I had severe and prolonged postpartum depression with my first child, moderate PPD with the second, and none at all with the third. While I’m by no means an expert, I wanted to sketch out some things that I thought might be helpful to those experiencing PPD and those who are in a position to help them (husbands, visiting teachers, ward leaders, etc.).
Before I get to that, though, I want to take up this question: Is PPD more likely among LDS women? I have no statistics here (and I would question their reliability because I refused to acknowledge my own PPD for a few years). But my hunch is that the following factors might exacerbate PPD among LDS women:
(1) Many LDS women have their first child(ren) away from their close circle of family and friends due to their husbands’ school or job requirements.
(2) LDS theology’s glorification of motherhood can make anyone struggling with it feel like they are doing something wrong. (more on this later) Additionally, LDS women who feel that ‘mother’ should be their primary identity marker may have more trouble than their non-LDS sisters.
(3) Similarly, feeling that one would be ‘wrong’ to use daycare can lead an LDS woman to feel trapped.
Of course, there are many ways that Church membership might mitigate PPD (everything from caring visiting teachers to attending the Temple to the ward park day). At any rate, for what it is worth, here is my advice for those experiencing PPD:
(1) You need the support of other mothers of young children. You must create a network. If your ward has a parkday, go, even if your baby is only a few weeks old (no one will laugh at you). If your ward doesn’t have one (but has critical mass of young mothers) start one. Or, invite another woman with a similarly-aged child to your home for a visit. If you don’t know anyone, ask your pediatrician or walk up to random strangers with babies in the grocery store. I’m serious. There is nothing more important than having momfriends and you need to do whatever it takes to find them. You need them to talk to, you need them for perspective, you need them for practical problem solving (how do I get the baby to stop pulling books off of the shelves?). You also need to start developing a group of mothers with whom you can trade children so that you can have some time to yourself.
(2) Which bring me to: you must have time away from your child(ren). This is nonnegotiable. Your husband is the obvious candidate here. A dangerous myth is that his job is the one he does for pay and your ‘job’ is the children. This only works out fairly if your husband works 91 hours per week. If he works less than that, sit down and figure out how many hours he is at home and awake. At least half of those hours should be spent with the child(ren) while you do something else. You should also (especially if your husband works long hours) develop a network of moms with whom you are comfortable swapping kids. I have no idea why people don’t do this more often; the kids love it and it is a real blessing for mom.
(3) Which leads me to: you must have an interest outside of your children. This is also nonnegotiable. It doesn’t really matter what it is: I’ve gone through a scrapbooking phase, a going-to-the-gym phase, a writing-a-book phase, and, I suppose you could say, a blogging phase. But you need something that is yours, that you enjoy, and preferably something that gives you something interesting to think about during the drudgery times. (A plug for gym membership: usually modest in price, usually with babysitting included, usually with physical benefits that may help PPD. Also, that 24/7 babysitting can feel like an important ‘out’ if you feel trapped.)
(4) Perhaps this isn’t an issue for everyone, but I really struggled at first with the lack of contour to my days. All of a sudden, time was not delineated, but weekday, weekend, sabbath, 2am, didn’t matter: there might be someone screaming. If this is an issue for you, contour your days, at least in part: make Monday grocery day, Tuesday park day, Wednesday library day, Thursday visiting teaching day, etc. Doesn’t matter how you work it out, just get out of that house each day, preferably at or near the same time. At the very least, go for a walk at the same time each day.
(5) Again, this might just be me, but I had to learn to stop thinking of the things that I wanted/needed to do as having an outside order and learn to live on the rhythms of my baby instead of fighting it. To give you an example, I used to insist on getting all of my housework done before doing any leisure reading. Result: cleaning while the baby napped, unable to read while the baby was awake (obviously). Now, I have two mental lists of things that need to be done each day: a list of things for while the baby is awake and another for when he is asleep. I’m also better at being efficient (i.e., wearing the baby in the snugli while cleaning house so my time really is free when he naps).
(6) I never took medication for PPD but you might want to consider it.
(7) I think that theology can be a double-edged sword when it comes to PPD. On the one hand, if you do not have a testimony of the fact that the work that you are doing as a mother has eternal significance, you need to work on that. On the other hand, if you already know that, but motherhood is causing you anguish, dwelling on it may just make you feel guilty. Probably better to focus your mental energies on finding comfort in Christ.
(8) Maintaining your spiritually while taking small children to Church can be very difficult. Be sure that you are reading your scriptures regularly and praying regularly. I can testify that God answers prayers that are offered up in the very act of nursing or changing diapers. Do what it takes to get to the Temple. These might be Sunday School answers, but the reason they are Sunday School answers is because they work.
(9) If you have the attitude than any sort of mental health issues (including PPD) are somehow shameful, you might need to think through that. Let me tell you how PPD was presented to me during each of my three hospital stays (note that #2 and #3 were the same hospital):
#1–nurse shoves large ream of papers covering everything from PPD to umbilical cord care on cart and says, “you need to read that.” Later, another nurse, noticing that I am crying, says, “You wouldn’t be having such a hard time recovering if you hadn’t gained so much weight while you were pregnant.” (I swear I am not making that up. It seems funny now, wasn’t then.)
#2–nurse sits down comfortably as if she has all the time in the world and says “Now honey, you have any problems with PPD, you tell us and we’ll fix it right up. You don’t have to put up with that!” (as if PPD were some man giving me the runaround who I should dump) (I actually liked this approach.)
#3–nurse, a little awkward, says “I’m required by law to talk to you about this, so . . .”
This is a shorthand example of how others’ attitudes can shape your own.
(10) A note to husbands and others who might be in a position to help: I have two pieces of advice for you (1) do what you can to give mother time away from the baby and (2) do whatever you can to minimize instead of adding tofeelings of guilt. You might find it hard to believe that someone home all day couldn’t find time to make the bed. If you have ever been home all day with small child(ren), you know that getting the bed made can sometimes fall somewhere between writing a dissertation and converting the pope on the scale of difficulty.
