How to Screen Yourself for Postpartum Depression

May is Mental Health Month. As childbirth education advocates, Lamaze believes that mental health during and after pregnancy is critical to the health and safety of moms and their babies. If you are experiencing depression, anxiety, psychosis, or any other mental health issues, contact your care provider and seek support and resources from Postpartum Progress and Postpartum Support International. You don’t have to suffer alone — and you don’t have to suffer. There is support and treatment available for mental health disorders. Also know that you are not alone — it has been found that 1 in 7 women will experience postpartum depression, though that rate is thought to be higher for all postpartum disorders.

So how do you know if you are experiencing a postpartum disorder? Many moms downplay or dismiss their feelings, chalking them up to “hormones,” but it’s important to take notice and check in with yourself. A postpartum disorder is more than just a “bad day,” and even if you feel as though you are coping, a postpartum disorder ultimately affects your quality of life. If you feel as though something is “off” or if your partner expresses concern about your state of well-being, you can take a free, quick, confidential, online screening quiz to determine whether you may be suffering from postpartum depression.

The Edinburgh Postnatal Depression Scale (EDPS) was developed in 1987 to help doctors determine whether a mother may be suffering from postpartum depression. The scale has since been validated, and evidence from a number of research studies has confirmed the tool to be both reliable and sensitive in detecting depression. The EPDS Score is designed to assist — not replace — clinical judgment. If you feel you may be at risk or suffering from post natal depression, please share the results with your care provider.

A Voice of Strength I Didn’t Know I Possessed: Part II of An Interview with Ivy Shih Leung

A Voice of Strength I Didn’t Know I Possessed: An Interview with Ivy Shih Leung, author of “One Mom’s Journey to Motherhood: Infertility, Childbirth Complications, and Postpartum Depression, Oh My!”

 

In this second part of my interview with Ivy, she shares insight into her Chinese culture and pregnancy and postpartum. Secondly, she delves into her experience with infertility and complications during pregnancy. Finally, Ivy shares wonderful thoughts as to how writing, blogging, and communication can help to end stigma about PPD and create the causes for healing. You can read the first part of our interview here.

 

How has culture affected your writing about your experience?

I don’t feel that my culture really affected my writing about my PPD experience.  Though, I have to say that I am one of the few Asian bloggers I’m aware of.  Unlike most of my Asian friends and acquaintances, I am very outspoken and opinionated.  The Chinese tend to keep their emotions bottled up and thoughts and experiences to themselves.  In general, they are a very proud people.  Everything is pretty much about “saving face,” which means not putting oneself out there when it comes to personal experiences, especially if there is anything in the least bit negative.  As we know from the Western culture, pregnancy and motherhood are supposed to be blissful experiences.  I, on the other hand, have a book that shares ALL my thoughts and experiences while suffering from PPD.  It’s a fairly big deal for any woman to share her PPD story, let alone publish a book about it.  It’s an even bigger deal for a Chinese woman to do either.  

 

What would you like mainstream culture to know about your culture regarding pregnancy and postpartum?

Although I am Chinese and even speak Mandarin fluently, I was born and raised here in the U.S.  As a result, I am very Westernized and do not observe many of the traditions my parents and the generations before them may have observed.  Actually, my mother gave birth here and was not privy to the custom of Zou Yue.  She gave birth in a foreign country with no loved ones around her.  She received less help with taking care of me when I was a newborn than I had when I had my own daughter.  At least when I had my daughter, my husband helped, and my mother and mother-in-law each stayed a week to help. 

