Here’s to Public Awareness about PPD…More of This Kind of Accurate Reporting is Needed!

A real quickie from me today……Check out this recent piece on CNN.com.  It’s a great example of the kind of information that should be more frequently made available to the public about postpartum depression (PPD)….not like those misleading articles in magazines (the most recent one I can think of was in Vanity Fair) that add to the misconceptions about PPD.  It’s chockfull of very important and useful information about PPD, including the following:

  1. One mom’s experience with it, plus links to 2 other moms who talk about their experiences on Parenting.com (in my opinion, very well written);
  2. why many women are afraid to speak up about/seek treatment for it;
  3. the Melanie Blocker Stokes MOTHERS Act and how it, once passed, can help fund related research and education, provide training to medical professionals, and increase treatment options and support services;
  4. difference between the blues and PPD;
  5. the hormonal/neurochemical/psychological/social factors that can lead a woman at risk to get PPD (and for some the depression begins during pregnancy);
  6. how moms with PPD can–and should–get help (and how they should NOT wait or try to tough it out and suffer silently); and
  7. last but definitely not least….importance of the new mother taking care of herself and getting the help (emotional, practical) she needs.

Other newspapers, magazines, etc. should follow this wonderful example of accurate reporting that provides helpful links to PPD stories and other resources.  We need more of this kind of reporting to help banish misconceptions, or myths, about motherhood–PPD included!  The public needs to be aware how prevalent PPD really is, it shouldn’t be confused with the blues (which about 80% of new mothers get), and that it should be taken seriously. 

Happy mothers mean happy babies.  Mothers deserve and need rest and support!  

Knowlege is power, folks….and don’t you forget it!

How anyone could think that PPD isn’t real is beyond me

Postpartum depression (PPD), and depression for that matter, is an imaginary, or make-believe illness, a state of mind that can be changed at will, a means to get attention, an excuse to take medication to escape from reality, a sign of weakness or self indulgence, an excuse to avoid the reality of motherhood.

Yeah, get a grip on reality–and get educated while you’re at it–for crying out loud.  These statements couldn’t be further away from the truth.  In this day and age, how anyone can believe any of this BS (especially other women) is beyond me.   Why can’t women be supportive of each other instead of being so critical and competitive with each other?!   That includes being supportive of and contributing toward efforts that will help mothers experiencing PPD rather than impeding those efforts (those people, by the way, should be ashamed of themselves).  Why women have to be so feline (note:  my #2 anger trigger is feline behavior, after my #1 anger trigger of behavior & remarks made out of ignorance/racism/condescension) is beyond me!

Skeptics will claim that, since PPD isn’t necessarily detectable via blood work nor a growth or wound or handicap that is visible to the naked eye, that it must not be real.   And please don’t say this is a recent phenomenon or that women have been giving birth thousands of years and we’ve only seen a rise in PPD awareness–and thank goodness for that–in the past decade, so it must be a new invention made up by women in today’s generation because they can’t cut it like the tougher women of previous generations.  Right.    Anyway, this “recent phenomenon” is thanks to the women out there (you go girls!)–plus celebrities who are finally gaining the courage to speak up more about a condition that has been documented as far back as the days of Hippocrates.  Scientists have not been spending years on research on treatments, detection, determination of risk factors, etc. for lack of anything better to do.

People out there scoff at the idea of PPD and claim to know all about it, when in fact they don’t.  Why?  Because they never suffered it themselves…duh.  They’ll claim that all new mothers experience mood shifts after childbirth.  Hello, you’re thinking of the blues, which happen within the first couple of weeks postpartum and resolve on its own.  They’ll claim that there is no scientific evidence that PPD exists.   They’ll claim that insomnia, a classic symptom of PPD, is merely sleep deprivation and fatigue that all new moms experience.  They’ll also claim that having a panic attack is the same thing as anxiety that comes from difficulties in transitioning to motherhood and being a first-time mom.  Now, had these people actually experienced real PPD, including real insomnia and real panic attacks, they would understand what it’s like to have PPD,  insomnia and panic attacks.   Until then, they should keep their ridiculous claims to themselves.  I’m not going to tell these skeptics to do their reading because no amount of facts will change these peoples’ minds…unless perhaps they experience any of these conditions for themselves.   It’s really a shame, isn’t it, that people insist on maintaining their stubborn beliefs, regardless of how ridiculous they are.

