Beyond the Baby Blues
A week after delivering a healthy baby girl, Jen Knox sat in her obstetrician's office, sobbing.
“I just want to run away,” she remembers telling the doctor. “I look at all these other moms and they're so happy, and I just feel constant pressure and panic about everything. It all seems so completely overwhelming.”
Her doctor, fortunately, recognized that the Northwest Columbus mom was suffering from postpartum depression, also known as maternal depression, and needed help.
The U.S. Department of Health and Human Services estimates that 10 to 15 percent of all women have postpartum depression after a birth, with symptoms such as fatigue, anxiety and feelings of restlessness and worthlessness. For low-income women and teen mothers, the rate is a startling 40 to 60 percent, according to the American Academy of Pediatrics.
“It's not uncommon for moms to feel overwhelmed,” said Dr. Andrew Garner, immediate past president of the Ohio Chapter of the American Academy of Pediatrics and a Cleveland-area pediatrician. “Baby blues are very common in the first month, but if it persists and gets worse, that's depression.”
In the past, little was said about the condition, and many women were too ashamed to admit they had a problem. That began to change in recent years, helped along by the Internet, social media and high-profile women who shared their own experiences. Actress Brooke Shields published a book about her postpartum depression in 2005, and model Chrissy Teigen, the wife of singer-songwriter John Legend, went public with her diagnosis this spring in an essay inGlamourmagazine.
Hospitals and doctors also have started to pay more attention to the condition. At OhioHealth hospitals, for example, new moms are sent home with a fact sheet about depression, and nurses discuss it with patients during their hospital stays, said spokeswoman Katie Logan.
Columbus obstetrician Dr. Anita Somani said she monitors patients by asking about their feelings during prenatal visits and pays particular attention to women with a family history of depression. She talks with them again at their postnatal visit to gauge their frame of mind, asking them a series of 10 questions designed to rate depression. “Society says when you have a baby, you should be so happy,” said Somani. “The reality is it's hard work, you're not sleeping because of the demands of the baby and you're not taking care of yourself. It can be overwhelming.”
Somani said the transition to parenthood can be particularly difficult for professional women who are hardwired to accomplish a great deal each day. New mothers, on the other hand, can be hard-pressed to accomplish anything but feeding and changing their newborns. “I tell mothers that if you get a shower by noon, you should feel like you've accomplished a lot,” she said.
Moms who feel depressed, extremely anxious or unable to cope shouldn't hesitate to call their doctor or talk with their baby's pediatrician, the Ohio AAP's Garner said. “We want to identify these moms and get them support,” he said.
He emphasizes six points, based on the first six letters of the alphabet:
A – You are not alone.
B – You are not to blame.
C – You are not crazy.
D – Deprivation increases symptoms, so don't deprive yourself of things such as exercise.
E – Use evidence-based treatments.
F – Follow up on symptoms.
Helping a new mom get better is important for a child's health, too, Garner said. Studies, including some he has worked on, have found that brain development after birth is affected by how much the child is attached to a primary caregiver, usually the mother.
“What we're beginning to understand is that it literally affects how your DNA works, how your genes work,” said Garner, who chaired the AAP's Leadership Workgroup on Early Brain and Child Development. “The environment a child has turns on certain genes. How mom is functioning dramatically impacts how the baby is going to develop.”
To bring the condition to light, the Ohio AAP, led by Garner, has trained pediatricians to conduct postpartum depression screenings on new moms at one, two, four and six months.
Women with postpartum depression also can contact POEM (Perinatal Outreach and Encouragement for Moms), which is affiliated with the nonprofit Mental Health America of Franklin County. POEM was started by Central Ohioans Tonya Fulwider and Amy Burt 18 years ago after both had suffered from postpartum depression and found few resources to help.
“I went to a counselor and she said, ‘You just need to relax and get more takeout,' ” recalled Fulwider of Upper Arlington, who now is POEM's program director.
The organization has online and in-person support groups for mothers with newborns up to teens, mentors for new moms and a comprehensive referral network that connects women to counselors and psychiatrists. Hospitals, pediatricians, obstetricians and visiting nurses all refer women to the program, and women can call or ask for help online, Fulwider said. “Those first few weeks after a birth, the focus is all about the baby,” she said. “Women feel guilty about caring for themselves, but their mental health is absolutely paramount.”
For Knox, medication and reassurances from her obstetrician helped her cope after the birth of Caroline, now 6, as did the support of her husband, sisters and co-workers. “Other moms would say, ‘I totally get it,' and that was helpful,” said Knox. “There were a lot of people who said, ‘I remember those feelings,' and they'd share with me what worked for them.”
When she had her second baby, Corbin, a year ago, Knox started medication a week before the birth, which she said helped tremendously. And she already knew ways to cope. “I took one day at a time and celebrated the little successes,” she said. “Like, hey, we made it to lunch and I didn't cry!”
She had learned, too, that friends and relatives are eager to help new moms, so after her second birth she didn't hesitate to ask for time to take a walk or for someone to pick up groceries for her.
Her advice to other new moms: “I want them to know that it's completely OK to have these feelings, but it's important to do something about it, to take action steps to make yourself better,” Knox said. “Because if you can't take care of yourself, you can't take care of your kids.”
The American Congress of Obstetricians and Gynecologists:acog.org/patients/faqs/postpartum-depression
Office on Women's Health: womenshealth.gov
POEM (Perinatal Outreach and Encouragement for Moms): poemonline.org, 614-315-8989
The Postpartum Stress Center: postpartumstress.com
Postpartum Support International: postpartum.net