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The day you've been anticipating for months has arrived: Your baby has been born. Now the perfect life you've planned for your little family can begin.

Fast-forward ahead a couple of months. You're tired, overwhelmed, don't want to get out of bed in the morning. You feel sad, anxious, empty, irritable. You can barely concentrate and find it difficult to make the simplest decision. You even think about hurting your baby although you will not act on these feelings. You think about death or suicide.

This is not what you expected when you were expecting. Now what?

Ashley, a 26-year-old professional woman, went through this ordeal after the birth of her first child earlier this year. The baby was born on a Sunday, mother and baby went home Wednesday and by Friday, Ashley was struggling. Postpartum depression had come on swiftly and with a vengeance.

"I felt hopeless," Ashley said. "I did not want to go on. I was very tired and didn't want to do anything. One of the main things was uncontrollable crying. ... I never wanted to hurt my child, but I wanted to hurt myself."

Ashley had a history of depression before becoming pregnant, so she had discussed the very real possibility of postpartum depression with her doctor. She immediately made an appointment began treatment.

In addition to medication, Ashley made some lifestyle changes. Her doctor helped her pinpoint some stressors that could be taken away, one of which was giving up breastfeeding.

"I was upset because breastfeeding was something I really wanted to do, but at that time, it was not possible," she said. "I realized that's what I had to do for myself in order to take care of my child."

Common occurrence

Melissa Beeler, a board certified women's health nurse practitioner with Women's Care Group, Maryville, explained that postpartum depression affects about 10 percent of women.

"It's serious but treatable," Beeler said. "Treatment requires the appropriate medications, possibly group and individual counseling, support groups and lifestyle modifications."

Having the "baby blues" is very common in new mothers and affects 70 to 80 percent of women after childbirth, Beeler said. Symptoms may include mood swings, anxiety, sadness, irritability, crying, decreased concentration or trouble sleeping. Postpartum depression, however, is much more intense and longer lasting, eventually interfering with the mother's ability to take care of her baby, herself and her normal daily tasks.

"Most of the time the baby blues go away," Beeler said. "Postpartum depression lasts longer and requires counseling and treatment. It won't go away by itself."

Postpartum depression may be caused by physical changes, emotional factors and lifestyle factors. After childbirth, a woman's estrogen and progesterone levels drop dramatically and hormones produced by the thyroid gland may also drop sharply, leaving the woman feeling tired, sluggish and depressed. Changes in blood volume, blood pressure, immune system and metabolism can lead to fatigue and mood swings. Emotionally, the mother is sleep-deprived and overwhelmed and may have problems handling even minor problems. She may be anxious about caring for a newborn. She may feel less attractive or struggle with her sense of identity, feel she has lost control over her life. Lifestyle factors coming into play can include a demanding baby or older siblings, difficulty breastfeeding, exhaustion, financial problems and lack of support from the mother's partner or other loved ones.

Risk factors

Postpartum depression can develop after the birth of any child, not just the first. The risk increases if, like Ashley, the woman has a history of depression, either during pregnancy or at other times; if she has a history of postpartum depression; has experienced stressful events during the past year, including illness, job loss or pregnancy complications; is experiencing marital conflict; has a weak support system; or the pregnancy is unplanned or unwanted.

Beeler said the "myths of motherhood" also play a part in a new mother's depression.

"These myths are that motherhood is instinctive, that there is a perfect baby and a perfect mother," Beeler said. First-time mothers often believe they should just know how to care for a newborn, but they need to learn mothering skills just as they learn any life skill.

"It's good to read child-care books," Beeler said, as well as watching skilled child caregivers and talking with other mothers. And there is no certain way a mom must feel about their newborn. Bonding often takes days or weeks, Beeler said.

Mothers also may have unrealistic expectations about their baby's personality or looks as well as about herself as a mother. When she doesn't live up to these, she feels like a failure. Beeler said.

Beeler, who also has a degree in nutrition, is beginning a postpartum depressive clinic at Women's Care Group. Any woman who may be suffering from postpartum depression, no matter whether she is a patient at the group or not, is welcome to attend. For information, call Beeler at 546-1642.

Postpartum anxiety

Barbara Lasater, director of Blount Memorial Hospital Counseling and CONCERN, has seen several patients with postpartum anxiety, which is a part of postpartum depression.

"These first-time mothers didn't fit the postpartum depression criteria, but they have pervasive anxiety and more than one episode of panic," Lasater said. She attributes this to the lack of a support system.

"All new mothers need a supportive support system -- one that sees them as competent and able; and one that the new mother sees as approachable. That may be the therapist or the pediatrician or hopefully someone that clinician helps her to identify. With our very mobile society, many new mothers don't have their own mothers close by and then many of the women I've seen don't have mothers.

"Another contributor seems to be the need to 'get it right.' All of these mothers are very bright, successful career women. They don't do anything by half measure. They 'get' how important it is to 'get it right' and fear the consequences of not doing so by their child. With no one to coach them that mistakes are bound to happen, without support, raising children is very anxiety provoking even for overachievers. The anxiety I've discussed could be minimized by organized supports and being willing to use them."

Ashley, with the help of her husband, her mother her physician and her friends, is feeling much better.

"I have improved quite a bit," she said. "A lot of it has to do with the medicine but also with my faith. ... I will continue taking the medicine because I don't want to get back to what I was like before. I've got this new child in my life and I know that to take care of him, I also have to take care of myself."