Many of these skeptics of PPD are also skeptical of depression, in general.  They’ll claim that depression is a matter of mind over matter.  They’ll claim that anyone can snap out of depression on their own accord.  Well, wake up!  The ability to will or wish away depression is a myth.  You can’t overcome it by just putting your mind to it.  PPD is a real illness with a biological cause, just like diabetes and heart disease.  You can’t just “snap out of it” any more than you could if you had an ulcer, diabetes or heart disease.  Until I experienced PPD, I thought depression is just a state of mind.  I used to say things like “I’m depressed” whenever I felt sad.  Now, I’m careful to not use the word “depressed” in the context of sadness.  I believe the majority of folks out there mistakenly think that being depressed is the same thing as being sad, feeling down or feeling blue.   People, particularly OB/GYNs,  need to stop getting these two very distinctly different conditions confused with each other because by doing so, they are preventing women with PPD from getting the help they need right at the beginning.  Not to mention, perpetuate the misconceptions about PPD.

With PPD, the longer you wait to seek help, the harder it is to recover from.  But why wouldn’t you get the help that you need to get better and enjoy motherhood sooner?  Why suffer longer than you have to?   There are many possible reasons, though high up at the top of the list would be 1) mistakenly thinking that this is just the way it is with being a first-time mother who is trying to cope but just going through a rough patch (because they don’t know any better due to lack of education about PPD and their doctors’ misdiagnosis as blues) and 2) fear from the stigma associated with mental illnesses and what others would think/say and.    All too many women will unnecessarily struggle with toughing it out or self medicating with alcohol or other substances.

My best piece of advice to you moms out there is to not give a damn what other people think.  Now, if I could take a dose of my own medicine, that would solve one of the biggest habits—or weaknesses, that is—I’ve had so much trouble kicking over the course of my lifetime!  Your priority should be the wellbeing of you and your family.  The best thing you can do for yourself and for your baby—in fact, for your whole family—is to seek help as soon as you experience three of more of the symptoms described in my post “Baby Blues is NOT the Same as PPD!”  Don’t wait until you are crippled by the effects of PPD like I was.    Prolonged and untreated depression can not only negatively affect your marriage and your baby’s cognitive and social development, it can unnecessarily strain your relationship with your partner.  Worse yet, untreated PPD can lead to such feelings of hopelessness that ending your life may seem like the only way out of the pain.  Don’t try to tough it out, thinking what you’re experiencing will pass on its own just as quickly as it developed.  Don’t try to tough it out because others around you are trying to convince you that this is all part of the process of transitioning to motherhood, that every new mom experiences sleep deprivation and anxiety (see previous post on the difference between that and true insomnia, a very common PPD symptom if it is experienced 3 weeks or later after childbirth).

Though the symptoms and their severity may be unique to every woman, PPD is debilitating to all those who suffer from it.  Depression–and there are thousands in this country today that are afflicted with it– affects people physically, not just mentally.  It is a physical illness that is the result of a chemical imbalance.   Hormonal changes are responsible for perinantal (during pregnancy and postpartum)—and even premenstrual dysphoric disorder (PMDD)—mood disorders and an imbalance in brain chemicals called neurotransmitters.  Serotonin is one such neurotransmitter.  Research shows that serotonin dysregulation is a primary cause of PMDD and PPD.  A sudden and huge drop in estrogen levels immediately after childbirth contributes to a decrease in serotonin availability in the brain.  Since serotonin promotes normal mood, a decrease in serotonin availability in the brain is associated with anxiety/depression.  This is why medications such as selective serotonin reuptake inhibitors (SSRIs), which increase serotonin availability in the brain, have in many cases been effective in the treatment of PPD.   An SSRI was effective for me.

Let me explain something here, lest the words “medications” and “SSRIs” trigger a violent reaction among the anti-pharma faction out there.  I am not advocating medication for everyone.  Different treatments will work for different women.  A woman must be informed enough to be able to make a decision that she feels is right for herself.   Being informed means having ready access to information about PPD, its symptoms, where to go for help, what treatments are available, what medications are usually prescribed and their side effects and risk of being passed to the baby via breastfeeding, etc.   It also means having a doctor that is adequately trained to detect, diagnose and treat perinatal mood disorders.  But many doctors are still not adequately qualified to do any of that, plus lack adequate tools and resources.  This is why awareness about PPD and preventive measures (like lining up adequate social support and getting 5 hours of interrupted sleep as much as possible in the first 6-8 weeks postpartum) are so, so critical to everyone who plans on having a baby. 

