I have turned this topic around and around in my head over the last few days. And now several bloggers have beat me to the punch.
But that’s okay, because I’ve decided to take a slightly different direction with it. I want to talk about medications used to treat depression, anxiety, irritability, anger, and suicidal ideation, and their place during breastfeeding, but not before a little chat about postpartum depression itself.
First, let me tell you what your votes say:
The majority of you (41%) would live with the depression and continue breastfeeding, 24% of you would take a medication with uncertain risk and continue breastfeeding, 17% would seek or increase counseling and continue, about 13% would wean (divided in half at less than 3 months or 6-12 months), and about 3% would do something else entirely, which I am not sure I want to know about. Okay, maybe this is not the best time for my dark sense of humor.
But let me tell you what is going on right at this moment:
I have a diaperless toddler running around who just peed on the floor, a 4 year old riding a Kettler trike around the dining room (where I am) because it’s been raining for 837 days, a pizza burning in the oven because that’s the only thing Ethan will eat at the moment, a blog post I desperately need to write, and a migraine. And all of this on two hours of sleep, because Beckett’s “language explosion” decided to happen today. At two in the morning.
You may find yourself thinking – clearly this woman is not depressed! She is far too funny and lighthearted to be depressed! And clearly she is totally insane. Not depressed at all.
And so here we begin. Some of the posts I’ve been reading on this issue indicate that the symptoms most people associate with depression can be lacking or distorted, leaving many women with confusion over their feelings and no help, since no one realizes they are suffering from depression.
Baby Ready, for instance, talks about the extreme anger she felt, which caused a terrible cycle of being irritable, yelling at kids, yelling at self for yelling at kids, then hating self, which causes more irritability. Joanna at the Modernity Ward writes about obsessing over safety issues, having outbursts of anger, and even punishing herself for perceived failings as a mother.
There are so many problems with diagnosing postpartum depression. The only time a woman really sees her care provider after the birth is at the six week checkup. If a woman has any kind of support network like a church or family close by, she has probably been getting at least a little help up to this point, in the form of meals, or just leave from a regular job. And the symptoms must be present for at least two weeks in order to meet DSM-IV criteria, although there is room for clinician judgment within the diagnostic framework. Postpartum depression typically manifests itself around four weeks after parturition, but can be delayed as long as a full year. And it can last beyond the one year mark. This means that a care provider might never see even the slightest hint of a problem.
When you have a baby, you know you will not get significant sleep for the first few weeks, so you nap when possible. You are encouraged to nap, in fact! People bring you meals, sometimes. You understand that a newborn is a particular kind of challenge so you are somewhat emotionally prepared for it. But then something else happens: the baby gets older. People start asking you if he is sleeping through the night yet (breast milk is more quickly digested than formula, and even formula does not guarantee a “good” sleeper; in fact, some studies show that a lighter sleep is best because the frequent rousings can prevent SIDS). Community members may expect you to start “getting back out there.” There is quite a lot of pressure to participate, to be active and constantly busy, which makes it hard to just be – home, snuggling with your baby, lying around in your pajamas when you feel like it, enjoying your children.
According to the Centre for Addiction and Mental Health (part of the University of Toronto), postpartum depression is the “most common complication of child-bearing,” affecting an average of 13% of women who have given birth. Did you hear that? THE MOST COMMON COMPLICATION OF CHILD-BEARING. Much higher than the rate of being diagnosed with breast cancer (I am aware that the breast cancer rate applies to every woman, and the PPD rate applies only to women who have given birth. For a woman who has given birth, the numbers mean the same. A woman who hasn’t – well, she wouldn’t have PPD, would she?)
I bring up the statistics only because I believe we need to begin having this conversation now. You know the facebook app asking if you’ve felt your titties? If we are comfortable enough to ask that question in that middle-school way, certainly we can ask the hard questions about “How are you doing?” and start to make it acceptable to answer honestly.
I don’t know a mother who doesn’t ever lose her temper. I don’t know a mother who doesn’t think she is screwing up her kids in some permanent way. I don’t know a mother who doesn’t wonder sometimes, in the really bad moments, why she ever had these children anyway. I do know mothers who pretend. And I know mothers who silently punish themselves for what they see as their inability to measure up, because they don’t know what happens in their friends’ homes.
Here are the main issues I see:
1. Women generally have to take care of life, whether they feel like it or not. We are more practiced at keeping our boat afloat because who the hell else is going to do it? Some things may get neglected, but enough might be held together that no one really notices there are problems until the situation has spiralled out of control.
2. The modern world is a scary place. If I say I’m afraid of lead in toys and phthalates in plastic, no one is going to think it’s all that strange because everyone is scared of that. Well, okay – a lot of people. Moms. A bunch of moms. Anyhoo – If you don’t press me, I’m not going to tell you that I lie awake at night imagining the damage the plastics are doing to my babies’ endocrine systems and telling myself what a bad mommy I am because my son played with that plastic toy at the book store today.
3. Women generally do not talk about committing violent acts, no matter how small. Throwing an iron (like Joanna), kicking a hole in the cupboard (um, that one’s mine), or striking a child are all violent acts. We want to model better behavior, but intense anger is a symptom – a symptom of depression! It took me 30 years of therapy for someone to let me in on this little secret.
So now you know what postpartum depression can look like. Tomorrow, we’ll see what medications are available to use while breastfeeding, as well as how we, as members of a community, can help women identify and recover from its most severe symptoms.
And then, when all the facts are delivered, I will tell you a story. My story.