Guest Blogger: Julie of Triplet Tales

Are Mother’s of Multiples More at Risk for Postpartum Depression?

Julie Gillespie
Author: Magical Multiple Moments
Editor: Triplettales.net

Is it more common for moms of multiples to have postpartum depression (PPD) than moms of singletons? It seems like a facetious question. Well, is it more common for someone with more than one car to have more engine failures? PPD is clinically defined as a “major depressive episode that occurs in the first four weeks after delivery” (Diagnostic and Statistical Manual of Mental Disorders-IV or DSM-IV). Although the DSM says patients are most susceptible in the first month, clinically, the experts say it can happen any time in the first year. Mothers of multiples have the potential for all of the same psychological stresses that mothers of singletons have such as feelings of guilt; social isolation; marital difficulties; and domestic overload; as well as concerns about having inadequate time for two or more children all at the same time.
Looking through all the literature the answer to the question is most likely, yes, if you have more than one child the potential to have postpartum depression (PPD) is greater. But, the percentage increase is not as exponential as it sometimes feels being a mother of multiples myself. Clearly, knowing the warning signs is the first step in battling the disease. We can try to make our mental health as fit as possible. Join a multiples group, get away for awhile or enlist some help (family or friends will do, it doesn’t have to be paid help). It’s hard to admit we need help once and awhile, but if taking a night out with the girls once a week makes me feel better than I’m a better parent in the long run. It’s just like they say on the airlines, “You have to put your oxygen mask on first, then you can help your kids.”
A recent study in Pediatrics this April sheds some fresh light on this topic. The study measured depressive symptoms of 8069 mothers 9 months after giving birth to a live child or children in 2001. The study showed that 19% of mothers of multiple infants had moderate/severe depressive symptoms, compared with 16% of mothers of singletons. The percentage with only “depressive symptoms” as opposed to moderate/severe depression was forty percent higher in mothers of multiples versus mothers of singletons. Within six months after delivery their statistics reported that maternal depression of mothers of multiples was 10%, which is equal to that in the general population. The difference was that the prevalence in the first 5 weeks after birth of the mothers of multiples was 3 times higher than in the general population (1).
One would expect that if having one baby has a sixteen percent likeliness of having moderate/severe postpartum depression, than, having two or more babies must mean double or triple the amount or a twenty-six to forty-two percent increase. Apparently it is not a simple case of mathematical addition. Only a three percent increase was shown for moms having more than one baby.

Prior to this study, in 2003, a study of 587 Mothers of Supertwins (MOST) showed 29 percent have depression after the birth of their multiples (4). According to another study of 758 mothers of twins and higher-order multiples in 2005, by the National Organization of Mothers of Twins Clubs Inc. (NOMOTC), mothers of multiple birth children are more at risk for this illness because of the already tremendous physical, financial, and psychological stressors they face (2). In the NOMOTC study, the rate of Postpartum Depression was found to be 37 percent. Singleton studies on Postpartum Depression (PPD) have generally shown the prevalence to be between ten and twenty-five percent in the first postpartum year, depending on the risk factors (2).
In my book Magical Multiple Moments I interviewed Dr. Rita Suri, an associate professor at the UCLA Semel Institute of Neuroscience and Human behavior whose research interests focus on mood disorders during pregnancy and the postpartum period. Dr. Suri has just completed a five year NIH study grant from three clinical sites on the risk factors of post partum depression.
Here is an excerpt from that interview: Dr. Suri said “The most vulnerable period is between three weeks and six months after delivery.” The three categories of Postpartum Depression Disorders are postpartum “blues”, postpartum major depression, and postpartum psychosis. The most common syndrome is “baby blues”, with 50-85% prevalence. Symptoms include fatigue, difficulty concentrating, irritability, mood swings, and fluctuations in appetite.
In the NOMOTC survey almost half of the moms (47%) confirmed experiencing “baby blues.” It usually lasts less than two weeks. However, if a mother experiences the “blues” for longer, she may need further evaluation and medication to help her through the depression. Postpartum Psychosis, thankfully, only occurs in 0.1 percent of all postpartum women, and is thought to be a variant of bipolar disorder. Patients with this diagnosis need aggressive, in-patient treatment because of the risk of suicide and/or infanticide.