Well, this is a long post on a topic that probably is of no interest to many of our readers. That’s OK. I wrote it because I hope that someday someone who needs this will find it. If that’s you, please feel free to email me.
Julie, thanks for writing this; it’s a really important subject. I think it’s important to add that not all healthcare professionals are as unsympathetic as the nurses you describe, and that for serious PPD, PROFESSIONAL HELP IS NECESSARY. There are really good meds and good therapeutic techniques–if the aftermath of pregnancy and childbirth left you with a broken tailbone, you would be a little embarrassed to discuss it with your doctor, but once you got over the initial discomfort, you’d be awfully glad for the pain relievers and special pillows she’d offer. Depression is often as much a physical response to the wacky effects of massive doses of hormones as it is a response to the psychological challenges of motherhood. For some reason, we’re still proud of pulling ourselves up by our own bootstraps when it comes to mental health. This is stupid and unproductive, and we should get over it already. Moreover, there’s good research to suggest that the more days you spend depressed, the worse the depression gets, *and* the more likely relapse becomes. If you are depressed (PPD or otherwise) GO TO A DOCTOR NOW–your children will thank you.
Excellent post Julie! This is a difficult topic, and I have very minimal experience with it. There is one item that needs to be emphasized which I learned from my wife, who is a doctor: If you ever have thoughts of hurting yourself or your children call your doctor immediately and tell them about it.
Thanks, Kristine and a random John for emphasizing the medical angle.
This is right on Julie. After the birth of my first daughter, I really struggled with PPD though I didn’t realize it for what it was at the time. It was only in contrast to how I felt after #2 that I thought, “Gee. Having a baby doesn’t mean that you cry for no apparent reason for months, feel NO ambition, can’t find any energy for the things that used to really grab your attention, etc.” How I wish that someone had told me all of these things that you explain. I didn’t ever ask anyone for help or invite myself to participate in things that moms with older kids were doing (I was new to the area at the time), so I doubt anybody knew that I was struggling. I am positive that there would have been an outpouring of love had I been open about it.
I made a conscious effort once I did get established to really include everyone I could in the activities I planned and places I went. The relationships I formed with other moms thorough all of this sustained me through some otherwise pretty lonely years while my husband was working 80-100 hours in Grad schoool. Don’t know how I would have made it otherwise. I really felt like the other women in my ward were my SISTERS and this in turn really enhanced my enjoyment of our spiritual interactions as well.
God bless you, Julie Smith.
I am 3.5 weeks into Daddyhood, and my wife took the afternoon on Saturday to go to (ironically enough) a baby shower. I was home with my kid for about 3 hours, and it was friggin’ awesome. We played with little toes, Daddy sang goofy songs, baby chowed on some milk that Mommy froze, baby puked on some blankets, and we had a gay olde time in general.
Later Saturday afternoon, however, I was appalled to learn 1) that people were shocked that I had stayed home with my infant daughter, 2) that people asked if my wife was worried about me taking care of the kid “by myself,” and 3) how many guys in my branch do NOTHING (or next to nothing) to help their wives with their children.
I think I swore when I heard it. Actually, I know I did. I am the oldest of 7 kids and have changed my fair share of diapers, and worn more than my fair share of spit-up. I am better at the diaper thing than my wife, frankly.
Maybe it is just because this is how my dad did it with me and my six siblings, but I am convinced that if (er… when…) the baby wakes up in the middle of the night and needs changing and feeding, it should be rather like a softer version of the pit crew at the Indianapolis 500. It is the ultimate team effort. Daddy picks up baby, kisses both cheeks, checks for blowout or wet diaper, and starts making up a song about poopy diapers. If necessary, changes said diaper (and sleeper, if required). Mommy readies pillows, drinks some water, positions Boppy and gets ready for what Daddy refers to as Hungry Hungry Hippos. Baby chows down until full. Daddy slumbers. Parents alternate burping duties and putting kiddo back into bassinet (which sounds to me like the name of a wind instrument, not a place to sleep). Mom saves a bit of sanity, and Dad gets some face (and bottom) time with the baby. Makes a @#$* of a lot of sense to me.
But nooo… not among the guys I hang out with, apparently. Most of them do none of these things, and some dabble with baby care things during daylight hours when they are home. I can’t imagine how they sleep at night.
My wife and I have this (somewhat) worked out — we both helped make this little one, and we both shoulder the burden of care, as much as is feasibly possible. The only times when I will not wake up at night (and I may even sleep downstairs) will be the nights before my medical school exams. Otherwise, we are in this together for the long haul.
We are dealing with the daycare issue that Julie mentioned, ourselves, since my wife works while I am in school. We have a few more weeks to figure this out, but she does, indeed, also feel a lot of guilt about having to work.
The things we do together to care for our baby may not prevent post-partum depression, but it can’t hurt. So far, aside from the normal “baby blues” of about 1 week into parenthood, things have run pretty smoothly.
Any father who doesn’t help with his kids is, in my opinion, ripping himself (and his spouse) off. I can think of precious few exceptions to this.
Great post Julie. I like a lot of your suggestions but am still wondering what to do if someone I know acts like she might need help. Any more thoughts on that?
I have heard that depression rates in general are higher among LDS, at least in Utah. Perhaps there is related data on PPD.
I do take a bit of an issue with how strongly #2 is pushed in our society. Perhaps separation from your child plays a different role in women with PPD, I don’t know because I don’t speak from experience on that. But I think a lot of women feel pushed to leave their tiny newborns in somone else’s care (I know I did) and are miserable about it. I’m all for taking a bath, or walk around the block, or some time to meditate alone in your room when daddy comes home, or someone trusted comes by to give you a break. But being badgered to leave your baby for hours at at time for your own mental health really is not helpful to lots of new mothers. (not saying _you_are badgering, but that it’s been known to happen)
Also, a plug for the protective effect of breastfeeding. Mothers for whom nursing is going well have a statistically lower incidence of PPD. Of course, I’m not putting this out as a rule, because there are LOTS of exceptions. I think this is also true of women who felt in control during their births, whatever “kind” of birth it was (natural, planned c- sec, anything in between).
