Please keep some of this in mind when expressing concerns about mothers who may or may not be suffering PPD. A lot of comments today seemed to forget that there were real women behind those confessions as well.
I knew something was wrong pretty early after giving birth to N. But instead of admitting it to myself I buried my depression under mountains of guilt, shame and embarrassment. It was a very dark time in which I blamed my inability to be the perfect mom on my shortcomings and personality flaws. I hid away in my room as soon as C, my husband came home. I told myself, I told my husband I just needed the break after being alone with her for 9 hours a day. I knew deep down but I wasn't able to admit it out loud; I had postpartum depression (PPD). I reluctantly told C this was why I was scurrying off to our bedroom as soon as he got home, why I yelled at N in frustration and cried from breastfeeding at the end of the day. He wanted me to tell our parents about it. I was horrified at the thought. I begged him to let us deal with this by ourselves. At this point I was four weeks postpartum and figured I would wait until my 6 week postpartum appointment with my OB/GYN to mention my PPD concerns. I progressively got worse, suicidal at times. C wanted to call crisis outreach multiple evenings when I was curled up in our closet crying; he probably should have. I wouldn't let him.
I cannot blame the people close to me for not reaching out to me and attempting to support me or get me help. I made the mistake of letting the shame overpower the sense I had to realize I was most likely predisposed to depression (family history and pre-pregnancy anxiety and depression). I really thought I could handle it all by myself. The truth was I couldn't. Yes, many women overcome postpartum depression without the aid of doctors, drugs, or even a basic support system. However, the recovery time can be shortened immensely if there is intervention. I believe part of being a good friend, a good partner and a good family member is watching for the signs of PPD in a woman you know who has given birth in the past year and knowing what to do if you see these signs. Remember that PPD can strike any woman in a number of ways. There is no gold standard on how to act but I think this can be a good starting point.
Recognizing the signs
Roughly 13% of women will suffer from depression and anxiety after giving birth. While the "baby blues" is a common phenomenon many women go through after giving birth these feelings shouldn't last more than a couple of weeks. Some things to look for according to the Office on Women's Health, a division of the US Department of Health and Human Services, include:
- 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 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
The Postpartum Health Alliance has an online screening you can ask the mother to take if she is willing. This test is used by doctors to screen for PPD, but taking this can't replace a diagnosis from a doctor. Please remember to encourge the mother to keep in touch with her OB about how she is feeling. My OB was a catalyst in making sure I got the help I needed. Dr. S. made phone calls on my behalf, fought to get me seen weekly because I needed it and found a new therapist who has been very helpful to me.
Risk factors that elevate her chances of developing PPD include a personal or family history of depression or other mental illness, a lack of a support system, negative feelings about the pregnancy, marriage or money problems, stressful life events, and young age. This list is not all inclusive. PPD is hormonal and can strike a woman no matter her economic situation, whether she feels positive about having a baby or not. PPD is an illness; we wouldn't expect someone to get over a broken arm by themselves.
She's depressed, now what?
There is a lot of stigma associated with postpartum depression. Celebrities like Brooke Shields and Bryce Howard Dallas have been very open and vocal about their PPD. These women are refreshing reminders that PPD can happen to any woman no matter her circumstances. But so many women internalize postpartum depression as being a failing on their part to be a good mother or even a good person. It doesn't help that the media demands famous women lose the baby weight in weeks, take the appropriate number of photos ops with their babies and always be perfectly put together and in love with being a mom. The reality is it's a massive life change to become responsible for another person, it's an amazing amount of pressure (especially on new moms) and it's just not fun sometimes. Babies can have colic or refuse to sleep unless you're driving them around the block for hours on end. I feel like this needs to be said more often out loud. It's okay not to love being a mom every second of every day.
Since the stigma can be so debilitating it's important to approach this topic very sensitively at first. Make sure any the concerns you share come from a place of true concern and are said in a way that implies the mother is not in any way at fault for this. Let her know your concerns are for her health. Never imply you're worried about the baby. Never accuse her of being a poor mother. Ask her how she is feeling often.
PPD is generally depression and/or anxiety diagnosed within one year of a birth. This means it can be months before the depression manifests itself. This is why it's really important to continue to check in with the mother often. Many times the depression causes a woman to withdraw from family and friends. Suggest meeting up for coffee, set up a phone date, email, just do something to let her know that you are thinking of her and hoping things are good. Always encourage and support her. Some other great suggestions include offering to watch the baby for a few hours, bringing over dinner and enough for leftovers or offering to go grocery shopping for her.
Ideally if a partner is in the picture they should be very encouraging of the mother to get help if she is struggling. If you are close with the partner consider discussing your concerns with them to get on the same page. Another good thing to remember is the mother's partner may be suffering as well. Often times PPD leaves the mother unable to help with childcare and doesn't allow the partner much of a break. So don't forget to offer support and just to listen if they need to talk as well.
Also remember these national resources as well. If anyone posts specific state or non US resources I will add them to the list below.
- American Psychological Association
- Mental Health America
- National Institute of Mental Health, NIH, HHS
- Postpartum Education for Parents
- Postpartum Support International
Phone: 800-944-4PPD, 800-944-4773
- Substance Abuse and Mental Health Administration Publications, SAMHSA, HHS
- Postpartum Progress online support, private forums, stories from other moms and resource listings
Have any other tips? Feel free to share below in the comments what worked for you in the past if a mother you know struggled with PPD. If you are a mother who had/has PPD what did you need in terms of support?
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