Finding Support for Postpartum Depression

By Debra Flashenberg, CD(DONA), LCCE, E-RYT 500 and Director of the Prenatal Yoga Center

Not long ago, I was speaking with a friend about her experience right after her babies were born. She confided in me that she suffered from postpartum depression and started to tell me her story. I asked her if she would be willing to share what she endured so that other women can learn from her struggle.

Here is my brave friend Nicole's story.

Please describe you postpartum experience.
The postpartum experience for me was shocking. I really had no idea what was wrong with me and it didn't occur to me for several weeks that it could actually be postpartum depression. I was walking around for weeks in a perpetual fog and funk. I was of course tired and overwhelmed after giving birth to twins, but what stood out was that I couldn't seem to shake the gloomies and had a very hard time bonding with my babies. To say I was not myself was an understatement. People would describe me as a girl who was always up and looked at things glass half full. I could barely pull myself out of bed in the morning and I dreaded the rigors that would lie ahead for me each day. I took absolutely no joy in being a new mother. I was so convinced that I had made a huge mistake in having children that if my doctor had come to me and assured me that I was a good person, that he knew I meant well but clearly I was not cut out to be a mother, I think I would have let him take my kids away. It is very hard for me to look back on those first couple of months, I feel guilty and ashamed about how I felt. The person that I was at the time was a complete stranger to me. As bad as I felt, I am thankful for the fact that never once did I think about harming myself or harming the children; but rather, I just wanted to run away.

When/how did you recognize that you were experiencing postpartum depression?
I felt the doom and glooms from day one. I had experienced HELLP syndrome when delivering the babies which caused my blood pressure to skyrocket and kept me in intensive care for a few days. I had to see my OB a few days after coming home from the hospital and mentioned that I was feeling bad -- feeling like I wasn't myself and I couldn't hold it together but he wrote it off as being overwhelmed, and the stress of the HELLP and the delivery. But help arrived on the day I took the girls for their 8 week check up at the pediatrician's office. We saw the physicians assistant, Dr. Gardiner for the check-up. I immediately liked her, she had such a calm and reassuring way about her. She took one look at me and asked me very gently how I was feeling. When I told her how sad and lost I felt (my husband was with me at the time and was obviously so worried about me), she immediately recognized the symptoms and was at least able to give me a reason and a name for what I was feeling. While it didn't help my depression it at least allowed me to realize that what was happening wasn't my fault and I wasn't going crazy!

What measures did you take to help relieve the situation?
Dr. Gardiner discussed medication with me and was very reassuring that it would help and I wouldn't have to take it forever. I have always had a phobia about taking medication (I don't even like to take Advil!), so I was reluctant. I kept thinking the next day would be better, that I would pull myself out of the fog and get back to being my old upbeat self. Somehow just knowing that it was a chemical issue and not me losing my mind really helped. I knew that my darkest times were when I was alone so I began to reach out to every friend, family member, neighbor and acquaintance to keep me occupied and the upside was they could help me with the babies. I didn't wind up taking any medication but it's a decision that quite honestly I regret. There was no reason I had to suffer the way I did when medication could have helped. I look back on it now and realize it was such a shame that I wasted precious months with the girls crying and feeling worthless and like a terrible mother/person when if I had at least tried the medication I could have enjoyed being on maternity leave and loving and appreciating my new family.

What measures best worked for you?
The only thing that really worked was time and honestly going back to work. It seems strange that going back to work helped cure me because the thought of returning to my job while I was home made me unbearably depressed each day. I felt so awful and knew that each day was slipping away - I became obsessed with the fact that each day I felt sad was one less happy day I was going to have with the kids. It became like this doomsday countdown in my mind knowing that each day my maternity leave was closer to being over. But somehow when I was forced to get up in the morning, take a shower, put on makeup and nice clothes and get back to the reality I knew prior to the babies, I felt rejuvenatetd. Having a little time to myself made me whole again and it allowed me to appreciate every waking moment I had with the girls when I was home. I became so much more patient and loving, I finally felt like a new mother was supposed to feel. Luckily I only had to go back to work three days a week so I really felt like I was having my cake and eating it too!

Did you feel like you could discuss what you were feeling with other people?
I felt like I could talk about it with my husband and my best friend and sisters but no one could understand what I was going through. They would try everything from sympathizing to tough love but no one really got it. I was so relieved when Dr. Gardiner was able to recognize my symptoms. For the first time I felt like I wasn't going crazy and someone really knew (at least from a clinical point of view) what I was going through. A couple of years later when I read Brooke Shield's book, Down Came the Rain, I cried (with sadness and relief) through every chapter. It brought back all the raw and painful emotions I felt each day and it made me so happy that someone with fame and noteriety was able to share such a personal story that was bound to help thousands of women. My only wish is that it had come out before I had my kids, not after. Since she had taken the medication, I think it would have given me the courage to do the same. I am tempted to go and see Brooke Shields in The Adamms Family and wait outside the stage door after the play in the hopes of telling her how much that book meant to me.

Do you have any advice for other mothers that may be experiencing postpartum depression?
My advice would be to try and recognize your symptoms early and to talk about it with your doctor. My biggest mistake was thinking that I could will the sadness away, that mind over matter would help me to persevere - instead the hormones won and I wasted four months feeling like there was a rain cloud above my head that followed me everywhere. It's also important to take time for yourself. Don't be afraid to take people up on their offers to help (another of my many mistakes) and get out and do something slightly indulgent like meet a friend for lunch or get your nails done. Don't waste precious free time doing mindless errands like food shopping and [drug store] runs, try and let others help you with it. Most of all, I would say that you have to remember you are powerless against this force of nature -- it is not your fault. It was such a waste of energy for me to carry the shame and the sadness that I did. Be very vocal with your doctor, let them help you whether it's taking medication or connecting you with a support group -- just putting a name to the issue will help the healing process.

