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Home Health Parents Perinatal and Postpartum Depression: How to Get Help

Perinatal and Postpartum Depression: How to Get Help

“I just didn’t know how to articulate what was wrong…I was a new mother, I was scared, and I didn’t know what to do.”

By Meagan Howell

I used to be a social worker at a community health center where many of the patients were poor and uninsured. The very best part of my job was providing advocacy and counseling to pregnant women and their families. After seeing far too many women struggling with stress, isolation, and depression during and after their pregnancies, I organized a series of support groups. Many of the women who attended were new to this country, without family or friends; making the transition into parenthood alone was incredibly stressful for them. During its first meeting, the Spanish-speaking group participants cried their way through an entire box of tissues. It was a seriously cathartic flood of tears! I peeked into the room where the mothers and mothers-to-be were finishing up, and saw women who had been strangers to one another an hour earlier smiling, hugging, and sharing phone numbers.SAD_MOM

The challenges of becoming a mother are considerable no matter the circumstances. I knew, because I had recently become one myself. I also knew many of the women in that room were facing difficulties I could only imagine. But the power of solidarity, at least for that hour, helped the hardship melt away.

Not long after that first group session, I met a neighbor named Amy. She was a married mother of two, had a very cool job, and seemed to be part of a close-knit network of friends and family. We got to talking one day about my fledgling support group, and she volunteered that she had gone through severe postpartum depression herself. Huh? I was shocked. She always seemed relaxed, grounded, and possessed of a strong sense of humor and perspective. It was hard to imagine her depressed. I had been so focused on the immigrant women at my clinic. They were different from me, which kept the reality of their struggles at a safe emotional distance. But here was someone I admired, someone with whom I shared friends and neighbors. I began to understand how common perinatal depression is. It can happen to anyone, regardless of where they live or what language they speak. The problem is that we don’t always talk to one another about it.

Amy’s first baby was born small, and spent his early days suffering a series of related minor problems in the NICU. One day, as Amy was standing beside his bassinet, a nurse turned to her and casually commented, “Full term, and he only weighed 5 lb 12 oz…? Did you smoke?” She hadn’t, but the idea that her baby’s medical problems were somehow her fault stuck. Suddenly, she felt guilty and scared. When it was time to take the baby home, Amy was still terrified, afraid that something would happen to him and she wouldn’t be able to help. The worry and fear were relentless. “I felt like there was a tornado going on all the time inside me. If I could only have unzipped, to step out and give myself a breather! I just didn’t know how to articulate what was wrong…I was a new mother, I was scared, and I didn’t know what to do.”

Amy hoped her feelings were related to shifting hormones, and that things would get better after she stopped breastfeeding – but when she did, nothing changed. Eventually, at a visit to her family doctor’s office, an astute and kind physician’s assistant asked some questions and recognized what was wrong. He prescribed medication, and everything got better – but at that point her baby was nearly a year old. “What really sucks,” reflects Amy, “is that I don’t remember much of it. I missed a lot of his first year.”

Perinatal depression refers to a period of depression that occurs either during pregnancy or during the first year of motherhood. It is estimated that 1 in 8 mothers experience postpartum depression, which is the most frequently occurring mood or anxiety disorder falling under the “perinatal” umbrella. Postpartum depression (PPD) is the most common complication of childbirth. In addition to the toll it takes on the mother, if PPD is left untreated it can interfere with her ability to care for her child, disrupting bonding and in some cases having a negative impact on the baby’s development.

The stigma women often feel about their depression is a major stumbling block to seeking treatment and getting better. Cheryl Rubenstein, PhD, is a clinical psychologist practicing in Annapolis who specializes in this area.  “It’s estimated that only 20% of women who have postpartum depression seek help, so when I meet with a mother I first congratulate her for having the courage to come forward. It’s not just important for her, but for her baby as well. I normalize her feelings, because even though having a baby is wonderful and exciting, it’s a huge stressor as well.”

Some women underestimate the seriousness of their symptoms, thinking it must be the “baby blues.” I sobbed uncontrollably when the nurse told me that my four day old daughter had a high bilirubin, and that we would need to take her in to the pediatrician’s office the next day to test if her jaundice had improved. Every time I calmed down, I’d think of the excruciating pain she’d undergo when they pricked her tiny heel, imagining a heartless nurse wielding the needle, indifferent to her screams … and I’d start crying all over again. A tiny part of me knew the situation wasn’t quite so tragic, but the tears kept coming. I had a classic case of the baby blues: feelings of sadness, confusion, and irritability that typically peak during the first few days after delivery. This intense moodiness is related to hormonal changes after birth, and usually resolves within the first two weeks of the baby’s life.