I’d like to close with this piece of advice to the skeptics.  Without knowing the full story (or without ever experiencing PPD or any other illness directly) one should NEVER pass judgment on the situation of others.   Women with PPD do not need to be scoffed at, doubted and criticized.  They need support and understanding.  If you were in their shoes, would you want to be on the receiving end of these negative or–shall I say–tasteless behaviors?

Baby Blues is NOT the Same as PPD!

The “baby blues” is a passing episode of mood instability that affects up to 80% –or 8 out of 10–of new mothers and is usually characterized by tearfulness, sadness, irritability, mood swings and anxiety-all normal and expected behavior due to the huge hormonal shifts. The blues, which can begin as early as immediately after delivery and up to one week postpartum, generally subsides on its own, with no medical/therapeutic intervention, within 2 weeks.  

You would think that obstetricians would be the experts on identifying PPD, but the sad truth is that even today, most of them still buy into the myth that any mood disorder experienced by the mother after delivery is merely a state of mind and a normal part of adjusting to motherhood. They will wave off your symptoms at the 6-week checkup and claim it’s just the blues and you’ll get over it.  It’s frustrating whenever I read about mothers who do seek treatment and get the ol’ “Oh, it’s just the blues. Everyone gets the blues. You’ll be fine before you know it.” Then, when you aren’t fine before you know it, you then end up with this despair that you don’t know what’s wrong with you. It makes me so angry when I read about these stories.  How many more doctors are going to wave off a woman–saying they have the blues, all is normal, it’ll go away by itself–who is claiming she has insomnia, appetite disturbance, inability to smile, laugh or feel happy  3 weeks or longer after childbirth?  

A New Mom Needs to be Evaluated for PPD if….

Practically every book I’ve read indicates that a new mom needs to be evaluated if she experiences 5 or more of these primary symptoms of PPD for most of each day for two or more consecutive weeks:

  • Persistent and mostly inexplicable sadness/tearfulness and feeling empty inside
  • Loss of interest/pleasure in most of your usual activities; inability to laugh
  • Overall impaired functioning*
  • Sleep difficulties (either insomnia or sleeping too much)
  • Weight loss (usually fairly quick) associated with a decrease in appetite
  • Weight gain associated with an increase in appetite
  • Excessive worrying (e.g., about the baby’s well-being)
  • Difficulty thinking, concentrating or making decisions
  • Feelings of guilt/inadequacy/of being a bad mom
  • Urge to run away/disappear/vanish into thin air
  • Onset of panic attacks
  • Sense of despair and/or hopelessness leading to thoughts of death/suicide

*What I mean by overall impaired functioning is feeling unable to do anything.  I prefer to use the “debilitating”  to describe my experience.  Debilitating meant the following for me: I would find myself frozen in one spot (either standing or sitting) not knowing what to do next and feeling helpless, useless and unable to function properly. All I could do was sit there, but even sitting there, I was deluged with feelings of hopelessness, in large part due to my not having a clue what was wrong with me. I couldn’t feel or think positively. I couldn’t smile. I couldn’t enjoy anything that I used to enjoy. If your symptoms are debilitating to the point that they interfere with your day-to-day functioning and prevent you from enjoying that which used to bring you interest/pleasure, you should be evaluated by a medical or mental health practitioner right away (don’t wait).

A sign for an OB/GYN that what you’re experiencing is PPD and not just the blues is if your symptoms are continuous, debilitating, and last beyond 2 weeks postpartum. The first question an OB/GYN should ask the patient to rule out PPD is whether or not the symptoms interfere with her everyday functioning. Usually, with the blues, you will feel weepy every once in a while, but the symptoms are not debilitating. In fact, they usually subside within 2 weeks with no medical intervention. My insomnia at 6 weeks should have been a clear indication to my OB/GYN (and his staff) that I had PPD at that point.  Instead of merely prescribing me Ambien to help me sleep, they should have screened for PPD.  Their insistence that I didn’t have the “classic” symptoms of PPD is founded on the minimal number of times I was willing to call the doctor’s office with a question or concern.  They never once bothered to ask me if I had certain common symptoms of PPD. If I had a medical practice that was concerned about women’s health before, during and after pregnancy, I would ensure I was trained on PPD detection and treatment since it has such a high occurrence rate, and make sure I took steps necessary to detect and treat PPD in my postpartum patients. In fact, I would even screen pregnant moms too, since so many cases of PPD arise during pregnancy.

