The Results Are In on the Elephant in the Living Room: Part I

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.


12 Responses to “The Results Are In on the Elephant in the Living Room: Part I”

  1. I know this subject doesn’t really apply to me, since I’ve never given birth – but I do understand depression. I’ve had low-grade depression since puberty, and have gone through life being told to “get over it”. I went to doctors who told me it was just that time of the month and that my boss would just have to understand. Then they invented anti-depressants – and they saved my life. I know the subject concerns breastfeeding, and I know breastfeeding is best – but if it were me, I would opt for the drugs to keep me from doing something I might regret, and hope the child would do well on formula (which is what my mom gave me). (Hmmm… wonder if there’s a connection.) Anyway, that’s my 2 cents.

  2. Thanks for a powerful post on this topic. It is something I feel so inadequate to address or to even talk about sometimes because I have never suffered depression and didn’t suffer any more than run of the mill sleep deprivation. I feel extremely lucky to have escaped PPD.

    But it is an important topic and I am sitting here nodding when I hear you talk about the shame that some women feel or perhaps the denial even. I have spent a great deal of time providing support to moms that want to breastfeed and moms that want to practice attachment parenting. Often I see the signs of PPD in a mom, but it is such a hard topic to raise, because it often puts moms on the defensive and makes them less likely to listen to the message you want to convey. I find myself battling between saying “it sounds like you may have PPD, maybe you should get some help” (of course in much more “touchy feely” words than that) or just ignoring the elephant in the room and doing my best to address the problems that person is facing without raising the PPD issue. The former approach often results in that person cutting off contact. The latter approach results in them coming back and back and back again, still frustrated, still feeling inadequate, still feeling overwhelmed. And I feel increasingly unable to help and find myself starting to ignore or avoid their calls for help.

    A woman that is very close to me suffers from depression and does take medication for it. She is doing much better than she was before. She doesn’t have children yet and I do worry about PPD knocking on her door when she does give birth and about her ability to make it through that phase. Even though she isn’t even pregnant yet, I already worry about my ability to give her the support that she will need, to be there for her, and so on. My hope is that since she has already battled with depression and found help through counseling and through medications, that she will at least be open to seeing what is going on and open to finding solutions.

    • @phdinparenting I keep coming back to the same thought, whether it’s about breastfeeding, positive childbirth, or support during the postpartum period. It’s always about the conversation.
      If we make it acceptable to talk about in honest terms, it will get easier and easier for women to seek out the support and help they need. We still have so far to go in eradicating the stigma associated with mental illness, especially when women are at their most vulnerable. Our identities can be so tied up in our mothering skills, it’s no wonder we can get defensive.
      I don’t know all the answers yet. I’m not sure I know any of them. Except if you know someone who is already struggling with depression and/or other mental illness, you cannot be vigilant enough. I at least understand at some level that even I am better than no mother at all. Not everyone can even get to that starting point.

      Thank you for your insight and concern. Be brave; ask the questions. My friend Jennifer is right about the people who really care about you being strong enough to speak the truth to you in love. It can save a life.

  3. I agree that it is important to speak the truth to the people that you love. It can be difficult, but I agree that it is so important and I wouldn’t hesitate.

    Where my challenge comes in is when working with people that I don’t know very well. People that are strangers that come to me looking for support. People that will vanish at the mere mention of PPD, because I have insulted them. That is where I find myself tiptoeing, looking for the right words, trying to find a way to tell them that they need to get help without scaring them away. It is a difficult balance.

    • @phdinparenting I don’t envy you that. I find myself in the same position as a doula, and I even have a case where I fell short and didn’t pursue someone that I should have. It is such a hard balance to strike. Let’s just hope someday women don’t have to feel inadequate if they are struggling, and that door to the conversation can be open just enough to let us in.

  4. bessieviola Says:

    Yeesh, thank you for writing this. I was incredibly angry and depressed after returning to work from maternity leave – suddenly I had to “do it all” and I didn’t know how. It was a scary, dark time for me; toward the end of it I finally realized that it was depression, but in the thick of it I couldn’t see that.

    I’ll be interested to read the rest of your posts – from what you’ve already said I feel that your story will be one I can relate to.

  5. My feelings on medication and breastfeeding are really complicated. I just wanted to say that I’m glad you’re starting this conversation, but I’m not sure I can take part. My post partum experiences were traumatic, and it’s not something that’s easy for me to talk about.

    I’m reading, though, and I thank you for writing this.

  6. Formula, like vaccinations, is very useful when used not supplant nature, but to supplement it when necessary. Birth and infancy and early motherhood are all very important to the people we are/become, but they are not the sum of everything we are.
    Now that I have said both formula and vaccinations are not the devil, I should really bar the door…

    • Don’t bar the door! That’s what I’ve tried to say with some of my posts: we are so quick to align with one side or the other when really there is this huge continuum of answers. I think the devil is inflexibility, no matter what the subject, no matter what the stance. I guess that could be seen as being inflexible, huh? Thank you for the kindness and reassurance. I deeply appreciate them.

  7. ha! ’twas sarcasm…..

  8. Ugh. I hate to see that the majority would rather continue to suffer than wean or get treatment. I understand why, of course, because all of us believe that the only way to be a good mother is to sacrifice everything for our children. But what many women don’t know is that there is a lot of serious research out there on the impact that untreated postpartum depression has on both the mom and the child. It’s never an easy decision, but I’d feel better if moms were fully informed on all sides before making their choice. Some of them might answer differently. Thank you so much for these pieces, as they are very honest, well written and helpful discussions. I look forward to sharing them with my readers at Postpartum Progress.

  9. I love that you point out we really don’t know what goes on behind our friend’s closed doors. You’re right. And then you say all these things I feel and have felt and I am so relieved. Thank you for writing this. I look forward to the “series.”

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