I think it’s great how the TV show Nashville is portraying Hayden Panettiere’s character, Juliette Barnes, as someone suffering from Postpartum Depression (PPD), which she is also now suffering from herself. PPD isn’t talked about often enough and it’s good to see a popular TV show actually show how bad it can get and not make light out of it. Mental illness isn’t on the top of the totem pole at the best of times, but PPD never really sees the light of day in mainstream media. I’m pretty sure that most people don’t really know much, if anything, about PPD unless they have been pregnant and/or spent a lot of time doing pregnancy and recovery research, chatting on message boards such as BabyCenter or What To Expect, and/or had a great doctor or midwife.
The thing is, while Nashville’s writers have implemented this hard-hitting and pretty sad storyline, Juliette’s life is far from the life of an everyday woman. She obviously feels very confused and alone, and is countering her depression with drugs and alcohol, in a very visible, and scary way. She is not however a mother of 4 living in the Bronx who is showing no outward signs of any problems until one day she throws her infant out of her apartment window. The two stories are a little different… One is a portrayal of PPD in a glitzy show, great for raising awareness and starting a discussion, the other being real life, as hard as it is to accept. PPD can hit anyone, no matter your age, income or familial structure, and while both cases listed above may be on the more severe side of the spectrum, this illness exists and needs to be understood.
Over the past three months THREE babies have died after being thrown from windows by their mothers in this city (NYC) alone (links below). The fact that these three infants died in exactly the same way at the hands of their mothers is a huge call for concern. It hurts me to even write about this but we must open up the conversation and talk about it, raise awareness and start pushing doctors, nurses, friends and families to look out for warning signs. And most importantly, let women know that they can ask for help. Throwing a child out of a window is not a typical act of premeditated murder. It seems to be a fatal and brutal act of impulsive violence; an act that happens on the spur of the moment without thoughts of the consequences, an act that may have been out of desperation and suffering. The point of this article is NOT to make what these women did seem less horrific, or to diagnose them with PPD myself, but to open up the conversation about depression and PPD and to hope that one day we won’t see mothers harming their children and themselves so regularly in the press, that at least women will know when to ask for help.
I consider myself lucky that I haven’t suffered from PPD after either of my pregnancies. I have suffered from depression in the past, a recurring issue which would push me to self-medicate with alcohol. Depressive times would usually equal many black outs followed by a period of sobriety. I am lucky to have learnt how to deal with these unexpected periods of darkness, and do not lean on alcohol to get me through them anymore. I have friends and family members who have had it a lot worse than me, but I think between us all we were able to help and educate each other. I had heard of PPD before my first pregnancy, but I didn’t think it was very common, and didn’t really think I was at risk. I was overjoyed to be pregnant and couldn’t wait to meet my daughter. My life was changing for the better, so what did I have to be depressed about?! This was until I talked to a friend who was telling me about her pregnancies and births, and she mentioned that she had had PPD with her first. She had never been depressed in her life, was over the moon with her child and couldn’t understand why she was finding it hard to bond with her daughter, was constantly crying and getting angry with everyone. She said that it was like seeing herself from the outside and didn’t know how to make it better. Luckily she was able to talk to her doctor who prescribed her the meds she needed to feel like herself again. She stopped taking the meds after a few months and had no further issues, and her PPD didn’t return after her second child.
It gave me a lot to think about after I had my first child. I cried quite a bit during the first few weeks, but then again, I cried a lot during my pregnancy. It wasn’t from sadness, or depression, or even from frustration, I just clocked it up to hormones. At my 6 week check up my midwife asked me a lot of questions and pressed upon me to never hesitate to contact her for a checkup if I felt unlike myself, sad or depressed. That type of follow up is what should systematically happen during a 6 week postpartum check up. It unfortunately doesn’t. I had a different group of doctors with my second child, and while the prenatal care as well as labour and delivery were more than excellent, my 6 week check up was practically in and out (granted I didn’t see the doctor who had followed most of my pregnancy, but that shouldn’t have mattered). I wasn’t asked about my moods, about how I was dealing with my newborn, if I was sleeping OK. Nobody ever asked if I had any prior history of mental illness, depression or PPD. Had I no real idea of what PPD is I could have just walked in and out of there none the wiser, suffering from a mental illness that no one had detected, or even bothered to detect.