Remember, if your doctor tells you that what you have is the blues, and you are 3+ weeks postpartum and are experiencing 5 or more of the symptoms listed above, you will need to make a decision on what to do to help yourself get better. 

If you’re comfortable with this doctor and prefer to stick with him/her, tell him/her he/she needs to screen you for PPD and reach out to Postpartum Support International (PSI) for information/resources.  

Even better (since time is of the essence), ask him/her if he/she can refer you to a medical or mental healthcare practitioner who has experience treating PPD.  You always have the option to find a psychiatrist who can screen you for PPD, provide you with a listening ear and advice, and prescribe any medications as necessary.  If this is your first time experiencing a mood disorder, don’t be afraid to seek therapy.  What matters is you must do what it takes to get well.  Certain PPD patients do well with a combination of medication–especially if they are very symptomatic and need treatment for their symptoms before therapy can be beneficial–and therapy.

If he/she doesn’t have any referrals, go to the PSI website to look up your state coordinator who can refer you to local medical/mental healthcare providers.

Pain, Sadness Hiding Behind Smiles…Never Assume and Think That All is Blissful for the New Mom

Never assume….never take for granted that everyone always has smooth deliveries and postpartum experiences…..never think that just because she’s smiling that everything is fine and blissful, as it always has to be after the birth of a baby.

I just got through reading a touching letter on Susan Stone’s blog written by a father who lost his daughter to postpartum depression (PPD) and is encouraging people to petition for the Melanie Blocker Stokes MOTHERS Act.   His daughter seemed fine though people realized too late that she appeared to be more consumed with worry in the days leading up to her suicide.    Touched and with tears in my eyes, I started to write this post.

Something has to be done to stop the silent suffering of so many new mothers, bring more public awareness on PPD, and more healthcare professionals (GPs, OB/GYNs) up to speed on detecting PPD before it spirals out of control and leads to sometimes disastrous consequences.  What we need to do is prevent these situations from happening in the first place.  The only way we can make progress is through public awareness, which includes dispelling the myths of motherhood.  Now, if you happen to be one of the proponents of those ridiculous myths because you feel threatened or whatever the reason might be, then take a reality pill and get with the program.  Jump off that la-la train that you’ve been riding.  You cannot possibly ignore the fact that PPD is the #1 complication of childbirth, with 1 out of 8 women suffering from it.  If you still want to ignore it, then that’s YOUR problem.  Don’t make it anyone else’s. 

How many more lives should be torn apart from an illness most people still think is a make-believe illness?  Some marriages do not survive.  Children of women with untreated PPD may end up with cognitive, social, emotional and behavioral delays and potentially anti-social issues down the road.  For God’s sake, some women whose illnesses spiral out of control don’t even make it through alive. 

Sure, mothers have been giving birth for thousands and thousands of years. Just because most women with PPD don’t speak up doesn’t mean it doesn’t exist. And you mothers out there….if you don’t speak up, people will continue to go on scoffing at the idea that PPD does exist.

Why the fear?  Why the secrecy?  Why not speak up?

You may be wondering why the heck, then, doesn’t a mother who’s not feeling herself get help in the first place, then think about this.  

  • Many (like me) don’t even know what is happening to them in the first place. 
  • Many go see their doctor about why they’re feeling the way they’re feeling, but are told that what they’re feeling (baby blues) is normal and should go away by itself; yes, doctors still misdiagnose even today (more on this in my next post – stay tuned). 
  • Many are afraid of what their family/friends may think. 
  • Many are afraid others will look down at them and call them weak/bad mothers. 
  • Many may even fear that if they speak up, their children will be taken away.  After all, media is doing a great job in painting the wrong picture about PPD  (see earlier post on ABC’s Private Practice) and the public seems to think, ever since the Andrea Yates case, that everyone who has PPD is at minimum a bad mother or will turn into an Andrea Yates.    Well, Andrea Yates had postpartum psychosis (PPP)–which occurs in 1 in 500 to 1,000 mothers– and was never successfully diagnosed and treated, and look at the disastrous consequences that resulted.   The healthcare system failed her and those around her didn’t help her.  Instead, the public chooses to put the blame squarely on her shoulders. This is why public awareness and education are CRITICAL!

