Beyond Baby Blues:
 Understanding and Coping With
Postpartum Depression
By Melanie Lawrence
© Copyright 2001 by Parents' Press.
CLICK FOR -About
PPD -Who's at Risk? -Coping
Thirteen years ago, I miscarried the baby my husband and I
had struggled so hard to conceive, an experience I wrote about
for the August 1988 issue of Parents' Press.
Two years and two more miscarriages later, I managed yet another
pregnancy, aided and encouraged by my husband and a support group,
and some mild medical intervention. This time we were more fortunate:
our daughter Margaret Isobel, a vigorous nine-pounder, came wailing
into the world on Aug. 22, 1989.
Again, I reported back to Parents' Press about the highs and
lows of parenting after infertility. The low was postpartum depression.
What follows here is a revised version of my 1991 account, with
resource updates.
The pregnancy was physically
easy, but labor was hard: 24 erratic hours, followed by three
hours of fruitless pushing before we decided that our obstetrician
was right: there was no way Margaret would emerge except through
my abdomen. I was disappointed to have gone so long only to end
with a C-section, but exhilarated to finally stop hurting and
to see our little girl.
The hospital seemed a joyous place to me after that: a healthy
child, John busy diapering, smiling visitors, flowers, meals
I didn't have to cook myself, attentive nurses.
The one exception was when I was filling out the birth certificate
paperwork and came across a blank in which I was supposed to
record any previous miscarriages. I broke into unexpected, painful
tears at the thought that those potential children had been reduced
to statistics on a form.
Falling
The worst was waiting for me. We had just brought 3-day-old
Margaret home from the hospital when I abruptly descended into
what I learned was postpartum depression.
I didn't know from depression, other than periods of mourning
for a death or a break-up, and this onslaught of misery was
and remains the worst shock of my life. I felt like a baby
myself. I wanted to cling to John and not have to face Margaret's
cries and demands. I wanted to feel like a strong, competent
woman again, not like this weary creature who could barely walk
and yet had to be responsible for a genuinely needy being.
However much diapering and rocking and cooking and support
John provided, I couldn't shake the feeling that I was solely
responsible for our daughter. After all, I had miscarried her
predecessors, so her well-being must also depend entirely on
me.
"Ghastly" is not too strong a word for those first
several weeks. I would sit in my rocking chair and stare at Margaret
as she nursed, listening to music (weeping at the least suggestion
of sadness in the lyrics) and wondering why on earth I had overturned
John's and my comfortable life together for this shrieking, red-faced
little grub who couldn't even respond to us, however much attention
we showered on her.
I finally gave up trying to look pleased with motherhood and
just cried. I even suggested to John, in all seriousness, that
perhaps a couple from our infertility group would like to adopt
Margaret surely the nadir of a parent's life. The only
thing I was sure of, apart from feeling lonely and trapped, was
that I would never be happy again and that I was a rotten mother
who didn't love her child.
At my most depressed, everything around me our
apartment, our neighborhood, friends, even my husband and stepdaughter
looked the same as ever, but felt completely different.
A gray, flat sensation pervaded the world, wherever I went. The
only analogy I could come up with was mourning the loss of a
cherished friend, and yet I had ostensibly gained someone to
love.
Mornings were manageable I could summon up a degree
of optimism then but afternoons were the worst; that was
when I felt utterly stuck, to the point of once having a panic
attack in the middle of a shop.
I still have a clear image of one of these down times, slowly
trudging around the block with John and Margaret in the late
summer sunshine, thinking in all seriousness that I'd never be
able to recapture anything of my old life. It would be like going
to a place I used to enjoy with someone I loved, only that person
was dead now, and we'd never enjoy it together again, ever.
Mourning is the key word here. Postpartum depression, for
me, was falling down a hole full of grief, pure and simple. I
understand now that the loss was that of my old self, which had
to change when I became a parent.
Digging Out
John kept assuring me that the first month was the worst and
that "things would get better," a phrase he patiently
repeated at least five times a day, along with assurances that
no one expected me to instantly adore someone I had never seen
before.
He had a point. Perhaps I loved Margaret then; certainly I
felt committed to taking care of her, despite my adoption fantasies.
I just didn't take any pleasure in her, not until she was 5 weeks
old and smiled at me for the first time. That smile and the intense
eye contact that accompanied it were enough to crack my misery,
to start turning my emotions around.
Perhaps my hormones had settled down as well. The depression
crept back every day for a few weeks, but it no longer frightened
me. Margaret's gradual transformation from inscrutable newborn
into alert, responsive human being kept me from bottoming out
again. That, and the research I did, encouraged my own transformation
and, with it, some coping skills.
Not Your
Imagination
Postpartum depression is an affliction of body and mind that
can range from a few days of weepiness to months of full-blown
psychosis. My case, lasting roughly two months, was nothing unusual
or severe. Even now, though, I can't be sure how much of my unhappiness
was caused by hormonal changes and how much resulted from my
particular blend of circumstances.
