Postpartum Depression

The baby's here, and I'm not doing cartwheels. Instead, I feel worthless, sad, weepy, and irritable and there's no sign of these feelings going away! Learn how to recognize symptoms of Postpartum Mood Disorders and what to do when it's more than the blues!

Lauren Hale, founder of PACE & PSI Coordinator for Georgia, will discuss how to prepare yourself, your family, and how to talk with your doctor if things aren't getting better if your symptoms have gone on for more than a couple of weeks.

Lauren is the owner of Unexpected Blessing, the Founder of PACE, runs a Message Board at iVillage and is sinking her teeth into her newest endeavor, a Project for Dads.

Welcome Lauren!

Lauren Hale: Hi Tiffani! I am so happy to be here today!

Tiffani Lawton: We are so happy to have you here!

Lauren Hale: Thanks. Learning about Postpartum Mood Disorders is so important yet it is one thing that is often forgotten in preparation for childbirth and if it is remembered, it is glossed over quickly, leaving new families floundering in confusion if anything more serious than the blues hits. For instance, let's say that a childbirth class is being held and there are 20 women in the class. 16 of the women in the class will experience normal emotional fluctuations, termed the "blues". The blues typically consist of mom crying for no reason or becoming stressed. However, the blues usually fade within two weeks or so and generally don't interfere with day-to-day living. When an overwhelming sadness, irritability, or new symptoms such as inability to sleep or rest, not taking care of oneself, or if potentially frightening thoughts about hurting oneself or baby start to enter the picture, it is definitely time to seek help.

But the majority of women who experience PPD won't have extreme experiences. That being said, no experience should be negated because you never know how that particular woman is handling things. Even the mom who looks pulled together while you've barely managed to get mascara on may be struggling and hiding it really well. That is one of the biggest lessons I've learned from my experiences - you can't tell just by looking which mom has PPD and which one doesn't.

Tiffani Lawton: You are so accurate, many women slip through completely unsuspecting, because they want to hide it due to the stigma

Lauren Hale: The stigma of PPD does keep a lot of women from seeking help. They are afraid they will be judged by others, seen as having failed, and more often than not they fear their child will be taken away if they admit how they're really feeling to some one. I was a great actress myself and was pretty much ignored by my first doctor because I was well-groomed, smiling, and appeared to be doing well. Meanwhile, I was having horrible intrusive thoughts about harming my child, unable to sleep well, and uncontrollably angry over everything.

Tiffani Lawton: How can health care providers see beyond the mask that women wear?

Lauren Hale: They can probe a bit deeper - ask how Mom has been sleeping, get permission to speak with the mom's partner because they may have noticed symptoms mom may not be owning up to. It is a hard thing to get past though because unfortunately we cannot help those who are not ready to ask for it.

Let's get into how to recognize a PMD (Postpartum Mood Disorder) and what symptoms women and their loved ones should look out for. Postpartum Mood Disorders is actually an umbrella term and refers to a wide range of emotional disorders than may occur after giving birth. Jodi Kluchar was here last week to discuss Postpartum Traumatic Stress Disorder. Some of the other disorders often included under the PMD umbrella are:

• Postpartum Depression
• Postpartum Anxiety
• Postpartum Obsessive Compulsive Disorder
• Postpartum Psychosis

Here's a list of general symptoms for the PMD's:

• Difficulty sleeping, even when the baby is sleeping,
• Sleeping too much,
• Appetite changes,
• Feeling irritable, angry, or nervous,
• Feeling exhausted,
• Lack of ability to enjoy life as much as in the past,
• Lack of interest in the baby,
• Lack of interest in friends and family,
• Lack of interest in sex or even being touched,
• Feeling guilty or worthless,
• Feeling hopeless,
• Crying for "no reason",
• Feeling as if you are a bad mother,
• Difficulty concentrating or focusing,
• Thoughts of harming self or the baby.

