July 12, 2010

Postpartum Depression: Beyond Baby Blues

The birth of a baby can cause mothers to have mixed emotions about the responsibilities of raising a child. Fear and anxiety can consume women and even lead to depression. Past the “baby blues” stage of crying and sadness, postpartum depression (PPD) is a clinical diagnosed depression; symptoms may include: insomnia, sadness, irritability, and excessive guilt.

Inspiring stories about women who overcome the clinical illness emerge everyday. Kate’s* story is one of them. Through the comfort of support groups and the use of technology, many women are able to heal.

Kate’s Story

The doctor ran the ultrasound in a circular motion around Kate’s pelvic area and up to her belly button. Kate, a thirty-year-old, college-educated African American woman, has long and skinny dread locks that swing past her waist. She turned toward the ultrasound monitor and watched a figure appear on the screen. This was the second time that she and her husband, Daniel waited to hear the sounds of a baby’s heartbeat.

The first time they conceived, resulted in a miscarriage at just nine weeks. A proclaimed “control freak,” Kate had already chosen their child’s name, zapped baby gift registry items, and had written a detailed five page, single-spaced birthing plan. All of that planning was thrown out the window. The loss of their child left them forever changed.

Nearly five months after losing their first child, they were surprised to find out they were five weeks pregnant. She held her breath anticipating the doctor’s results. Kate said, “People were telling me that I was big. Then the doctor said that he heard something else thumping around. I dismissed it. It didn’t cross my mind, because I always thought my older sister would have twins. She is so motherly. No big deal. They got something wrong.”

Kate, sitting patiently, looked at her husband and tried to put him at ease. “I think I hear two heartbeats,” the doctor said. Kate laughed, “My husband became silent, because he knew that they were going to take on more than one life and have an even greater responsibility.” Kate decided to relax with the second pregnancy, because of her history of battling with depression and taking prescribed antidepressant drugs, while in college. She also tried not to be a control freak.

Second Time Around

During pregnancy, she switched medication from Paxil to Prozac, an antidepressant oftentimes prescribed to pregnant women. Definitely not planned, Kate’s water broke at her surprise baby shower. Her healthy identical twin boys were delivered by cesarean at 35 weeks. Kate’s birth plan and vision of natural births were a no-go, because the doctor’s couldn’t hear one of the children’s heartbeats. Once again Kate was crushed.

“It alarmed the doctors. I was laboring just fine and wanted them to follow my birthing plan. I wasn’t the one that earned an MD, but I was the mother and these were my children. Everything in my mind that was supposed to happen naturally did not. One hundred years ago, a woman would have been able to have these babies on her own. I felt like a failure.”

At the hospital, Kate also suffered from a bad reaction to the anesthesia. Without her or her husband’s consent, she was taken off of medication. The withdrawal from her medication affected her terribly, both physically and emotionally. Clueless to what transpired, her sister said that she couldn’t stop crying and screaming, “You took my babies! You took my babies!” repeating the phrase over and over again. Because she was not mentally alert, the doctors decided to keep Kate’s newborns in the nursery, located down the hall from her room.

Frustrated from everyone’s glowing reaction to her twins, Kate became even more upset, because the babies were not roomed with her and she had only briefly seen them. Without permission, she snuck out of her room to the nursery. Drowsy and weak, Kate pressed her face and palms against the window where she could see her boys resting in their clear, plastic bassinets. Kate opened the nursery door and unexpectedly sounded an alarm. Nurses rushed to the room, and moments after with some clarification, Kate was allowed to stay and visit for a while. She was instructed shortly after to return to her room. Though heartbroken, Kate said that the doctors were “protecting her babies from her.”

Kate and Daniel left the hospital without their boys. Her depression still lingered, and she felt horrible about herself and doubted her ability to be a good mother. Daniel kept telling her that she was “a wonderful mom.” Kate cried every day that her children were not with her.