According to Carol Dix, one of the first parenting writers
to investigate Dr. Katharina Dalton's break-through research
into postpartum depression (PPD), there are two forms of the
syndrome.
One begins during the first three weeks after birth and ranges
from mild "baby blues" to depression to actual psychosis.
The second syndrome starts after three weeks, but also ranges
in severity.
The physical aspects of PPD tearfulness, insomnia, panic
attacks, mood swings, mental confusion occur because, immediately
after childbirth, the mother's estrogen and progesterone levels
plummet, as do thyroid and pituitary function. Women also lose
blood and body fluids during birth and gain prolactin if breastfeeding.
The result, says Dix, is an unbalanced brain chemistry that
lowers the supply of endorphins, the internally produced opiates
that help us feel relaxed and optimistic.
"Professionals agree," Dix continues, "that
80 percent of all new mothers experience some form of the symptoms
[of PPD]." She further estimates that of every 1,000 new
mothers, two or three might actually require hospitalization,
with accompanying symptoms of confusion, delusions, auditory
hallucinations, or extreme mood swings. (And, I wonder, how many
cases of PPD go unreported by women who are ashamed to admit
that they don't find motherhood an ecstatic experience?)
Treatment might include therapy and possibly administration
of progesterone or antidepressants.
Who's
at Risk?
More than 12 years after Dix's ground-breaking work, there
are now some fine guides to PPD, as well as support groups and
professional conferences, but still little hard data as to predictors
and their possible interaction with postnatal body chemistry.
Mental health professionals such as Dr. Carol E. Watkins of
Baltimore hypothesize that risk factors for outright depression
after childbirth include a history of clinical depression, difficult
labor, premature delivery, a history of severe PMS, low self-esteem,
an unwanted pregnancy, and/or lack of social support. (Even adoptive
mothers can suffer a form of PPD, one that is not biochemically
induced, perhaps due to their high expectations of motherhood
and themselves.)
I would add to these possible causes a history of infertility
after all, how depressing to work so hard to attain a goal
and then not want it! and our popular images of new motherhood.
Image Versus Reality
High expectations play a leading role in pregnancy, whether
conception was easy or difficult, desired or not. Pregnant women
are bombarded with the same sugary media fantasies, usually a
soft-focus, exquisitely furnished nursery or bedroom starring
a radiant mother (in a flowing white robe) and her laughing,
contented child (clad in spotless pastels).
Perhaps some new mothers inhabit this dream world, but I wasn't
one of them. During my depression, I felt as though I inhabited
a prison, bounded by the bedroom and Margaret's nursery. I wore
jeans and a T-shirt every day, as did John, and we could just
about summon up enough energy to keep our daughter in diapers
and clean shirts. The constant readjustment of expectations and
habits, not to mention the lack of sleep and the demands of nursing,
simply reinforced the physical depression that was already present.
Coping
and Beyond
So much for our feelings of inadequacy and sadness. What can
we do about them? How do we nourish ourselves as well as our
children?
 Read
up on parenthood and postpartum depression early in your pregnancy.
And don't assume that because you have no history of depression,
it can't happen to you.
Try
your hardest not to schedule anything for the first three months
of your child's life, preferably longer. This is not a good time
to plan a move, a remodel, an elaborate trip, or a new job. Let
smaller projects go as well.
Keeping
a pre- and postnatal journal, perhaps in the form of a letter
to your child, can be wonderfully therapeutic. (I used to strap
Margaret to my chest and type. The hum of the computer helped
soothe her to sleep.)
Instead
of putting on a good front, talk to your partner, family, and
friends about your negative feelings. Remember that most of these
people however hard they try will have some difficulty
understanding what you're going through. Tell them they don't
have to understand, or to "cure" you; just listening
sympathetically helps.
Request
more than sympathy. How many cute little dress-up outfits does
a newborn really need? Instead, ask friends and family for meals
and short sprints of babysitting (so that you can take a walk
alone or eat lunch with both hands) and maybe some gardening
or light housekeeping.
Arrange
for help before the birth. If you can afford it, hire a diaper
service and household help for at least a month after your child
is due, even if it's only someone who comes in a few hours a
week to scrub and vacuum.
Repressing
your fears and frustrations will not make them go away. Cry when
you need to. Pound pillows. Yell.
When
you're feeling depressed, get out of the house, no matter how
nervous or tired the idea makes you. Fresh air and exercise are
essential to restoring your optimism. Take the baby along or
enlist a friend or a sitter to look after her.
Some
PPD specialists believe that up to 150 milligrams of vitamin
B-6 a day are helpful in restoring your body's chemical balance.