My medical school had a guest lecturer on PPD recently, and she pointed out that in other developed countries it is viewed much differently than it is here in the US. The idea, not only among LDS mothers but with American society in general, is often that PPD is somehow a failure on the part of the new mother. That just isn’t so. PPD is an organic problem which, as Random John and Kristine so aptly pointed out, often requires compassionate psychiatric care.
New mothers should be assisted in finding a caring physician or other caregiver, one with whom they feel comfortable talking about all of the slings and arrows of new motherhood (my wife’s doc is a new mother, herself, and has been there, done that). That means the full array of difficulties, from lactation challenges to difficulty with bowel movements, the whole nine yards. That can take a special caregiver, to gain that kind of trust, but it is worth finding one.
Julie, your Nurse #1 should have been fired. Nurse #3 needs a clue.
Oh, one other thing — my wife and I hired a doula for our recent childbirth. A doula is a trained, non-medical birth assistant for the new mother. Ours is a massage therapist, to boot, and she is an experienced mother, as well. She was available 24 hours a day for whatever we needed, 3 weeks before and 3 weeks after the birth. What a godsend!
Doc-Kwadwo, I think you hit the nail on the head with the doula thing. Like Julie said, a lot of us have our babies far a way from family and friends and feel extremely isolated rather than helped and cared for. Doulas are a modern way of replacing the extended family, and I’m all for it!
Claire wrote, “I like a lot of your suggestions but am still wondering what to do if someone I know acts like she might need help. Any more thoughts on that?”
The most success that I have had in situations like this is an email or note saying something like, “I had a hard time with PPD and want you to know that I’d be happy to talk to you if you are having any problems.” (I frequently write this on the card along with baby shower gifts.) I wouldn’t talk face-to-face, just because I was very good at being stony and in denial because the alternative was, usually, bursting into tears.
I appreciate your point on #2. To clarify, I wasn’t suggesting that 40 hours per week of daycare is the solution to PPD. But, as a nursing, cosleeping, babywearing mom, I was rarely out of skin contact with the baby. While in general this has been good and useful for me (still doing all of it with #3), with PPD, I never had any psychological distance brought on by physical distance to be myself. Myself got lost, and this depressed me. The kind of distance that I’m talking about is going to the movies by yourself once per week or similar.
Great post Julie…
Elder LeGrand Richards had a good philosophy that should help an LDS husband understand his responsibility to his wife. A July, 1982 Ensign profile on him said
“Elder Richards always tried to be attentive to Ina’s needs. He says matter-of-factly: “While the children were babies, I don’t think my wife ever got up at night unless they were sick. I figured that if she took care of the kiddies in the day (and it is a wrestle to keep them happy), and I just had book work to do, that I could afford to spell her off at night. So, if a baby cried, I’d be out of bed in a hurry; if it was a bottle they needed, I’d get it; or I’d change their pants. As long as they weren’t sick, I relieved her of the responsibility of caring for them at night.”
Julie, thanks for your clarification. I’m still unsure what to do, though, as a non-PPD sufferer, but someone aware of the symptoms. I recently had a conversation at soccer practice with a friend of mine. She was telling a story in a sort of ‘can you believe this one’ context about an acquaintance of hers who had a 6 week old. The first two weeks her mother was there, the second two weeks her mother in law was there, and now that everyone had gone home, she’d hired a full time baby nurse to be there during the day so she had NEVER been alone with her baby. People were chuckling when it occured to me this poor mother was probably deathly afraid of being alone with the intense needs of her child, and possibly was afraid she’d hurt the baby. Since it was not someone I knew personally, it was not me who needed to suggest it, but I emailed my friend that night to point out the possibility of PPD and suggest she might be in a position to help her get the help she needed. I don’t know what happened, but I’ve been wondering ever since what I would say if it were my friend showing signs.
In light of this, I wonder about rhetoric like this (heard at a recenet testimony meeting in our ward):
“Since the birth of my new baby, I have been deliriously happy. God is blessing me with happiness. I can’t see how people aren’t always happy when around babies.”
Julie, really good advice.
I had my last baby, with two young stepchildren, and a thirteen year old, who didn’t want to be part of our family and tried to do everything I did before. I was so exhausted and stressed. I tried to be supermom, doing a 4-H for my stepdaughter, and nursing, with Sarah hanging off me while I was doing activities. This did not work. She had terrible colic.
By the time she was three months old, she refused to nurse. I did not have classic PPD, but I did not follow the suggestions Julie made here, they are very good and I recommend them. God bless.
#12 Ivan:
“Since the birth of my new baby, I have been deliriously happy. God is blessing me with happiness. I can’t see how people aren’t always happy when around babies.”
In our broader culture, there is enough stigma attached to baby blues as it is, and depression (whether following childbirth or not) is largely seen as a personal failing. When we add the idea that it can be relieved simply by accepting the calling of parenthood, we overgeneralize personal experiences and implicate the faith of those in different situations (something we do too often anyway).
I think that sort of rhetoric is one of the few real reasons that PPD may be as or more likely among religious women (though I can’t back that up statistically). As a psychotherapist I have heard women point to such statements and question whether their mental health problems are a result of a lack of faith or even some irreparable action (sin) they have committeed. One woman discussed meeting with her bishop and being counseled to fast and pray for her depression to go away. After following this counsel diligently for several months she came to the conclusion that “maybe depression is even stronger than God.” I don’t fault her priesthood leaders for their best efforts, but why is it that we are still so hesitant to consider that mental illness may be 1) a biopsychosocial outcome that has nothing to do with faith, or 2) part of our personal package of life experiences that God may not want us to get rid of right away? Of course, neither of those answers does much to assuage our pain, so what we really need is to accept that PPD (and indeed, all depressive disorders) are part of life, parts that can generally be relieved to some degree by doing the types of things Julie has recommended above.
As a mental health professional (legal aside: I’m still in a doctoral training program, not trying to willfully misrepresent myself), I encourage you to make some mental notes of Julie’s suggestions. Many of them are right in line with research findings, and because my own area of research is on maternal depression, I read a lot of that stuff. I endorse them even more whole-heartedly as a father of two and husband of a woman who does an amazing job mothering those children but who occasionally falls pray to implicating herself for struggles that are just part of the job.
