This Isn't What I Expected

Notes on healing postpartum depression

Journalists, Doctors, Everyone: Let's Get it Right

Definitions and distractions are sending mixed messages

 

Let’s get it right. Lives depend on it.

There are, to be sure, tons of complex theories and contradicting explanations when it comes to mental illness and diagnoses. Discussing maternal mental health is no exception. Definitions are blurry, research is not always consistent with what we see in clinical practice, experts challenge existing classifications, and perhaps above all, what is printed in words does not necessarily hold true for any individual woman’s experience. Thus, explanations remain ambiguous and open to interpretation.

What IS postpartum depression?

When a (trigger alert) tragic story splashes the headlines, we again engage in a national conversation reporting diagnoses and definitions; we explore meanings and implications that carry profound significance. Media outlets, hungry for exposure, typically raise the question of whether these heartbreaking catastrophes are the result of “postpartum depression.” However well-intended, this reference misdirects our attention and focuses on the wrong illness.

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There are not a lot of absolutes in this field of study. Mental health issues are forever misunderstood and misrepresented. I have accepted that this lack of clarity comes with the territory and have tried, for three decades, to be a spokesperson on behalf of what we DO know. And to be fair, more recently, some journalists are beginning to get it right. Some do correctly differentiate between postpartum depression and postpartum psychosis. This is a huge step in the right direction.

Recently, there was an impressive study  (Woolhouse) that raised important questions about whether our current mental health practices and primary care for mothers are actually sufficient. The research concluded that the proportion of women experiencing depression is HIGHER among mothers of four year olds, than among mothers within the first 12 months after childbirth year. This is huge information and reminds us that we are not done paying attention to a mother’s mental health after the first postpartum year.

It’s not surprising that the Internet is all over this and the study is being posted for the general public to see that we are increasingly expanding our knowledge about the mental health needs of mothers. This is wonderful.

However, this morning, I read this article on the subject - same great information, same research, same references to the great significance of this research, same everything.

Except for one thing. The title of this particular article: “Baby Blues More Likely After Four Years of Childbirth.”

Really?

Read the words. “Four Years of Childbirth?” Okay, I'll give them a break. They meant to say, "Four Years After Childbirth." Honest mistake.

However, more disturbing: “Baby Blues.”

Baby blues? Four years "of" or after childbirth? C'mon. It's time to get this straight.

Though it may seem irrelevant, if not nit picky to highlight the inappropriate words chosen for one article, it speaks to a pervasive pattern of misinformation that infects public access to information.

Let’s be clear about we do know:

1) Baby blues ONLY occur during the first 2-3 weeks postpartum. 

Baby blues refer to a hormonally driven, time-limited, transitory event, marked by emotional lability, anxiety and sadness, alternating with periods of joy and excitement, fatigue and irritability. This is considered a “normal” post-childbirth experience, and occurs in almost 80 percent of all new mothers. No treatment is necessary and these mild feelings of distress resolve on their own. If symptoms that appear to be or feel like the blues, last longer than 2-3 weeks, it is not baby blues.

Doctors, healthcare providers, journalists and other professionals who are dedicated to maintaining and improving maternal health need to learn and remember this. If symptoms that appear to be blues-like linger beyond the 2-3 week marker, it is no longer the baby blues. It may be another postpartum mood or anxiety disorder and requires a comprehensive assessment.

 2) Women with postpartum depression do not kill their babies.

Women with postpartum depression (sadness, guilt, anxiety, fatigue, weepiness, irritablity, hopelessness, insomnia) go to extreme lengths to protect their children. Actually, women with postpartum depression are much more likely to kill themselves and the potential for suicide is high when symptoms are severe. There is mild postpartum depression, moderate postpartum depression and severe postpartum depression, depending on the intensity of symptoms and level of distress. Severe postpartum depression is not the same thing as postpartum psychosis.

Women with postpartum psychosis, which is an illness, distinct from postpartum depression, can (unbelievably so) hide their symptoms of psychosis (hallucinations, bizarre beliefs, paranoia, delusions) to some extent. Family, friends, healthcare providers must be vigilant if psychosis is suspected or if she is at risk. Symptoms are aggressive and always an emergency. 

Why is it so urgent that we get this right? Because women are scared. Women are confused. When the media and their own doctors are not clear, how can we expect them to find comfort in the care they are receiving or the words they are reading?

As we increase awareness, we can, inadvertently increase anxiety if we are not careful. Those of us who work in this field, in any capacity, have a responsibility to be clear about what we are saying and how we are saying it. Be informed. Do your homework. There is a great deal at stake. 

 

copyright 2014 Karen Kleiman, MSW

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Karen Kleiman is founder and director of The Postpartum Stress Center, a treatment and training center for prenatal and postpartum mood and anxiety disorders. more...

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