It can happen to anyone: Post Partum Depression
By Rania Awaad, MD
“How can I be so ungrateful for this beautiful baby?” she asked, her voice filled with despair and trepidation.
Before I knew it, she had burst into uncontrollable sobbing. For moments, I sat there uncertain what to say next. Yet, this was my field and I had trained for years to help women like Sarah* throughout my psychiatric training at Stanford Hospital. Especially during my advanced specialty training in women’s mental health, I commonly instructed women about postpartum depression (PPD). Moreover, I have lectured widely about this condition and stood in front of audiences with hundreds of people and asked: “How many of you know four women who have been pregnant?” All hands would rise. To this I would respond, “Then all of you know a woman who has had postpartum depression!” The expressions I would get back were always the same: mostly startled disbelief and a sprinkling of a few emphatic nods.
Most people don’t realize how common PPD really is- up to 25% of women will experience PPD. Most people also don’t realize that PPD can be a normal complication of giving birth. In fact, the normal yet dramatic drop in the very same hormones that keep a pregnancy going (estrogen and progesterone) are often to blame. The culprit can also be the normal but sharp drop in the thyroid hormone, or changes in blood pressure, blood volume, immune system or metabolism. The same is true for the normal experience of being sleep deprived and overwhelmed after delivering a baby. All of these are very normal, yet all can adversely affect a newly postpartum mom’s mood and lead to PPD. None of this is the mom’s fault. Nor the baby’s. Nor the husband’s. Nor the in-law’s. Nor her genes nor his! Post-partum depression is simply a normal complication of giving birth. Period!
What’s more amazing is that PPD is highly treatable. In fact, sometimes counseling alone is sufficient. Finding a psychiatrist, psychologist, or other mental health professional to help the mom talk through her feelings and find better ways to cope can sometimes be the key. For some women, medications or hormone replacement therapy are advised. With treatment, PPD usually goes away in a few months. Without treatment, however, PPD can turn into a very scary but rare disorder called postpartum psychosis that often requires immediate hospitalization. The symptoms of this disorder go beyond the typical sadness of PPD and enter into the realm of hallucinations, delusions, paranoia and attempts to harm oneself or one’s baby. If symptoms of depression do not fade within two weeks after giving birth, a woman should see a doctor so that PPD can be treated immediately and not develop into postpartum psychosis. Untreated PPD can also turn into a chronic depressive disorder that affects a woman for life; all the more reason to seek out professional help as soon as PPD is suspected.
Even though PPD is normal, highly treatable and experienced by one in four women, it is still a difficult disorder. Often moms who experience PPD will feel overwhelming fatigue, have severe mood swings, lose joy in life, withdraw from family and friends, lose appetite and have trouble sleeping. Additionally, PPD often leads to difficulty bonding with the baby, which can cause feelings of shame, guilt or inadequacy.
This is exactly the point Sarah had reached. Sarah is an educated woman who had just recently graduated from law school. She is also quite active as a leader in her community and a volunteer mentor for a local youth group for high school aged girls. The best description of her personality is: a bubbling fountain of energy and joy. Her laughs are contagious and her hugs squeeze the very juices out of you.
Yet, here was Sarah crying uncontrollably, riddled with guilt that she couldn’t bond with her newborn son as she had been able to with her firstborn. She was also terrified that her family and friends would think she was ungrateful for feeling this way after being blessed with a health pregnancy and child. Something about her being educated and a community activist stopped me in my tracks for a few moments. Then all my medical training came rushing back to me: this is PPD! “Dear Sarah, What you’re experiencing is normal. It’s called postpartum depression. It’s very common and very treatable.”
Sarah certainly didn’t accept what I was saying right away. She was convinced that because she was a strong person all her life, that she should be able to “just snap out of it”. She wondered if she was losing her mind or if because she was feeling this way it meant she was a “bad mother”. None of this was true, of course. But in her altered emotional state, it all seemed very real to her. It also certainly didn’t help that friends and acquaintances were attempting to diagnose her with “a simple case of jitters” or telling her the solution was to “just get some fresh air or read a good book”. Sarah had trouble getting out of bed, and even brushing her own teeth was a challenge. She actually ached to read again, but just couldn’t concentrate; all the words blurred together. Certainly, fresh air is always helpful, but before being prescribed a stroll in the park, Sana needed to be well enough to get out of bed and start taking care of routine daily tasks, like tending to her own hygiene again!
Sarah finally agreed to get help. We worked through the concepts that PPD can hit anyone, including leaders and the well educated, it had no bearing on how good of a mother she would become, and no, she wasn’t going crazy! We also talked through what it meant to break this news to her husband, and how her family and friends would react if she they knew she was getting counselling. We also talked through the importance of finding good help even if it meant hiring help in the short run to give her some time for herself. We discussed the importance of reaching out to family and friends in times of need and asking for their support whether physical, financial or emotional.
Family and friends who take the initiative to offer what may seem like simple tasks such as cooking meals for the newly delivered mom, or visiting to keep her company or looking after the baby for a few hours while she takes a nap or just takes a shower, or even taking her out for a walk or shopping trip all can make a big difference in a postpartum mom’s well-being. These simple tasks are all protective factors that can help safeguard women from developing PPD.
Often, many immigrants mention that this kind of support was naturally embedded in their traditions and cultures back home. However, many women do not have their extended family living nearby or in America with them. This lack of support after giving birth often leaves women more vulnerable to PPD than had previous generations of women within the same family. Friends and community members can help fill this void, as can professional counselors who can play a very important role if PPD is detected or diagnosed.
Today, Sarah is back to being a bubbling fountain of energy and joy. She is a happy mom of two kids and an aspiring attorney. She continues to be an outspoken community activist and mentors a youth group of equally bubbly young women. Like every woman, she experiences normal ups and downs in mood. But she is grateful for her experience with PPD and is passionate about helping other mothers understand how normal and treatable this condition actually is. She plans to write a book about her experiences with PPD one day.
* name changed for privacy