This is my dear friend Beth’s story. I’m honored that she shared this with me, and I’m thankful to know her.
Beth wasn’t new to feelings of depression. She speaks about anti-depressants and dosages with the ease of a psychiatrist, even though she’s an accountant. Beth suffered from suicidal thoughts for three years during her early twenties, and she has continued to battle depression into her thirties, but she found the right combination of medicine, Prozac and Wellbutrin, and kept her depression under control for the most part; though “it’s always in the background” for her. Beth isn’t alone in this battle with depression. 11% of women in the US have symptoms of depression during their childbearing years. And many of the women I’ve spoken with continue to cope with depression after postpartum depression, unsure of where the two meet or separate. Most doctors will say postpartum depression ends when a mother’s child turns one, but that’s an arbitrary guideline. Many women don’t begin to face their depression/anxiety until late in the first year, and recovery takes time.
Unfortunately, Beth’s successful medications are not pregnancy or breastfeeding approved. So for pregnancy, she switched to Lexapro and was, shockingly to Beth, fine. She didn’t expect her pregnancy to go well in terms of her mood, so when she felt mostly good, she thought “we’re home free.”
But Beth’s labor and delivery was traumatic, one of the top triggers for PPD. After thirteen hours of labor, and no epidural due to the speed at which she progressed from 4 to 10 cm, Beth pushed her baby girl, Bria, out with only six pushes under the stress of the doctor exclaiming that Bria’s heart rate was decelerating. The intensity of her labor and delivery caused Beth to begin bleeding “and I wouldn’t stop bleeding.” A dilation and curettage (D&C) was performed right there on the table. This is a procedure in which the cervix is dilated and the uterine lining is scraped with a surgical tool. When planned, a woman always receives anesthesia during such a procedure but there wasn’t time for Beth. Her own doctor called her “superwoman,” but it’s all a blur for Beth, who kept passing out while her husband walked a screaming baby up and down the hospital hallway for five hours during this emergency procedure.
Once the chaos finally began to subside and Beth was able to hold her baby, she sent her husband home to rest. She tried breastfeeding but was unsuccessful due to the stress her body was under from her labor complications. Her husband had fallen asleep for no more than 45 minutes when he got the call from Beth to hurry back to the hospital: she was going into surgery for another D&C, and if this didn’t work, she’d have to have a hysterectomy.
The second and final D&C did work and Beth and her baby went home just one day later. Bria was born the weekend before Easter, and Beth remembers that Easter vividly:
“When I’m depressed, I will sit and I will just rethink everything bad that’s happening, and it’s like a spiral. So that’s what I would do. I would sit on the couch while trying to pump and look around the house and see all the crap on the floor and the cat hair in corners and it just made me feel worse and worse.”
On Easter Sunday, Beth’s entire family came and cleaned her house, scrubbing it from top to bottom, but all she could focus on was her inability to do anything on her own.
“I’m sitting on the couch with my mom on one side, my sister on the other, Bria in my lap and I’m just scary crying, heaving, can’t even breathe hardly. And then my sister said, ‘I went through this kind of thing and didn’t recognize it for what it was, but it was PPD.’”
Beth immediately said she needed to see her doctor. Thankfully, she was already established with a psychiatrist, who was very responsive to her needs and began trying to tweak Beth’s medication. This scenario, immediately being able to see a doctor who is responsive to a mother’s needs, is not one I hear about often.
First, they tried upping her Lexapro dosage since it was safe for breastfeeding, and Beth was still trying to breastfeed Bria. No change, though. Then they tried Zoloft, which had never worked for Beth in the past, but it’s the number one prescribed anti-depressant for breastfeeding woman. No improvement. Her psychiatrist said what it seems like so many OBGYNs and midwives won’t say: “I know you really want to breastfeed, but I think it would be more beneficial to you to switch back to meds that work.”
Beth was both relieved and anxious. “It never occurred to me that I wouldn’t be able to breastfeed, especially not two weeks in.” But both Beth’s psychiatrist and her husband said they should do what was best for Beth, so she weaned Bria and switch back to her Wellbutrin-Prozac combination, yet it still took a month for her medications to start working.
Beth has an understanding of both everyday depression and postpartum depression. She describes PPD as an “overwhelming despair, more immediate and incapacitating.” Whereas, her regular depression feels more like a longterm “bleakness.”
Beth thinks PPD was worse than the depression she knew before childbirth because “you have so many people depending on you” and so much more at stake now that a child is involved.
While Beth feels that she’ll always have depression “in the background,” she is able to “turn the thoughts around” now and can focus on taking care of her daughter.