My husband and I are in our mid-30s and are the parents of a wonderful 2 year old. We want to have another child soon, so our daughter doesn’t grow up as an only child. But I had a severe case of post-partum depression after our daughter was born and I’m terrified that it could happen again. How do we make this decision?

Written by our mental health expert, Dr. Janet Takefman.  

I certainly understand your fear and can reassure you that many women have asked themselves this same question. In fact I often recommend a book by Karen Kleiman who founded the Postpartum Stress Center in Philadelphia ( entitled, “What Am I Thinking? Having A Baby After Postpartum Depression”.

First let me offer a brief background on postpartum depression (PPD) which affects 15% of women. PPD differs from the “baby blues” which most new mothers experience within days or weeks after giving birth. The baby blues can include symptoms like tearfulness, anxiety, exhaustion and irritability. Most women are unprepared for these feelings because they already feel profound love for their newborn and expect to be basking in the joy of its arrival. The baby blues are a normal consequence of giving birth and probably caused by the rapid drop in hormonal levels (estrogen and progesterone). We know that whenever a woman experiences hormonal change related to her reproductive life, whether it is when she first begins menstruating in adolescence (menarche), before she gets her monthly period (premenstrual dysphoric disorder – PMDD), when she starts the process of menopause at the end of her reproductive life, or when she experiences infertility; mood changes and depression are a natural, temporary occurrence. So it is no surprise the same happens after giving birth, but generally once the hormones level off mood returns to normal.

PPD is different from the baby blues in that the symptoms are usually more severe from the start, the duration is months not weeks and it can interfere with a mother’s ability to care for her baby. In fact, if left untreated or ignored PPD can have long-lasting negative repercussions for both the mother and child.

We know quite a bit about risk factors related to PPD. Studies show there is a high correlation between those who experience PMDD and PPD. Similarly, PPD is more likely to occur after infertility. Given these findings it is reasonable to conclude that a subset of women are particularly sensitive to changes in reproductive hormones and respond to these normal changes by experiencing depression. Given you have experienced one episode of PPD, your chances of experiencing it again are indeed greater, however by no means is it a sure thing. In fact, the majority of women experience PPD only once, in spite of having 2 or more children.

There are several psychosocial factors which we know put a woman at risk for PPD. For instance, women who have experienced prenatal anxiety or depression, who suffer from low self-esteem, who have poor social support or are unhappy in their marriage, who have current life stresses, who had an unplanned pregnancy, who have twins or whose infant is fussy or has colic, are more likely to experience PPD.

Thus it is reasonable to conclude that PPD results from a combination of factors; specifically hormonal changes, physical changes, stress levels and predispositions. Now there is not much you can do to change your natural response to hormonal changes or your predispositions, but you can reduce the likelihood of experiencing PPD by attending to the physical and stressful aspects of your life pre- and post- pregnancy.

Early identification and intervention, even preemptive treatment have been shown to lower a woman’s chances of experiencing persistent PPD. Exercise, proper nutrition, and consistent sleep also play a major role in improving prognosis just as these lifestyle factors do for depression in general. Having a support network and available partner who can arrange meals, allow you to sleep uninterrupted and break up your day from childcare will make a substantive difference.

With regard to treatment, options include cognitive behavioral therapy (CBT), anti-depressant medications, and support groups. Some studies show the combination of medication and CBT work most effectively; others show that CBT on its own can be just as effective. Since trace amounts of anti-depressant medications are passed to the baby through breast milk it is important to consult with a specialist before going on antidepressants.

I am in no position to tell you whether to have a second child or not. Your family can have a fulfilling life whether you are 3, 4 or more. Our research shows that solo children are not disadvantaged compared to those with siblings. But you said you did want a second child and it was the fear of another episode of PPD that was impeding you from pursuing this goal. It’s my opinion that any decision made based on fear is the wrong decision. Rather than give in to fear which may lead to regret later in life, I would encourage you to confront your fear and make changes in your prenatal life to lower the risk factors mentioned above. In addition, contingency plans to intervene swiftly at the first signs of PPD, or even to begin a regimen of treatment before you give birth will likely minimize the impact of PPD by lowering its severity and duration. Remember PPD is a temporary, manageable problem; having a second child is an enriching, lifetime experience.


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