Thanks for this post Julie and for all of the responses. I am about 2 1/2 weeks from giving birth to my first child and this is a real worry of mine. I have been treated for depression before in the past and my own mother had a seriously hard time with PPD. (Do the rates of PPD go up if you have been diagnosed with depression and anxiety before?) I will also be quitting my full time job after I have the baby and I am worried about this as well. Right now it looks like leaving work is going to be a nice break, but I know in 8 weeks I’m going to be missing the routine and interaction that work can offer. One nice thing, I live in married student housing at a university in the Mid-west and there are several other young mother’s hanging around, several LDS ones too. Hopefully I can make some contacts with them out on the playground.
Mary, the good thing is that you know what to look for. Understanding what’s happening is half the battle, I think. I didn’t ever have true PPD, although I’ve had pretty bad depression. I did always get depressed when my babies were weaned–by the third time around, I was clever enough to make an appointment with a psychopharmacologist and a therapist *before* I started feeling bad. Having that bit already set up really helped, so that I could just call when things started to slide south a bit; if you wait till you’re really depressed, it’s too hard to do any of the things (like making an appointment with a doctor, or joining a playgroup) that will help. If you don’t have a doc in mind yet, it probably wouldn’t hurt to go for an initial consult now, instead of after the baby’s born, just in case. Also, most OB/GYNs are now alert to the issues and can steer you the right direction *if you talk to them*.
Ivan–
I don’t doubt that that testimony bearer was telling the truth (that is, telling her truth), but she was also being (as we all are, sometimes) insensitive to people who have different experiences than we do. I have to admit that if I were there, I would have had a hard time not giving a ‘rebuttal testimony.’ Hopefully, it wouldn’t have come across that way, but I would probably have prayed to know whether I should get up and share some of my own struggles (without mentioning the previous speaker) so that if anyone in the audience suffered from PPD, she wouldn’t feel horrid.
Kristine makes a really important point that I didn’t emphasize enough: all of my solutions soulnd pretty obvious and basic, but require almost superhuman effort when you are depressed. Just about everything requires superhuman effort when you are depressed.
This is a great post, thanks Julie.
Besides the feeling that you might hurt yourself or your children, what are some of the warning signs of PPD? I guess I could look it up on-line – any particularly good resources out there? I’m just wondering what the difference is between having a bad week (or month) and figuring out you need outside help.
Elisabeth–
This probably won’t hold water with any clinicians, but this is how I would define it: regular bad mommy day ends when your husband comes home and you cuddle up alone in bed with a good book while your husband deals with your brood. If you are depressed, the book (or whatever else you used to enjoy) will no longer bring you any joy or relief. You dont’ look forward to anything and you don’t want to do anything.
Incidentally, I don’t know that desire to hurt self or children is characteristic of most PPD; it wasn’t part of mine.
I also forgot to mention originally that there are plenty of community based mother’s groups (not PPD support per se) that plan activities that can provide a built-in support network. Try http://www.mops.org to start.
Oops, I wasn’t thinking of MOPS. That’s an evangelical Christian group (I think). I’m thinking of preschool mother’s club or the like. Do some googling of (your town) mother group and you’ll find something.
Elisabeth,
My post wasn’t meant to provide a way of diagnosing a problem. It was more of a statement that even if you have previously resisted getting professional help, there is a point where you need it, because you aren’t thinking rationally anymore. Thinking about harming yourself or your children is a clear sign that you need immediate help.
“Thinking about harming yourself or your children is a clear sign that you need immediate help. ”
Yes! Additionally, the impulse to harm your baby may be a manifestation of post-partum psychosis, related to PPD, but much, much more severe. This is not a call-and-make-the-next-available-appointment symptom, it’s a go-to-the-ER-now! kind of crisis.
ARJ-
Your post gave an example of an excellent wake-up call to get help, but what can be done to prevent PPD before it gets to that level? I don’t have children, and I can’t imagine how overwhelming it is to give birth and care for a newborn child. It’s almost absurd that just “anyone” can have a baby without any education about what to expect and how to cope with the normal frustrations of caring for a child. Sometimes I think it would be a good thing if every couple had to take a crash course in child care before they could have children.
It is amazing how mothers adjust to having children differently. My brother’s wife, who I thought was a bit immature at 19 to have a baby, is a wonderful, happy mother to my nephew (at least when I see her).
Thank you, thank you, thank you for writing about this. Not enough is said anywhere about PPD. I am a frequent reader, first time commenter. I have a 9 month old son and suffered from bad PPD after his birth. We have just told family and close friends about it the past couple weeks, as we were sharing the news that we will be adopting child #2 (too nervous to go through a possible 2nd bout with PPD anytime in the near future). The biggest question I got was “why didn’t you tell me so I could help?” While I had read all the literature myself on ppd before giving birth (and passing it to DH, as well), I honestly did not recognize a lot of the symptoms myself in the beginning. Once I figured out the problem, it still took another 4-6 weeks for me to talk to my husband and tell him the truth about all the symptoms, and then still another month or so to see a doctor for medication. Several months after starting the meds, I had a one month stint with an LDS therapist, which was invaluable to getting better. My point: if I couldn’t tell my husband, why would I be able to tell my mother or my friends? I was so terrified of “telling” – I was sure my dh would take the baby and leave; I was sure that if I went to the doctor, they would take my baby away from me. Now I realize how irrational that is (and another symptom of the disorder), but at the time, I was full of fear. Other symptoms I experienced, for those who are looking for them in others: I had very vivid ‘daydreams’ where I would see myself injuring my child and couldn’t make the thoughts stop, even though they were horrifying to me; I couldn’t sleep because I was petrified that my son was dying of SIDS all night long; I was sad all the time; I had major guilt issues – major ones; simple things such as tidying the house or going to the grocery store seemed absolutely overwhelming to me and I could barely function. I could go on but don’t want to threadjack. The things I want to emphasize: my husband was desperate to help me, but didn’t know what to do or where to go for help. He kept suggesting I “talk to someone” but stopped short of insisting because he didn’t want me to get mad at him. Now he realizes he should have thrown me over his shoulder kicking and screaming to get help earlier. Yes, I would’ve hated him then; but loved him for it later. Also: many of the ppd symptoms I had were very easy to hide – even from my husband. Sadly, they were the most serious ones. Don’t think that just because someone appears fine in the first months after giving birth that they are (not to suggest that anyone bother their visting teachees to the point of torture looking for symptoms that aren’t there). Lastly: nothing helped my recovery more than an understanding husband and the priesthood blessings he gave me. Yes, I needed medication and therapy at the worst, but I believe the period of sickness would have gone on much longer if not for the gospel and the priesthood blessings.