For patients whose problem progresses from the “baby blues” phase into major depression, a psychiatrist will often recommend an anti-depressant medication (most typically an SSRI or selective serotonin reuptake inhibitor) or psychotherapy, or a combination of both. The SSRI drugs are safe for women who are nursing babies of any age. Dr. Suri has seen these drugs used even in the NICU on mothers with premature babies. Dr. Suri continues: “The peri-natalogists and I agree that treatment won’t stop just because a mother is nursing. We will monitor the babies and look for changes in sleep patterns, colic, or growth issues. But developing babies are always changing, having growth spurts that upset sleeping patterns or eating issues that interfere with growth, so you can’t blame it on the medication.” For most people this type of medication is very helpful and has minimal side effects.
____________________________________________________
Signs and Symptoms of Post Partum Depression

Changes in appetite and sleep patterns (up or down)
Lack of interest in all activities
Fatigue
Feelings of anger, worthlessness, hopelessness
Forgetfulness
Poor personal hygiene
Excessive anxiety
Isolating behaviors
Fear of being alone with or harming the babies or oneself
Ruminations of persistent negative thoughts,
i.e.“Will the baby stop breathing at night” (3)

Mothers who are at high risk for PPD include those with poor social support, those caring for multiple other small children in the house (prior to the birth of the new baby), a history of previous depression or family history of depression or if the mother has a history of post partum depression, with previous pregnancies.

In popular culture, moms relate to Charlotte (played by Kristin Davis), the mom on the new movie “Sex in the City 2.” She admits after a coxing from her gal pal Miranda (played by Cynthia Nixon) and a few more sips of wine,that raising two children is not what she expected. She admits her two daughters are beautiful and everything she ever wanted, but explains that the day in and day out job of being a mom is ever-tiring, and not very gratifying.
One of the funniest lines in the whole movie comes next when Charlotte confesses that even though her hot-nanny “Erin go bra-less” may be a potential threat to her marriage her greatest concern is losing her, not her husband to an affair. “I hate to say it, but when Samantha was teasing me about this girl having an affair with my husband I wasn’t worried so much about what was going to happen to my marriage, I was trying to figure out how I was going to live without my nanny!” In the end, she realizes that a little time away makes her feel like herself again. She takes Carrie Bradshaw’s (played by Sarah Jessica Parker) offer to stay at her vacant apartment as a “get away” in order to make her feel a little more relaxed about parenting.
More important than focusing on the incidence and likeliness of depression, it might help to focus on what can be done about it.

Of those respondents in the NOMOTC study experiencing depression postpartum, a large majority of mothers (70%) reported that joining a multiples club/support group was instrumental in helping maintain good mental health. It is true that there is safety in numbers. So, if you know a mother of multiples or are a mother of multiples I suggest geting involved in any of the online support groups provided by mom blog sites or magazines for mothers of multiples. It’s like the old African riddle which asks “Which is stronger one big stick or a bunch of little ones?” The answer naturally, is “A bunch of small sticks are stronger because they can be tied together. When the sticks are banded together they can not be broken.” If we stick together we can’t be broken!

1. Y Choi Dr. PH, D Bishai MD, MPH, PhD, C Minkovitz MD, MPP. Multiple Births Are a Risk Factor for Postpartum Maternal Depressive Symptoms. Pediatrics, 20101. Vol 123: No 4, pp. 1147-1154.

2. Gale and Harlow. Literature Review. Journal of Psychosomatic Obstetrics and Gynecology, 2003 (a review of clinical and epidemiologic factors affecting postpartum mood disorders).

3. J Gillespie. Magical Multiple Moments. Wyatt-MacKenzie Publishing, 2010. pp. 152-7.

4. S Griffith. Postpartum Depression in Mothers of Multiples COMBO Editor, National Organization of Mothers of Twins Clubs, Inc. Web publication ’07. Abstracts for the ISTS Mid-Congress Conference Los Angeles, June 29, 2005.

~Julie

*Julie Gillespie, mother of five, author, physical therapist, and blogger is a graduate of Mt. St. Mary’s College and the University of Southern California. She is widely recognized as an authority in the field of women’s health physical therapy. Most recently she’s published “Magical Multiple Moments” a book about raising multiples in the first five years. You can find her at: triplettales.net, magicalmultiplemoments@yahoo.com, gillespiemagic@twitter.com, or on facebook.

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