How many other women has this happened to? Doctors practically follow your every move during pregnancy, offering all types of tests and procedures to make sure mama and baby are doing well. Once a woman goes into labour she is offered all types of interventions and pain relief options, everything to make sure mama and baby have an easy and safe delivery. Two or three days later you are discharged from hospital, with stitches, bleeding and slightly dazed, and told to follow up with your doctor in 6 weeks to make sure everything has healed well. Can I tell you what happens in those first few weeks, especially as a first time mother? You may need to learn how to breastfeed properly, and that isn’t always easy. Babies don’t “sleep like babies”, they sleep whenever they want which may be all day and not at night. Your hormones are all over the place and you are worried about doing everything wrong. If you have other kids then you are learning to cope with the transition of adding one more to the nest, and not abandoning the others to the TV. Some women can’t afford to take time off and rush off back to work still bleeding and tired as hell. Some women don’t have the help of family members. Some women don’t have a partner to help with nightly feedings or diaper changes. Some women have partners who work around the clock and can’t count on them to help in the day to day routine. There are not many women who are able to really rest for those few weeks after delivering a baby, and it is in our nature to just get up and get on with it, never showing what we may perceive as fears or weaknesses. We talk about those with very close friends who have been through it all and with strangers on message boards.
We have become so good at hiding issues that it’s very easy for PPD to go undetected. Especially if nobody bothers to check on you. If anyone asks me how I am, I always respond that I am OK, even if I am not. Not only is this my nature – it is also inherent in many women. Why would we say that we feel depressed when we have nothing to be depressed about? Why would we “complain” about our feelings when we should be bursting with happiness? Tired? Yes, that’s normal. Depressed, sad and angry? No, that’s not the way it should be.
So what exactly IS PPD? Let’s review some facts and stats. The Centers for Disease Control and Prevention (CDC) has some general information on depression in women and PPD, not enough to my liking, but they do provide some statistics and some survey results and findings. All of the statistics from the CDC website come from surveys that you can find linked below. The CDC calculates the percentage of women who suffer from PPD at between 8 and 19%. Other stats provided give us an idea of how common depression is for women: 8% of pregnant women suffer from depression and 11% of non-pregnant women. These stats are all based on reported cases as well as live births, so women who suffer a miscarriage or still birth are not included. So who really knows how many cases of PPD there are a year? A fantastic website called Postpartum Progress takes these stats and fleshes them out a little. This quote really helps put into perspective how common PPD really is:
“According to the Centers for Disease Control, 11 to 20% of women who give birth each year have postpartum depression symptoms. If you settled on an average of 15% of four million live births in the US annually, this would mean approximately 600,000 women get PPD each year in the United States alone.
In fact, more women will suffer from postpartum depression and related illnesses in a year than the combined number of new cases for men and women of tuberculosis, leukemia, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, lupus, and epilepsy.”
I can hear many of you thinking “but it’s only depression! Why not ask for help?!” There is no such thing as “only” depression. Depression comes in shapes and sizes and often hits you when you don’t expect it. Many women who suffer from PPD have actually never suffered from depression in their lives! There are no “telltale signs” of impending doom. A black cloud doesn’t appear above your head. Depression also often creeps up on you, little by little, until you are surrounded by a fog that just won’t lift. There may be warning signs, but most women avoid picking up on them or acknowledging them before it’s too late. PPD can be treated with therapy and meds, but it needs to be treated. While some women can get better without treatment, others may find themselves becoming more and more despondent, leading to a lack of self-care and a lack of care for their child(ren), and in extreme conditions to self-harm or harming their child(ren). Some women also have other diagnosed or undiagnosed mental illnesses that either mask the symptoms of PPD or make them worse.
There are quite a few reasons for why women will not talk about depression or feeling depressed:
- The stigma of depression. Who wants to admit they feel depressed when they are supposed to be going through the happiest moments of their lives?
- No proper screening. Too many doctors fail to screen post partum women correctly in order to diagnose PPD, or brush concerns off as “baby blues” and “hormones readjusting themselves”. The baby blues are not the same as PPD. Most women go through them after birth, crying about silly things, but after a couple of weeks you stop bursting into tears at things like the sight of the Clydesdales in the Budweiser advert or the little stray dog on the street. PPD symptoms tend not to disappear but worsen.
