The importance of fostering the mother-baby relationship in the therapeutic treatment of postpartum depression

Postpartum depression - CALDA Clinic
Author: Claudia M. Elsig, MD

Forming a healthy maternal bond with a child is one of the most significant psychological processes for a mother in the postpartum period and the first year of a child’s life. This bonding is hugely important for both mother and child.

Research shows that postpartum depression (PPD) creates an environment that is not conducive to the personal development of mothers or the optimal development of a child. 1 It can have severe and lasting consequences and is increasingly recognised as a significant public health problem.2

Studies show that children growing up with the experience of strong maternal bonding are more likely to have better physical, cognitive, and psychosocial outcomes as adults.3 Fostering the mother-baby relationship during the therapeutic treatment of PPD is therefore vital.

What is postpartum depression?

Postpartum depression is a type of depression that mothers can experience after having a baby. It affects between 10 and 20% of all mothers.

Symptoms are characterized by despondency, tearfulness (crying for no reason), anxiety, feelings of inadequacy and guilt, difficulty concentrating, and fatigue. Mothers with postpartum depression display a general lack of enjoyment and loss of interest in the wider world.

Physical symptoms can include headaches and rapid heart rate. There is often a change in appetite (not interested in food or overeating) and a lack of interest in sex. Other comorbidities, such as compulsive behaviours, such as excessive cleaning, can also occur.

A lack of feeling for the baby is particularly concerning. And mothers can even have frightening thoughts – for example, about hurting their baby.

So, why do some mothers suffer PPD and others not? The causes are complex and there are many contributing factors, including the rapid changes in oestrogen and progesterone hormone levels. Other factors include birth satisfaction, socioeconomic and psychosocial risk, social isolation, stress levels, insomnia, diet, orthomolecular status, and cessation of breastfeeding.

Some women are at higher risk. For example, women who experience depression during pregnancy tend to be at a greater risk of depression after giving birth. There are cultural pressures, such as different viewpoints on mental health and stigma, which may exacerbate anxious feelings.

It is also possible for a mother to develop PTSD after a traumatic birth experience. And a small number of women (less than 1%) develop a more severe condition, known as postpartum psychosis, which is extremely serious and requires immediate medical attention.

What is the difference between ‘baby blues’ and postnatal depression?

It is natural for mothers to feel overwhelmed during the first few days and weeks after giving birth as they adjust to new demands and different sleep patterns. The phrase ‘baby blues’ is used to describe a brief period of low mood, feeling emotional and tearful around three to 10 days after giving birth. It usually occurs for just a few days but occasionally symptoms can fluctuate over a few weeks. Baby blues is extremely common – up to 80% of women who have given birth experience it.

The important difference between baby blues and postpartum depression is that baby blues is transient, short-lived and is generally manageable. Importantly, the mother still bonds with the child.

Postpartum depression, on the other hand, is much deeper and longer term. It usually develops between 3-6 weeks after the baby is born but can occur anytime in the first year. Studies suggest that depressive episodes are significantly more common in the first three months after delivery.4 PPD impairs a mother’s relationship with her infant.

How does PPD affect the mother-infant relationship?

The beginning of an infant’s life is a critical time for the development of the mother-infant attachment. Interactions in the first 3 months are vital for the development of a healthy relationship.5

Postpartum depression is a serious condition in which maternal brain response and behaviour are compromised.6 So, for example, depressed mothers tend to be slower to respond to infant stress or other social signals. They also vocalise less often to their infant and engage in less joint activity or imitation. Mothers with PPD find it more difficult to stimulate and offer affection and have less face-to-face interaction with their baby.

Care for the child becomes mechanical and social interaction with the infant minimal. If prolonged, this poses extreme risks for a child’s development. When a mother is unavailable, unpredictable, and insensitive, infants can go on to develop trust issues, and feel unworthy and rejected. This experience early in life results in attachment disorders and behavioural problems later on.

Research shows that maternal depression is associated with a range of difficulties in infants and toddlers including “emotional dysregulation, lower frustration tolerance, higher rates of non‐compliant behaviour and emotional lability and decreased positive affect and ability to self‐sooth.

“Infants of depressed mothers have electroencephalograph (EEG) activity that demonstrates more negative affect and crying, more reactivity and decreased abilities to regulate arousal.”7

This has significant implications for a child’s attention, focus and ultimately learning. Infants of mothers with postpartum depression have been found to perform lower on cognitive tasks, even as early as two months old.8

For mothers, postpartum depression has a significant impact. They can feel shame and guilt and withdraw from everyday life. This has implications for family, friends and the whole community.

What are the treatment options for postpartum depression?

It is important to remember depression is treatable. But left untreated, postpartum depression can worsen. In extreme cases, this can even lead to suicidal thoughts or even suicide when a mother feels there is no way out. Detecting and treating postpartum depression early will help to avoid any harmful consequences.

So, what are the treatment options? Conventional medicine may include psychotherapy, help and relief in everyday life, as well as the use of psychiatric drugs. However, for many mothers, the use of medication can be problematic for breastfeeding because active ingredients can pass into breast milk.

A review of literature in 2010 supports the application of comprehensive, psychotherapeutic interventions that target the functioning of the infant, the mother, and the mother–infant relationship.7

Therapeutic help is essential.

If you are a mother suffering with PPD it is first important to recognise the condition and be kind to yourself. Don’t beat yourself up if you can’t do something you planned to do. Keep a mood diary if you aren’t sure. Small things can make a big difference, so try to take a shower and get dressed even if you aren’t going out of the house. Peer support can also be helpful – perhaps one of the other mothers in your antenatal group is feeling the same? Contact a support group if you can.

A mother who cannot develop feelings for her child is often considered taboo. It is very important to get practical assistance from friends and family, but above all, seek therapeutic help.

Treatment at the CALDA Clinic

Treatment at the CALDA Clinic works to uncover and correct the causes of depression and supports women to develop a bond with their infant. Wherever possible, individualized therapy programs are developed without the use of psychiatric drugs.

CALDA’s postpartum depression treatment program uses highly effective precision therapy to treat every level of the organism. Central to the program is the bonding process between mother and infant. We listen, address imbalances, treat the causes, and help mothers to enjoy time with their baby again.

Our clients stay in luxurious residences that are optimally prepared for the special needs of mothers with children. During the entire stay, infants are lovingly looked after and cared for by a specially trained paediatric nurse, allowing mothers to engage in the therapeutic program knowing their baby is close by and in safe hands.

Our clients are self-payers, which is the basis to enabling absolute discretion and privacy. If you would like to know more about our postpartum depression program, please get in touch.