Postpartum Mental Health: The Silent Darkness

By Michele Inzelbuch, LCSW, LCADC

Postpartum depression (PPD) is a disease where many women suffer in silence. Often it is something not spoken about, is rarely accepted, and sadly goes untreated in many new mothers. According to the Center for Disease Control (CDC), there were almost four million live births in the United States in 2015. Another two million women had miscarriages and/or stillbirths. These women are highly susceptible to postpartum depression due to their bodies experiencing the same hormonal and chemical changes as a woman who had a live birth, but with the added emotional distress of the loss of their baby.

A self-report to the CDC in 2015 showed an average of 15% of women who had live births in the U.S. suffered from some form of postpartum mental health concerns. When you include women who had miscarriages or stillbirths, the number is about 900,000 women that reported their symptoms. This makes one question how many women are out there that do not report.

Only 15% of these women receive help. Why? Out of 900,000 women, 850,000 of these do not receive any form of treatment, according to Postpartum Progress, a national organization for the awareness and advocacy of postpartum health. In many areas of the country, there is still a stigma around mental health and some women hear, “Women have babies every day; get over it.” Others live in areas where services are not accessible. Other obstacles are that some women lack family support and the stressors in returning to work shortly after a pregnancy without local family to assist. According to Postpartum Progress, even more women lack community support and have the stress of needing to return to work in six weeks. Postpartum mental health is the number one complication of pregnancy and birth.

What is PPD?

PPD is more than the “baby blues” and is a result of a sudden decrease of estrogen and progesterone that greatly increases in the body when a woman becomes pregnant. Many women need time to adjust to the life changes that come with becoming a mother or having another child. Women who suffer from PPD many have a prolonged hormonal imbalance and do not adjust to the life changes as quickly as those with the “baby blues.” PPD is not just depression. It also includes anxiety, OCD, and the rarest form, psychosis.

So how can you identify a loved one with PPD? These women may be crying more often than usual, show increased anger, become withdrawn, have feelings of being numb or disconnected from their baby, be unable to be away from their baby, worry about their baby getting hurt, or experience thoughts of harm to self or baby. Don’t be mistaken. Mothers have extreme levels of guilt and shame about all of these feelings and thoughts. Many women are unable to care for themselves. Some women may go for a longer than normal period of time without showering, changing their clothes, and eating. Getting out of bed becomes difficult and normal daily activities can cause a level of anxiety-driven fear.

Risk Factors

Each woman may have her own risk factors. This can include stress, low to nominal – if any – social support, difficulty getting pregnant, difficult high-risk pregnancy, traumatic birth (including change in birth plan or complications during birth), loss of baby, having multiple births (twins or triplets), a baby having medical complications, or a history of mental health issues. This is all above and beyond the hormonal changes that a woman’s body is already going through. Women who have a history of mental health or PPD are at a higher risk of developing PPD. Having awareness and seeking treatment while still pregnant may be able to decrease the severity or recovery time.

Treatment

Due to PPD being a hormonal and chemical imbalance, medications may be needed. But finding a psychiatrist willing to prescribe medication for a disorder thought to fall under the obstetric/gynecologist’s treatment umbrella can make it difficult to receive appropriate treatment. Many OB/GYNs will refer women to a psychiatrist for treatment, causing a cycle of referrals that may cause a woman to feel lost and delay her start of treatment. Many psychiatrists misinform women as to what medications they can take while they continue to breastfeed. Some women may feel they need to make a decision between taking medications or nursing their baby, thus causing another stress on these already overwhelmed moms. Breastfeeding is important and may help some individuals improve PPD symptoms and promote a bond with the baby.

“In conjunction with medication management, peer support and talk therapy function to change internalized stigma and defeating self-talk,” explained Jasmine Banks, program coordinator of Climb Out of the Darkness, a branch of Postpartum Progress. “Peer support and talk therapy are tools in a toolbox, meant to create sustainable change by equipping mothers with new ways of coping and more positive ways of seeing ourselves in light of mental illness.”

Talk therapy allows the woman to freely discuss her thoughts and feelings without judgement or fear of hospitalization. Support groups allow women to know they are not alone. Women who attend these groups often create a bond with each other and, many being at different places in their healing, help each other see light at the end of the tunnel.

Monmouth Medical Center created the Perinatal Mood and Anxiety Disorder Program, a program that offers an array of services for women with PPD, including support groups, individual counseling services, and medication management. These three services, in combination or separate, are the key to survival of this disease. The program was founded in 2015, though the first support group was held in 2011. According to program director Lisa Tremayne, the program has served over 500 women since 2015 and currently has 170 pregnant or new moms in the program, averaging 30 new moms a month.

If you or someone you know has concerns regarding PPD or is showing symptoms, do not ignore them. You are not alone and there is help out there for you. Please reach out to the Central Jersey Family Health Consortium at (732) 937-5437 or the Perinatal Mood and Anxiety Disorder Program at Monmouth Medical Center at (732) 923-5573.