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Of the 4 million American women who give birth each year, it is reported that up to half of them experience the baby blues in the first few weeks after childbirth, and about 10 to 15 percent experience postpartum depression. Reported is the operative word here. We’ll be bold and say that we’re sure the number is far greater than that—but for many reasons (fear, anxiety, guilt, embarrassment, shame, confusion, denial), a lot of women don’t report this illness.
Well, listen up mamas and mamas-to-be: Postpartum depression strikes in some very deep, dark and unexpected ways. You do not have to suffer in silence. There are things you can do and organizations that can help you get back to yourself again.
Here, we talk to Wendy Davis, PhD, program director of Postpartum Support International (PSI), about the global network that has been helping moms (and dads) since 1987 while working to eliminate denial and ignorance about the emotional health issues related to childbirth, and what every couple needs to know about the many faces of postpartum depression.
THE FAMILY GROOVE: “Postpartum depression” is a term bandied about in our modern-day world, but many women don’t really know what it means. It’s a far more comprehensive and involved subject than often realized. What exactly is postpartum depression?
WENDY DAVIS: Every new parent goes through emotional changes and challenges during and after pregnancy, but postpartum depression is more than the normal transition or the early maternity blues. About one out of every eight women will have a true depression or anxiety reaction that creates a significant disruption in her daily life and affects her physical, mental, emotional and social well-being. Symptoms might start right after birth, but more commonly she will start feeling bad in the first two months, and [the symptoms] can start anytime in the first year. We often now use the term “perinatal mood disorders” so that we include depression and anxiety in pregnancy as well as postpartum, but “postpartum depression” is the term most people are familiar with. The term can be confusing, because people often use it to describe a whole range of reactions, including depression, anxiety and sometimes even postpartum psychosis.
Perinatal depression or anxiety is not just a bad mood. All of these reactions are temporary and treatable, but symptoms make life very difficult, and women often feel ashamed and mistake their symptoms for inadequacy. When women don’t receive support, information and treatment for depression or anxiety, the whole family suffers unnecessarily. PSI exists to provide nonjudgmental, informed and effective help for women, families and providers. We want all to understand that perinatal depression and anxiety are common, treatable and nothing to be ashamed of.
TFG: Postpartum Support International was founded 22 years ago. How has the organization changed since then?
WD: PSI was started in 1987 by founder Jane Honikman to represent self-help and support groups working to prevent the negative emotional reactions to childbearing. She was a pioneer in the field of maternal mental health and created an international organization at a time when families and the medical community were hardly talking about women’s emotional needs. Jane began offering support to postpartum families on the phone from her house in Santa Barbara, Calif. Jane’s original mission—to promote awareness, prevention and treatment of mental health issues related to childbearing in every country worldwide—has guided the organization from the beginning, which is a true test of an effective mission.
From the beginning, PSI volunteers have offered emotional support, information and resources to families at no cost. Jane talked to families and professionals by phone and at conferences all over the world, and started to identify and keep in touch with people who could be support coordinators in their own communities. In 1987, that support was by telephone, letters and meetings. Now we have grown to have more than 130 volunteers around the world; the Internet, our website and our toll-free phone line have dramatically increased our ability to develop a network of education and support. Many women contact PSI through e-mail, and several of our volunteers moderate online support pages. Our PSI coordinators are wonderful and caring souls—men and women who offer nonjudgmental support and information by telephone and e-mail every day of the year, all over the world. More than half of them also facilitate mom-to-mom support groups. We have volunteers who speak many languages, including a support telephone warm-line staffed by Spanish-speaking volunteers every day of the week. In addition to our state, province and country coordinators, we also now have specialized coordinators for military families, Spanish-speaking families, dads and legal resources.
TFG: In the past five or so years, there has been a lot of light shed on PPD, but it’s still not enough. There are still so many women who suffer in silence. What is PSI doing to help new moms now?