Zou Yue is like some of the other mother-nurturing customs observed by other cultures (la cuarentena in Mexico, sarantisma in Greece, Jaappa in India) in terms of observing a 30 or 40 day period of taking care of the mother, so she can take care of her baby and get adequate sleep to recover from childbirth.  Forty seems to be a magical number, a number that has survived through the centuries and therefore has special significance….no doubt it has something to do with the fact that 40 days is the average length of time for a new mother’s body to recover from childbirth and return to a pre-pregnant state.  It’s also why an OB/GYN will tell the new mother, once she’s given birth, that he will see her in 6 weeks.  Each of these traditions involves female family members and friends of the new mother providing her and her baby with care, so that the new mother’s only focus is on getting rest and bonding with/feeding her baby.  They also help around the house and prepare meals.  Certain rituals are observed in which food is prepared a certain way to help keep her body/system warm. She is protected from feeling overwhelmed; hence, visitors are kept away (or kept at a very minimum) during this time. She is told to avoid bathing for fear of catching cold.  All these rituals have the mother’s well-being in mind.  In terms of breastfeeding, female family members are on hand to teach her how to do it. In these other cultures, there is no expectation that the new mother know how to breastfeed instinctively and easily.  There is a reason behind the phrase “it takes a village.”

I have blogged about the importance of social support and how, through the years, we seem to have lost perspective on things when it comes to the community coming together to help a new mother who has just had a baby.   Getting adequate social support—comprised of both emotional support (e.g., shoulder to cry on, listening non-judgmentally) and practical support (e.g., help with breastfeeding, cleaning, errands, laundry, taking care of the baby for a few hours so mom can take a nap or shower) is critical for new moms. Having enough support during the first 4-6 weeks—until a new mom’s body recovers from childbirth and her hormone levels return to their pre-pregnancy state—can help keep anxiety levels down, help her get the rest she needs from all the changes her body has gone through with childbirth.

 

When you were pregnant, how was your culture addressed by care providers in ways that were helpful? And what about during your recovery from PPD?

I don’t remember if my OB/GYN and hospital staff asked me any questions, either orally or via a written questionnaire, as to whether I had any cultural preferences that needed to be taken into consideration during or after childbirth.  There definitely was no attempt on the part of my OB/GYN to ask me if I had any preferences for the duration of my pregnancy.  Fortunately, I didn’t have any preferences, anyway.  I just wanted to be treated with respect and care, both of which my doctor ended up failing at. Now, in terms of the GP who treated me during my PPD, he was the ultimate example of a doctor with extremely poor bedside manner.  The way I was treated by him and my OB/GYN angered me so much that I wrote them both letters during my recovery from PPD, telling them that their treatment of me aggravated my already extremely painful experience, they should get with the program when it comes to PPD, and I was dropping them and moving on to doctors who didn’t lack bedside manner the way they did.

 

Infertility and Complications

Can you share a little about your experiences with both?

Without getting into the details as covered in my book about my infertility experience and childbirth complications, I’ll just say that, like more and more women these days, I got married late (at age 36 ), had a dermoid cyst removed a year later to increase the likelihood of getting pregnant and not having it get in the way of a developing fetus, tried to conceive naturally for over a year before being referred to an IVF center where we failed our first cycle (it was such less than optimal experience mostly because the staff and environmental overall were cold and disorganized), and got pregnant successfully via my 2nd IVF cycle at a different center.  What started off as 2 fetuses became only one after a car accident I had about 2 months into the pregnancy.  Other than nausea that lasted my entire pregnancy, some spotting, and overall anxiety that I would carry to term, my pregnancy went well.  I delivered vaginally (with an epidural and episiotomy), but ended up having my uterus removed 3 days afterwards due to placenta accreta.  During my entire 7-day stay, I was constantly woken up for blood work and extremely exhausted as a result.  On top of that, I was starved for nearly the whole time I was there.  Due to my surgical procedure, I was kept in an entirely different wing from my daughter for over a day, and whenever I called for a nurse, no one came.  Some nurses were not nice to me at all.  It was like a living hell for me most of the time I was in the hospital.  To get the full details of my infertility, childbirth complications, and PPD experiences, you can read my book. 

 

How can your experience help the readers of Giving Birth with Confidence?

