Promoting Hope, Preventing Suicide

Research and advice on preventing teen and adult suicide

The Happiest Mommy on the Block?

Can depression screening help pregnant and parenting women?

Cynthia Wachenheim, a mother for just a few months more than I’ve been, died last week by suicide. I read news of her death through a different lens than I would have viewed it several months ago. Coinciding with new research about postpartum depression, Wachenheim’s death poses an opportunity for the mental health community to consider some critical questions. 

After the new-baby sheen wears off, it becomes clear that there’s nothing easy about being a parent. It sometimes feels like one of those terrible dreams when you realize there’s a final exam for a class you didn’t even know you were taking. Even the most prepared people aren’t prepared. And once you feel like you’ve “mastered” something, your child changes and you realize who’s really in charge.

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On one of the few breaks I’ve had from my new little master, I found myself stuck on a page in Naomi Wolf’s book about motherhood, “Misconceptions.” She lays out the range of normal feelings and perspectives many women experience in the first weeks and months following childbirth:

I am so irritable. I can’t sleep. I can’t think straight. I am nauseated. I feel so nervous. I feel so guilty. I feel so ugly. I feel like a failure. I have no interest in sex or other normal activities. I cry all the time. I can’t get going. I feel so worried. I can’t stop eating. I have scary thoughts. I feel so alone. I feel so ashamed. I feel so tired. I can’t feel anything.

It struck me how true many of these statements would be for anyone experiencing depression - anyone, man or woman, experiencing depression at any point in life.

It appears that the normal range of emotions for women following the birth of a child includes the symptoms of clinical depression.

That’s how much having a baby can affect your body and mind. And that’s why new research on screening for postpartum depression is so important.

A large study conducted in a Pittsburgh hospital found that as many as 1 in 7 women experience postpartum depression. Of the women studied, 20 percent were identified as being at risk for suicide, some with plans for how they would end their lives.

These numbers, along with Wachenheim’s recent death and stories I’ve heard from peers about postpartum depression, raised a number of questions for me that challenged some of my own conventional wisdom about screening and depression.

  • I can’t help but wonder if we, culturally, normalize the experience of depression that many women have following pregnancy and childbirth. Is it really okay - “normal” - to feel nervous, or like a failure, or like you can’t get going? Is it okay to feel that way for a couple of weeks after you have your baby, or a couple of months, or a year? 
  • Do we miss an opportunity to treat women with depression by separating out the “baby blues” from more “serious” depression? How important are these distinctions when potentially 1 in 5 new mothers at risk for suicide?
  • We know that screening without adequate resources for supporting pregnant and parenting women through depression creates a challenge for the system. If more women are identified as needing help, but there aren’t enough resources, where do those women go?
  • Is it critical for a woman to be seen by a mental health provider who specifically understands postpartum depression? Or is it enough to be seen by someone who just really understands depression?

Just a couple of weeks after my son was born, a friend came to visit me. She shared: 

“For nine months after my daughter was born, I thought, ‘This can’t be my life.’ But, I thought that was how you were supposed to feel after you have a baby, because your life does change in so many ways. I didn’t realize that many people don’t feel that way at all. It took going to my doctor and crying in her office for the whole appointment for me to realize that I had been experiencing postpartum depression the whole time.”

How many other women have a similar experience? How many get help? How many do not? Now, in the shadow of a mother’s death, it seems particularly important for us to find out.

Copyright 2013, Elana Premack Sandler. All rights reserved.

Elana Premack Sandler, M.S.W., M.P.H., is a public health social worker specializing in violence and injury prevention and adolescent health promotion.

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