(Since this is well over the U.S. RDA recommended daily
allowance check with your physician first.) Drink plenty
of liquids and eat small, frequent meals, especially if you're
nursing.
Reward
yourself. Pregnancy, childbirth, and nursing are hard work for
your body and soul, and you need to take care of yourself. Try
to spend at least one hour every day relaxing in a warm bath,
taking a leisurely stroll, lying with your feet up and a book
for company, phoning a friend, watching a video, or whatever
makes you feel good. An old crony of mine rewarded herself every
morning with a chocolate truffle.
Join
a support group. I can't stress this enough, even if you firmly
believe yourself not to be a "group sort" of person.
Other new mothers know better than anyone else how you feel.
And if you're still self-conscious about going out with a child
who might start shrieking any minute, this is an incentive to
get out of the house and into a situation that will be tolerant
of your small hell raiser. Encourage your husband to find a group
for new dads.
If
you find that you're still unable to take care of yourself or
your child or that you're having persistent fantasies of harming
him or yourself, get help immediately: call your physician or
a local mental health agency, or have someone do so for you.
Severe postpartum stress is an illness that can be treated. Even
when your symptoms aren't that severe, you might think about
finding professional help if the depression doesn't begin to
lift after a month.
It
gets better, I promise you. And as a wise friend pointed out,
"It's a fabulous growth opportunity." (True, I could
have smacked her at the time for saying so, but she proved to
be right.)
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RESOURCES
CLICK FOR
Local
Resources
Useful
Books
Local Resources: Where to Find Help Fast If Postpartum
Depression Has Got You Down
 (888) 773-7090. Hotline
operated by the Postpartum Health Alliance of Northern California
for new mothers experiencing a postpartum mood disorder such
as depression or anxiety. 9 a.m.-9 p.m., seven days a week. Caller
can leave a first name and phone number, and a volunteer will
return the call within about two hours. All volunteers are moms
who experienced a postpartum disorder and have recovered. Referrals
to professional help, books, etc. also available.
Postpartum DepressionHelp.com
and www.BeyondtheBlues.com
are websites run by Shoshana S. Bennett, Ph.D., a licensed psychologist
in Danville who has been a leader in bringing attention to postpartum
depression. She may also be reached by phone, (888) 530-2211
or (925) 552-5127.
Call
your family physician. If you don't have one, or don't want to
confide in yours, call one of the following numbers. (And if
you can't bring yourself to make the call, get your partner or
a friend to do it for you.)
Parental
Stress Service
offers counseling, crisis intervention, and referrals to community
resources. 24-hour hotline: (510) 893-5444 in the East Bay or
(800) 829-3777.
Family
Service Mid-Peninsula
offers a free, confidential, anonymous hotline, 9 a.m.-9 p.m,
7 days a week: (650) 327-3333 or (408) 993-8336.
Depression After
Delivery. National postpartum support organization.
Books
Karen Kleiman and Valerie Raskin,
This Isn't
What I Expected: Overcoming Postpartum Depression (Bantam, 1994, $19 paperback). An excellent
overview.
Shoshana S. Bennett and Pec
Indman, Beyond
the Blues: A Guide to Understanding and Treating Prenatal and
Postpartum Depression (Moodswings
Press, 2003, $14.95 paperback). Bennett is an East Bay therapist
specializing in postpartum depression.
Brooke Shields, Down Came the Rain:
My Journey Through Postpartum Depression (Hyperion, 2005, $23.95 hardcover). Yes, that
Brooke Shields. The harrowing description of her experience makes
this recommended reading for anyone trying to understand just
what a family member or friend is feeling.
Katharina Dalton & Wendy
Holton, Depression
After Childbirth: How to Recognise, Treat and Prevent Postnatal
Depression, 3rd edition
(Oxford University Press, 1996).
Carol Dix, The New Mother Syndrome (Pocket Books, 1988).
Ann Dunnewold & Diane G.
Sanford, Postpartum
Survival Guide (New Harbinger,
1994).
Arlene M. Huysman, A Mother's Tears: Understanding
the Mood Swings That Follow Childbirth (Seven Stories Press, 1998, $23.95).
Karen R. Kleiman & Valerie
Davis Raskin, This
Isn't What I Expected: Overcoming Postpartum Depression (Bantam Books, 1994).
Susan Kushner Resnick, Sleepless Days: One
Woman's Journey Through Postpartum Depression (St. Martin's Press, 2000).
Lynn Madsen, Rebounding from Childbirth (Bergin & Garvey, 1994).
Sally Placksin, Mothering the New Mother:
Women's Feelings and Needs After Childbirth (Newmarket Press, 2000).
Linda Sebastian, Overcoming Postpartum
Depression & Anxiety
(LPC, 1998).
Fiona Shaw, Composing Myself: A Journey Through
Postpartum Depression (Steerforth
Press, 1998).
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