Recognizing and Screening for Postpartum Depression in Mothers of NICU Infants

Adv Neonatal Care. 2003;3(1) 

In This Article

The Experience of PPD

Loss of control is the underlying problem that women with PPD experience. Women lack control over all aspects of their lives: their emotions, their thoughts, and their actions.[20] Using grounded theory methods, Beck identified a 4-stage process she termed "teetering on the edge" by which women suffering from PPD attempt to cope with the problem of loss of control.[20] Teetering on the edge refers to mothers' walking the fine line between sanity and insanity. The 4 stages consist of (1) encountering terror, (2) dying of self, (3) struggling to survive, and (4) regaining control.

In the first stage of encountering terror, women are suddenly hit with this mood disorder. They experience horrifying anxiety, relentless obsessive thinking, and mental confusion.

In the second stage, described as the dying of self, mothers believed that their normal selves are no longer present. They felt an alarming unrealness in which they just went through the motions, feeling like robots. Believing that no one truly understood the magnitude of their living nightmare, women isolated themselves and contemplated ending their lives.

In the third stage, mothers used 3 strategies as they struggled to survive. These strategies consisted of battling the health care system, praying for relief, and seeking solace in a PPD support group.

As the depression began to lift, mothers entered the fourth stage—that of regaining control. This final stage was a slow process, and it consisted of unpredictable transitioning to recovery, mourning the lost time with their infants that PPD stole from them, and guarded recovery. Mothers felt that PPD had left an indelible mark on their lives. They feared that at some point they could again be stricken with depression.

Provocative research on the experience of PPD, explored from the mothers' perspective, provides insight into the experiences with which mothers are grappling during the depths of their depression. A phenomenologic study (n = 12 [11 Caucasian and 1 Asian]; all mothers of healthy full-term infants) revealed 9 themes that described the essence of the new mothers' experience.[21] Mothers were overwhelmed by the responsibilities of caring for their infants and were petrified that they could not cope. Mothers wanted to reach out to their infants, but PPD prevented them from doing so. Some women erected a wall to separate themselves emotionally and physically from their infants. Guilt, irrational thinking, and anger filled the mothers' interaction with their infants. Women often reported that they failed to respond to their infants' cues.

Dangerous myths, perpetuated by both society and the media, equate new motherhood with total fulfillment and joy. These myths set unrealistic expectations for women to attain. These unrealistic expectations are shattered by the reality of motherhood, and a mother's mental health hangs in the balance. In a meta-synthesis of 18 qualitative studies on PPD, Beck identified 4 overarching themes[22]: (1) incongruity between expectations and the reality of new motherhood, (2) a spiraling downward process, (3) pervasive loss, and (4) making gains (Fig 2).

Four perspectives involved with postpartum depression. Reprinted from Beck CT, Qualitative Health Research (12:4), p 461, copyright © 2002 by Sage Publications, with permission from Sage Publications.

The final overarching theme revealed in the meta-synthesis, making gains, focused on mothers' recovery from PPD. It included surrendering, recognizing they needed help, struggling to survive, and reintegration/change in which mothers adjusted the unrealistic expectations they had for themselves.

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