Motherhood Cafe

The Edinburgh Postpartum Depression Scale (EPDS) is one of the most commonly-used screening tools for postpartum depression. In Canada for example, mothers are routinely offered the Edinburgh Postpartum Depression Scale as a part of their 6-week postnatal visit to the public health clinic.(1-2)

If you are having a tough time coping, or if you are wondering about PPD symptoms this simple 10-item questionnaire can be a helpful tool. You can easily complete and score it at home.

While the Edinburgh Postpartum Depression Scale is NOT meant to provide an actual diagnosis for PPD (you still have to see your health care provider for that), it IS considered a very good indicator. (1-3) In other words, if you score high enough on the Edinburgh Postpartum Depression Scale, there is a good likelihood that you ARE suffering from PPD. If this is the case, please go and talk to someone, get help, see your health care provider.

Print this page out to complete the Edinburgh Postpartum Depression Scale (you will find it directly below). Then, when you follow-up with your health care provider, he/she can see how you responded to the questionnaire. If your computer is not attached to a printer, just record your responses on a scrap piece of paper.

THE EDINBURGH POSTPARTUM DEPRESSION SCALE

(3)
As you are pregnant or have recently had a baby, we would like to know how you are feeling. Please indicate the answer that comes closest to how you have felt IN THE PAST 7 DAYS, not just how you feel today.

1. I have been able to laugh and see the funny side of things
……….(0) As much as I always could
……….(1) Not quite as much as now
……….(2) Definitely not so much
……….(3) Not at all

2. I have looked forward with enjoyment to things
……….(0) As much as I always could
……….(1) Rather less than I used to
……….(2) Definitely less than I used to
……….(3) Hardly at all

3. I have blamed myself unnecessarily when things go wrong
……….(3) Yes, most of the time
……….(2) Yes, some of the time
……….(1) Not very often
……….(0) No, never

4. I have been anxious or worried for no good reason
……….(0) No, not at all
……….(1) Hardly ever
……….(2) Yes, sometimes
……….(3) Yes, very often

5. I have felt scared or panicky for no very good reason
……….(3) Yes, quite a lot
……….(2) Yes, sometimes
……….(1) No, not much
……….(0) No, not at all

6. Things have been getting on top of me
……….(3) Yes, most of the time I haven’t been able to cope at all
……….(2) Yes, sometimes I haven’t been coping as well as usual
……….(1) No, most of the time I have coped quite well
……….(0) No, I have been coping as well as ever

7. I have been so unhappy that I have had difficulty sleeping
……….(3) Yes, most of the time
……….(2) Yes, sometimes
……….(1) Not very often
……….(0) No, not at all

8. I have felt sad or miserable
……….(3) Yes, most of the time
……….(2) Yes, quite often
……….(1) Not very often
……….(0) No, not at all

9. I have been so unhappy that I have been crying
……….(3) Yes, most of the time
……….(2) Yes, quite often
……….(1) Only occasionally
……….(0) No, never

10. The thought of harming myself has occurred to me
……….(3) Yes, quite often
……….(2) Sometimes
……….(1) Hardly ever
……….(0) Never

……….ENTER YOUR TOTAL SCORE HERE: __________

SCORING THE EDINBURGH POSTPARTUM DEPRESSION SCALE

1. Once completed, add up all your responses to get your total score (the highest you can get is 30; the lowest is 0).

2. Interpret your Edinburgh Postpartum Depression Scale score:

…..A score of 0-10: If your score is 10 or less, you are considered to be in the “normal” range. This means you likely DON’T have postpartum depression. If you are feeling like you are struggling, consider your fatigue – could getting more rest and sleep help? If so, do whatever you need to do in order to make this a priority.

…..A score of 11 or 12: A score or 11 or 12 is something that health practitioners usually like to take a closer look at. It is considered a kind of “borderline” score for “probable” postpartum depression. If you are in this range, you might find it helpful to talk to your health care provider so that the two of you can dig a bit deeper into how you are feeling, figure out what exactly is going on, and talk about how best to help you get on track.

…..A score of 13 or higher: A score of 13 or higher suggests significant depression. Please see a health care provider. Your health care provider will be able to make the proper diagnosis about what’s going on with you. He/she can also get you pointed in the right direction regarding treatment options, available supports, etc.

