Wednesday, October 24, 2007

When Childbirth Brings Sadness

PSI: Blog Day for the Mothers Act

You are handed a tiny precious thing after the most exhausting and painful experience of your life and you are expected to give it total care. You are two vulnerable animals, one big, one small, and with luck and some compassionate help, you will both emerge from the infancy period intact and in love.

But you have caught a glimpse of the unthinkable. You hear whispers of the worst - when you sweetly sing the rock-a-bye song of hatred to this helpless bundle, when the wind blows and the cradle rocks, when you are jerked awake for the fourth time in one long night with no desire left to care for her, when you stumble forward driven by nothing but some automatic maternal machine and the vague hope that this will get better, better, in a few days.

I went to see my friend and her new baby. He was beautiful, perfect. Tucked into a round bundle in her sling, his long dark lashes resting on his cheeks, he was the picture of a blissfully peaceful newborn.

But my friend looked at me with hollow eyes. She was transformed. Here before me was a woman I had always and only known as confident, talented, highly competent. She is a friend and colleague I had admired from the day I met her. An excellent educator, hostess extraordinaire, pie baker, quilt-maker, artist, confidante. And all these talents executed with love and laughter. Now she looked lost and tired.

“I think having him was a mistake,” she whispered.

I listened with a sinking heart. I felt helpless. I’ve known deep loss but I had nothing to say in the face of grief like this – how do you comfort someone whose very abundance has created her own despair?

Anna M. Georgiopoulos, MD, defines postpartum depression (PPD) as "is a serious, common, and treatable condition. The effects can be devastating for the entire family. The couple’s relationship often suffers and women afflicted with PPD are at high risk for recurrent depression. Children of depressed mothers have been reported to have impaired cognitive development and behavioral disturbances." ("Routine Screening for Postpartum Depression" in The Journal of Family Practice.)

I tried to respond to my friend with sympathy and understanding.

I tried to tell her the postpartum period is hard, but temporary. But even as I said this, I knew that words alone are sometimes not enough. Tell a depressed person that her thinking is wrong, that she has every reason to be happy and you have only added to the chorus of destructive voices in her head.

I’ve felt depression; I’ve seen mental illness strike people I love. And I’ve learned there are some spirals of despair that talk alone cannot pull us out of.

On October 15, the Melanie Blocker-Stokes Postpartum Depression Research and Care Act passed the House of Representatives by an amazingly bipartisan vote of 383-3. The bill expands PPD research and services for those women and families afflicted with the disorder.

Melanie Blocker-Stokes’s story is harrowing. The hotel where she plunged to her death looks over the Lincoln Park zoo. I think of her and her anguish every time I catch a glimpse of the Days Inn sign through the trees when we are walking through Lincoln Park. The passage of the bill in Melanie's name is a great victory for her family, and especially for her mother who became a passionate activist for PPD research and prevention after her daughter’s death and for new mothers and those close to them.

However, as Dr. Georgiopoulous continues, “despite the serious consequences and the availability of highly effective pharmacologic and nonpharmacologic therapies, PPD often remains unrecognized and untreated. Routine screening for postpartum depression is not common in the United States.”

In a recent survey conducted by researchers at the University of North Carolina at Chapel Hill, a majority of doctors do not probe for signs of postpartum depression in new mothers. Of the 228 North Carolina physicians responding to the survey who said they had seen women for postpartum visits in the previous three months, 79 percent said they were unlikely to formally screen the patients for depression.

Here is the published study in the May/June 2007 North Caroline Medical Journal.

The Mothers Act is a bill seeking to increase screening for the disorder. In part, the bill ensures that “new mothers, during visits to a physician, certified nurse midwife, certified midwife, nurse, or licensed healthcare professional who is licensed or certified by the State, within the first year after the birth of their child, are offered screenings for postpartum conditions by using the Edinburgh Postnatal Depression Scale (EPDS), or other appropriate tests. If the results of such screening provide warning signs for postpartum conditions, the new mother shall be referred to an appropriate mental healthcare provider.”

You can find out more about the MOTHERS act and how you can support it at Postpartum Support International and Postpartum Progress.

My friend eventually sought out a prescription for an anti-depressant and took it for a time. Her brightness, humor and perception returned. She bonded tenderly with her son who grows more and more wonderful every day.

Today is Blog Day for the Mothers Act. Go to Blogher to read more posts about this important issue.

Here is a wonderful blog by a woman who not only writes eloquently about her own post partum depression, but offers help, comfort and a wealth of information to others who are looking for answers about PPD.

And here is my review of Brooke Shields book about her battle with PPD.

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