a joy in life, not a burden.”
Sanford offers a nurse clinic phone line and same-day appointments which can be especially helpful to these patients. New mothers can quickly get answers to questions about what is normal, or not, through a personal MyChart interactive health record system at Sanford.
Altru Health System also offers a similar service, MyHealth, through which patients can send a message to their health care provider and receive a response within two business days, according to Angie Laxdal, Altru public relations specialist.
Altru is “looking at adding a phone nurse line,” according to Lynn Huot, manager of clinical operations, Laxdal said in an email to the Herald, which “would be available after 5 p.m. and on weekends to respond to patient needs.
“We also encourage patients to use MyHealth provider messaging as a convenient way to ask non-urgent questions.”
If you have concerns about postpartum depression, talk to your health care provider.
Here are other ways to get help:
• Call My Sanford Nurse line: 1-800-821-5167 or (701) 234-5000 (open to anyone with a concern)
• Call Same Day at Sanford to see a provider that day: (855) SAME-DAY or go to www.sanfordhealth.org/SameDay for more information
• Visit Altru Walk-in Clinic or Urgent Care
• Altru Professional Center (732-7600) offers extended hours (until 8 p.m., Monday through Thursday)
• In emergencies, go to Altru Emergency Room or call 911