…….Look at your score for item 10: Be sure you’ve answered item 10 of the Edinburgh Postpartum Depression Scale honestly. If you HAVE had thoughts of harming yourself, it is a good idea to follow-up with your health care provider right away. DO THIS EVEN IF YOUR TOTAL SCORE IS LOW.

Preventing postpartum depression (PPD) is possible. Because PPD is a bio-psychosocial phenomenon, the causes of PPD involve more than just hormones.

Stress and coping issues, as well as the social organization of the postpartum period, are also major factors in the development of PPD and postpartum adjustment problems.(1-2)

In 2005, I conducted a major study on mothers’ postpartum experiences. (3-4).  I discovered that there are six main resources for preventing postpartum depression. These six resources are the main reasons that the mothers in my study gave for “why they felt the way they did,” emotionally, in the weeks and months after their baby was born. In other words:

• The moms who adjusted well and stayed emotionally healthy said it was thanks to these six resources they did so well.
• By contrast, the mothers who had PPD and who struggled emotionally in the postpartum felt that a big reason for why they had such a tough time was because they lacked many, most, or all, of these resources.

The six key resources for preventing postpartum depression are:

1. Prioritizing your own self care.

As tough as it is sometimes, it is essential to place your own needs for sleep, for “getting a break,” and for adequate nutrition and activit on the same priority level as your baby’s. Prioritizing self care is also important while you are still pregnant Many women who struggle with postpartum depression feel that getting physically worn down ;while pregnant set them up for emotional problems.

2. Having enough help in meeting your day-to-day demands and responsibilities.

Having material support (i.e., “help”) is crucially important for preventing postpartum depression by helping to keep those stress levels in check, and to help you prioritize your own self care.

Do you feel ;guilty about asking for help? Believe me, there is no need. Mothering is not, nor should it be, a one-persona job. The adage that ‘it takes a village to raise a child’ is as true to today as it has ever been.

3. Having manageable levels of situational stress.

Sometimes you can’t help the stressors you face. The key, though, is to find ways to keep that stress manageable. Sometimes it means doing less. Sometimes it means changing expectations. Sometimes it means getting more help. Sometimes it means getting emotional support by talking to others about what you are going through. Sometimes it means developing new coping skills. Figure out what it is for you and do it.

4. Feeling understood by, and connected to, others.

This resource for preventing postpartum depression is about reaching out emotionally. Having a confidant helps you share your feelings and experiences, and helps you make better sense of things. Reaching out also provides you with information and knowledge, helpful for figuring out what to do.

So TALK to the important others in your life. If you can’t do that, find an online or in-person support group where you can connect with other mothers, and talk honestly and openly. Believe me, you are not alone.

5. Having realistic beliefs and expectations about mothering and motherhood.

Experiencing some gap between expectations and reality is normal. Indeed, finding ways to reconcile those gaps between expectations and reality is one of the main tasks of the adjustment process.

However, if your “core” beliefs or expectations (those beliefs that are SO central to your very idea of being a “good” mom) become threatened, this can lead to emotional difficulties.

Among moms I’ve interviewed, some of these “problem” core beliefs are: the belief that mother/baby bonding should be instinctual and immediate (it’s not); the belief that breastfeeding is necessary for good mothering (it’s not); and the belief that mothers must always be there completely with/for their babies (also not true).

These are all examples of mythical “perfect mother” constructs. The key is to not get sucked in by them! As one of my interviewees so eloquently said:

“…definitely, there’s an ideal out there about what the perfect mother is. It’s not me. And that’s fine. I know you can be different than this perceived ideal and still be a great mother.”

5. Feeling ready, both physically and emotionally, for the baby and all that that entails.

This is a resource for pregnancy. One part of this resource for preventing postpartum depression has to do with knowing what to expect. Knowledge and information provide coping skills — if you know what to expect (both good and bad), you’re better prepared to handle what comes along.

Another part of this resource is emotional readiness — getting emotionally prepared for taking on the new responsibilities of parenthood. That means being honest about your feelings about this new baby. You will need to deal with ambivalent feelings sooner or later — better to acknowledge and start confronting them now.

The third part of this resource for preventing postpartum depression is to take care of yourself physically, as best you can, during pregnancy.