Hospitalized for Depression

Kate and Daniel’s twin boys came home on November 17th. Her sister was back in town to help them with the newborns. During a regular psychiatric visit, the doctor asked Kate how she felt. She had been having horrible and frightening dreams of hurting or dropping the babies. The doctor asked Kate, “Do you think about hurting yourself? Do you think about hurting the babies?” She replied, “Yes, I think I may throw them down the steps.”

Kate’s sister was in the waiting room watching the babies. Waiting room guests continued to complement the children. The doctor proceeded to ask a question, “Would you be interested in staying at a clinic in order to receive help?” Kate agreed to get help.

The EMTs came to escort Kate from the doctor’s office. Surreal about the entire situation, Kate kissed her boys goodbye. Unfortunately, Kate didn’t know PPD existed. She was also unaware of anyone who had experienced this illness. Kate said, I remember going to the hospital and sitting in this cold waiting room. It felt like a cell. They handed me a manual pump, and I sat there trying to teach myself how to use it. I thought to myself, I should be at home. Instead, I’m in this cold room by myself, in this weird hospital. Had I gotten that bad? When Kate left the hospital a couple days later, her church group brought food to her home, while family continued to visit her. That’s when her support group began. By talking to other women, Kate realized that she wasn’t the only one who suffered for PPD. She also used the Internet to communicate with her siblings. Their emails comforted her. Kate began to slowly heal.

Suffering from Postpartum

Before people knew what PPD was, Ilyene Barsky, LCSW (licensed clinical social worker), and founder of The Center for Postpartum Adjustment, had been counseling, educating, and working with women who suffered from the unnamed illness. A counselor who survived two battles of PPD, Barsky has worked and counseled thousands of women for over 20 years. Talking about her experience Barsky stated, “I had strange symptoms after the birth of my first child. I went through my psychology books, and couldn’t find anything. After suffering from insomnia, I went to a psychiatrist and he gave me antidepressants. That did the trick and quieted the noises in my head. Four years later my daughter was born in 1984, and I experienced the same symptoms.”

Barsky’s first workshop took place in a living room, and soon after, her message extended to hospitals, and social service agencies. Since 1988, Barsky has been a member and affiliated with a nonprofit organization, Postpartum Support International (PSI). The organization’s “mission is to promote awareness, prevention, and treatment of mental health issues related to childbearing in every country worldwide.” Currently, Barsky lectures at large conferences across the country. Barsky stated, “I enjoy working with this population, because it is extremely rewarding.” Her passionate vibe and genuine commitment to help others seeped through the telephone. She said, “It really wasn’t until 2001 that shined a light and woke people up all of a sudden and now there was an interest in PPD. Women started saying, ‘I have this. My mother had this, and my friend has it.’”
Celebrities also started coming out of the closet. Courtney Cox-Arquette, Amanda Peet, and Catherine Tate all reportedly suffered from PPD. Brooke Shields wrote a book, Down Came the Rain revealing her personal experience with the illness. Women were finding comfort in realizing that they were not alone.

Online Support Groups

Kate was fortunate that she had a support group. She also utilized the Internet for support. There are many new mothers that either do not have support, or who are afraid to ask for help. A study published in the Social Psychiatry and Psychiatric Epidemiology journal by the University of Iowa’s psychologist Lisa Segre discovered that African American women and lower-income women suffer at a higher rate from postpartum depression than any other demographic. The study found that “low-income women already coping with financial burden are at an increased risk of suffering from depression after becoming mothers.” According to Segre, “Women who are poor already have a lot of stress, ranging from poor living conditions to concerns about paying the bills. The birth of an infant can represent additional financial and emotional stress, and depression negatively impacts the woman’s ability to cope with these already difficult circumstances.”

