Postpartum Depression is a very narrow term that encompasses a broad spectrum of mental health disorders that affect 20% of women during pregnancy and up to one year after the baby is born. If you did not know this, you are not alone. I am an OB/GYN and my training only taught me to look out for severely depressed moms who had thoughts of killing themselves or their babies. So when I developed severe anxiety, panic disorder, and obsessive compulsive behaviors I had no clue that this was not just the hyper-vigilance of a new mom. I thought it was normal to not be able to fall asleep and to imagine every possible scenario in which my child may get hurt. I thought it would get better as my daughter got older but when she started crawling and putting things in her mouth I constantly imagined she would choke on something or poison herself. I almost gave into the industry created just for people like myself- professional baby proofers who for thousands of dollars baby proof your home so that every possible disaster scenario can be avoided. I doubt this would have assuaged my anxiety however as the mind has a way of then moving on to the next readily available disaster scenario. My friends teased me because now that I was a mom I went to bed at 8pm. This was because I was so exhausted from constantly being on high alert that I could not function by evening. It eventually got to the point that I could no longer enjoy a lot of the activities I used to or the normal moments with my daughter without preparing for what may happen and my anxiety became compounded by depression. Ironically it was living in the epicenter of the COVID pandemic that finally gave me the path to reclaim my sanity. The stress of COVID accelerated the decompensation of my mental health. I became so run down that I had no energy to get through the day and I could not focus very well. I began to worry that I was suffering from autoimmune disease or cancer. I had a low point and I was forced to start searching for answers.
I eventually gained insight into my disorders when I read this article in the New York Times and subsequently the book Ordinary Insanity that is the subject of the article. Some of the initial stories in the book seemed very extreme to me, but as I kept reading more and more of the stories resonated with me. I was dumbstruck. How could I, a board certified OB/GYN, spent two years suffering and found myself on the precipice of an emotional breakdown before I was able to diagnose my own severe anxiety and depression? I then went online and administered the Edinburgh Postpartum Depression Scale, a screening tool used for determining women at high risk, to myself. I scored off of the charts. I had never really fully paid attention to the survey but instead focused on tabulating scores and making sure patients did not answer affirmative to the question regarding suicidal ideation. When I had delivered my daughter my obstetrician had never asked me pointed questions in regards to anxiety, depression, PTSD, or OCD. She was very compassionate however the topic of perinatal mood and anxiety disorders never once entered the conversation during my pregnancy or postpartum visits. This is very common as postpartum depression, along with the rest of mental health care, is only now gaining the attention it deserves. We are still a long way from where we need to be to have the necessary conversations, normalize and de-stigmatize the diagnosis and treatment of mental health conditions, and improve access to basic mental health services.
Postpartum depression includes depression, anxiety/panic disorder, obsessive compulsive disorder, post traumatic stress disorder, bipolar disorder, and postpartum psychosis. OB/GYNs are not trained on how to appropriately diagnose and treat these disorders. Only recently has the topic of perinatal mental health started to gain more awareness. Many providers have started screening patients at their six week postpartum visit for postpartum depression, however the most common tools, the PHQ-9 and the EPDS, are checking for symptoms of depression and will not pick up anxiety, OCD, PTSD, or bipolar disorder. Women are often not asked how they are doing in a way that will really pick up these symptoms and a lot of women will say they are fine even when they are not because they either think that what they are experiencing is normal or they feel bad or guilty not being a perfect mom and for having feelings that do not align with what society tells us we should feel when we are pregnant and new moms. Many women, such as myself, also do not realize when their normal preoccupation with the baby tips over into clinical anxiety, panic disorder, or OCD. They may not be able to differentiate when their “baby blues”, which is almost universal, tips over into depression. Women can also develop mania or paranoid delusions and postpartum psychosis but not appear psychotic to others- I have had conversations with women who are very placid and calm but admit that they thought about killing themselves or drowning their baby when asked targeted questions. For some women these thoughts are intrusive, they are horrifying, and they would never even want to think about harming their baby but they can not keep the nightmarish images from popping into their head. For others, the thoughts are part of a belief that they need to find a way out and they feel that killing themselves and/or their baby is the only way to escape the world they are living in.
There are many online resources, support groups, and hotlines to help women who are suffering from any of the disorders along the spectrum of peripartum mood and anxiety disorders (PMADs). The largest online resource is Postpartum Support International. There is a wealth of helpful resources on their website including access to a 24/7 warm call line and free weekly support groups. Postpartum Progress, the largest online blog, has the New Mom Checklist for Maternal Mental Health Help which I love. It is often difficult for both patients and providers to discuss mental health and this checklist is a great tool to help women voice their concerns. We all need to become more comfortable having conversations regarding mental health, especially when it involves women during such a vulnerable time in their lives. All moms should feel empowered to speak up for themselves and ask for help without fear of judgement- do it for yourself, your baby, and your family. For the rest of us we need to talk to the moms in our lives, ask more questions, and listen better. We need to create a supportive space where moms feel safe to talk about how they are feeling. Please join Metamorphosis to Mom, my new community for moms and moms to be, where I will be posting more resources from experts on this and other important topics to help moms on their journey. And please, never hesitate to ask for help when you need it.