Pregnancy Week By Week

Postpartum depression (PPD) or the “Baby Blues,” sometimes hits new mothers right after the baby is born.  A mild case can dissipate within a week.   On the other hand, a serious bout of depression, however, is real cause for concern because of the damage it can inflict on the budding relationship between mother and newborn baby.

Postpartum depression is difficult to diagnose, because some of its symptoms are indistinguishable from the side effects of the new mother’s chronic need for sleep.   These include sadness, fatigue, insomnia, appetite changes, diminished sex drive, crying episodes, anxiety, and irritability.  Newborn babies must eat every hour or so, and they often nap during the day and wake up at night.  Whether it is fed by breast or bottle, the baby needs attention frequently and at unpredictable times, which forces its caregivers to wake up repeatedly during the night.

New mothers with the most severe cases of PPD are more easily identified. Their symptoms can be dramatic, and may include despair, a feeling of emptiness and futility, exhaustion, lethargy, a sense of inadequacy in caring for the new baby, a tendency to withdraw from any social contact and to get easily frustrated, moments of rage, incoherent speech and writing, panic attacks and severe anxiety.   If any of these symptoms are present in a new mother, healthcare providers can administer a diagnostic test known as the Edinburgh Postnatal Depression Scale.  Mothers who score higher than 13 on this test are likely to have the disease.

Postpartum depression is not uncommon, yet it is much rarer than morning sickness.   It may occur in anywhere from 5% to 25% of new mothers in the first few months after the baby is born.   Evidence some recent medical research suggests that the condition is a side effect of changes in the mother’s hormone levels at the end of pregnancy.  However, this explanation is somewhat controversial, because of the lack of evidence that hormonal treatment has helped postpartum depression victims.

In addition to hormone imbalances, some researchers have identified other health conditions that are more common than average among mothers with PPD.  These include the choice to feed by formula rather than the breast — which can contribute to a weaker bond between mother and child — as well as a tendency toward depression in the mother before pregnancy, cigarette smoking, poor self-image, stress deriving from problems finding childcare, depression and anxiety during pregnancy, life stress, single parenthood, the lack of support from family and friends, a difficult relationship with the father of the child, the temperament of the child — colicky babies can increase the mother’s frustration — and the mother’s feelings about the pregnancy itself.   Unplanned and unwanted pregnancies may increase the likelihood of postpartum depression.

These findings should be taken with a grain of salt.  Scientists have conducted studies of postpartum depression in many different ways and with different size samples of women, so the results of any one study are difficult to compare with the results of any other.    In reality   nobody really knows why a substantial minority of women with newborn babies get severely depressed.

Perhaps because of the difficulties with diagnosis, one in five of mothers with postpartum depression actually seek professional help. And yet, it is abundantly clear that many new mothers recover from depression after participating in a support group or in counseling.

Even though the causes of PPD are still unknown, it is clearly a dangerous disease. Most mothers with PPD are emotionally paralyzed by their depression, and probably get inadequate social support as a result.  Their mothering suffers, and their babies don’t get the love and care they need.   PPD mothers focus more on the negative events of childcare than the positive, and cannot cope with their negative feelings.  As a result, they can be inconsistent with childcare, for example, by ignoring the baby’s crying.

When post-partum depression is left untreated, and causes a new mother to reject her baby, the long-term result can be an insecure attachment between mother and child and later, lifetime problems with the child’s ability to form emotional attachments with any one at all. According to research by child psychologists such as Edhborg, an infant that feels rejected by its mother may become so subdued that it will not interact with the mother or any other adult, and the lack of connection with others in its first few months of life will, in turn, deprive the baby of the stimulation it needs for its brain to grow, and lead to a lifetime of difficulties with attachment.  A seriously depressed mother, therefore,  cannot be expected to support her baby’s healthy development on her own. She will need help from a team of professionals from different fields — therapists, doctors, nurses,  and other experts who work with families and children.

A mother with the baby blues needs to stay in touch with her doctor. If her depression is identified early, and she gets treatment either with counseling or with anti-depressants or both, her long term prognosis and that of her child will both be the better for it.

*This article is based on the information at http://www.nlm.nih.gov,http://en.wikipedia.org, http://www.nmha.org and http://familydoctor.org

Foods an expectant mother eats are the only source of nutrition for her maturing baby.  Therefore, it is important to develop a balanced and healthy diet, even before pregnancy begins.  When a woman decides to get pregnant and visits her health care provider for a full checkup, the doctor or nurse she sees will ask questions about her family life, her work, and her lifestyle, including her diet.  In their discussion about pregnancy, a mother-to-be and her doctor will work together to develop a diet plan that includes important nutrients for the baby, such as folic acid.