WD: PSI is always working to reduce shame and increase awareness of the spectrum of emotional and mental health challenges that women and their families experience during pregnancy and postpartum. We are working to educate both health care professionals and families, and to create support communities that connect families with informed and compassionate resources near them. We will be launching a new website this fall that will provide more information on all the perinatal mood and anxiety disorders, including postpartum obsessive compulsive disorder, depression during pregnancy and through the first postpartum year, and postpartum post-traumatic stress disorder. We are also working to add more information to support family members, like husbands and partners who want to know how to help their loved ones.
We have also added some new services recently, such as our twice-weekly “Chat with the Experts.” This is a free conference call where anyone with questions about perinatal mood and anxiety disorders can call a toll-free number and speak with a PSI expert and other callers. We are really pleased to be able to offer this service, which allows people to remain anonymous if they choose and to get answers in the comfort of their own homes. Monday calls are for men, and Wednesdays are for women. You can find the link to the chats at http://postpartum.net/info-sessions.
We have a standardized, evidence-based training curriculum through which we educate care providers all over the country. This is the most thorough training in the field and receives outstanding reviews for its relevancy, breadth, and the knowledge base and teaching of our trainers. We’re excited that we can reach so many caregivers, from medical providers to support group leaders, clergy, families and mental health providers.
We have more information and services for men, including partners of women who are going through depression or anxiety, as well as men who are experiencing their own postpartum depression.
And, of course, we have our support volunteers around the United States and the world who help connect moms and families every day to the resources they need in their local area as they set out on the path to recovery. These coordinators are truly the heart of PSI.
TFG: What are the organization’s plans for the future?
WD: We want to connect with more health care providers and families so that they know that our PSI volunteers can provide informed and caring support and information every day of the year. We are making stronger alliances with public health systems and childbirth educators so that we can reduce the gap of care for the mental and emotional health needs of new and expecting parents. We want to provide more support and information in languages other than English and Spanish, and to find more providers to help the most isolated and vulnerable families. We would like to apply for grants and other funds so that we have a greater ability to serve all families and offer quality training for providers.
TFG: So let’s talk about PPD itself. Is there anything women can do during their pregnancy to hedge postpartum depression?
WD: Yes, probably the most important thing women can do is to create a solid plan of care and support during pregnancy and for the postpartum period, and include plans for practical and emotional support. We tell moms that if they want to be perfect mothers, then work on being “perfect” at letting other people help! We all want to be “good mothers,” and it seems as though we think that means that we should manage everything by ourselves, with no vulnerabilities, negative feelings or need for help.
The other very important preventive step is to learn about the risk factors for postpartum depression and anxiety, and discuss them with their doctor and their families. Risk factors include:
a personal or family history of depression, anxiety or postpartum depression
a recent trauma or stressful event such as job loss, recent move or death of a loved one
having gestational diabetes, diabetes 1 or 2
fertility treatments
traumatic births, past trauma or pregnancy losses
a lack of social or family support
perfectionism and difficulty asking for help
If the patient, her family and her health care provider are aware that a mom has one or more of these risk factors for PPD, they can put together a good self-care plan and provide the extra support she needs. She can ask friends and family to keep in touch with her and call her to check in.
It is essential to have both parents understand the risk factors, symptoms, and resources for mental health during pregnancy and postpartum. There are some great resources for dads and other partners—you can find links at our website here.
TFG: What are the symptoms of PPD?
WD: They can include the following symptoms, lasting more than two weeks:
 |
crying jags | |
| changes in sleep patterns (either can’t sleep or feel the need to sleep all the time) | ||
| lack of pleasure in things you used to enjoy | ||
| changes in appetite | ||
| difficulty concentrating, focusing and making decisions | ||
| anger and irritability | ||
| feeling out of control or overwhelmed | ||
| feelings of guilt and comparison, or feeling like you aren’t meant to be a mother | ||
| feeling anxious or insecure, fears about being alone | ||
| suicidal thinking |
Depression is not the only symptom of postpartum mood disorders. Some women also might experience postpartum anxiety. The symptoms of pregnancy or postpartum anxiety can include racing thoughts, feeling agitated and uneasy, constant worry about the baby or other loved ones without cause, and difficulty sleeping and eating.