- Human nature. We are meant to be strong, tough enough to endure anything. Why would we complain about something as silly as a little sadness?! We need to get on and do things, because if we don’t they will never get done. We are so used to multitasking, juggling and wearing different hats (with or without children), but the fear of falling off our paths or dropping a ball is always there, shimmering in the background. We just don’t ask for help because we don’t want to show that we are struggling.
Postpartum Depression is only one, albeit the most common, of a variety of perinatal mood and anxiety disorders. Others are Pregnancy Depression (depression during pregnancy), Postpartum Anxiety (while it’s natural for new mothers to feel anxious during the first few weeks postpartum, PPA is more serious, including inability to stop worrying and the appearance of fears that will not go away), Postpartum OCD, Postpartum Panic Disorder (the onset of panic attacks), Postpartum Post Traumatic Stress Disorder (often after a difficult pregnancy or traumatic birth experience) and the rarer but very dangerous Postpartum Psychosis.
We all struggle at some point or another in life, and there should be no problem reaching out for help. Asking for help isn’t a sign of weakness but one of strength. No one should be made to suffer depression alone.
What are the signs to look out for?
- Not sleeping well (outside of the usual lack of sleep that comes with having a newborn.
- Inability to eat properly
- Feeling overwhelmed on a regular basis
- Inability to take care of yourself and your child properly
- Issues bonding with your baby
- Feelings of sadness, anger and despondency
- Feelings of guilt
- Thoughts of self-harm or escape
- Thoughts of harming your baby
- Turning to alcohol and/or drugs to tune out reality
It’s important to know these signs and to make sure those around you are aware of them too. In so many cases women will hide their feelings and thoughts because they don’t want to feel like a failure in the eyes of others. PPD doesn’t just happen to first time mothers, it can randomly happen at any time within the first 12 months after any child. It also doesn’t always appear immediately after birth either – some women may feel fine for months until it rears its ugly head. While not as common, men can also suffer from a form of depression after the birth of a child, and it is equally as important to make sure it is taken care of with treatment and/or therapy. According the CDC website, 4% of fathers will suffer from depression during the first year of a child’s life, and 21% of fathers will suffer one or more depressive episodes by the child’s twelfth birthday. Not something to be swept under the carpet.
Certain women may be more at risk of getting PPD than others (hard time getting pregnant, complications during pregnancy and/or birth, premature child, multiples, pre-existing mental illness, child in the NICU for example), but there is just as much chance of getting it after a healthy and easy pregnancy and delivery.
Postpartum Progress states that “one in every seven women gets a perinatal mood or anxiety disorder like PPD” - if only half of those women get treatment, what about the other half? Do they suffer in silence? Do their children suffer because their mother cannot care for them properly? Growing up in the presence of a depressed parent is mentally harmful, and way too common. If you have ever let yourself in to your home after (elementary) school and made your own dinner, done your homework alone and tiptoed around the house, afraid to make any noise, then you know what I am talking about. So let’s talk about depression, and let’s talk about PPD, and let’s remove the stigma that comes with asking for help.
While not every PPD case will end in such an extreme or horrific manner as the stories mentioned above; with proper, effective screening and education on the illness, we may be able to avoid such tragedies in the future. There is no need for entire families to suffer from a disorder that can be so easily treated. As I stated earlier, no one should be left to suffer alone, and we should not force ourselves to suffer alone.
It’s natural not to want to take medication for a mood disorder and it is not always necessary. Some women who have PPD successfully manage it through therapy. There is not a one size fits all solution for the illness, just like there isn’t for any mental illness, including depression. The most important part is the diagnosis and then an effective path of treatment.
If you feel like you may be suffering from PPD, reach out to a doctor or a counselor. Postpartum Progress also provides different types of support groups and help via their website here.
If you feel like a friend or family member is suffering from PPD or depression, reach out to them. Provide support in any capacity that you can, even just watching the kid(s) for an hour while so she can relax in the bath by herself can help. You cannot force someone to seek help for depression, but you can help make it easier to talk about, which is the first step towards seeking treatment.