Coffee Chat: Postpartum Depression

I mentioned we would be getting into postpartum depression in Tuesday’s Child(ish) Reads review of Mother Brain. This is essentially Part Two of that review. Since this post is also a Coffee Chat, we wanted to add in our personal postpartum experiences and the outdated/false/damaging thought processes that contribute to the PPD stigma.

I experienced Postpartum Depression (PPD) not once, but twice.

When my son was born, I didn’t immediately get that mom glow that has been advertised in tv and movies. He was a preemie and required a two-month stay in the hospital to gain weight and breathe on his own. I wasn’t able to hold and bond with him, and those two months in the NICU definitely took a toll on both me and my husband. However, it wasn’t until he came home when I began experiencing PPD.

Even though a NICU stay isn’t easy, it did provide a safety net while he was in the hospital. We were able to get adequate sleep and finish his nursery since our whole third trimester was cut short. We also had all the extra hands from the nurses and specialists. That all went out the window when he was home.

The stresses that I experienced were:

The constant expectation for him to gain weight and frustration when he wouldn’t finish his bottle
Concerns about his development, including possible brain issues from being a preemie, resulting in delays
The frequent crying, especially when he couldn’t easily be consoled
The pressure I put on myself that I’m supposed to know what I was doing because I was a pediatric OT (I educate parents on child development, I should know what I’m doing)
Limited support outside of my husband (both our families live in other states)
A sudden shift from a full-time employee to a stay-at-home mom

I was angry, irritated, and overwhelmed with the changes and expectations motherhood brought. Once I thought I had it figured out, my son’s sleep or eating would regress and would start the emotional cycle over again. It didn’t help when people would tell me to “enjoy every moment of it” because every moment wasn’t fun. It was hell. It got to the point where my husband was concerned for my well-being, asking what he could do or what I needed to make things easier or better for me. But I didn’t even know what I needed; I just wanted it to be easier.

To be honest, I didn’t know I was going through PPD because I thought these feelings were part of the process, a parent rite of passage if you will. It wasn’t until my doctor acknowledged and labeled what it was that I was able to get the support I needed to be not only be a better parent for our son, but to mentally be okay.

When I told my mother that I was experiencing PPD, she wasn’t surprised. She told me she had it after having me, but that there wasn’t really a label or recognition for it then (it was the 80s). She revealed that her depression came in the form of not wanting to hold or care for me once I was born. That “motherly instinct” didn’t immediately kick in for her, even though she desperately wanted to bond with me. Two weeks after giving birth, she went right back to work full-time. So that connection between mother and daughter didn’t happen until much later.

When my twin girls were born, I figured I’d have an easier go as I knew what to expect. I was wrong. The new stresses encountered were:

COVID times. Period.
Recovering from a C-section (which is MAJOR surgery)
The adjustment from one kid to three
The constant amount of noise and chaos in our house

Even though our parents were present to help and support us the best they could in the first 2 months, they too would get overwhelmed by the kids, admitting that it was too much for them to handle. I felt guilty to ask for any more help after; I didn’t want to put anyone through that again.

As I felt myself begin to sink into PPD, I realized my husband was experiencing it too. At the time, not much was written or discussed about men having PPD. Aside from the girls, my husband’s anxiety also came from external factors: financial stability, job security, and managing a new work-life balance with three small kids. With limited resources for my husband, it was difficult to help him get through it as well as trying to deal with myself.

As for me, I thought I could get through these feelings on my own, despite the lack of support systems I previously had the first time around. I didn’t want to burden anyone with something I thought I should be to handle on my own. I also didn’t want to face judgement from others. However, the intensity and demand that twins placed on me (double feeding, double put-down, double carrying, double screaming/crying) wore me down. Eventually, the internal negative talk, the rage, and the helplessness began to consume me to a point where I sought out professional help.

Looking back, getting help sooner would have prevented my emotions from spiraling out of control. But it’s a hard thing to accept when other people seem to have this parenting and motherhood gig under control. I felt that seeking assistance would mean that I was weak or a failure at being a parent.

I’m here to tell you that you are not a failure as a parent if you are experiencing PPD. There is nothing wrong in accepting and getting help to keep you mentally and emotionally healthy as you navigate this new role.

~Mary

Before we get into the rest of the book review, here are some stats on postpartum depression:

PPD, the most frequent complication of childbirth, affects approximately 10-15% of mothers worldwide. Prevalence rates increase to 40% for mothers whose infant is admitted to the NICU.
In 2006, as many as half of PPD in new mothers go undiagnosed because of conflict in privacy and not wanting to disclose to close family members.
PPD affects the mother and her relationship with the infant. Maternal brain response and behavior are compromised.
Postpartum Depression is not considered a disease according to the DSM-5. Instead, it is classified as a “major depressive episode along with a peripartum onset.” This is also a different from “Baby Blues” which resolves around 10-14 days post-birth.
10% of men experience PPD.

For more stats, visit Postpartumdepression.org.
See also: Postpartum anxiety, Postpartum rage, Parent burnout.

The Expectation

It’s definitely common for a mother to hold their newborn baby for the first time and expect “the glow”. Instead, there’s a flood of emotions and we don’t know what to think. A romantic notion of love at first sight and “everything was worth it” and “now everything is perfect” sometimes just isn’t there.

