Postpartum Depression

[blade]

An important new study was recently published by the University of Pittsburgh in JAMA-Psychiatry [high-level journal] re-assessing the risks of postpartum depression. Researchers found that fully 14% of all women experience clinical PPD, and 20% have at least transient suicidal thoughts in the first 6 weeks after giving birth. This is far higher than previously thought.

There are definitely risk factors for PPD (some fairly obvious-- lack of social support, young age, financial stress). For women who have a diagnosis of a mood disorder, either depression or bipolar disorder, the risk is very high. Fully 50% of women with BPD experience clinical PPD, and 40% of women with major depression do.

However, I think PPD is just like Down Syndrome. Sure, older women are at much higher risk of having children with DS. But since the majority of babies are born to women <35, the majority of DS babies are also born to women <35, due to sheer numbers. The same is true for postpartum depression-- the majority of cases are in women who have no known risk factors going into pregnancy.

Why am I writing this? I think it's because nameberry, as a happy place focusing on baby names, with sections for sweet stories and photos of adorable babies, reinforces the preexisting notions propogated by the overshare social media culture that motherhood is an absolute breeze, that it's all ups and no downs. I think it's important to normalize negative experiences because that's exactly what they are, normal.

So does anyone have any advice to share on mitigating PPD risk factors or symptoms? If anyone has actually had the diagnosis, would you be willing to share how you recognized it, what prompted you to get help, and how you made things easier for yourself?

I didn't have it. But I tried to make things as easy for myself as possible. Sleeplessness is definitely linked to mood disorders, and nothing is as sleepless as the first month with a new baby. When someone wanted to look after my son so I could nap, I jumped on it, guilt be damned. If someone wanted to give him a bottle of formula so I could rest and not have to feed him every 90min, I accepted. Disposable diapers, definitely. It's about 1/10th of the work and 1/100th of the yuck factor of cloth ones. I let people bring over food, do a load of laundry, put things away in my house even if it was done 'incorrectly.' In short, I relinquished as much control as possible, and in doing do I relinquished a lot of pressure, potential anxiety, and fatigue.

[jemama]

I did after my stillbirth. But that was expected given the situation. I did a year of therapy and about a year and a half on Zoloft (prescribed by my psych). Both helped tremendously. I know i struggled after Seb was born given our life situation at the time and he was a sweet yet very colicky baby. Feeling great now even with how busy life is, but I know the support system I have is rare. Thank you for posting this, mental health of a new mama is just ad important as her physical health.

[ottilie]

I'm prepared for PPD, I've been told one in five women with bipolar disorder gets this. I have a bad track record of major depressive episodes (last one just a few months ago), and I've been reading and asking around about this to prepare myself for what very well might come. What we've done is hire a maternity nurse for the first month. She'll basically do all the non fun stuff with Baby, and I can do all the cuddles and cute stuff. We've also got a cleaner who comes to our house three times a week, and that will help a lot too. My boyfriend doesn't have a normal job, he's always around the house, so that's a relief, and my therapist (whom I've been seeing for the past 12 years) is very involved in what's going on. I've also filled our huge freezer with food. I'm a pretty good cook, so having other people who aren't my dad cook for me is usually a let down. So freezer is full of pasta sauces, lasagnas and things like that. I've also made shopping lists at ocado (web grocery shop) so it'll be easy for my boyfriend to do the shopping without bugging me.

I'm interested to see what other people say!

[renrose]

I have depression. I've often thought that if I ever have kids I might be more likely to get PPD because of it. I too shall be reading this thread with interest!

[labmama]

I definitely struggled with baby blues. I never had an official diagnosis of PPD.

When Willow was born, I had a very hard time breast feeding. I had nearly daily appointments at the public health clinic with the nurses, and lactation specialists. I planned to breast feed, and it didn't occur to me that it might not work out. I tried different positioning for baby (and me), nipples shields, and pumping. Oh, the pumping.... There was nothing to it! I rented a good quality machine a few days after Willow was born, upon the recommendation of one of the nurses I saw. But even three weeks in, I could pump for an hour, and have less than 1oz of milk. Because she wasn't really gaining weight, they (strictly) wanted me to feed her every 3 hours. I would set my alarm, spend at least 45 minutes trying to wake her up to get her to latch, then at least another hour trying to get her latched on and sucking properly. That was nearly 2 hrs right there. So I was supposed to go back to sleep (and get rest??) in the hour that was left, before getting up again. Hubby did his best to help, but neither of us has family closeby, so it was just us. His are outside of the country, and mine are so far east of here, that they may as well be!

