Hidden face of postpartum depression

The welcoming of new life is a time of celebration. Baby showers, decorating nurseries and more fill the days and dreams of expectant parents. Yet for many parents, a surprising and unwelcome visitor, postpartum depression (PPD), accompanies the arrival of a new baby.

Anna Laman, 38, is one such mother. A freelance writer prior to the birth of her 19-month-old daughter, Laman quickly lost time, energy and interest in the pursuits that had previously excited her. After a complicated birth and ensuing cesarean section that landed her daughter in the neonatal intensive care unit, plus the extra demands associated with the newborn’s colic, Laman began to experience a growing sense that something wasn’t right. “I didn’t realize that that’s [PPD] what was going on until she was about 12 months old. I just could tell that I was overreacting to everything, and everything was weighing on me really heavily, and it was just exhausting. Getting back to normal life, going back to work, all those things other moms were doing — I literally could not comprehend how they were doing it.”

According to the Centers for Disease Control and Prevention, PPD affects at least 20 percent of women who give birth each year — approximately 600,000 women in the U.S. alone. Often discussed only in hushed tones (if at all), postpartum depression is a perinatal mood and anxiety disorder that ranks as the most common complication of childbirth. Both environmental and physiological factors are thought to contribute to the condition. In addition to the formidable responsibility that caring for a newborn entails, a dramatic post-birth shift in hormones increases women’s risk for developing PPD. As estrogen and progesterone plummet, mothers may be left feeling exhausted, confused and depressed.

Asheville-area psychotherapist Elizabeth Gillette is intimately familiar with the unique challenges faced by new parents. (It is important to note that caregivers, not just birth mothers, may also suffer from PPD.) Gillete, a social worker at Porch Light Counseling, offers family-centered counseling specifically focused on the perinatal experience. Inspired by her work as a postpartum and birth doula, Gillete recognizes the specific challenges present for new parents in a culture that places a great deal of focus on the prebirth experience, yet often negates the postnatal journey. “We’re all so focused on this moment when you have the baby, all the preparation, the birth classes, what your birth plan is going to look like, if you’re going to do it naturally or if you’re going to use medication, but there’s not a lot of preparation for when you are home and you’re being a parent to the baby.”

It’s precisely this lack of preparation, coupled with isolation, that leads many new parents to the sense of overwhelm that is characteristic of PPD.

Compounding Laman’s experience was perhaps the greatest burden in the recognition and treatment of PPD — a nagging sense of shame that often felt overwhelming. “The thing that just kept going through my head was, ‘Why can’t I get my shit together? I should be able to do this.’ And it was, ‘Why aren’t I strong enough, why aren’t I smart enough?’ I wasn’t enjoying it,” she says.

“I wasn’t enjoying it the way I thought I would, the way I wanted to, the way other people seemed like they were.”

Gillete confirms that Laman’s repetitive thoughts are shared by virtually every PPD client she meets. “There’s such a stigma around [postpartum depression]. If you admit that you’re not feeling well or you’re not loving being a mom, there’s so much evidence in society to tell you that there’s something wrong with you and it’s better just to keep it to yourself, which we know is the worst thing to do,” says Gillete. “[With] depression and anxiety, you become so isolated, and that doesn’t help you feel better. Parents say, ‘I’m not feeling well,’ and have someone reply, ‘Well, maybe you shouldn’t have been a parent’ — it starts to [exacerbate] all of these insecurities and doubts that new parents already have.”

Dr. Jon Larrabee, OB/GYN at Asheville Women’s Medical Center, names the stigma associated with PPD as one of the primary barriers to recognition and treatment. “The expectation that this is a happy time and everybody should be superexcited about this, that this should be a fun time — all of this is sort of a myth that overwhelms the patient’s sense of self, so that they’re losing touch with how they’re really feeling and covering over that with the sense that everything should be OK. And that’s not always the case.”

At her wit’s end, Laman sought counseling. After combining therapy with medication, the fog lifted, and what she describes as a perpetual feeling of “being underwater” subsided.

This very support, providing the end to isolation, is critical in the treatment and prevention of PPD — a sentiment Larrabee echoes wholeheartedly. “To me that’s the more critical component — to front-load and have these conversations early on. This community is primed for that.”

Gillette agrees, saying, “Having conversations about it with your provider ahead of time, talking with your partner, knowing what to look for … the earlier that we address it, the better the prognosis.”

As for Laman? Now that the clouds have parted, she finds herself with a renewed vigor for both motherhood and the career that evaded her in her darkest months. And despite her struggle, she now reflects, “I want to help other people through this, in whatever little way, to acknowledge this exists and to do for other people what I wasn’t doing for myself.

“What I can only recognize now that I’m not in it is that everything they tell you about it is true: It’s making you think it’s your fault; it’s trying to brainwash you. The only way you can get out of it is to talk to other people — whether it’s a friend that’s gone through it before, or your therapist or doctor. There are just so many ways that you’re taking care of this other person and so many hundreds of things you have to do every day just to make that work that you don’t really have the bandwidth to focus on yourself, but it’s really essential. You’re a much better mom if you’re a healthy and happy mom.”