Basically, with the exception that the birth of a child is a life-changing experience for all women, though in different ways and to different degrees, no one woman’s motherhood experience is the same as any other. The only experiences you will hear are the mothers who have positive experiences gushing to everyone they know and run across “I love being a mother. Being a mother is such a fulfilling, wonderful experience that I wouldn’t trade it for the world. I couldn’t ask for anything more. It’s all I ever dreamed motherhood to be.” Since you only ever hear about the positive experiences, women whose experiences aren’t as positive will tend to keep their feelings to themselves.  It takes courage and a desire to empower other women to speak up.  Slowly, the numbers of women who speak up are growing until hopefully, one day, this suffering in silence nonsense will finally come to an end.  I’m hoping this momentum continues to the point until the motherhood myths disappear and mother-centered programs (mental/physical health and practical/social support) during the postpartum period become the norm rather than the exception.

Don’t compare yourself to other mothers that appear to be coping extremely well with motherhood–those who never look tired, always look happy and seem to do it all without needing any help at all. I know how tempting and almost second nature it is, but you must resist doing so.  Don’t assume that, just because other new mothers around you seem to have a picture-perfect motherhood experience, they’re natural mothers because they seem to know what to do and do everything right, and even look great  even immediately after having given birth. It could also be that some of these women have hired help in the form of a doula/nanny/housekeeper, which does in fact help new mothers get the rest they need to recover (see previous post on social support).  Unfortunately, however, not everyone has the ability to hire such help. 

You don’t know what truly goes on behind closed doors.   Just like others won’t know something’s wrong unless you open up, you’ll never know whether these seemingly perfect mothers are just putting up a façade. It’s scary how common it is for a woman to disguise how she’s truly feeling–it’s called make-up and good acting–all so others won’t know she’s not coping as well as she thinks she should.  She wants to give the impression that she’s handling it like the supermom that other mothers give the impression they are and how she wants to be viewed as.  This is one of the reasons why even today people are surprised to hear that PPD is the #1 complication of childbirth.  

No one’s life is perfect, despite appearances.

Please see a doctor if you don’t feel yourself even after 2-3 weeks postpartum, and you’re feeling down, unable to smile, unable to enjoy anything and/or unable to sleep even when the baby sleeps.

How Public Awareness, Screening Can Help Moms

I have read in several forums that it is believed that the reason why so many New Jerseyans are supportive of the Melanie Blocker Stokes MOTHERS Act is due to the fact that New Jersey happens to be the pharma capital of the country, with the largest concentration of pharma companies located in this state. Can you honestly say that everyone who has thus far signed their names in support of this bill (click here to see latest list) is a pharma-related person? I’m certainly not. I am simply a PPD survivor. My PPD so debilitated me that I could not function on a day-to-day basis, period. With panic attacks I couldn’t control and a feeling that I would not physically be able to survive my experience, I needed medication to return my brain chemistry back to its normal levels. As soon as that occurred—which was 4 weeks after I started taking it—I was fine and happily able to enjoy motherhood, my baby and my life once again. I would think that there is wide support in New Jersey because its citizens have seen the benefits to a law that was passed nearly 3 years ago to benefit mothers through early detection and education.

What I learned from my experience was that the way in which my doctor treated me could have been different. I probably would have been better off seeing a psychiatrist who could provide the comfort and reassurance that I needed, due to my doctor’s lack in bedside manner. Either way, I’m confident that the psychiatrist would have prescribed an SSRI anyway, given my level of functioning—or lack thereof—plus insomnia, quick weight loss and inability to smile and enjoy all that I used to before PPD hit me.  And this is coming from someone who–if you’ve read my previous posts–has avoided taking medication since I was a toddler and able to run away from mom and that spoonful of yucky stuff!

I do not blame mothers out there who feel the way they do about being misdiagnosed and prescribed the wrong medication. It’s unfortunate, but true, that many healthcare providers still need to learn to properly recognize the symptoms of a postpartum mood disorder (PPMD), including PPD, postpartum OCD (PP OCD) and postpartum psychosis (PPP). If a mother has PPP but is improperly diagnosed as having PPD and is prescribed an SSRI, the symptoms can worsen terribly. You can find more information about all these differences and why it is critical for early and proper detection and treatment of these postpartum mood disorders in the wonderfully informative books that I’ve had the pleasure of reading:  “Postpartum Depression Demystified” by Joyce Venis, RNC and Suzanne McCloskey, and “Postpartum Depression for Dummies” by Shoshana S. Bennett.