Julie–
Thanks for posting. A lot of your description of your experience reminds me of my own, only you articulated it better.
Of course, no one’s experiences are identical: when I told an LDS counselor that I wanted to adopt to avoid PPD, she laughed at me. (In case you can’t tell, I got terrible medical ‘help’ all through this. That might explain why I didn’t emphasize it in the original post; I’m glad others have mentioned it more–and had better experiences than I did.)
Elisabeth,
On your point that “anyone” can have a baby. A few years ago my wife and I visited the Humane Society looking to adopt a dog. The woman we met with asked my wife a few questions and finally got to, “What is your job?” When my wife responded the woman said, “Well, you guys can’t have a dog, we wouldn’t give one to people so busy.” She didn’t even bother to ask what I do. While driving home the thought struck us that nobody would look down on us for having a baby, but this woman wouldn’t let us get a dog. “Worse” still, almost anybody can have a baby and there is no interview process to determine if you would be a good parent or even have time for a child. This all seems very backwards, but I can’t think of a good way to change either the way (and restrictions upon the way) that dogs are adopted or that people become parents.
Well done Julie – this is a brave post but really helpful.
All the best
Marie Osmond wrote a book about her experiences with postpartum depression and spent some time trying to generate awareness of the issues surrounding it a while back. Google will produce some links for you. Here’s an interview she did with WebMD and the Amazon page for her book.
Julie, I’m not a mom, but I appreciate reading this, as so many of my friends are new moms. I would like to reiterate the reaching out part. I think it’s totally invaluable to find others who are in your situation (i.e. other mothers) to share responsibilities with. But don’t forget that you can ask people to help who aren’t in the same situation. My single friends and I try to schedule time with our married friends so we can spend time with their kids and that way have children in our lives. If I’m free, I love babysitting my friends’ kids so they can take a night off. If I’m busy I’ll tell you, but don’t hesitate to ask.
I was nervous about a church program once, and my YW teacher told me to just remember that everyone in the ward cared about me, and was rooting for me to do well. I think that sentiment has informed the way I look at a ward family. Unless you’re in a dysfunctional ward (and I’m sorry if you are!), there are dozens of people who really care about you and are rooting for you to have a good experience with motherhood. Even those who haven’t had PPD or depression can understand that things are hard and care that you are going through a hard time. One of the biggest blessings of the church is being part of a ward family…
I have had PPD. What surprised me was how LONG it was. Most of what I had read mentioned a few weeks. I only read ONE article that said it could last a year. Mine lasted about 11 months on average. And I didn’t go on medication because it was getting better……slowly, and I’d think, I made it 6 months and its getting better, why bother getting help now.
The first baby I chalked it up to stress of working fulltime (bringing baby along which you can imagine was hard and took 7 days a week just to log 35 hours of actual work).
For #3 I looked at medication more seriously. The year after #2 had been the worst year of my life. But the possible side effects scared me off. I finally went on medication 6 months after baby #3 was born and stayed on for 6 months.
I’ve never been embarrassed about PPD. But I find it is hard for people to understand. My husband tried, but honestly the ups and downs of PMS and pregnancy confused him. PPD was not any easier.
As a woman it is easy to start to forget what feeling normal is like. There’s PMS. Pregnancy. Post partum. What exactly is normal?
I have a thyroid disease. I always think it is silly when the endocrinologist would ask me if I felt anxiety? Irritability? As compared to what. Doesn’t everyone get irritated? How am I supposed to know if my irritability is my personality, my disease or if my husband and kids actually are irritating?
Wonderful post – I’d like to add one more suggestion:
GET SOME SLEEP! Sleep deprivation can be devastating to your mental, emotional, and physical health. Some of the symptoms of sleep deprivation can mimic PPD, and it is occasionally possible that you do not have PPD, you are just severely sleep deprived.
So – nap, anyway that you can! If you only have one child, sleep whenever the baby sleeps. Let your house go to pot – it does not matter. Hire a maid service for six weeks to handle the housework while you concentrate on surviving the post partum period. If you have more than one child and find it hard to take naps – when your visiting teachers, friends, relatives, etc., ask if there is something they can do for you – say YES – have them come over while you nap. When DH gets home from work, NAP. When Grandma comes over, NAP. Nap, nap, nap.
I suffered from a short-lived but severe bout with PPD after the birth of my first child. My most pronounced symptom was what my doctor-husband later diagnosed as “anhedonia”–things that used to bring me pleasure, like food, warm showers, sleep, reading and exercise, ceased to bring me any pleasure or relief at all. I could hardly bring myself to eat (and lost weight precipitously) or care for myself; I cried every day for six weeks; I felt utterly incapable of caring for my daughter. I never had thoughts of hurting myself or the baby, but I did make very specific and sincere plans to give the baby to my mom to adopt, because I was convinced that I was unable to mother. I also suffered from intense anxiety during the same time: I experienced almost unbearable anxiety whenever I was away from the baby (so no leaving the baby with dad and going to the movies!), and in videos taken during those weeks I literally sat on the edge of my seat all the time, my shoulders pulled to my ears, my body a picture of tension. I had a severe and long-term insomnia–I’ve never been able to nap during the day, and during those weeks I would also lie awake for hours at night, completely miserable with anxiety and tension.
