Postpartum Depression. We’ve all heard about it. Most pregnant women have read about it. Many of us know people personally who have experienced it. As one of the most common complications of childbirth, nearly 1 in 7 women (about 500,000 per year) will experience Postpartum Depression (PPD). In spite of this high prevalence, there remains a stigma to the disorder that leaves many women undiagnosed and untreated during an extremely vulnerable time.

Having a baby and becoming a mother does not come without challenges. Even in the “best” circumstances, its really hard. How many times in your life will someone tell you to go through the rigors of labor and delivery, then proceed to stay up for hours on end, nursing, changing, burping, and generally attending to someone else’s needs without an end in sight? Any parents reading this can probably vividly remember what I am describing. I know I sure can.

As a mental health professional, I knew the warning signs to look for. I made sure to discuss them with my husband so he would know how to intervene. In spite of this, I was still surprised when some of the symptoms popped up. I was even more surprised at the feelings of isolation and shame I felt following the birth of both of my two children. I had beautiful, healthy babies and yet had moments where I felt angry, scared, sad, anxious, and questioning my ability to be a “good mother.” I also wondered what others would think if they knew I was feeling this way. I stayed quiet. While my symptoms didn’t develop into a full PPD episode and resolved relatively quickly, my reluctance to openly discuss my feelings gave important insight into the shame and stigma associated with the illness.

It’s normal to feel exhausted, emotionally labile, tearful, scared, and anxious in the immediate postpartum period. Approximately 50-80 % of women experience these symptoms that are commonly referred to as the “Baby Blues.” The Baby Blues are largely related to rapid hormone changes occurring in a new mom’s body. Symptoms typically peak 5 days after delivery and are resolved within 2-3 weeks after birth.

PPD is more than just the “Baby Blues.” PPD is an extremely agitated depressive episode that involves a number of symptoms that can interfere with a mother’s ability to care for herself and/or her baby. The Postpartum Stress Center outlines the following symptoms for PPD:

• Weepiness, excessive worry, agitation, anxiety
• Feelings of inadequacy, hopelessness, despair
• Difficulty sleeping, exhaustion
• Changes in appetite, weight loss/gain
• Distorted/negative thinking, ruminations
• Scary, ego-dystonic thoughts about baby
• Guilt, sadness, fear of being alone, irritability
• Difficulty concentrating, panic, anger
• Thoughts of death, dying, suicide

PPD can significantly impact a mother’s ability to care for herself and her baby. With such high stakes, it is critical to consider why more women aren’t getting treated for PPD. There are a number of barriers that prevent women from accessing appropriate treatment and support and many are related to the stigma associated with the illness.

(1) Mother-related barriers

• Many women are in denial of the severity of their symptoms.
• Confuses clinically significant symptoms with normal maternal adjustment difficulties.
• There can be an inability to mobilize self to reach out for help; feeling stuck.
• Desire for a quick fix.
• Afraid of potential stigma of being labeled as “depressed” or a “bad mother”

(2) Physician-related barriers

• Failure to adequately screen for postpartum distress of any kind.
• Failure to recognize symptoms for what they are—many moms go to great lengths to hide just how bad they are feeling.
• Misinterpreting PDD for the Baby Blues; often results in being told they will “feel better soon” when it might not be true.
• Failure to refer for medication evaluation or supportive therapy.

(3) Environment-related barriers

• Societal pressure—we live in a society that expects (and often demands) women be happy and resume normal functioning shortly after a new baby arrives.
• Family expectations—new moms may be under pressure from family to behave a certain way as a mother. She might not tell those around her how bad she feels if she thinks they will tell her to “suck it up” or perceive her as a bad mom.
• Geographic isolation—many people live in rural areas where access to screening and treatment is limited.
• Cost—therapy and medication can be expensive if one lacks insurance or sliding scale options.

Another significant barrier to women reaching out for help relates to the media’s sensationalism of PPD. When the media highlights stories related to PPD, it often tells stories of maternal suicide or a mother harming/killing her baby. These types of stories are meant to grab headlines and often end up doing a disservice to women by perpetuating fear and confusion about the way they feel. The media frequently refers to clinical postpartum terms interchangeably (e.g., baby blues, PPD, Postpartum Anxiety, Postpartum OCD, and Postpartum Psychosis) and as though they are the same thing. These diagnoses are NOT the same things. Let me repeat, they are not the same thing! Saying someone has the Baby Blues is not the same thing as having PPD or Postpartum Psychosis. They are different disorders and require different treatment approaches.

Some of you might remember when Andrea Yates drowned her 5 children in the bathtub back in 2001. This was a terrible tragedy but it’s a good example of the media presenting a headline story about a woman with “PPD” when it was really Postpartum Psychosis that led to this event. Unfortunately, this type of misinformation further reinforces a woman’s desire to stay quiet about her symptoms. She would rather suffer in silence than be told she is “going crazy,” be told she is a bad mother, have her baby taken away, or have her family/society reject her. It’s important to note that women with PPD do not want to hurt their babies. Most would rather hurt themselves in order to protect their babies from the experience of having a “terrible mother.”

Much of this comes down to stigma. In a time where there is more access to help than ever before, PPD remains a misunderstood, under diagnosed, and mistreated illness. Women are afraid to speak out due to stigma of being labeled as sick, damaged, inadequate, wrong, a bad mother, a bad wife, etc. To any mothers out there reading this who think you might be dealing with postpartum adjustment issues, help is available. Your symptoms do not define you as a mother, wife, or friend. You can feel better with adequate support and treatment. All you have to do is ask. If you know someone who you think might be suffering from PPD or other postpartum adjustment issues, please offer your support and understanding. Try to connect them with help as soon as possible. Things can get better.

For more information about PPD, treatment, and support, please visit the following websites:

www.PostpartumStress.com
www.PostpartumProgress.com
www.PostpartumSupportInternational.com

Elizabeth Hatchuel, PhD, LPC
Elizabeth@evolveclinicalservices.com

Dr. Hatchuel is a Licensed Professional Counselor practicing in Alexandria, VA specializing in the treatment of depression, anxiety, and perinatal mood disorders. She is also a counselor educator on faculty at Walden University in the graduate School of Counseling. Dr. Hatchuel tweets @EvolveClinical.