One symptom many moms overlook quite often is; uncontrollable anger and increased irritability. I suffered from both of these - I was not sad, I was angry. I snapped at my husband, at the dogs (for looking at me the wrong way), at baby for well, crying. What on earth was wrong with me? A lot of moms think that unless they're crying, it can't be a PMD. I'm here to tell you it CAN be.

Tiffani Lawton: Depression often manifests itself in the form of extreme irritability, it is not always laying in the bed crying into the pillow

Lauren Hale: Precisely! There has been increased attention to this particular symptom recently which is a tremendous relief because it IS a symptom yet not one often associated with Depression in the general course of thought.

I would like to talk about Postpartum Psychosis and Obsessive Compulsive Disorder first. Both of these are very similar but the rate of occurrence for Psychosis is one per two thousand births. This means out of four thousand mothers who give birth, only TWO moms have a chance of developing psychosis. Many times Psychosis erupts as Psychosis and does not start out as Postpartum Depression.

Psychosis manifests quickly (typically within two to three days) and has a very specific set of symptoms that would be difficult to miss such as delusional thinking, irrational behavior, difficulty in making decisions, belief that God or a higher power has commanded a particular behavior. Psychosis has a four to five percent suicide/infanticide rate, making it the most lethal of all the Postpartum Mood Disorders which is why so much emphasis is put on this particular condition. It is a medical emergency and a mother suspected of Psychosis should NOT be left with her infant under any circumstances. She should be transported to the ER immediately.

Tiffani Lawton: This topic is of utmost concern for me because the media needs to get the help to these women instead of just waiting to bite on the next sensational story

Lauren Hale: I totally agree. In fact, I have started an award program at my blog, Unexpected Blessing that is designed to recognize journalists who do their homework in the realm of Perinatal Mood Disorders.

Tiffani Lawton: What are the awards?

Lauren Hale: The awards are called the "Grace Awards" and are given out quarterly. I'm a little behind now - life gets in the way sometime!

Tiffani Lawton: That is a great program...

Lauren Hale: Thanks - it started as a response to an article I read in which a journalist basically stated that the blues and psychosis were the same thing. I got SO angry!

Tiffani Lawton: EEEE! That would have infuriated me.

Lauren Hale: Psychosis can be a result of improper medication as well, something I do want to address as it did happen to me. This is why it is of the utmost importance to discuss your meds and any new symptoms that occur on them with your Psychiatrist or caregiver. After my second daughter was born, I was put on medication at just 10 days postpartum. She had a cleft palate and underwent major surgery at just 9 days old. The medication I was on worked until she had been home for a month. My dosage was upped and things really started to go downhill. I suffered from Obsessive Compulsive Disorder but the intrusive thoughts began to make sense to me and I finally crawled into bed and just laid there in the fetal position afraid to get up. I was hospitalized and my medication was changed. Things began to improve greatly. But I did the right thing - I sought help and was thankfully able to change the course of things.

Tiffani Lawton: It is terrific that you were able to seek help

Lauren Hale: Everyone at my OB's office, the ER, and the psych hospital I went to was awesome.

Now, onto Obsessive Compulsive Disorder. This is the one I have had personal experience with - twice. And yes, I am here to tell the tale. When you suffer from PPOCD, you have what are termed intrusive thoughts. Intrusive thoughts are typically graphic in nature, disturbing thoughts of harming your baby, imagining worst case scenarios, etc. With my first baby, I couldn't be near knives. With my second, it was pillows. My Compulsion? Cleaning. My house was SPOTLESS. When my second was born, she had a cleft palate and I pumped for seven months. Whoo - I LOVED (and yet hated) the cleaning routine for that. It fed into my OCD big time. Three to five percent of new moms will experience PP OCD making it one of the rarer disorders yet it is the one closest to psychosis. The difference between Psychosis and OCD is that moms who have OCD will RARELY harm their children.

As soon as you have an intrusive thought, you are disturbed and horrified at the thought that just flew through your mind. This is YOUR CHILD - How on EARTH could you think such horrid things? What's wrong? You would never do that! Right? Right?