To be honest, and the book says this in the best way, even though our bodies are naturally equipped to give birth, that does not make it a pleasant experience. Labor is confusing, dangerous, and for many women (especially women of color), traumatic.

So right in that moment where we expect our “maternal instinct” to kick in, instead we get the first pangs of mom guilt. We’re supposed to be in love with the baby immediately. Everything is supposed to just click. And when it doesn’t (because this is rarely ever the case), those feelings start to unravel the larger questions of “Am I OK? What is wrong with me? I’m already a terrible parent”.

After my twins were born, I had to fill out a three-page survey on my mental health before their periodic check-ups. So every couple months, they would ask me questions about suicidal thoughts or how I deal with stress or do I feel comfortable being alone with my child. I always thought this was a hassle, mostly because I had to fill it out twice, one for each child, and the survey wasn’t the easiest on a mobile device.

What is surprising is that this survey is coming from my pediatrician and not my OB/GYN. Although it was a pain to complete these, it really was one of the only times where I had to actually reflect on my mental health in the postpartum year. I think the quiz stopped coming automatically after my girls turned 18 months. In the book, Conaboy shares that this survey completely depends on your doctor; so in some cases, you may only get asked about your mental health at your single follow-up appointment six weeks after birth.

After a quick Google search, postpartum depression is thought to start anywhere in the first 12 months after birth, and is most common between 3-6 months. That does not mean it automatically ends by 12 months.

Here is a key part of the book that really drives home how complex our mental health and mental balance are during the postpartum time. Conaboy explains that there are environmental and cognitive factors that can contribute to PPD, as well as genetic predisposition.

For instance, parents dealing with financial insecurity may have added stressors to their daily routine. Parents that don’t have additional support and are running on decreased sleep may have added stressors. A mother who stays at home, but whose husband isn’t there during most of the day to help may not only feel unsupported but also alone, and that would add to the emotional stress. A working parent might feel anxiety or guilt knowing that they have to go back into the office soon. Remember last year when there was a baby formula shortage? Add in food insecurity. A baby refusing to breast feed, a baby with a genetic or medical condition, a parent also dealing with past trauma; all of these are factors that are not completely within a parent’s control that can contribute to PPD. 40% of PPD sufferers had never had a depressive episode prior.

Other internal and external factors include pre-existing anxiety, balancing the schedule and needs of your older children, hormonal side effects on existing medications or being off of usual medication during the pregnancy, overall frustration with baby brain, and overall emotional dysregulation.

On a related note that I got from a podcast, there is a huge desire for women to “get back to their old selves” after having a baby. One way that’s easiest to measure is to get back to the same weight. However, going back to the hormones, your metabolism can be completely different postpartum as well as your body’s time of recovery. Even when you do shed the extra baby weight, your body does not usually have the same tone and proportion. So putting so much emphasis on weight, a subject that is already so sensitive and triggering for women, now can lead to greater self-loathing, stress and depression.

“Some things are predetermined [like our genetics], but the work we do matters.”

Parenting as a job

I feel like our mothers and coworkers will tease about it, but parenting really is a job. There is absolutely no way to train to be a parent before you actually become one. And even if you did take Baby Boot Camp classes and child development courses and were around kids every day, this would still be your first time being a primary caregiver and triggering all those hormones in your brain.

“Nurturing has to be teased out, developed and maintained. It does not come immediately after birth.”

Of course, you’re going to be overwhelmed in the first months. This is purely learning on the job. It’s figuring it out as you go along, and no one expects you to be perfect at this right off the bat. Yet, despite all the warnings, we still feel like if we’re not perfect mothers, if we don’t know all the answers, if we aren’t handling this with ease, then we must be failing. That dichotomy simply is not true.

Rugged American Individualism is another small mention in the book. Conaboy explains that the concept of American Individualism, the “I don’t need help, pull myself up by my bootstraps” mentality seriously damages our perspective on asking for support. This is literally the opposite of It Takes a Village. If we aren’t willing to ask for help, or even consider the possibility of help, what are long-term effects on our kids and ourselves?

Figuring out how to regulate yourself with a baby is a huge challenge, one that we’ve mentioned many times and are still surprised that it is not more widely shared in the expectant mother phase. This is where therapy/counseling can be a game changer. Unfortunately, therapy services without a Depression diagnosis are rarely ever covered by insurance. The book explains that at one point, it was recommended that expectant mothers be pre-screened for PPD, and if they had markers for depression or a genetic history of PPD, then counseling services, medication and care would be covered under insurance as preventative health. I don’t think I’ve ever heard such an amazing, breakthrough idea, and I don’t think I’ve ever been so heartbroken to know that that recommendation has not been put into action. Please don’t let the expense of postpartum care be a barrier to getting the help you need.

This is a difficult post to close out. We know this is already one of our longest to date. We’ve had so many talks in our friend group about our personal postpartum experiences and it’s still so frustrating that even though we all have trouble, it’s still hard to talk about the possibility of PPD.

Shake the stigma. Find support. Familiarize yourself with “your normal” so that you can recognize when you’re not.

~Patti

Sources:
Postpartum Depression, by Saba Mughal; Yusra Azhar; Waquar Siddiqui. National Library of Medicine.
Mother Brain: How Neuroscience is Rewriting the Story of Parenthood, by Chelsea Conaboy. Macmillan, 2022.