Postpartum Depression and Shaken Baby Syndrome

Thanks to Sarah Pulliam, LICSW, MPH, social worker at Seattle Children's Hospital and Open Arms Board Treasurer, for sending much of the information that appears in this blog post.

In this post, I'm again talking about postpartum depression. There has been increasing discussion about postpartum depression in the news, and I'm glad that this is coming up more to help build awareness.

As a mother who had undiagnosed (or perhaps unaddressed is a better term) postpartum depression during much of the first year of my own children's lives, I can say from personal experience that it is something that has a big impact on mothers' lives and abilities to care for their children. We as women often rationalize why we feel the way we do and don't address it, especially since it's something that we see reflecting on our abilities to parent. Women might think, "I'm not blissfully happy like a mom should be - in fact, I'm a wreck - but I can't let anyone see I don't have it all together so I'll hide it." Even partners, friends, family members and physicians can think, of course you're irritable, you're postpartum and don't have enough sleep - that's normal. But postpartum depression should not be dismissed - if "baby blues" last more than two or three weeks, there could be a problem. No one should feel the need to suffer in silence because postpartum depression is treatable.

I'm glad to see this issue coming to the forefront more, so physicians can address it and can help women and their families receive help in whatever form is needed.

Heidi Koss-Nobel, Executive Director of Postpartum Support International of Washington, was just interviewed on King 5's Learning for Life program on the topic of Postpartum Mood Disorders. She stressed that postpartum depression affects one out of eight women after pregnancy and is the most common complication of childbirth. In this video, she discusses ways to distinguish postpartum depression from baby blues and regular sleep deprivation during postpartum and how to get help.



Heidi Koss-Nobel also talked about the factors that increase the likelihood of postpartum depression: women with lots of stressors in their life, women with a history of infertility, teen moms, women with a history of depression or family history of depression, military families, low income women, even those who moved recently.

Related to this topic, Sarah also went to a presentation recently on Child Abuse prevention by Dr. Jenny Radesky at Seattle Children's Hospital. Dr. Redesky said that paternal postpartum depression is now becoming more accepted as a real problem as well. She said that environmental stressors such as poverty and unstable living conditions contribute to higher rates of postpartum depression in both parents, not just mothers.

We certainly can see why this can be a problem within a family, but the reason why this is so important is that the consequences of having parents with untreated postpartum depression are so high. There are real lasting effects. As Heidi Koss-Nobel says in the video, postpartum depression can eventually lead to long-term health problems for both parents & baby. As a result of depression, parents can interact less with the baby, be less responsive to their babies, and babies can later develop their own depression and anxiety as well. On the extreme side, postpartum depression can lead to more serious problems of neglect, abuse, psychosis or suicidal thoughts or actions on the part of the parent. These kind of grave consequences cannot be ignored.

A review of the literature suggests that a baby is more likely to be physically abused (also known as Shaken Baby Syndrome, or Abusive Head Trauma or AHT in the medical literature) by parents who are depressed in the postpartum, usually 2-3 months after birth. One of the main reasons is that these parents are having difficulty attaching to the baby in the first place. They may have trouble reading infant cues or responding to them appropriately. They may be sleeping and eating irregularly, and feeling ineffective and overwhelmed, and ambivalent about parenthood. This cumulative stress understandably tends to lower the threshold of self-control. But another important reason is that babies of depressed mothers are at higher risk for abuse is that the babies are often more irritable and resist soothing (stemming from attachment difficulty or even possibly inadequate care).

Taken together, it is not surprising that depression is a strong risk factor for trauma in infants — and the outcomes are grave. About 30% of babies who suffer abusive head trauma will die. The remaining infants who survive often have life-long disability and health care problems. The cost of one intensive care stay is on average $80,000. That is not including all of the chronic care a child may need the rest of their life, a cost borne by society. The real tragedy? These outcomes are entirely preventable.

A link to local support groups and other resources for parents is the Shaken Baby Coalition.

I'm pleased to say that Open Arms is now including postpartum screening as part of our program with all our clients. We believe that postpartum depression can occur for any woman regardless of her education, socioeconomic status, or any other measure. We strongly believe that all parents and their babies deserve to be as healthy as possible, and this means mental health as well.

No woman is immune to postpartum depression. I'm delighted that this issue is receiving the widespread attention it deserves.

For more information, visit the Postpartum Support International of Washington website.