It will take a federal mandate in the form of the Melanie Blocker Stokes MOTHERS Act for progress to be made in the improvement in public perception– not to mention accurate diagnoses and treatment–of postpartum mood disorders.  Research and education are the two core elements of the Melanie Blocker Stokes MOTHERS Act that can enable us to make any kind of significant progress in helping to reduce the rates of occurrence, misdiagnosis, and incidences where cases go untreated.

Increase in Research Efforts: To determine the factors (e.g., hereditary, environmental) that predispose women to PPMDs, as well as new ways to screen for and treat PPMDs.   Speaking of screening, unlike what opponents of the bill are claiming (and complaining loudly about), no mother is ever forced to do anything they don’t want to do.  The option of screening would be offered, but it’s ultimately the mother’s decision whether to be screened or not.  Unlike what opponents of the bill claim, it’s NOT just about prescribing meds to the unsuspecting mother. It’s about early detection and treatment of a PPMD, so the new mother’s postpartum experience–and motherhood experience overall–is as happy a period as possible. After all, a happy mother means a happy baby. A PPMD that goes untreated is detrimental not just for the mother but for her relationship with her partner and the baby’s cognitive, speech and behavioral development. Whenever a PPMD is detected, the healthcare professional should offer treatment options (e.g.,  medication, therapy, alternative remedies, support groups, etc.). It should ultimately be up to the patient to decide what treatment option is right for them. Early detection (plus education) would help prevent a PPMD from spiraling into a situation that renders a new mother utterly debilitated, helpless and unable to enjoy her time as a new mother. Had I been screened for PPD right at the moment my insomnia started, I could have been spared the frightening panic attacks I experienced, and having to take Xanax to help me get through those moments until the Paxil could kick in 4 weeks later (and then I was stuck taking Paxil for a year).Had I known about PPD, its risk factors and symptoms, I may not have had moments where I thought I would never return to my old self again. I would not have felt so utterly hopeless and miserable.

Public Awareness Campaigns (for the layperson as well as healthcare professional) would help address the following issues prevalent today: 

1.  PPMDs continue to be misunderstood, under-treated and misdiagnosed today, and new mothers pay the price of the ignorance of the very healthcare professionals to whom they entrust their care.  Even today,  medical professionals still have the tendency to confuse PPD with the baby blues.

Solution: There must be a push for all healthcare professionals who come in contact with postpartum mothers to be able to detect, properly diagnose (i.e., being able to discern the differences between PPD, PP OCD and PPP), and properly treat these disorders. It would help if people realized baby blues typically ends by the second week postpartum.  Symptoms like insomnia, loss of appetite, and inability to smile and find enjoyment in anything beyond the first two weeks should be indicators that she needs to be examined for a PPMD.  If she already knows all this by receiving literature about PPMDs before she has her baby, she will more likely question the doctor if her gut is telling her she might have a PPMD.  The minimum that should happen–and is very feasible and not difficult to accomplish in the near-term–is for medical professionals who aren’t that knowledgeable about PPMDs to build an extensive network of referrals for those who specialize in the treatment of these disorders (e.g., certain doctors, psychiatrists, psychologists, etc.).  It should be mandatory for all OB/GYNs and hospitals to be able to refer patients to Postpartum Support International’s warmline for support and local referrals and resources.

 

2.  Most new mothers have certain expectations of what childbirth and motherhood will be like. When a new mother goes into childbirth not knowing what PPMDs are, what her risk factors are (if any), and what to do if she does become ill, she will basically– let’s face it– be blindsided if she does succumb to a PPMD. She will feel alone, ashamed, helpless, and frightened that she will never return to her old self again.