A couple of years back, I wrote an academic article on breastfeeding and bottle feeding for the Canadian Journal of Public Health. In this article, I express my concern about the informational biases that inform our understanding of breastfeeding and bottle feeding.

I am going to summarize the key points of this article to provide some perspective about breastfeeding and formula feeding — perspective I hope can help relieve some the stress, worry and anxiety that so many mothers experience with respect to feeding.

First of all, I want to emphasize that I support women’s right to breastfeed. I am also 100% in favour of providing correct information, support, and assistance to women (and their partners) to help them breastfeed and to help them decide what and how to feed their babies.

HOWEVER…..

I am concerned that we have gotten too sloppy in interpreting what the scientific evidence about breastfeeding and bottle feeding actually says.

We have gone way too far in putting breastfeeding on a pedestal — and also way too far in denigrating formula feeding as an acceptable option — either as a supplement to breastfeeding, or as a main source of food.

The impression that is increasingly being communicated to new moms is that breastfeeding is vital — not only for health reasons but also because it’s part of what being a good mother is all about. By contrast, formula feeding is increasingly being communicated as “bad” or “wrong”.

Well guess what? This is not what the balance of the scientific evidence actually suggests.

What the current evidence suggests is that, yes, breastfeeding is healthier for babies than not breastfeeding. We know that babies who are breastfed are less likely to suffer from colds (i.e. “respiratory infections”), gastrointestinal illness (e.g., diarrhea/constipation) and/or ear infections in the first year of life than are babies who are never breastfed.

Beyond that, most hypotheses are considerably less substantiated, more controversial in their findings, or completely unfounded. 

Yet, we are bombarded with the claims anyway — mostly because we have gotten caught up in an ideological belief system that wants to idolize breastfeeding and demonize bottle feeding.

More and more, breastfeeding and bottle feeding are taking on a problematic symbolic significance that goes way beyond the actualities of feeding and nutrition.

And this unfair symbolic significance is being fueled by a biased communication and interpretation of the scientific literature on breastfeeding and bottle feeding. Here are some of the specific problems:

• Scientific Selectivity 1 ~ Promoting/using only those studies that show a significant health advantage associated with breastfeeding (and ignoring studies that show no relationship).

One example of this kind of “scientific selectivity” is the claim that breastfeeding enhances cognitive development and IQ. While there are studies that show IQ differences between breastfeeding and bottle feeding, there are also a number of studies that do not support this relationship.

In fact, the highest quality and most comprehensive scientific studies that have been done on this specific question (i.e., meta-analyses, studies that properly control for “confounding variables, and major reviews), find no significant relationship between breastfeeding and bottle feeding and cognitive development or IQ.

• Scientific Selectivity 2 ~ Promoting studies that don’t properly control for “confounding variables.”  Confounding variables are other factors/variables that can influence the results of a study. They can be a serious limitation to the validity of a study’s findings if they are not properly controlled for.

In the research on breastfeeding and bottle feeding, many of the studies do not properly control for one of the biggest confounding variables of all — socio-economic status (e.g., ensuring that the study is set up in such a way that the “bottle fed” study group has the same socio-economic status as the “breastfed” study group). Granted, properly “matching up” the study samples in this way is often difficult for breastfeeding and bottle feeding research, mostly because the demographic characteristics of moms who formula feed vs moms who breastfeed tend to be quite different.

The issue for the validity of the science comes in when we learn that socio-economic status is perhaps the most significant of any other single determinant of health!

What does this means for the research on breastfeeding and bottle feeding? It means that many of the studies we have (and that we use to promote breastfeeding) are mostly demonstrating the impact of socio-economic status on the health of babies, not the incremental impact of breastfeeding.

• Mis-Contextualizing Risk 1 ~ Comparing apples to oranges. I recently came across a Canadian breastfeeding-promotion flyer warning that one of the major risks of formula feeding was an “increased risk of mortality.”[19] Well that certainly sounds scary!

However, the research being referred to in this flyer was on developing countries [e.g.20] — communities where the context of risk is totally different. For example, access to clean water and sanitation is not a significant issue in the developed world; the affordability of formula is less an issue, and we have good access to immediate and quality medical care, making infant mortality due to such things as diarrhea and respiratory infection significantly less of a concern.

In other words, the health differences between breastfeeding and bottle feeding in the developed world are quite different than those in developing countries.