Facts

* Up to 1 in 7 women experience PPD (approximately 13% of postpartum women)

* For half of women diagnosed with PPD, this is their first episode of depression

* About half of women who are later diagnosed with PPD may have begun experiencing symptoms during pregnancy so it's important to seek help early!* Postpartum depression can occur at any time after birth, but it most commonly starts 13 weeks after delivery.

Reasons

It is impossible to pinpoint what may be the cause of one's PPD. There are several reasons that can contribute to PPD, but not one single reason often leads to postpartum depression.

* Infant temperament and maternal anxiety and depressed mood in the early postpartum period. (1)

* Isolation

* Expectations of what motherhood would be like, what the baby would be like

* Lack of support

* Overcoming a difficult birth (If you experienced a challenging birth, you may be interested in the article, Birth Trauma)

* Ambiguous feeling about the pregnancy - may have been an unplanned pregnancy

* Loss of freedom and personal identity

* Body image issue; loss of pre-pregnancy body

* More prone to experiencing PPD if there is a history of depression or mental illness pre-pregnancy or family history of depression or mental illness.

* Stress from marital problems or financial problems

What are the Signs of Postpartum Depression?

* Feeling restless or moody

* Feeling sad, hopeless, and overwhelmed

* Crying a lot

* Having no energy or motivation

* Eating too little or too much

* Sleeping too little or too much

* Having trouble focusing or making decisions

* Having memory problems

* Feeling worthless and guilty

* Losing interest or pleasure in activities you used to enjoy

* Withdrawing from friends and family

* Having headaches, aches and pains, or stomach problems that don't go away

It is normal to see a change in mood and desires postpartum, especially considering the huge hormonal shift your body experiences after birth and sleep deprivation. However, if you are experiencing any of the symptoms of depression listed above (2) for more then two weeks, it is best to consult with your care provider. Your doctor can figure out if your symptoms are caused by depression or something else.

Getting Help

Even the idea of reaching out for help may seem overwhelming. If you need, start small, maybe your partner can make a phone call or two to get the ball rolling for additional support. Help can come from many resources:

* Seek professional help

* LifeNet Call Center: Listening Service for people in crisis, including substance abuse. (800-543-3638)

* Get support from partner, family and friends

* Sleep! Sleep deprivation can really wear on the mind and body!!* Find a New Mother's Support Group in your area.

* Try to get some time away from your baby, even if that is just going outside and walk around the block a couple times.

* Placental Arts. (Check out the article in NY Mag on this) It is believed that ingesting the placenta postpartum helps balance the estrogen which drops significantly after birth. This can be done by having a professional first dehydrate the placenta and encapsulate it. I had this done with my placenta and took the capsules for about 2 months postpartum. This also helps with low iron levels, which is not uncommon postpartum.

* Supplements: Fish Oil Promising Against Postpartum Depression in Small Trial

Society's Expectations and Stigma

From my own experience, I believe a new mother may feel a certain amount of pressure to get it right. Many people said to me, You seem to be doing great! While it was nice to have the encouraging support and feedback, there was a part of me that felt, if the outsider thinks I am doing a great job, why don't I? Was there even room for me not to be doing so great when everyone believed (and maybe expected) I was?!

I clearly remember one difficult Wednesday afternoon when Shay was about 2 1/2 weeks old. All the family had left and our postpartum doula was not in that day. At this time, our pediatrician wanted Shay to eat every two hours. I had been up with him since 6 am and managed to get him down for a few rounds of feeding. But then the successful cycle of eat, change him and put him down for a nap stopped abruptly. He had gone straight through three feedings with no nap. He was tired and irritable and I was exhausted. I tried every position and trick I had learned in my few weeks of motherhood. We bounced on the birth ball, I swaddled him, rocked him, sang to him, sh'd him. Around 3 pm that afternoon, I called my husband asking him when he was going to come home. He said soon. I hung up the phone and just started crying. Fifteen minutes later, my husband entered the apartment to find me sitting in our bedroom, rocking on the ball with the baby in my arms and tears streaming down my face. He gave me a kiss and took the child. After a few minutes, he said, Thank you for calling me. Now please go to sleep. I had never been so grateful for the opportunity to rest and for help to arrive.

As Nicole explained in her story, it may be challenging and disappointing to face that one can not pull themselves out of the funk they are feeling by themselves. Some people may have a level of embarrassment or shame that goes along with experiencing PPD and needing a medication. Even though pharmaceutical drugs are very prevalent in our society, some may still feel stigmatized for taking SSRIs (Selective Serotonin Reuptake Inhibitors). A close friend of mine talked to me about how she was finally able to accept taking medication. She said she could acknowledge that if she had diabetes and needed insulin, there would be no doubt that she would take the medication. So she was able to rationalize, taking a medication for her mental health was no different then taking a medication for her physical health.

No matter what level of depression or anxiety one feels, there is always a way to find support and feel better.

Sources

(1) http://www.ncbi.nlm.nih.gov/pubmed/21391161

(2) http://womenshealth.gov/publications/our-publications/fact-sheet/depression-pregnancy.cfm

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004481/

American Psychological Association

http://www.acog.org/publications/patient_education/bp091.cfm

http://www.womenshealth.gov/faq/depression-pregnancy.cfm