Maybe No One Talks About Postpartum Depression Enough Because No One Is Actually Sure if They Have it

If you have had yourself a baby, then you’ve likely experienced the infamous “hormone crash” that comes with it — the out-of-this-world soar of humanity-affirming juice that makes you feel pain-free, lightweight and crazy in love with your offspring, followed by the swift, unceremonious thud of reality that hits a few days later, when, you realize, oh yes, I just gave birth, feel as if I’m perpetually wading in quicksand, and can’t stop sobbing. But if you were unsure as to whether this sudden shift from euphoria to melancholy is normal “baby blues” or full-fledged PPD, you wouldn’t be alone.

Make no mistake: It’s not that there isn’t any information out there on PPD. Judging by the media coverage of it, every celebrity lady who has had a baby has “struggled” with postpartum depression, and every woman who has killed her own young child was “clearly” experiencing postpartum psychosis. At a glance, this makes it seem both innocuous and terrifying, and neither of those things makes you in any rush to label yourself among its sufferers. Also, hello, in the thick of the early weeks of newborn care, you can barely brush your own hair, much less self-diagnose (and it doesn’t help that lack of interest in your own care is supposedly one of the symptoms).

In light of the tragic death of 45-year-old mother Cynthia Wachenheim in New York last week (said to have jumped from her apartment eight stories up, holding her 10-month-old in her arms — who, at present, survived) a piece called “It’s Time to Get The Facts Straight on Postpartum Depression” by Katherine Stone lays out the swell of misinformation circulating:

This happens a lot. There’s bad news — a mother has died, a baby is harmed, a celebrity speaks up — and the media decides it’s time to cover postpartum depression again. The writers or producers are in a hurry, which is their unfortunate general state, so they rush to grab someone to appear, someone who often doesn’t know all the facts. And what does this lead to?

A morning show equates PPD to the baby blues when they’re not at all the same thing, and the celeb mom they’re covering has to clarify she actually never had PPD. Postpartum depression is equated with postpartum psychosis when they’re very different. Common symptoms of postpartum depression, like anger and rage for instance, are never mentioned. Someone misstates when postpartum depression can occur. Someone else endorses bad practices for treatment, like quitting medications cold turkey or trying something that hasn’t been proven in any way by science to be effective. A national magazine article gets the facts wrong about screening or treatment effectiveness. A show furthers the idea that moms with mental illness are dangerous. I’m sad to say I can probably only count on one hand the number of talk show and news segments I’ve seen over the last 10 years where someone hasn’t gotten something wrong or furthered stigma.

But as Stone’s collection of links makes clear, if you’re a mother who thinks you might have PPD reading it, you’d still have to go on an Internet Easter egg hunt to read everything, synthesize the information, and then attempt to draw a conclusion about whether you’re affected — and would you be doing this before or after sobbing and nursing? (P.S. Even after reading all the information out there, you still won’t be sure if you’re sobbing because of PPD or because you haven’t slept well in weeks and your vagina hurts.)

It’s not just that there’s misinformation about PPD, it’s that the information isn’t as distinctively helpful as it might think. Let’s take a look at the signs and symptoms that distinguish baby blues from PPD, according to the New York State Health Dept. website the NYT piece on Wachenheim links to.

These are the “Baby Blues” — which happen to some 80% of mothers :

Feeling overwhelmed
Irritability
Frustration
Anxiety
Mood lability (ups and downs — mom is elated one minute, and crying the next)
Feeling weepy and crying
Exhaustion
Trouble falling or staying asleep
Time Frame — symptoms usually resolve by two weeks post delivery

These are the symptoms of PPD, which strikes in 10 to 20% of mothers:

Frequent episodes of crying or weepiness
Persistent sadness and flat affect (mom won’t smile)
Fatigue
Feelings of inadequacy or guilt
Sleep disturbances (not due to baby’s night awakenings)
Appetite disturbances
Irritability
Mood instability
Overly intense worries about the baby
Difficulty concentrating or making decisions
Lack of interest in the baby, family or activities
Anxiety may manifest as bizarre thoughts and fears, such as obsessional thoughts of harm to the infant
Poor bonding with baby: No attachment
Feeling overwhelmed
Thoughts of death or suicide
May also present with somatic symptoms, e.g., headaches, chest pains, heart palpitations, numbness and hyperventilation.
Time Frame — If symptoms lasts more that 14 days it is postpartum depression

What is somewhat clear is that PPD is not a brief difficult time, but something bigger and more sustained, something unlikely to resolve itself. But reading this list, I still have no idea if I had the baby blues or PPD after my own pregnancy. I was not suicidal, and did not have any inclinations of harming my child, nor did I have difficulty bonding. But as I struggled to adjust to hormonal changes, nursing difficulties, lack of sleep, and the challenges of parenting, I did experience everything else on that list to one degree or another in those first few months, for longer than two weeks, all in a fog of transformation and tentativeness about my role as a new mother.