Since more than half of all expecting mothers experience morning sickness in the early months of their pregnancies, a health care provider usually offers guidance to the mother about nutritious foods that will be easy on her stomach.  Even if she craves certain foods or does not feel like eating in the early months, it is still important to try eating a variety of foods each day so she gets all her important nutrients.

Among the healthy foods that providers usually recommend for expecting mothers are grains such as bread, cereal or pasta, raw vegetables and fruits, small amounts of meats, beans, seeds and nuts, and dairy products such as milk, yogurt, or cheese.  A diet with lots of small healthy snacks may be the best way to go, because large meals are hard to digest, and can worsen nausea and heartburn.

Some specific nutrients are also essential for a healthy pregnancybecause they contribute to the strength of both baby and mother.   Most of them can be found in ordinary foods.

• The calcium in milk, cheese, yogurt and sardines, for example, helps the baby develop strong teeth and bones.   Some forms of salmon, spinach and fortified orange juice also contain calcium.
• Lean red meat (beef, pork and so on), as well as dried beans and peas, iron-fortified cereals, and prune juice, are all good sources of iron, which prevents fatigue and helps the body create red blood cells that deliver oxygen to the baby.
• Baby’s skin, eyes, and bones all need Vitamin A, which is available in carrots, sweet potatoes, and dark leafy greens.   Other essential nutrients include
• Vitamin C, which can be found in strawberries, tomatoes, broccoli, and citrus fruits, and strengthens the baby’s gums, teeth and bones;
• Vitamin B-8, which the body uses to make blood cells and process fat, protein and carbohydrates, and is present in beef, pork, ham, liver, bananas, and whole-grain cereals
• Vitamin B12, a crucial element in the maintenance of the nervous system and the production of red blood cells, which is easily obtained from animal foods such as liver, meat, fish, poultry and milk
• Folate, an ingredient in green leafy vegetables, liver, orange juice, legumes and nuts that the body needs in order to produce blood, protein and fully functional enzymes.

For expecting mothers who do not eat some of the foods listed above, prenatal supplement pills are available that can provide them with the extra iron, folic acid, Vitamin B12 and Vitamin D they need for a healthy pregnancy and birth.   In the month preceding pregnancy, and the first 3 months of pregnancy, a regimen of 400 micrograms of folic acid every day can help prevent neural tube defects in the baby.   Mothers whose first child was born with neural tube defects are especially likely to give birth to another baby with similar defects, so they in particular must take large doses of folic acid– as much as 4 milligrams (ten times as much as those without a history of the disease) before and after the baby’s birth.

The best sources of calcium are dairy products, but since many expecting mothers are lactose-intolerant, doctors sometimes prescribe calcium supplements.

There are also substances that pregnant women should avoid at all costs, because they could harm t he baby rather than help it grow.  For example, it is important to avoid alcohol of any kind, as well as marijuana, tobacco, cocaine or any other drug that isn’t prescribed by a doctor — because these can all be extremely harmful to the baby.  Fetal alcohol syndrome, a disease in which the mother’s placenta has absorbed so much alcohol that it has prevented sufficient oxygen from reaching baby’s brain, is responsible for one of the most common forms of mental retardation among American children.

Caffeine may also be a problem.  There is some evidence that pregnant women who drink more than two daily cups of coffee are more likely than non-coffee drinkers to have miscarriages.  However, nobody knows if it is the coffee itself that causes the loss of the baby or if some other unidentified health condition drives some women both to drink lots of coffee and to lose their babies.

The planning of meals in advance has proven to be one successful method for incorporating all these do’s and don’ts into the daily diet of the expecting mother, and many tools are available for this.

The USDA (US Department of Agriculture) publishes a food pyramid which can help mothers put together a personalized healthy diet. (www.mypyramid.gov) Revised in the last five years,  the pyramid helps the mother  calculate the appropriate number of servings in each food group; grains, vegetables, fruits, oils, milk, and meat and beans — based on her age, gender, and level of daily exercise.

Another useful tool is the RDA—recommended daily allowance—on food labels, which show the levels of nutrients a mother needs every day. During pregnancy, the RDAs are higher for most nutrients.

*This article is based on the information at http://www.acog.org, http://kidshealth.org,http://www.webmd.com and http://www.womenshealthchannel.com