When I was pregnant back in 1997, I wish my doctor had told me I might be at risk for postpartum depression. Her words wouldn’t have alarmed me. They would have prompted me to get treatment when the darkness did indeed hit.
During my six-week postpartum checkup when I was at my worst, I wish my OB/GYN had handed me a mental health screening and explained the difference between the “blues” and depression.
Perhaps I would have lied on the screening, although I doubt it. At the time I was desperately trapped inside my terrified silence. Only my husband knew how far I’d fallen until one night on the phone with my sister, I sobbed uncontrollably.
“I’ve never heard you like this,” she said quietly. “It will get better. I promise.” But her words fell flat under the weight of my despair.
In January, for the first time, the United States Preventive Services Task Force recommended screening pregnant and postpartum women for maternal mental illness. It is my hope that these guidelines will prompt more health care practitioners to discuss maternal mental health with their pregnant and postpartum patients. Women need to know help is available, that they’re not bad mothers and that they’re not alone.
Ten percent of pregnant women and 13 percent of postpartum women worldwide have a mental disorder and the numbers are higher in developing countries.
Although maternal mental illness is sometimes lumped into the catchall term postpartum depression it’s often far more complicated. Symptoms can show up during pregnancy or long after birth. And symptoms don’t always look like depression. Sometimes they look like anxiety, panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, or psychosis, alone or in combination.
Several factors put women at higher risk, including:
- Sensitivity to hormonal changes during pregnancy and after birth.
- A difficult or traumatic pregnancy or childbirth.
- A personal or family history of depression or other psychiatric disorders.
- A history of early loss, trauma or abuse.
- Stress such as job loss, a move, illness, death, divorce, financial or relationship issues, a premature or sick newborn, or leaving the workforce to be at home.
“A complex interplay of genes, stress and hormones cause maternal mental illness, scientists say. Hormones go up more than a hundredfold,” explains Dr. Margaret Spinelli, the director of the Women’s Program in Columbia University’s psychiatry department. “After birth, hormones plummet, a rollercoaster that can “disrupt brain chemistry.”
In my case, I met several criteria. As a teen I had (and hid) mild depression and anxiety. My mother abruptly abandoned our family when I was five. My daughter’s delivery was long, brutal and complicated. I have a pituitary disorder that makes me sensitive to hormonal changes. When my daughter was 9 months I left the workforce but I never totally adapted to being at home full-time.
Although my pregnancy was largely uneventful and the complex cocktail of surging hormones made my moods surprisingly stable, after I delivered and my hormones plummeted, so did I.
One morning when my daughter was two months I leaned over to my husband during breakfast and with zero emotion said, “I feel like I want to die. But don’t worry, I know I need to take care of our daughter so I won’t do anything stupid. I just don’t want to feel like this.”
I was convinced I’d made a mistake (good mothers don’t want to die, right?). I felt overwhelmed, hopeless and strangely separated from myself, like my mind had been hijacked by a malevolent invader.
Mental illness has long been stigmatized but never more so than inside the idealized institution of motherhood. New mothers are often expected to possess superhuman resilience to massive hormonal shifts, to tortuous sleep deprivation and to the tidal wave of emotional, situational and psychological changes that inevitably come with first-time parenting. It’s not surprising many mothers hide their depressed, violent, anxious or obsessive thoughts. Thousands suffer in silence until their kids and partner have no choice but to suffer alongside them.
While a few screening questions can’t capture the complexity and transience of a new mother’s emotions, they can open up dialogue for new parents who might otherwise be unaware, and who might struggle in pained silence. At the time, I was too ashamed, insecure and unproven a mother to admit to my doctor that I wanted to crawl into a hole and temporarily die. Instead, I choked back tears when she asked, “So, how are you?” And while I was deeply depressed and overwhelmed I half-smiled and told her what I needed to believe, “I’m tired, but I’m okay.” Because good mothers, I thought, must always be okay.