My hope is that those who read about my experience in my book—which covers a lot, including key statistics and information on the biopsychosocial factors behind PPD (infertility and childbirth complications are risk factors)—will become more knowledgeable about perinatal mood disorders.  I hope that they will also read the growing numbers of blogs of mothers who are speaking up about their struggles with perinatal mood disorders.  Why?  Well, knowledge is power.  With more knowledge, there would be less ignorance and stigma, and motherhood myths will have less of a negative impact on mothers than they do today. I want to see fewer mothers being caught off guard and not knowing what is happening to them, should PPD strike.  Being ignorant and unprepared for it causes unnecessary fear, anxiety, guilt, and inability to appreciate one’s baby. For example, insomnia after the third week postpartum is a common first symptom of PPD. 

My blog is hit numerous times each day via Google and other search engines using words like “postpartum insomnia,” “new mom insomnia,” “insomnia four weeks after childbirth,” “can’t sleep when the baby sleeps,” “can’t sleep six weeks postpartum,” and so on, which means that there are many moms out there who are going through what I went through, in terms of insomnia as a symptom of PPD, beginning at around 40 days.  That’s right, there’s that magical number again!  Had I known about PPD before my daughter was born, I would not have been as scared as I was as to why I had insomnia and couldn’t sleep even though I was exhausted beyond words and even during the times she slept. My fear would not have escalated to full-blown anxiety attacks. I would’ve recognized other symptoms like loss of appetite (I lost so much weight so fast that within a couple of weeks I weighed less than I did before I got pregnant!). As soon as I started to have insomnia, instead of merely taking the Ambien prescribed to me by my OB/GYN, I would’ve immediately known to question it as a sign of PPD and gotten the right treatment then.  As they say, hindsight is 20/20….

 

I would like to thank Ivy for her wonderful work and sharing her experiences and knowledge with Giving Birth with Confidence. To learn more about Ivy, visit her blog at http://ivysppdblog.wordpress.com/.

Real Life Is…. An Interview With Mom, Postpartum Depression Survivor, and Photographer Melissa Miller

As happens between women who have experienced postpartum depression (PPD), we find our ways to each other. Out of seemingly nowhere — an email, a conversation — some sort of connection is formed and coincidence creates opportunity to share the extraordinary journey of motherhood with a postpartum mood disorder (PPMD).  In this case, Melissa and I were introduced to each other!  I watched her photo project, “PPMD“ and my heart was so moved. She captures the essence of the beauty and bravery of women who have walked through hell and back — not only recovering from PPD, but growing from it. What Melissa brings to Giving Birth with Confidence is the real story of a real mom realizing her creativity as an essential part of the healing process following postpartum depression.  I am honored to know her, and introduce her to you!

 

When did you realize you had postpartum depression?

This is actually a tough question for me.  Not for emotional reasons but because I think I was in denial or maybe even unaware I had PPD for a long time.  Postpartum depression came about after the birth of my 2nd child.  I am also beginning to realize I may have suffered with depression while I was pregnant with her too.  After she was born I made excuses for my depression and anxiety that it was due to lack of sleep and my daughter being colicky.  It was on a visit to my daughter’s naturopathic pediatrician that my having PPMD came out.  The doctor had been concerned about me when I brought my daughter in and it was during one of the visits that she addressed her concerns with me.  Although I felt there was something wrong with how I was feeling, I was still in denial about admitting I had postpartum depression.  I was scared to admit it.  I tried confiding in a few people and the look on their faces told me they didn’t understand and they were now scared.  Some even suggested taking my kids.  I clammed up.  I didn’t say another word.  Again, I was grateful for my daughter’s doctor.  She is also a midwife.  She was the one person I could speak to without judgment and I owe her so much.     

 

How did your photography and creativity help your recovery?

Photography became my voice.  I remember days when I would be crying, anxious and filled with so much emotion that I didn’t know what to do. I could pick up my camera and in a way, detach myself from it all.  All of a sudden I was looking through my viewfinder and looking at life around me in a different way.  It is difficult for me to express but at that moment it helped me, it helped lift the anxiety and depression for just a minute.  It broke the cycle.  At other times I couldn’t express to people how I was feeling so I used my photography to express emotions in other ways.  Not specifically just my emotions and voice, but others too.  I couldn’t talk about what I was feeling because I didn’t feel anyone would understand.   As I poured myself into my photography I found myself wanting to do more, to learn more, so I went back to school.  It is funny how, in life, there are really no accidents.  If it hadn’t been for my picking up the camera as a way to stay creative being at home with my kids I wouldn’t have had this incredible gift to use while dealing with my PPMD.  And, if it hadn’t been for my having PPMD I wouldn’t have gone back to school and if I didn’t go back to school I wouldn’t have done my project, “PPMD.”