And it seemed completely normal to me. Had I thought about harming anyone, I’d have been concerned. But short of that, all the stuff that COULD be PPD is also not that difficult to think of as normal, first-time mother anxiety/stress/worries/issues that will hit you on occasion when you are in the fog of it, regardless of how long it lasts. Never underestimate the lack of sleep on your judgment or emotional state.

Or your brain. One of the common things both my husband and I experienced as new parents were what we called “flash-forwards” — we got these flashes of all these ways our baby could be harmed by anything around our immediate environment. Some of them were mundane images — if you drop your baby on this hard tile floor, she could bust her head open. Others were truly absurd: Once, I imagined tripping over a pair of shoes kicked off thoughtlessly in a walkway, and saw me falling, and the baby flying up and out of my arms and sailing into the open refrigerator freezer. It was so ridiculous and improbable that I had to laugh, but it was weird, because I felt like I had no control over what my brain was “showing me.”

Brains are weird, their machinations elusive. If we want to play the evolutionary guessing game, it makes sense that to some degree your brain is going to make you, as a new parent, extraordinarily attuned to potential hazards that could harm your newborn. It’s how you protect your child. There were times I wondered why my brain felt so vigilant about it in those early weeks and months, but it eventually faded, and I can only guess it was all a result of underlying anxiety about new parenting, the real fear that my baby could be seriously injured in her first year of life, whether from SIDS or a bad fall. (This still happens when I walk into a new place: TERMINATOR SCAN, PARK EDITION: Rusty can at 11 o’clock.)

Again, I have no idea if this is “normal” or not, and I say all this not to minimize PPD, or to further murkify the waters here, but to illustrate how easy it is to chalk up the feelings to what is normal and expected in pregnancy, and how difficult it would be to make the call yourself while in the midst of navigating all this new, uncertain terrain.

Stone says:

I’ve been through postpartum OCD myself, and I’ve spoken with thousands of women who’ve had PPD. I know how they think. If you don’t mention a mom’s particular symptoms, she assumes she doesn’t have PPD, she’s gone crazy and no one can help her. If you suggest she do something that’s never been proven effective, she will try it because she’s grasping at every single straw to try and find a solution and she’ll probably end up wasting months and continuing to suffer, time that only has the potential to cement the potential negative lasting effects of PPD forever on her or her child. If you mistakenly cite the period of time when postpartum depression might arise, if her symptoms came after that she’ll be convinced no one can help her and will likely never make that call. This is life or death we are talking about. Details matter.

Which is why that, for something so critical to the wellbeing of mothers, children, and families, you’d think it would come up more often in prenatal and postpartum counseling. You’d think we would treat the issue like something that every single new mother is at risk for, right in there with the lectures to avoid drinking, smoking, and excessive weight gain.

Personally, of the at least seven pregnancy-related emotional “disorders” I could have experienced, I can tell you that exactly zero of those things was ever mentioned to me during the entire course of my pregnancy, not even once. It wasn’t for want of the opportunity. There is perhaps no more captive audience than the broody pregnant woman, devouring untold quantities of information about her diet, health, wardrobe and how to best prepare for the birth of her child.

I had an OB-GYN for part of my pregnancy, and then, four — count ’em, FOUR — midwives, when I switched midway through to a midwifery program at a reputable university. And yet, I was talked to far more frequently about my “old” age at pregnancy — 33 — and the risk of gestational diabetes than I ever was about my emotional state.

And, after most women give birth, your first appointment to check back in with your doctor is typically not for six weeks, and it’s usually just a medical exam. Six weeks! By that count, the average woman would be a month into the potentially dangerous symptoms of PPD before she would even pass back through the net of the medical community to get on someone’s radar.

Of course, the issue here is that we need better information, better prenatal and postpartum care that centers around more than just giving you a thumbs up to return to intercourse at six weeks, and the awareness to more accurately help pregnant women and new mothers understand the warning signs of PPD, so that they aren’t left playing armchair psychologist about their own emotional problems during this extraordinarily transformational time in their lives.