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Giving birth to depression
New mothers can suffer from postpartum anxieties

The Augusta Chronicle
24.7.2005

By Rebecca Trela

"The thing," Pam McFarland called her daughter Aubrie when the baby was born in December 2002.

"I had no feeling toward her," said the Marietta, Ga., woman.

"I thought, that thing has ruined my life. I had to get rid of the baby," Mrs. McFarland said, explaining an anxiety attack she had in the hospital after her Caesarean section. "I had this vision of suffocating her with a pillow. I felt like I couldn't breathe; like I couldn't live."

Mrs. McFarland, 36, knew that something was wrong immediately after giving birth. Normal women, as the hype would have people believe, are blissfully happy after delivering a child. Normal women love their babies. Normal women don't suffer from postpartum depression.

Fifteen percent to 20 percent of new mothers suffer from postpartum depression, which includes symptoms of persistent exhaustion, hopelessness, anxiety and teariness that strike just after giving birth.

These feelings are caused by a combination of natural chemical and hormonal changes after giving birth and psychological issues with which the new mother might be dealing. Those with a predisposition or genetic history of depression might be more severely affected.

Postpartum depression was first identified in France in the late 1800s, according to Dr. Shoshana Bennett, the president of Postpartum Support International.

It was thrown out of public discussion and treatment in America in the 1950s, she said, because "we didn't know how to categorize the mood disorders."

"The word 'postpartum' just got reintroduced into the Diagnostic and Statistical Manual," she said. "It was really in 1980 when the first gathering of professionals got together in England and said, 'We need to pay attention to this.'"

Postpartum depression recently re-entered the public debate through an exchange between actors Tom Cruise and Brooke Shields.

After Ms. Shields began promoting her autobiographical account of postpartum depression, Mr. Cruise criticized her use of prescription drugs on the road to recovery, based on his beliefs as a Scientologist.

"When they hear him say that, it causes these women to think, 'Maybe I shouldn't be taking this! Maybe it's my fault!'" said Meeka Centimano, a Kansas City, Kan., social worker who volunteers for Postpartum Support International.

"It's just dangerous," she said. "What comes next is an incredible amount of shame, and women just shut up."

Women fear that their struggle will be misunderstood; they fear accusations of not being "a good mother" or "a good wife."

"It's like telling a diabetic, 'Think healthy thoughts!' and they won't need insulin anymore," Mrs. Centimano said.

Unlike the "baby blues," which affect nearly 80 percent of new mothers, postpartum depression persists beyond 10 days after delivery and is marked by significant anxiety, sadness and sleep problems.

Postpartum depression, which can take a year to show symptoms, is attributable to a wide array of factors.

They include: a genetic history of depression, postdelivery hormonal changes, the mother's family and partner situation and what type of personality she has. Perfectionists and control freaks are at highest risk, and it has a 59 percent to 88 percent chance of recurrence.

Mrs. McFarland said she had anxiety attacks about financial issues, in addition to troubling visions and dreams.

"I wouldn't be planning on doing anything violent," she said, speaking of her anxiety problems, "and all of a sudden, something would just suggest itself."

"I thought about throwing (Aubrie) off the roof of a building and watching her smash into a thousand pieces like a watermelon," she said.

To combat these symptoms, Mrs. McFarland called friends and family every day, trying to live five minutes at a time.

She tried to plan a daily trip out of the house and relied on her husband and her mother for help.

Dr. Bennett said that Mrs. McFarland took all of the right steps.

It's important for a mother to surround herself with a loving support network and to take alone time - both to prevent and combat depression. Exercise is also key, Dr. Bennett said.

Without a safety net, these depressed women might just keep falling, she said.

Postpartum depression can affect a mother's relationship with her child.

"Babies of depressed mothers cry more and express more negative emotions," said Dr. Amy House, a Medical College of Georgia psychologist.

"Over the long term, they tend to develop more slowly," she said.

For more severe cases, antidepressants can be prescribed.

"Generally, what works for regular depression works in the postpartum," Dr. House said.

She recommended six to 12 therapy sessions, exercise and "mother's day out" programs.

"I think the main issue in treating postpartum depression is recognition," she said.

Hormone therapy might become the main treatment for postpartum depression, several doctors said. .

"There is some controversial preliminary evidence about bio-identical hormones," Mrs. Centimano said.

She explained that today's female hormone therapy is mainly produced from horse urine and might not be as effective as synthesized estrogen and progesterone.

"I think I was on too much medication at some points," Mrs. McFarland said, while admitting that there was "no way" she could have recovered without some prescriptions.

"I want women to know that you can relinquish responsibility to someone else if you can't do it (alone)," she said.

"This (childbirth) is supposed to be the perfect experience. And it's not. It's horrible for a lot of women."

Mrs. McFarland pronounces herself cured today.

"What a precious gift I have been given," she said, emphasizing a positive relationship with her healthy, happy 2-year-old. "I am finally happy that I did not use that gun or take those pills."

Reach Rebecca Trela at (706) 828-3904 or rebecca.trela at augustachronicle.com.

What to say

- "We will get through this."

- "I love you very much."

- "This is temporary."

- "You're a great mom." Give specific examples.

- "You will get well." what not to say

- "Think about everything you have to feel happy about."

- "Just relax."

- "Snap out of it."

- "Just think positively."

- "I went through this, too." This is not the "baby blues," said Dr. Shoshana Bennett, the resident of Postpartum Support International. Don't marginalize her experience unless you have really suffered with postpartum depression yourself.

Source: Beyond the Blues, by Dr. Shoshana Bennett

Where to get help: If you think you might be suffering from depression, consult your primary care physician. For additional support: - Postpartum Support International: Georgia coordinator: Licia Freeman; (770) 352-0029; www.postpartum.net - Welcome Baby: A support group for new mothers: Sponsored by the Aiken County Mental Health Association; (803) 641-4164

Do you have Postpartum depression?

Consider consulting a medical professional if these thoughts are recurring:

- No one has ever felt as bad as I do.

- I'm all alone. No one understands.

- I'm a failure as a woman/mother/wife.

- I'll never be myself again.

- I've made a terrible mistake.

- I'm on an emotional rollercoaster.

- I'm losing it.

Source: Beyond the Blues, by Dr. Shoshana Bennett

Postpartum depression is NOT Postpartum psychosis

Postpartum psychosis is a form of serious depression and delusion that occurs directly after giving birth. It is marked by hallucinations, hearing voices, insomnia and bizarre behavior. It affects approximately one in 500 to 1,000 new mothers, according to the National Women's Health Information Center.

Usually, the mother is hospitalized immediately so that she does not harm herself or the new baby and can receive medication."It's a very severe variance," Dr. House said. "Postpartum depression does not become psychosis." Most people are familiar with postpartum psychosis through the widely publicized trial of Andrea Yates, a Houston mother who is serving a life sentence for drowning her five children in a bathtub in 2001.

Sources: Dr. Amy House; National Women's Health Information Center; www.answers.com; www.wrongdiagnosis.com

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