I often tell moms that as long as you are immediately horrified, it's OCD. It's when the thoughts begin to manifest in such a way that they make sense or you find yourself rationalizing them that you should seek help immediately. It's a good idea to have a point person with whom you can openly discuss your feelings because honestly, if you are at a point where these thoughts start to manifest this way - you may not be able to seek help

Tiffani Lawton: Please describe "imagining worst case scenarios".

Lauren Hale: Worst case scenarios such as a tremendous flood, fire, someone breaking into your house, extreme things that are not common occurrences. I had to stop watching the news and am still on a news blackout for the most part.

Tiffani Lawton: I ask because I am an obsessive worry wart. I worry about my teens, my tots, very emotional...

Lauren Hale: My strong faith has really allowed me to give a lot of things to God now and I worry a lot less. My general rule is that if it doesn't affect me right here and right now, I don't worry about it.

Postpartum Anxiety involves anxiety/panic attacks and increased worried behavior about the baby. Mom goes to check to see if baby is breathing, hovers, doesn't like others caring for baby because she's convinced no one else can do it right. Anxiety attacks feel quite a bit like a heart attack - your chest becomes constricted, your breathing becomes shallow, sometimes you black out. The key to dealing with a panic attack is to interrupt the process.

If you feel one coming on, imagine a stop sign, start singing a favorite song, if you're driving, pull over to the side and take deep breaths. Get out of the car if you can and walk back and forth for a few minutes, call a friend, or take a cold shower. Make sure to be honest with your caregiver about these symptoms as anxiety attacks will require a different type of medication than the standard SSRI. But I digress as medication is something that should only be discussed between you and your medical professional.

Postpartum Depression is when Mom feels increasingly sad and heartbroken. She doesn't want to get out of bed, doesn't want to have anything to do with baby, doesn't shower, just feels worthless and isn't eating. This too needs to be treated by a professional. And as we spoke about before, anger can also be a symptom.

Treatment options for PMD's is vast - there are a lot of options open to moms but first mom needs to get to a caregiver. As I support moms through the postpartum period, I respect their choices. I offer them reliable information for whatever form of treatment they have chosen to be best for them and their families whether that be SSRI's, herbal treatments, electro-shock therapy, EMDR, acupuncture, CBT (Cognitive Behavioral therapy), etc. As a peer support person, it is my goal to support and not interfere with the choices of families I work with. I do offer advice on how to approach your doctor though - something a lot of moms just don't know how to do or are nervous about doing. It is very intimidating to let someone else know that "No, things are NOT ok". On a certain level, this feels like failure. But in this case it is not. It is doing the right thing, the brave thing, the courageous thing. Admitting something is wrong is the biggest step towards recovery and should be commended.

When you have made the decision to approach your doctor, do so with conviction. Be forceful and demand to be seen ASAP. Do not let office staff dismiss your concerns and if your doctor does so, find another doctor. You deserve to be heard and you deserve to be treated with compassion. Once you've made the call, make a list of symptoms you've experienced. Take another person with you to the doctor's office, preferably someone who is with you everyday and knows you intimately. They may have noticed symptoms you have not been aware of and can help in speaking with the doctor if you lose your courage. If your family struggles with understanding PMD's, you can refer them to Postpartum Support International or to Karen Kleiman's site Postpartum Stress Center. Both sites have excellent resources and information regarding PMD's and how family members can help. If your husband is particularly resistant to your treatment and aiding in recovery, a trip to the OB's or Psychiatrist's office with you may be the ticket to helping him understand.

Tiffani Lawton: Have you heard from women who sought help, only to be turned away?

Lauren Hale: I have. I have also experienced that first hand.

Tiffani Lawton: What do you advise them to do in these cases?

Lauren Hale: Being told that it can't be postpartum depression or to call back later because you're not yet thinking of suicide (yes, I've heard that one) is extremely frustrating. I advise them to go to their local ER or another caregiver. I offer to help them find practitioners in their area or help them get connected with their PSI Coordinator who can also help them find reliable help

Tiffani Lawton: There is a PSI coordinator in every state, correct?

