QUESTION: I suffered from mild postpartum depression with my first child and I've heard that it can be worse with each subsequent child. With all the TV coverage about postpartum depression and the woman who killed her children, it makes me worry even more. My doctor said that she had postpartum psychosis and I've never heard of that. How often does that happen? Can you reassure me a bit?

ANSWER: There are three types of postpartum depression:

Mild depression (the baby blues) occurs in 50 to 66 percent of new moms in the first 10 days after giving birth. It is generally transient and related to hormonal changes, adjustment reactions to childbirth and the imminent life transiton.

Postpartum syndrome is a more serious depression which lasts for about the first year of motherhood. When this occurs, counseling serves an important tool in resolving a woman's anxiety and resolving the adjustment to motherhood and other family relationships.

Postpartum psychosis generally occurs in mothers who have a history of mental imbalance or family history of mental illness, especially in the mother's mother. In short, an inability or lack of knowledge of how to mother may be present. Some studies suggest that two key factors (among others) associated with postpartum psychosis are marital discord and unwanted pregnancy. Keep in mind that postpartum psychosis may contain the element that the mother wants or feels the urge to hurt her children ... a big step beyond depression, as most of us view it.

Motherhood is a major life transiton. Women who suffer anxiety or depressive disorders before becoming pregnant may be at greater risk for postpartum depression. When this is the case, preventative counseling support should definitely be considered as a support throughout the pregnancy, as well as the transiton through the first year of motherhood.

Mild depression does not necessarily intensify with each subsequent pregnancy. This may also depend on whether you have found ways to enjoy the adjustments of motherhood, without over-sacrifice on your part. Giving appropriate attention to your feelings about the delivery is also important. Postpartum depression can be triggered by confusion and psychological trauma which is associated with childbirth. Feelings about the childbirth experience can be resolved, if allowed full discussion and importance, following delivery. However, in our prenatal/postpartum care, mothers are rarely given the opportunity to "de-brief"! The need to integrate the experience of childbirth into her current life changes and identity as a mother are seriously underestimated. Still, doing so, enables a woman to enter motherhood with a more confident, rather than traumatized self-image.

Mothers needs are important, too. And, although hormones can play a part, the transition to motherhood in our society is largely undervalued, under-supported, and under-rated! Give attention to your needs and if you find depression lingering, definitely seek professional help.

In the U.S., approximately 4,000 new mothers are hospitalized each year with postpartum disorders. Outpatient psychiatric help and psyhotropic meds are sought in about 3 to 7 percent of new mothers. Prevention means caring about women before they become mothers and supporting them through the prenatal and postpartum adjustment period.