The symptoms of depression last for at least two weeks, and include sadness, irritability, crying, problems with sleeping and/or eating, worrying, feeling guilty or hopeless, and fear of being incapable of caring for the baby. It can be hard for a new mother to recognize the severity of the problem for the simple fact that she is sleep-deprived, overwhelmed, and struggling to adjust to all the changes that a new baby brings. In the midst of such a major life transition, she may think these new difficulties might just come with the new territory.

Many women going through a perinatal depression fear they aren’t able to be good mothers, blaming themselves for their symptoms, rather than understanding them as resulting from a medical condition that happens to respond well to treatment. Some are ashamed of their feelings, and inclined to keep them secret. Motherhood is supposed to be idyllic and happy – so why isn’t it that way for them? As Amy recalled, “No one else was talking about it [PPD], and it just seemed that everybody else was as happy as could be. I remember taking Duncan to classes at the JCC and there would be women with toddlers around the same age. It seemed like everyone else was having a great time … everything was so fun and cute for them. I felt totally isolated.”

Women are at higher risk for perinatal depression if they have a personal or family history of mood disorders like depression; insufficient support in caring for their baby; marital or financial stress; other complications in pregnancy or childbirth; a recent major loss; or, like Amy, have a baby in the NICU.  If a mother has any or some of these risk factors, she should talk to her medical provider about them during pregnancy, in order to be better prepared and have a plan in place should symptoms of depression emerge.

If you or someone you know is struggling with signs of perinatal depression, it’s important to seek help as soon as possible. Talking to an OB/GYN or midwife is often the first step. Mothers can also talk to their new baby’s pediatrician. A good pediatrician understands that the health of the mother is closely tied to the health of her baby and can make referrals to qualified clinical therapists or reproductive psychiatrists (doctors who specialize in treating women during and after pregnancy).

Heather J. Silver, LCSW-C, is the maternal and child health social worker at Baltimore Washington Medical Center. She often sees women struggling with perinatal depression. Problems can arise when women who were on an antidepressant before pregnancy stop taking it out of concern for their baby.  “I will get phone calls from mothers who are in a state of severe depression or anxiety. Some have suicidal ideation. They’re going through withdrawal symptoms because they have suddenly stopped taking their meds without talking with their doctor – because they think that’s the best thing for their baby. But many antidepressants are safe. And if there’s a problem, their doctor can find medication that is more appropriate and make a switch.”

The contact Silver has with women can help them consider the option of counseling. “Sometimes me sitting down with them – having someone really listen to them – opens women up to the idea. I think it’s important to incorporate some kind of counseling into treatment for perinatal depression. Medication helps, but counseling and medication together are most effective.”

In addition to supportive psychotherapy and medications, Dr. Rubenstein emphasizes a few other things that can be of significant help to women. Postpartum or perinatal depression support groups can be invaluable. A social mothers group can also reduce isolation and increase support. The disrupted sleep most mothers struggle with in the early weeks and months of a baby’s life can compound psychological difficulties, so protecting sleep is paramount for women who are struggling with depression. Dr. Rubenstein helps women think through how to make that happen, whether it means pumping during the day, preparing bottles for a partner to give, napping when the baby does, or accepting additional help from family and close friends. Finally, though it can be challenging for a new mother, taking time for herself is essential. “Sometimes women need permission to ask for what they need,” says Dr. Rubenstein. “If necessary, we’ll bring a dad into a session so that he knows how important this is for the whole family.”

The good news is that with treatment, the prognosis for perinatal depression is excellent. After Amy got better, she connected with a midwife in her area and the two of them began a support group for women with postpartum depression. Amy found the group to be a great source of support and connection for her, as well as a way to de-stigmatize PPD and help other mothers.

When she became pregnant with her second child, she knew it was likely she would experience the symptoms of depression again; she just didn’t expect that they would begin in her second trimester. “That threw me for a loop. I didn’t expect it to happen prenatally. I went right away to one of the midwives I was seeing. I asked for an emergency appointment, and I explained what was happening. They knew my history, and I started on meds right away … that really helped a lot.”

What had taken nearly a year to get better after her son was born was under control within a few days during her second pregnancy. She had more support, could recognize what was happening, and knew how to get help. Fourteen years later, Amy still facilitates her perinatal depression support group. The need for it hasn’t gone away, though happily there are far more resources available today than there were when she first became depressed. Meeting with other women who have gone through perinatal depression and made a complete recovery is reassuring for newcomers to the group. “This isn’t a life sentence,” says Amy, “though it’s hard to believe when you’re in it. There is a light at the end of the tunnel. It gets better.”

Meagan Howell is a freelance writer with a background in social work. She writes about motherhood at  http://homemadetime.blogspot.com.  

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