Lauren Hale: In just about every state, correct. Even if there is not a Coordinator, there are members in at least every state and we can work with them to help moms locate help.

Tiffani Lawton: I feel that not enough OB's, GP's or even mental health practitioners are adequately education about perinatal mood disorders

Lauren Hale: Amen to that. And this is precisely why the Mother's Act is a very valuable piece of legislation

Tiffani Lawton: For women who are waiting for the blues to just pass, when should they seek help?

Lauren Hale: The blues can last anywhere from a few hours to a couple of weeks. If you're still feeling down and/or things have worsened or new symptoms have appeared by the end of the first month after giving birth, it's time to get some help.

Tiffani Lawton: So if mom is at 6 weeks, and still feels off, she should look for help?

Lauren Hale: Precisely. Most OB's do ask how you're doing at the 6 week visit but I wish more ped's would pay attention to how mom is doing in those first few weeks as they see the new family more than the OB

Tiffani Lawton: I agree with that 100%...the whole family is the patient in pediatrics and doc's often forget that

Lauren Hale: Yes, the whole family is the patient in pediatrics. Our new pediatrician follows that belief and is the reason we chose her.

Tiffani Lawton: Do you find alternative therapy helps many women?

Lauren Hale: A lot of moms are turning to alternative therapy as another option as they want to breastfeed and don't want medication in their breast milk. I know quite a few women who have had success with this approach and there is a blog, www.wellpostpartum.com which is run by Cheryl Jazzar. She offers wonderful insight and contacts into this emerging field of treatment. I have learned so much from her.

Tiffani Lawton: Cheryl is amazing, she will be one of our upcoming chatters!

Lauren Hale: I'd like to talk briefly about pregnancy after postpartum depression. When I found myself unexpectedly pregnant after my first two episodes, I was understandably nervous. I had already started to educate myself and do peer support for other families. I reached for my copy of What Am I Thinking? Having a Baby after Postpartum Depression by Karen Kleiman. It inspired me to start my blog, Unexpected Blessing. One thing Karen points out is that a healthy fear is a good sign. A lack of fear or an overwhelming fear are not good signs. These feelings should be evaluated by a professional.

Through my blog and increased contacts with professionals in the PPD care realm, I re-framed my pregnancy and did a LOT of preparation. I educated my family, my husband's family, my daughters (yes, even my four year old understands postpartum mood disorders - ok, it's in toddler speak, but she gets it), and I remained in therapy and shared my concerns openly with my OB. I was confident and outspoken and worked with my doctors. I did end up with a little additional anxiety after birth but thankfully did not relapse into a full blown case as I was able to recognize the early symptoms. I also created a Postpartum Action Plan. My in-laws, parents, OB, therapist, and husband all received copies. This included my past mental health history including what my previous PPD symptoms had been, what therapies had NOT worked for me, what had worked for me, the contact info for my therapist and OB, husband, family members, friends, important website links, and who could or could not be made privy to my emotional state and care. If you would like a template copy of this, feel free to email me at ppdacceptance@gmail.com and request the PPD Action Plan as well as a Prenatal Guide to Postpartum Mood Disorders.

Tiffani Lawton: This is EXCELLENT! What a brilliant idea, the Postpartum Action Plan!

Lauren Hale: Karen Kleiman has a Postpartum Pact available. It's a great place to start to sit down with your partner and get prepared.

In closing, I'd like to remind folks that PPD is temporary, it IS treatable, and above all, it is NOT YOUR FAULT. It's not anyone's fault. The best thing a woman struggling emotionally after childbirth can do is to talk about it. Get your feelings out in the open with other women who have been there and can relate to you and won't judge you for your thoughts and feelings. You will get better with help and there's a lot of help out there. The key is to find it before you need it and utilize it as soon as you even think there may be a problem.

Cesarean Society, a support group within Pampered Pregger & Beyond, hosted this online chat. The Cesarean Society meets the 4^th Tuesday of every month for a monthly chat. Come join us!