I’m convinced that my experience was mostly biological (although my depression started to go away about six weeks postpartum, I was diagnosed with severe postpartum hypothyroidism a few months later, and this may have been a contributing factor), but there were also some psychological factors that contributed. One of them, ironically, was my experience as the oldest of eleven children: because I had so much experience with babies, and because I remembered my mother having babies and literally not missing a day (she taught gospel doctrine with a two-day-old in her arms, once), I was disastrously over-confident. When things were not at all what I expected–big sisters never have to do the night shift, and by the time my mother was having her seventh, eighth, ninth, tenth babies she had things down to a science–I felt that there was something fundamentally, horrifyingly wrong with me as a woman and as a person.
For what it’s worth, things were much better with my second: I made arrangements never to be alone with the children for six full weeks, but in the end I probably didn’t need such a long support period. Just watch, I’m setting myself up for disaster with the next one by getting my confidence up again…
Rosalynde–
I’m so glad I’m not the only one who contemplated putting my baby up for adoption!
I wouldn’t worry about getting your confidence up again. My experience–and what everyone else with 3+ kids has told me–is that #3 is pretty easy.
It’s good to see this discussion. Here’s another story to add to the mix: I experience baby blues after every birth (my fourth was born in January), but so far, I have only had PPD after my third baby and it wasn’t until she was about 6 months old, getting progressively worse until it peaked when she was about 9 months old.
I want to note that I follow many of the items on Julie’s advice list and they all help with baby blues, but for me PPD was different. Upon experiencing PPD, there isn’t a single thing on the list that I was able to do. I describe it as paralysis of the brain. I couldn’t make a phone call, because I’d first have to locate the phone or the phone number and any multiple steps were basically impossible to accomplish. For the same reason, I couldn’t go out because I’d have to get dressed, and that means I’d have to pick out clothes and do my hair — too many steps. In addition to the brain paralysis, there was the constant crying and thoughts of death that have already been described so well in previous comments.
I only got healthy again because of intervention. A woman in my ward recognized what was wrong because she had watched her daughter go through PPD. She insisted I speak with the Bishop to get some help. I wasn’t opposed to this, but again, it was too much effort to make the appointment. A couple of weeks later, when she realized I still hadn’t seen the Bishop, she sent the Bishop directly to my house. We visited. He made some phone calls and set an appointment for me with a doctor. He bought the Marie Osmond book (mentioned above) and brought it to me at church in a brown paper bag. He told me he’d had his wife check it out to make sure it wasn’t too dorky — thoughfulness which I appreciated. I read quickly and the Marie Osmond part actually was pretty awful (it turns out Marie is a little bit country and a little bit lacking as a writer), but at the back there’s a section written by Dr. Judith Moore that’s very helpful. On page 238, Dr. Moore provides a questionnaire that helps you discover if you might have PPD. A score of 15 or more indicates”high probability of experiencing clinical post-partum depression.” Although I felt a little like I was in Junior High again, taking a quiz in Seventeen magazine to see if I really had a crush on so-and-so, I took Dr. Moore’s quiz and scored 22.
Incidentally, a symptoms checklist of clinical post-partum depression and clinical depression look awfully similar. One doctor explained to me that any clinical depression within a year of the baby’s birth is called PPD.
Anyway, by the time I met with the doctor, I knew much more about PPD. The doctor was helpful. She confirmed I had PPD. She recommended wellbuterol. I was told I would feel better after I had been taking the drug for 2 weeks and the drug had built up. It was true. I felt great. Not artificially happy, just normal. No more hiding behind the bed in the fetal position. I took the drug for a few months and slowly weaned off. That’s basically it. I still have sad days now and again, but they are nothing like PPD.
A couple of other notes:
I was saddened to hear from the counselor that in addition to all the awfulness I was feeling, the typical person with PPD also feels 1) unloved and 2) guilty of bringing on the depression. I didn’t experience either of these. (Even depressed I seemed to have an unusually high self-image. How could anyone not love me? And, What? My fault? You think I WANT to feel like this? No way — I refuse to take any blame for this crappiness. . . ) I just think it’s terrible that a person could feel even worse than I was feeling.
Also, I want to reiterate how necessary the intervention was. Even if I had discovered a depression symptom checklist on my own, I wouldn’t have been able to do anything about it. The appointments had to be made for me. I had to be driven to the doctor’s or have someone write down the correct subway stops and put me on the train. I had to be handed the medicine and the glass of water.
One more thing: not that Dr. Moore is the end-all expert, but I’m going to quote from her book again to be clear on the difference between baby blues and PPD. On page 237 she notes: “Up to 80 percent of women experience some degree of “baby blues” This is a feeling of sadness or of being overwhelmed. The new mother may experience mood swings and bouts of crying that begin a few days after the birth of the baby and can last two or three weeks. . . Ten to 15 percent of women go deeper into what is called PPD. PPD usually includes all the symptoms of baby blues, but they are more intense and debilitating, are frequently unrelenting, and do not go away after a few weeks. . . Commonly, there are feelings of inadequacy, guilt, hopelessness, tearfulness, fatigue and irritability or anger. The symptoms may also include suicidal thoughts or the desire for death, the desire to harm the baby or someone else, irrational fears, anxiety, panic attacks. . .These feelings rarely let up, and the mother, no matter how hard she works at it, cannot seem to lift herself out of the depression. In approximately 1 out of 1,000 births, a mother experiences postpartum psychosis.”
In my experience, if it’s truely PPD, you will almost assuredly need medical help to get healthy. Baby number 4 is almost 4 months old and so far all is well — but I’m totally paranoid of a relapse. I have my husband and all friends on the lookout for any symptoms I may be experiencing and not be aware of. In the meantime, I’m delighted to just feel normal — at least as normal as I can feel when my baby likes to feed 5 times a night. . .
First I want to comment on JKS’s #30: “…Anxiety? Irritability? As compared to what. Doesn’t everyone get irritated? How am I supposed to know if my irritability is my personality, my disease or if my husband and kids actually are irritating?”
Mostly I laughed at that because I ask myself the same questions–and I’m not a mother, just a woman! I also laughed because I was glad somebody could put into words what I’ve felt so many times.