I was crying all the time because I felt like a complete failure. I couldn't even feed my baby! I didn't want to see my friends, who of course wanted to see our new baby! I nearly broke down on the phone with one of my best friends when I told her I wasn't ready for visitors yet. She called back and told my hubby she was coming over anyway. I am so grateful to her. She too struggled with breastfeeding and reassured me that my sanity really was important. She reminded me that my baby would be healthy and well nourished, even if I used formula. So on day 22, I decided to switch to formula, and everything started to turn around.

I had, of course, broken down, into a tearful mess in front of the public health nurses, and they had a ppd assessment questionnaire that they asked me to answer. It's about a dozen questions that they asked me, and they followed up with me several times, including after I switched to formula.

When Veda came along, I planned to try breastfeeding again. The first night, in the hospital, she was on my breast constantly. I'd finally get to put her down after an hour, and then she was crying again within 15/20 minutes, and then we'd go again for another hour or so. I started feeling the old frustration coming back, and I knew I couldn't handle going through that again. Morning rolled around, and I got a nurse to take her for me, so I could shower. I basically switched over to formula after that, with small bouts of letting her latch on for about 3/4 days. This was a much better experience for me, since I hadn't put that pressure on myself. Because of my issues the first time around, the public health nurses did follow up with me on my mental state, for which I was very thankful. I guess I felt like I needed someone to check in on me, even though I knew I was doing better than I had with Willow.

*Just wanted to add in that I had never suffered from depression before (I don't think feeling sad, and completely pathetic after a break-up counts, does it?), but I do have a couple of cousins with bipolar disorder, and a brother (although, he's adopted), who had a bout of depression during university.

[sleepysessha]

My family doesn't do therapy or put much stock in psychology, but my mom had my sister when she was 42, and I remember her being "very sick" afterwards. I was 11 at the time and the oldest child, and I remember absorbing a significant amount of the household responsibilities. At the time, the ways in which it altered our family routine didn't seem abnormal...after all, there was a new baby in the house, and I was only 6 the last time that happened. Looking back I'm pretty sure she had PPD, even though she was never diagnosed. She just wasn't herself at all, and I was essentially the mom during that time. She also mentioned at one point that the most depressed she'd ever felt was after she had one of us...either me or my oldest brother...and she didn't understand why, because being a mom was what she'd always wanted, and it was "supposed to be a happy time."

I too will be following this thread with interest. I think Blade makes a great point about having realistic expectations. Not to go way too TMI on everyone, but I was a virgin when I got married, and let me tell you, I did NOT have realistic expectations about how THAT was going to play out. I'm sure motherhood will be full of joys, but it will also have moments where it absolutely sucks, and painting an unrealistic rose-colored picture doesn't adequately prepare us to handle the sucky moments. Great discussion topic, Blade!

ETA: While my family is largely distrustful of therapists and psychology in general, I am not. Just didn't want to give the wrong impression

[shvibziks]

Not being either expecting nor a mum, I don't usually read this part of the forum, but stumbling across this thread just really made me wanna thank you for making it. I have struggled with a major depression for the last couple of years, and have family members who's been suffering from PPD, so I know just how horrible it is, and I think that this is a very important thread.

[rowangreeneyes]

I have a history of anxiety and panic attacks, but not major depression. I made sure to research all about PPD when I was pregnant so I would recognize the signs and be aware if I had it or not. I remember the first few weeks after I had her, my moods were very low and I was definitely in a funk for awhile. I remember it hitting me like a ton of bricks too, as soon as we got home after the hospital stay I had a feeling of such utter hopelessness... it was very scary. But I got out of it within a couple weeks, mostly because I kept telling myself "This is all hormonal. It's because my body is normalizing itself again. This is temporary." Talking about it helped too, with my husband and friends. I think being aware of it, educating myself about it, and being realistic and honest with myself helped get me through it quickly.

[pinkballerina]

I'm very grateful for this topic, Blade, thanks for starting it. I too feel that NB can sometimes gloss over serious issues and its nice to talk about something like this because of that.

I suffered from PPD. I had a surprise pregnancy, but my DH and I came round to the idea of having a baby extremely quickly. We couldn't wait to be parents. I didn't know anything about PPD at all, no one in my family had suffered from it. I had a normal pregnancy - A few blips but nothing major. I was lucky that unlike a lot of unplanned pregnancies, DH and I were financially stable enough not to have too many money or stability worries.