When we talk about the science on breastfeeding and bottle feeding, we need to be sure we’re comparing apples to apples, and oranges to oranges. (On that note, I would agree that breastfeeding is a significantly more important thing to do — both for babies and mothers — in developing countries as compared to developed ones).

• Mis-Contextualizing Risk 2 ~ Presenting “relative” data instead of “absolute” data. This same pro-breastfeeding flyer also makes reference to a study that found “diarrheal disease to be twice as high for formula-fed infants than for those who were breastfed.” [19] This sounds pretty huge, right? Well, I went and read that study

It found that the average number of episodes of diarrhea in the “formula-fed group” was 1.07 bouts of diarrhea per baby over the whole first year of life. By contrast, the average number of diarrheal episodes for the “breastfed group” was 0.49 bouts per baby.[9]

In other words, we’re talking about one bout of diarreha per year versus half a bout per year. Knowing the actual numbers, I believe, is key to being able to put study results into proper perspective.

• Mis-Contextualizing Risk 3 ~ Comparing ONLY breastfeeding and bottle feeding when talking about risk. My argument here is that we are not doing a very good job at properly contextualizing the “risks and benefits” of breastfeeding and bottle feeding.

For example, we spend too much time playing breastfeeding and bottle feeding off against one another. Well, what about the risks associated with feeding something other than either breast milk or formula? Put in this kind of context we are quickly reminded that both formula and breast milk are relatively healthy and safe — the real risks come when we start feeding our new babies something other than either of these two substances. Another way to realign our understanding of risk is to situate the relative health impacts of breastfeeding and bottle feeding within a broader context of risk. For example, by asking questions like:

• “How significant to the overall health of our children is the quality of their solid food diet in comparison to their infant diet?
• What ultimately presents a bigger risk for respiratory, gastrointestinal and/or ear infections — formula feeding or exposure to viruses through older siblings, lack of hand-washing, and other sources?
• How serious is a respiratory infection (i.e., a cold) or an ear infection to overall infant health? And how serious are these things in relation to other infant health concerns, such as accidents, for example?

The main point here is that we need to incorporate a broader contextualization of risk into our “talk” and our thinking about breastfeeding and bottle feeding. Doing this will enable us to better evaluate the relative significance of their infant feeding decisions in relation to the myriad other considerations and decisions we must make each and every day of our parenting lives.   

The bottom line? Breastfeeding is a reproductive right that deserves to be protected and supported. However, we’ve gone too far in putting breastfeeding up on a pedestal — and also in denigrating/discouraging formula feeding — either as a supplement to breastfeeding, or as a main source of food. Health is a complex thing, and there many many different aspects that go into making a baby (or child or adult) healthy and strong. There is never “one magic thing” to being and staying healthy — it’s always a combination. Our health is influenced by the overall quality of our diet. It’s also influenced by our degree of exposure to various environmental toxins. It has to do with whether or not we smoke and/or are exposed to smoke, how we deal with stress, what the quality of our social, economic and educational resources are, the type and amount of physical activity we do, our genetics, our access to health care, and so many other factors!

Adjusting to motherhood is a major process. Not only do you have to adapt to the massive responsibility of parenthood, you also need to figure out how to make it all fit together. The process of adjusting to motherhood ultimately involves a change in identity. This means:

• building your identity as a mom; and
• finding a way to integrate your new mother-identity with your existing life and sense of self. (1-4)

And here’s the important point: this process of adjustment is not just a bunch of psychological “who am I now?” stuff. It’s actually based in our everyday actions and activities. More specifically, adjusting to motherhood involves accomplishing the following seven main tasks:

———-

1. Connecting with the baby
Contrary to popular belief, many moms don’t fall in love with their babies automatically or instantaneously. Bonding IS a process.(5) It can happen right away, but it can also take time (up to six weeks or more). So, don’t be surprised if you don’t feel that connection instantaneously. Be patient. Keep cuddling and taking care of your baby and these feelings will come.

Also, get enough rest. This helps a lot in getting you bonding with your baby, one of the main tasks of the early adjusting phase.