Solution: She wouldn’t feel this way if she had gone into childbirth already knowing that PPD is the #1 complication of childbirth. She wouldn’t feel ashamed that she isn’t glowing with blissful happiness day in and day out in the days and weeks following childbirth. She wouldn’t have to hide her suffering behind smiles and a well-groomed appearance, so that even the doctors who specialize in PPMD care won’t be able to diagnose her with a PPMD. All mothers-to-be should know that: 1) No woman who has just given birth is completely immune from developing a PPMD; with the right combination of risk factors–from genetic to environmental–any mother can develop a PPMD; 2) you can and should consult with your OB/GYN (if they’re not knowledgeable, ask for a referral and/or call your PSI state coordinator for a referral to someone who specializes in PPMDs) on your risk factors; and 3) measures to minimize the likelihood of developing a PPMD would include setting up a support network before you have your baby to allow you to get 5 hours of uninterrupted sleep a night. See my previous post on social support.

 

3.  Mothers suffering from a PPMD tend to feel ashamed for not being able to cope like all other mothers around them (not realizing that many around them may also be suffering in silence). As long as women continue to suffer in silence, there will continue to be a large number of untreated and misdiagnosed cases. They must realize that by doing so, not only do they suffer unnecessarily, they increase their recovery time as well (and perhaps even jeopardize their lives and their babies’ lives).

Solution: With consistent education and information made available to the public–not to mention brave PPD survivors telling their stories–mothers suffering from PPMDs will realize there is absolutely nothing to be ashamed of, they are not alone in their experience, PPD occurs in as many as one out of eight mothers, they shouldn’t wait to get the treatment they need to be well again, and not getting any treatment at all can have negative consequences for her, her baby and her partner.

 

4.  Literature about PPMDs isn’t consistently given/made available to all new mothers.

Solution: Information should be provided to all new mothers to educate them on PPMDs, so they can make informed decisions about their treatment options. Information should be made readily available through websites, books, magazines, media campaigns, television commercials, public service announcements, the Postpartum Support International (PSI) poster posted in OB/GYN offices/exam rooms and hospitals.  GPs, OB/GYNs and pediatricians should have material about PPMDs readily available for patients to take, like the PSI pamphlet “Postpartum Mood Disorders: What Every New Parent Should Know” or New Jersey’s pamphlet “Speak Up When You’re Down.”  All OB/GYNs should hand out info on PPMDs, including a list of symptoms and local and online resources, to all pregnant women. All hospitals where babies are born should provide departing new parents with information about PPMDs including symptoms, resources, and treatment options.  What needs to catch the attention and make people realize that PPD can happen to them are such eye-catching phrases like “The #1 complication of childbirth is depression” and “You may not think you can ever be depressed after having a baby, but the reality is ONE OUT OF EIGHT new moms has postpartum depression.”

 

5.  It is still not standard practice for all childbirth education classes offered through hospitals around the country to inform first-time parents of PPMDs.

Solution: All first-time parents should receive a “first-time parents primer” as a segment of the childbirth preparation and/or childcare classes to educate them about: 1) the wide range of physical and emotional changes that occurs during pregnancy and immediately after childbirth, including the differences between the baby blues and PPD, how to recognize their symptoms, and know when/how to get help; 2) how the brain (neurotransmitters), hormones, mood, stress and family history that are unique to each woman can cause PPMDs; 3) emphasis on the importance of emotional and practical support during the first 4-6 weeks postpartum to enable the new mother to get the rest she needs while she is recovering from childbirth and at her most vulnerable; and 4) keeping a real perspective on and managing expectations with regard to childbirth and motherhood. What I mean by keeping a real perspective on things is basically dropping all notions that you will be some kind of supermom. It is key for first-time parents to be aware that, as with anything else, the higher their expectations are–in this case, with respect to childbirth and childcare–the more they are setting themselves up for disappointment. For example, don’t set yourself up for a huge let-down by thinking that 1) taking care of a baby is a cinch since all a baby does is sleep, eat, pee and poop, 2) motherhood is instinctive, and 3) breastfeeding will come naturally (it’s not as simple as it may appear to be, at least for most first-time mothers it’s not). They should focus more on the variety of bumps in the road that have a tendency to pop up but were never really covered in any great detail in the typical childcare class, magazines or books. Real-life training on how to soothe a crying baby, how to cope with reflux and colic, how to identify and deal with eczema and cradle cap, how to deal with food allergies, and how and why moms should get 4-5 hours of uninterrupted sleep at night. A basic explanation of why newborns only sleep in short spurts for the first three months–i.e., due to neurological development–wouldn’t hurt. Some sources state that the infant’s immature neurological development may be behind colic as well. Knowing more about the why’s in infant development will leave less room for surprises and, ultimately, feelings of guilt when a mother can’t soothe her child.