 

Walker: Tell us about your current photo project, “PPMD.”

 My project. Well, as I mentioned about no accidents in life, I was sitting in my Assignment and Editorial class and the topic of our final assignment came up.  We had weekly assignments throughout the 10 weeks of class while also working on a final assignment to be presented at the last class.  The instructor mentioned the best projects are those we can connect with.  I don’t know how it came out but all of a sudden postpartum mood disorder (PPMD) popped into my head.  I also immediately questioned how I was going to present a photo essay on postpartum mood disorder.  I had no idea but presented my idea anyhow.  My instructor loved the idea and encouraged me to include audio.  So, I decided I was going to take photos of women who had or were currently struggling with postpartum mood disorder.  I was going to pose them in their homes and then ask them to provide me with an experience, memory or something else of significance that related to their own experience with PPMD.  I was encouraged to have 10 images for my final and this meant 10 women.  I had no idea how I was going to find that many.  

I should also point out that my main goal was to create a project that would not only empower women who had experienced PPMD but to also educate people about PPMD in hopes of eliminating the judgment and stigma associated with it.  I didn’t want women to be scared, like me, to share their experiences and I wanted all women to get help and to not be ashamed.  I want women to look at these photos and hear the voices and say “hey, I am not alone,” and “these women don’t look crazy; I am not crazy either.”  I used my resources and emailed my local parents community yahoo group and the staff at the non-profit I volunteered for.  I was overwhelmed at the responses I got.  I had over 15 people respond.  It also awakened me to how many women suffer PPMD.  I scheduled time to meet with each woman without my camera.  I wanted to connect and hear their stories.  This was the most amazing experience.  I cried with these women, I laughed with these women.  I heard their stories, I shared mine.  We were not alone.  It was amazingly cathartic for me and for them.  I have received many thank yous, because for most of us, it was the first time we were able to share our stories without judgment.  The horrible things in our heads we were able to laugh about.  We knew they were not reality and we just needed to be heard.  My project shares the voices of the women and their portraits capture them in a way that is reflective of me and my experience.  This project has only just begun.  My dream is to share this project worldwide. To travel and meet with women and then photograph and audio record them.  At this time I am unsure how the project will continue to grow but am still going to school and this project is an active part of my education.  

 

 

 

Melissa Miller is a photographer, student, wife and mother of two living in Seattle, WA.  Photography came about as a way to explore her creative voice.  She’s done work for Open Arms Perinatal Services, PALS Doulas and Thrive by Five’s “Love.Talk.Play.” campaign.  She is currently enrolled at Photographic Center NW where she is taking classes and continuing her personal project, “PPMD“ on the subject of postpartum mood disorders.

One Dad’s Survival Experience with Postpartum Depression

When Tony and I had Ziggy, the first few months were nightmarish. It was Christmas time in Seattle, and I remember having insomnia so bad I thought I had lost the ability to sleep. In an attempt to heal, I decided to ask Tony 10 questions about his experience of being a partner to someone suffering from postpartum depression/anxiety and PTSD.

When did you realize something was wrong?
I knew something was wrong right away. But I didn’t realize the extent of the problem. I kept thinking it would get better. But instead it got worse. I didn’t know where mild baby blues ended and where postpartum depression began. Nor did I have any information on how to get help.
 

What was that experience like for you?
Extraordinarily frightening. I didn’t know what was happening during labor. We were so connected as a couple and it began to shift in a way that was very scary. Once the full force of the PPD began to level itself in our lives in the first few weeks of being home with the baby, I felt confused and helpless and I was experiencing extreme anxiety. When you passed out from lack of sleep and fell to the floor behind me as I was holding the baby, my anxiety changed to terror.