———–

2. Physically recovering
Pregnancy, labor, birth, the early postpartum — these wreak havoc on our bodies and our physical well-being. Thus, one of the most important parts of adjusting to motherhood is to get yourself physically recovered. Of course, this can take a while, especially while your baby is still getting up at night. Remember though, your own physical health  is an absolute necessity. It is directly linked to your emotional well-being, not to mention your ability to take care of baby in the way you want.

In general, the longer it takes for you to feel better rested and recovered, the longer you will be in the stage of early adjusting — the toughest part of the process.

For this reason, it’s a good idea to make this task a top priority, even if it means getting more help with child care, expressing breast milk/letting someone give a relief bottle, delegating others to take on some of your household (and other) responsibilities for a while, etc.

———–

3. Developing a sense of confidence and competence in your ability to take care of the baby
This can also take time — anywhere from a few weeks to many months. You need to get to know your baby, and you need to figure out how best to take care of him/her/them in a way that also works for you and your family.

Sometimes this means following a particular child care approach. Most often, though, it means reaching that point where, as a parent, you feel comfortable enough “tweaking” various expert tips and approaches in ways that allow them to work for YOU, your child, your family.

This task is also typically part of the early phase of this adjusting to motherhood process. Remember, there is often very little routine or control or predictability in those first weeks or months. That’s normal. Just keep getting to know your baby and keep working to figure out what works best for YOU, your child, your situation. Trust yourself.

———–

Regaining control and re-building routines.
This task is about regaining control and re-building your day-to-day life and routines. This task is one of the main components of the later adjusting phase of this process.

Don’t worry about trying to get a handle on this right away. It’s just not possible to get out a lot, to get back to your own things, or to build new activities and routines until your baby is on some kind of semi-predictable routine, and until you are feeling more rested and energetic.

———–

5. Making decisions about work / returning to work
Paid work is a big part of all of our lives. It’s also often a big part of our identities. Some of us love our jobs. Some of us don’t. Some of us work because we have to. Some of us have a choice.

No matter what YOUR situation might be, figuring out what to do about work — whether to return to work, whether to stay home, whether to change jobs, whether to go part time, whether to go back to school etc. — is not always easy.

It is, however, something moms do have to figure out — and actually DO — as part of adjusting to motherhood. Again, each baby and each situation is different.

That means you might make a different decision about work after each baby. There might be different considerations.

Sometimes figuring out whether or how to work is straightforward. Sometimes it can be really tough. Remember, too, that whatever you do doesn’t have to be a “forever” kind of thing. It’s actually very common for mothers to change up their work situation every few years or so.

———–

6. Reconciling expectations with reality
Make no mistake — this is a MAJOR part of the adjusting process! And it’s something we have to do in both the early and later stages of adjusting to motherhood.

The bottom line is that there are always things that don’t match our expectations about what we thought or believed it would be like. A huge part of adjusting to motherhood is the task of working through any disconnects between “what we thought” and “what we got.”

Whether it’s an unpleasant birth experience, unexpected relationship difficulties, unexpected difficulties with breastfeeding, an unexpected colicky baby, unexpected emotions, or any other gaps between what we expected and believed and what the reality of our situation actually is, we won’t feel properly adjusted until we’ve dealt with these gaps.

———–

7. Reconfiguring existing relationships/Building new relationships
The relationship between you and baby’s Dad is the one that requires the most attention.

Both of you are now parents to a new child, and your family is forever changed as a result. You two need to figure out what this means for you as a couple, and as parents. It’s very important that you talk to each other about your expectations and needs, fears and concerns, pressures and joys.

Typically, a big part of this adjustment task is negotiating “who does what” as well as “how” things should be done.

In doing this, you may find that you each had different assumptions about the division of responsibility — and/or the division of labor — vis-a-vis the baby, the house, the earning of income, etc. Working out these kinks, and re-positioning your relationship TO EACH OTHER (now that you are parents to a new baby) is thus a key part of adjusting to motherhood.

This adjustment task also has to do with the other relationships in your life. You may find, for example, that connecting or making NEW friendships with other mothers is part of what you need to do as a new mother. You may also find that you are spending less time with some people you saw a lot of previously, and more time with others.

All of this reconfiguring takes a bit of effort and attention. It is also normal and to be expected. Indeed, when you become a new parent — especially for the first time — your day-to-day life and needs and priorities do tend to shift.

It only makes sense, then, that you will also need to pay some attention to your relationships — how you spend time and interact with the various people in your life.