Like I said, not a mother, but I have wondered whether I’d experience PPD someday since I do get pretty crappy PMS, and I know how it feels to be irrationally lonely/depressed/sad/weary/sluggish, due to hormones or whatever. Good to know that other LDS women have similar concerns–it’s a hard balance to strike between skepticism and hypochondria when it comes to mental health, especially in LDS culture. Great post and great comments–this idea sharing and connection among strangers is one of the reasons I love blogging.
Thank you, Julie in A, and all other commenters! I think this is a great thing for men to read, too.
I echo the refrain of those who emphasized seeking (and not fearing) professional help and medication. While I obviously have no PPD experience, I have been previously diagnosed with severe depression. A sister had noted the symptoms, but I refused to do more than see my physician to see if there was a physical health issue. A year later, when a severe episode landed me in the hospital, I began receiving medication and therapy.
After the first few sessions of highly competent therapy, I concluded that “preventative therapy” could have been quite useful even before I suffered severe depression. It could have helped me overcome some of my typical anxieties which I had assumed were just a normal part of life. For that reason, some comments above by soon-to-be mothers struck me as insightful, where there was consideration of early therapy, just in case.
Again to commend the comments on medication, I was encouraged at comments by two co-workers after I returned to work from my hospitalization. She basically said, “People don’t hesitate to take medication for their liver or thyroid or heart or kidneys. Why should they think it odd to take medication to help an afflicted brain?” And a man there agreed, “The brain is so much more complex. We can’t necessarily ‘will it’ to repair itself.”
Finally, I’ll add to Sue’s #31 comment on sleep and napping. For me, consistent nutrition, sleep, and exercise do wonders for my well-being. Of course, check with your doctor on appropriate physical exercise, but by all means eat and sleep as best as you can. (When I was depressed, I needed others to supply the nutritious food for me. Cooking takes too many steps when depressed.)
Speaking of going to see the bishop, what makes me laugh a little now is that I felt so horrible inside that the closest way to describe it was it felt like guilt. Think of how you felt after doing something irreversible….like crashing the car, losing something really important, or when your baby falls off the couch. I even went to the bishop after baby #1 and tried to confess anything and everything I could think of that I had ever done wrong or felt I was currently wrong, hoping that it would make that sick, pit of the stomach, I-hate-myself-I’m-a-bad-person feeling go away. It didn’t. But he was very sweet and gave me a blessing.
JKS in #37 reminds me of another point I wanted to make, which I think others have previously stated. People need to understand that in some instances of severe depression, competent professional help and intervention is essential. Some common advice like “give service” won’t do, when there is nothing to give.
Earlier I mentioned taking wellbuterol for depression. Oops. It was actually wellbutrin. That should teach me: no more commenting during middle of the night nursing.
Julie, this question is administrative. (Perhaps Kaimi will answer.)
If my wife and I are approaching childbirth, say a year from now, how do I quickly refer back to this thread on T&S? Is there some sort of keyword search mechanism? It seems to be easy to find the most popular threads from the past, and recent entries. Is my best bet to remember that it’s in the April 2005 archives? Thanks for a warmly educational post and discussion.
There’s probably a swoopier way to do this, but when I want an old post, I usually go under Posts By Author. Happy multiplying ;>
The biggest problem for me had to do with the relatively small (but still present) risk of continuing to take an anti-depressant drug while pregnant and nursing. (There are few studies on the safety of taking this drug (the filter won’t let me post if I write the name of the drug, but it starts with a “P” and ends with an “axil”) while carrying a child, and it is secreted in small amounts in breast milk.)
Every situation is different, and my husband and I spent a good amount of time praying, fasting, researching, and pondering what was right for us. In the end, we decided that I would stay on the medication. As one doctor put it, all the benefits of nursing go right out the window if the mother is too depressed to function, too stressed out by the overwhelming nature of mothering, or worried about harming herself or her child. All of my doctors and my psychologist have been very supportive in our decision (and my extended family, too.) That has been an incredible blessing.
This post and resulting thread have been wonderful to read, and the advice has been very welcome. We moved here to Spanish Fork only a few months ago, and I miss my friends in my old ward. I think I’ll try to start a park date with some of the ladies in my ward as soon as my son is better! (He’s only 18 months, and he was diagnosed with pneumonia yesterday! And I have a five-week old daughter. Yes, I’m looking for sympathy.)
Mark —
You can also use the “search Times & Seasons” function in the sidebar. a search for post-partum depression should do the trick. Note that the search function only looks through posts, and not comments.
You can force google to return results from a specific site as well, by using site:www.timesandseasons.org in your search, which will include comments in the search.
I really appreciate this post, and all the thoughtful comments. If you don’t mind lending the wisdom of your (collective) experience, I’d love your input on my situation.
My son is almost 10 months old, and I’ve struggled with PPD off and on since he was born. Lately, it’s been more on than off. A couple weeks ago, when not being able to open a jar of baby food reduced me to tears I knew it was time to get professional help.
I’ve had a few sessions with a psychologist, and I have seen some improvement. However, my counselor still thinks I need to be on antidepressants, and has urged me to see a physician so that I can get started on them right away. That’s where I’ve run into problems. Despite numerous frustrating phone calls, I can’t get on a physician’s schedule any sooner than mid-May. (My insurance coverage is limited to the university hospital where my husband is a med student, so going elsewhere isn’t really an option.) It just makes me want to scream. (Maybe I should; if I had a sore throat, I could get in right away. The insanity of prioritizing routine health care over mental health! It’s like they’re asking for a crisis!)
Even if I were able to start medication immediately, I have some ambivalence about nursing while on antidepressants. Does anyone have experience with that? Should I wait another month or two to start the drugs? Should I wean my son now? Should I continue to nurse while on medication? Normally with these kinds of choices I do a lot of research and carefully weigh the pros and cons. But that kind of research just feels too daunting right now, and every time I think about it I just feel overwhelmed. Any thoughts or suggestions would be most welcome.
Diana,
First, a disclaimer: I’m a geologist, not a doctor of any kind.
