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Postpartum depression and the couple

Postpartum depression and the couple
The stress and strain on the marriage is exacerbated if the woman is suffering from postpartum depression (PPD). The new mother feels overwhelmed, exhausted, sad, anxious and unable to cope with the baby and household chores.

The arrival of a baby is a powerful event that brings permanent changes to the life of the couple. Parenthood can affect the perception of one’s self, one’s partner, other relationships, and the world in general. The awareness of being totally responsible for the life of a helpless infant is an awesome, and often frightening, realization. Whether or not this is the couple’s first baby, planned or unplanned, its arrival is always a time of transition and possible crisis.

Many relationships that were based on a foundation of equality and sharing, often lapse into traditional roles after the baby is born. The man may view himself as the “breadwinner” while the woman (whether she works outside of the home or not) may view herself as the “housekeeper”, as well as the one responsible for the emotional and physical well-being of the family. While the financial support of the family often falls on him, (thereby creating extra stress for him), she may  be resentful that the tasks of baby and domestic care are thrust on her. In addition, and not to minimize the changes a new dad goes through, his life has probably not changed as dramatically as hers. Her resentment may be based on reality or by misperception.  There is a real struggle for balance and return to equilibrium. Research shows that roughly 70% of all relationships will experience conflict and discord during the first year postpartum.

The stress and strain on the marriage is exacerbated if the woman is suffering from postpartum depression (PPD). The new mother feels overwhelmed, exhausted, sad, anxious and unable to cope with the baby and household chores. She may be withdrawn and having difficulty with day to day activities. She is struggling to find herself in this role transition to “mother”. The new father is also confused (and possibly depressed) by his wife’s behavior. He usually does not know what to do or say so he may try to help by pitching in with the housework. Those men who have been helping  with the housework all along, may double their efforts and do even more. They may also take over some (or most, or even all) of the childcare responsibilities. The woman suffering from PPD knows she needs the help and that she “should” appreciate her partners efforts. However, as her partner takes over more and more of “her” duties, she begins to feel increasingly inadequate. This puts the new dad in a double bind. In order to help his wife, he does more of “her” work. The more of “her” work he does, the more inadequate she feels and then starts to resent him. Meanwhile, he starts to resent her for being unable to cope. In addition, the new mother may be overwhelmed by her own reaction. PPD carries with it, its own shock factor. The woman didn’t expect to feel depressed or anxious. In fact, she probably expected this to be the happiest time of her life. As such, the depression begins to feed on itself - she feels guilty and inadequate because she sees herself as weak to become depressed in the first place.  She doesn’t know that PPD is a medical condition, and certainly not a sign of weakness.

Rather than help with the housework, sometimes all the new mother needs is emotional support. If she is caught up in the grips of PPD, she may not be able to ask for or even identify what she needs.  Worse, she may expect her husband to instinctively know what she needs or wants and if she has to ask for it, his response (no matter how positive) becomes meaningless. This is, of course, irrational and implies that the husband should be able to read her mind and anticipate  her needs.

What the new mother might really need is a simple hug, kiss or some display of physical affection. However, she may be unable to ask for this because experience has taught her that physical affection often leads to sexual activity. A very real symptom of PPD is loss of libido or sexual drive. In the book, The New Mother Syndrome, Carol Dix cites a Masters and Johnson study which had revealed, “A lower level of sexuality even at three months postpartum and that achieving orgasm after birth can be more difficult because of fatigue or tension,  breast tenderness, soreness after episiotomy, exhaustion from a C-section delivery, or fears that sexual organs have changed and that vaginal muscles are either tighter or looser.” Difficulties with or disinterest in sex adds to the postpartum woman’s feelings of low self worth. This is usually related to her physical changes and a negative body image. She likely has stretch marks and excess weight to contend with.  And if she is  depressed, she simply doesn’t have the energy or motivation to exercise take proper care of herself. Rather than recognize decreased sexual desire as symptomatic of PPD, the new dad can  perceive this as a rejection of him. He may react by distancing himself from her emotionally and physically, by working longer hours, or “going out with the boys.” He might even seek relationships outside of the marriage. His withdrawal may cause her to feel even more isolated and deepen the depression.

Therefore, anger, resentment, and even jealousy can rear their ugly heads on both sides. Each may be envious of the other’s attention to the baby. This is especially true for the father of the breastfed baby. Even though he may rationally know that he is not being replaced by the baby, he still feels the loss of his partner’s attention. On the other hand, the new mother may feel as though her partner is more interested in the the baby than in her. If there are other children around, they will naturally gravitate to their father who is more likely to be more available to them than their mother whose time and energy is more absorbed by the infant. This can be quite devastating. Unfortunately, all of this happens at a time when each of the parents really need extra doses of nurturing from each other.

Most issues that arise during this stage of the marriage can be resolved through communication, compromise, and a re-commitment to making the relationship work. A  psychotherapist who specializes in postpartum depression, and the transition to parenthood, may be their best resource. Being a parent is a tough job - there is no previous training, no “how-to” manuals. It requires making choices which include giving up things previously valued, in the interest of the child and the marriage. As each individual strives to adapt, the relationship may very well be strained, but with a concerted effort by both, the couple can grow and emerge stronger than ever.

Ilyene Barsky, LCSW

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