It’s also important to know that a woman with postpartum anxiety or postpartum obsessive compulsive disorder might experience something called intrusive thoughts, which are repetitive, unwanted, upsetting thoughts or images. Research has shown that these imaginations are actually the result of an overactive maternal instinct, but moms, of course, are frightened and don’t know why they’re experiencing such repetitive and upsetting images in their minds. It is so important to know that this is a symptom of postpartum anxiety; it is very difficult but treatable and temporary. Women and their families need to know that this symptom is a symptom of anxiety, not of psychosis, in which the woman has a complete break with reality. When a woman is psychotic, she might have delusions that include harm, but if she has postpartum psychosis, she believes those imaginations to be valid and true. She is not thinking with her usual ability to perceive reality, and in that case, she and her child need immediate care.
PSI helps families and providers learn more and find professional resources so they can quickly assess the level of risk and treatment options for any of the perinatal mental health disorders.
TFG: What can women do to help stave off PPD after Baby is born?
WD: Women can:
Let friends and family help.
Write down a self-care plan before Baby comes.
Keep expectations reasonable and be kind to yourself.
Break down tasks and goals into small, manageable steps.
Keep good nutrition, including vitamins; avoid sugar, caffeine and alcohol.
If you are having symptoms, have a complete physical, including a check for thyroid function and anemia.
If you have a partner, agree on a plan for sharing house and baby care.
If you are single, ask others to help.
Take breaks from baby care, even for short periods.
Communicate, express your feelings and make requests.
Work toward getting exercise or some activity every day.
TFG: Does it run in families the same way that other afflictions do?
WD: While we don’t know exactly what causes postpartum depression, research does show that women who have a history of depression or whose family members have a history of depression or postpartum depression are at a higher risk. This is why it is important for women to know if their mothers, grandmothers, sisters or others in the family suffered from postpartum depression or related illnesses.
TFG: What external factors can bring on PPD?
WD: External events don’t cause PPD but exacerbate an already stressful time. If you also have biological risk factors, other stressors or traumatic events such as job stress, financial loss, family discord or medical complications add to the risk of developing a postpartum mood or anxiety disorder. Research has shown that women have higher rates of postpartum depression if they live in poverty, are single teen moms or have poor access to health care.
TFG: How long after you give birth can you feel the effects of PPD?
WD: Most women experience baby blues, which is a hormonal adjustment that occurs in the first two weeks after giving birth. If a new mother’s symptoms are similar to those listed above, occur after two weeks postpartum and either remain the same over a two-week period or get worse, she may be suffering from a perinatal mood and anxiety disorder and should contact her physician to discuss her symptoms.
It is also important to note that a woman can experience postpartum depression anytime in the first 12 months after birth. While most women realize they have PPD in the three- to four-month period postpartum, others will tell you that they didn’t recognize they were ill until much later. Symptoms might start later with rapid weaning, resumption of birth control, or if there is an added stress like an illness or job loss.
TFG: What constitutes late-onset PPD?
WD: Postpartum depression or anxiety can begin anytime in the first year postpartum and sometimes surprises both families and providers if it begins after the first few months.
TFG: If there were one thing that you wanted people to take away from this interview, what would it be?
WD: The emotional needs of mothers and families are as important as any other part of our health. If you need help or have any questions, please don’t hesitate to contact a PSI volunteer near you. We are not here to give advice but to offer a listening ear, good information and resources for help. We want everyone to know the universal message we give to families who are struggling with a perinatal mood disorder: You are not alone, you are not to blame, and with help, you will be well.
TFG: How can our readers help PSI?
WD: There are so many ways to help. One way, of course, is to become a member and be part of this growing support network. Here is our link to become a new member: http://postpartum.net/become-member.
Another way, of course, is to make a donation. We are a nonprofit, volunteer organization and welcome donations that allow us tocontinue our work, whether that means being able to send out brochures, translate materials, host training for health care professionals, maintain our website or answer phone calls. You can donate at www.postpartum.net/donate.
People can also volunteer, either to help support new parents or to help with fundraising or local event planning. Learn more about volunteering here.
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