My first thought is: Call your counselor (or get your husband to do it for you). Tell him you aren’t sure you can wait the three weeks it is going to take to see a physician. (On top of that, it can SOMETIMES take a week or more for the medication to really kick in. At least, it did for me.) See if there are some strings he can pull or people he can contact to get you in sooner.
My mother was able to spend a week with me after both my babies, and that was wonderful. Is your mother in a position to come and spend a week or two with you until your appointment? Sometimes just having someone around who can share the burden and get your mind off things can be really helpful. (I know a lot of times this isn’t an option, but I thought I’d throw it out there for you. If your mother isn’t an especially restful visitor, though, or if any visitor would stress you out, forget I said anything about it!)
And finally, about breastfeeding: As far as my own experience goes, I nursed my son while taking an anti-depressant (see comment #42 for which one), and I am currently nursing my daughter while on the same medication. I didn’t have any problems, and neither did they. However, I do know that this is a personal choice. If your son is almost 10 months old, however, you might consider weaning him. I once remember being told (oh, second-hand information!) that the most important health benefits from nursing come in the first six months, so I don’t think you would be short-changing your son in a huge way by weaning him now.
Good luck! I hope that things get better for you.
Diana,
Ditto what Keryn said. When I have talked with doctors, they told me it usually takes a couple of weeks on the medication before you see the benefits, so if your psychologist can help expedite the process, that would be best.
After I was placed on medication at a hospital, I was referred to a Nurse Practitioner (NP) for periodic follow-up after I went home. She was excellent, and I could only wish you would have someone like her available to you! As an NP, she could prescribe medication, and she also had a background in mental counseling. When you get a combination of someone who is good at listening, discussing your situation, and doing all the little things to help improve things, it is wonderful! For example, I told her that one of my concerns on a previous anti-depressant was that it had made me drowsy, which was the last thing I needed. She guided me to take my current medication two hours before bedtime, since if any drowsiness did kick in, it would take a couple of hours and hence would coincide with my sleep. I hope you do get connected with a great health care provider!
Lighthearted observation…
It’s sometimes amusing to note the juxtaposition in the “Recent Comments” sidebar. For example:
“Updating the Expansion … Against King Benjamin”
Or if you look cross-eyed, you can see things like I did yesterday:
“Against… Postpartum Depression” or
“Postpartum… King Benjamin”
Um, maybe it’s just from hanging out around here with too many lawyers for too long, but I feel compelled to point out that everything happening here is friendly talking between friends, and should not be mistaken for medical advice from people who know what they’re doing. If you need that kind of advice, by all means take heart from the friendly observations here, but also be sure to ask people with letters after their names that mean they have actual training!
Hi Diana,
I was unsuccessful at nursing all three of my kids, I really felt bad the last time, I had plenty of milk, but it gave my daughter terrible colic.
But you know, she went through three months of colic, I went through three months of trying to soothe her for 5 hours a night, and I just wish I hadn’t put that on myself, I know there are other things I should have done differently, but I think it would just have been better had I started out with a bottle. Once she got a bottle, and didn’t have a stomachache after, she refused to nurse. No more colic. No more hours of walking the floor with a screaming baby. That little three month old was smarter than I was.
I felt bad, like I said, but in retrospect, it wasn’t that big a deal. Being a new mom is exhausting, and I think in a lot of cases, simple exhaustion could account for a lot of symptoms that women describe with PPD. I suggest doing whatever you can to ease the pressure.
Diana,
I nursed my son while taking Prozac – it’s had long term studies done about taking the meds while breastfeeding and pregnant. I was very hesitant at first, but it worked out great.
About not getting in with your doctor: not ok. Shocking, actually. Can you call your insurance? Can your therapist recommend you to a psychiatrist? Really, I think you need to call the dcotor and demand an appointment that day. Good luck to you.
You could try showing up at the clinic and, while holding your baby, tell them “I need an appointment for post partum depression today. I am sure you know how serious post partum depression is. My counselor says I need to be seen by a doctor to get medication. What will your legal department say if you deny me the help I need when there is a baby to consider?”
You would be doing two things here. Threatening them with their possible liabilities, since you are a patient there. Also, you would be showing up in person. It is ALWAYS easier to get your way in person, rather than on the phone. They can’t put you off. They have to face you, etc. You can immediately ask to speak to a supervisor and you don’t leave until you talk to them, and then the next person. They will probably find a way to squeeze you in and you can be very polite and thank them and they will feel good because they have helped you.
Julie in A,
Your hope had been that someone would find this and I stumbled across it. I have you same hope that if it’s here it will help someone, so here are a couple of things.
First, there is a support group for this…hard to find, but there. We welcome all sufferers and survivors of PPD.
http://health.groups.yahoo.com/group/LDSppd/
or just send an email to [email protected]
You should not feel alone…
Here was my advice to a woman who’s sister was dealing with ppd…
1. Let your sister get some time by herself — to get out of the house, go for
a walk in the park, go shopping (for herself, not grocery shooping or for
the kids), etc.
2. Help your sister find a few more support people — she doesn’t need to tell
everyone, but she always needs to have 2-3 people she can call who
know/understand her situation, someone else coping with ppd (or who has in
the past) would be great.
3. Get her to go to a support group — my local hospital has one. Call around
and ask, and then drag her there and go with her if you can.
4. Talk to your sister about her interests, or help her find a few
interests/hobbies even if she hasn’t done them before she was married/had
kids. Have her block out time to work on these (and feel like she is
accomplishing something). This could be as simple as 30min/day playing the
piano or reading a book.
5. Time for her and taking care of herself is just as (if not more) important
than taking care of her kids/family…especially right now.
My experience was more like Gabrielle in #34. It took me 8 mos to recognize like wasn’t just going to go back to normal and get to a doctor. Not that anyone is reading this, since this is way old, but I found that being around other moms just made it worse because I would struggle with why they were happy when I wasn’t…and why they were enjoying their babies and talking about their babies…I still have a hard time being around other moms especially at church…
Julie and all others that commented…if you ever see this again…please join the yahoogroup so we can have an ongoing discussion…