If women cannot find support, then online support groups and other uses of technology (videoconferencing), voice-over-IP (Internet phone), web-based messaging and other Internet communications, can be wonderful resources for women suffering from PPD. If women are unable to find a support group in their area, they can visit an online PPD Support Group. Henry W. Potts’ article, “Online Support Groups: An Overlooked Resource for Patients” suggests, “Online support groups (OSG’s) date back to around1982 and possibly the late seventies. They involve mutual support and information provision (the two are often inseparable). Compared to the use of web sites, research on OSG’s has lagged behind; despite the fact they are very numerous. Yahoo! Groups list almost 25,000 support groups, although this may represent only 7,000 active groups. There are many other sources of OSG’s. The aforementioned US survey found that 28% of Internet users had contacted an OSG, a figure that has grown since.”

Barsky agrees, “I think online support groups are very good for women who have barriers to treatment; which may include finances, transportation, child care, and no one in her area that can specialize in this (PPD).”

John M. Grohol, Psy.D. stated in his article, “What to Look for in Quality Online Support Groups” that “the best online support groups are those where the members are actively posting messages to the group on a daily basis and where forum leaders take an active role in helping the community thrive. You’ll recognize such a group not only by its high daily activity and membership roster, but also by the positive participation of its leaders or moderators.”

I reached out to women that had experience using online support groups. I posted a question, “Do online support groups help moms cope with PPD?” on Yahoo Answers! and CafeMom web sites in their “Ask a Question” section.

My first email message from StarMom101* read, “They provide a type of social outlet for women. While it may not be as useful as face to face interaction, for some without the resources to travel or those that are a bit more socially reserved, this is a means of helping women cope with the demands of new motherhood.”

MomJoy1028* answered my CafeMom online question, “I joined one here on CafeMom. I think it helped to an extent, just knowing that I wasn’t alone helped greatly. My main support came from my family…without my husband; I don’t think I’d be here.”

Sam responded to my question in an email:
I’d imagine that it helps those women that don’t have access to ‘real life’ support groups (maybe because they are geographically isolated or because of time constraints), those that don’t feel comfortable talking in person about their problems, and it has the potential to bring together a much wider range of experiences than would be possible in small groups offline. Also it can be a lot easier to switch on the computer than get up the motivation to make a doctor’s appointment, though through online support women may be encouraged to seek medical help as well.

Another response came in an email from Shoshana Bennett, Ph.D., author of Postpartum Depression for Dummies and co-author of Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression, responded to my email, “Depending upon the quality of the group (monitoring, ground rules, and such), I agree that online groups can be helpful for a variety of reasons. There are also potential disadvantages as well.” Whether women are going online to find support, technology continues to play a key role in communicating and healing by using a virtual format.

A New Day

Kate’s babies are now 18-months old and doing great. She is still taking medication, but her energy and thought processes are a lot different than they were nearly two years ago. Kate stated, “I have to tell myself every day that there is no such thing as a super woman. It’s hard for me to admit, but if I don’t admit it then my family won’t be OK and I won’t be OK. I have to accept that I am not perfect. No one tells you about all of the things that may happen in life. Don’t feel you’re the only one in the world who had these bad thoughts. It’s OK. Just tell somebody. I’ve had every bad thought, but understanding that confessing your thoughts is not a sin. The sin is in being prideful in thinking that you don’t need help through them. That’s what was big for me. These are normal thoughts. You just need to be open and get help. No one expects you to be super mom and everything will be OK. You need help.”

The Mother’s Act proposed by U.S. Senators Robert Menendez (D-NJ) and Richard Durbin (D-L) in 2006, “aims to eradicate the devastating effects of postpartum depression on American families. The legislation, introduced in the Senate proposes grants to better increase education and access to screenings for new mothers and to increase research into this difficult illness. The bill also proposes grants to health care providers, to facilitate the delivery of healthcare to those suffering from postpartum depression.”

Barsky said it best, when citing the Postpartum Support International mantra, “You are not alone, you are not to blame, and, with help, you will be well.” Women suffering from PPD should reach out to someone they can trust. If family and friends are not available for support, then online support is just a click away.

* Names have been changed to protect identity.

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