What would you do differently now that you know about postpartum depression?
I would have reached out immediately to health care professionals for help. I would have encouraged formula feeding and weaning of breastfeeding right away to facilitate more ease of movement for you to be away from the baby for treatment or even just a break. I would have encouraged proper prescribed medication under the guidance of a psychiatrist to begin to ease the terrible burdens of the disease. It is so difficult to remember how helpless I felt and how under the influence I was of all the media hype about breastfeeding and bonding. That really affected my ability to act.

Were you aware of the PTSD in birth?
I think that my first clue that something was beginning to happen was during labor. It was specifically during transition that I noticed a slow but clear change in your presence. It appeared as though you began to dissociate from not only me but the world, as if your body had been left behind to experience the rest of the experience without you. It changed after we were home with the baby but for me, that was the moment it began.

What surprised you about PPD?
The insomnia. I was used to seeing depression and how it affected your daily life due to your chronic condition, but the affects of the insomnia were devastating.

What scared you the most?
The scariest thing was the constant fear that you may try to hurt yourself.

What advice would you give a partner?
To act quickly. To know that no matter what the level of depression, anxiety or insomnia your partner is experiencing, they should be seen by a health care professional and there are lots of options.

What do you think women need most if they have PPD?
They need people in their lives who are willing to acknowledge it for what it is and are willing to be there with them no matter how scary it is. They also need good professional medical care as quickly as possible. Whether it is therapy or medication, they need to be under the care of a professional. They also need to know that they are not permanently damaging their baby and that they can take time away during the day or night, whenever possible, for a break.

How did you see the interaction with our son?
I was worried about him a lot at first. Not just because of your depression but also because of my own stress and anxiety. I was very afraid that it would affect him adversely. But having watched him grow and mature over the last ten years, I am completely convinced that having the treatment that you finally did receive, starting around his third month of life was an invaluable change in the dynamic between the three of us. It was not all smooth sailing after that but it continued to improve because of it. I shudder to think of what might of happen, had you not found and accepted the treatments of the wonderful therapist and psychiatrists that first saw you.

How did the next pregnancy and birth of our daughter differ?
Everything was different, but for me, the most notable difference was choosing to bottle feed with formula from the start. That gave you a much greater sense of freedom. You were able to be away without the constant fear that the baby would starve without you. I can’t recommend that enough to other parents. I know it goes against the conventional wisdom of the day regarding breastfeeding. But in my humble opinion (which is grounded in personal experience) they are flat out wrong. Our daughter is attached, loving, kind, deeply in touch with emotions and easily able to connect to others. Not to mention she is flipping brilliant (state test score fact…not merely a parental opinion) and she was bottle fed from infancy.

Postscript from Lamaze:
Every woman and family’s experience with PPMD is different, along with every set of solutions to address the illness.  We at Lamaze honor Walker and Tony for their courage in sharing this story, as well as the means by which they engaged to seek treatment and healing. We also stand behind evidence-based research that in most cases, breastfeeding is the healthiest choice for mom and baby and can be relaxing, calming and healing in and of itself.

Weekly Reads: Postpartum Depression (PPD)

Depression runs in my family, but I have been fortunate never to have experienced it personally. I do, however, know women who have lived through postpartum depression, including members of my family. Postpartum depression (PPD) is a serious — and very common — disorder. Women who experience a postpartum mood disorder (PPMD), including PPD, need to know that they are not at fault and they are not alone. If you’re in the postpartum period and experiencing issues, contact your doctor or midwife first. If you’re pregnant, take some time to learn more about PPMDs and become aware of the signs and symptoms.  

Fact sheets, local support groups locator and resources. @ Postpartum Support International  

How to find the right doctor for postpartum depression. @ Postpartum Progress  

Learn how to spot the symptoms. @ Lamaze for Expectant Parents

One woman’s raw account of dealing with PPD and finding little successes, including a tip that may help you too. @ Heir to Blair

From his perspective — a husband’s account of his wife’s struggle with PPD, including a comparison of the first and second time around. @ blurb~o~mat

Do you know that dads can experience PPD too? @ Washington Post and Postpartum Men