When Amelie was born it hit me like a tonne of bricks. I'm not sure how to verbalise this without sounding super self absorbed, but here it goes. When I was pregnant, every thing was about me. "How are you doing? Are you hungry? Are you tired? Are you too hot/cold? Can I get you anything?". You get my idea. I felt like I had so much loving support from all my family and friends.

At the hospital, the nurses helped me get the hang of things. Well wishing relatives came to congratulate us. And then we went home.

Suddenly, it was all about Amelie. Don't get me wrong, I WAS NOT jealous of the attention my daughter was getting. What started my PND (I believe) was the fact that my feelings were ignored. Everyone asked about Amelie - How she was sleeping, eating, developing, learning...And no one stopped to think for a second about me. Asked how I was holding up being a new mom. How I felt after my body went through the trauma of birth. How I was coping with sleep deprivation, how I barely had time to shower because I had such a high needs baby. I felt ignored, and this made me feel inadequate.

Maybe everyone deals with this fine, and that's why they're not asking how I'm doing? Because they just expect me to be fine? Those thoughts went through my head all the time. I was so confused.

The first 6 months of her life are a haze, looking back. I struggled to get through each day, only thinking in the present, and not about the future, because hell knows nothing made me panic more than thinking about going through 18 years of those feelings of ignored inadequacy. I loved my daughter to death but in my inferior mindset, I often wondered was I even good enough to be her mother. If someone else deserved to bring her up more than me.

I finally got help when she was 6months old and was put on some medications. When I realised that my feelings and experience was normal, it was like I had been set free. I blame the rose-tinted version of motherhood that is so commonly talked about socially and in the media for a lot of my feelings - If I had known it was normal for my baby to cry, for her to not sleep through the night at a month old, for her to need to be held all the time, I might not have gotten PPD. Instead I listened to all the other moms, moms whose babies slept through the night from birth without rocking/swaddling/cuddles, whose babies had no reflux and never cried..You know the type.

I'm perfectly fine now. I won't be so hard on myself with this baby. I'm human, I can only do my best, I'm not supermom. I know the signs, as does my DH, and I'll be vigilant for them this time around.

[hilary]

Blade, thank you for starting this thread, and thank you to everyone else for sharing your experiences. I'll share a bit of my story--I'm kind of a detail person when it comes to this sort of thing, so I'm sorry if this is lengthy. Anyway, I've suffered episodes of depression all of my life and have in the past been diagnosed with dysthymic disorder (a sort of chronic, low-grade depression). When I got pregnant with my daughter, I'd been taking an SSRI for a number of years. In consultation with my psychiatrist (and with my husband's support), I decided to remain on the medication for the first two trimesters, after which I'd taper off, as some studies at the time (7 1/2 years ago) suggested that infants born to mothers who were on SSRIs through the birth had a decent risk of respiratory distress and withdrawal symptoms at birth. My first two trimesters were pretty excellent, but upon tapering off my med, I became severely depressed. My students (I teach yoga) threw me this lovely shower/blessing and I felt compelled to act all full of joy and light, but really I felt completely doomed. I couldn't any longer locate a drop of maternal desire, but at the same time I was possessed by fear that the baby would die. I went into the birth basically in this state, had twenty-four hours of unmedicated back labor followed by a C-section, as what turned out to be our short, flaccid cord was causing my girl considerable distress during pushing.

This was not a great way to enter motherhood, and yes, I had terrible PPD. @labmama, I could identify with a lot of what you said about breastfeeding difficulties--I'm sure depression had a hand in mine (though there were many other factors as well) and, conversely, failing to breastfeed became the singular, obsessive focus of my depression. Therapy and resuming medication (which I did after two weeks) helped to take the edge off, but the damage felt pretty deep and I struggled significantly for some time into my sweet girl's life.

I'm finishing up my MSW and have done some research (by which I mean literature reviews, not original research) on PPD and it happens that not only a history of depression in general but prenatal depression in particular is one the hugest risk factors for PPD. I have no medical training, but I've seen the warnings against prenatal SSRI use pretty convincingly refuted. Also, though much is made of the effects of antidepressants upon the growing baby, fetal exposure to maternal depression is not exactly benign either. And as you can imagine, PPD can have lasting effects on both mother and baby. Which is all to say that if I were to do it over again, I'm pretty sure I would stay on medication for the length of my pregnancy.

I adore my daughter and am so grateful for her, but I think it's really important that we don't perpetuate images of universal maternal euphoria, so again, thanks to all who've contributed to this thread.