Did you know that there is a higher rate of depression in mothers of four year olds than in newborn mothers?
The latest numbers show doctors only screen 5% of women for postpartum mood disorders in the first six-weeks after having a baby, so many women slip through the cracks. Where do they go? Some of them power through the struggle by a miracle. Some of them find answers on their own. Some of them return to work and that helps. Some of them have a family member who gets them help. Some of them commit suicide. And some of them are still struggling and trying to “power through” after four years. Four years.
Doctors, midwives, and psychologists label postpartum depression/anxiety as a mental illness due to childbirth that occurs in the first twelve months of a baby’s life. But what happens when the majority of the 15-20% of women who experience this illness aren’t treated or given resources?
The more women I talk with, the more research I do, I’m beginning to realize that postpartum depression and anxiety can and does go well beyond the first year for many, many women. And Irene’s essay is proof of this as well.
When I arrived at Irene’s house, she was teaching a little girl how to play Uno, but I assumed the toddler was just learning her colors from the cards. “No,” Irene said, “we’ve just continued to try again and again and now I no longer have to prompt her about picking a number or color. She’s got it. It’s amazing what we can learn if we don’t underestimate ourselves.” That’s a sentiment that Irene lives by now—not underestimating herself, but she didn’t always feel this way, not even close.
In the months before Irene’s first son’s birth, in 2006, she was consumed with taking care of her husband who had suffered a severe infection of the digestive tract. While caring for her husband and planning maternity-leave lessons for her sixth grade classroom, Irene surprisingly went into labor in late September, six weeks early.
“I don’t even remember how I really felt in my pregnancy other than taking care of my husband and feeling tired,” Irene said. Irene is a woman who puts her all into everything, and is a bit of a perfectionist, so she was very focused on her students’ and husband’s well-being. When Connor made his early entry into this world, Irene didn’t feel ready to let go of her duties to others.
By the time Irene accepted she was actually in labor and her husband got her to the hospital, she was ten centimeters. No time for the epidural she’d planned for. She arrived at the hospital by 6:10 and Connor was born at 6:24. “And then our birthing class at the hospital started at 7 PM,” so Irene’s husband popped in to tell the other participants labor wasn’t “so bad” and the baby was already here! They wouldn’t be needing birthing class anymore.
“It makes for a fun labor story, but when he was born, my first thought was I don’t have lesson plans, so the stress began immediately,” Irene said. “I even requested to stay one extra night in the hospital because I was just so overwhelmed, and I remember walking out of the hospital, pushing the stroller and just crying. I got really overwhelmed.”
So there was immediate surprise and stress. Then nursing was a “nightmare” and Irene was at the pediatrician’s office “every other day” to try and get help for the constant crying and the difficult nursing and lack of sleep. And I think Irene’s journey as a sleep coach really begins in the depths of this despair. All she wanted was for a doctor or professional to problem solve with her. Instead, she was sent home with little to no guidance or support. And this mimics her cycle of depression and anxiety postpartum: worry about the issue, then ask for help, no helps comes, and sink into depression. “I wasn’t given any resources,” Irene affirmed. In hindsight, Irene can see “all the red flags” for postpartum depression and anxiety, but no one around her was saying anything. Irene remembers feeling “like I didn’t want to do anything but I had to. It took a lot of energy. I remember thinking it shouldn’t be this hard to make a lunch for myself or to pump another bottle.”
Eventually, Irene’s husband encouraged her to speak with her doctor, and while her doctor took a lot of time and spoke with her openly, she left his office without any resources or a plan for her care. This is not an uncommon experience. Many doctors and midwives recognize postpartum mood issues in their patients, and they talk with them about these issues, but the doctors either don’t know specialized therapist, can’t get their patients in with these specialist due to a waitlist, or they don’t put much stock in alternative forms of help, like a postpartum doula, a sleep coach, a moms support group. Women are left in an in between place, not know where to go next for help.
Irene was sleep-deprived and without resources already, and then at a month old, Connor was in the hospital for a week with a staph infection. Then in December, her husband had another surgery. “I can’t even remember those first six months,” Irene said with sadness. “It was as nightmare for me.” Irene can’t remember any developmental milestones or moments from Connor’s first year. Her memory is etched with these traumas instead: the hospital visits, the pediatrician, the screaming baby at her breast. Irene had also been influenced by the message that so many moms are given in our society: “I’m a mom now and I should know what to do. Get it together.” This pull-yourself-up-by-the-boot-straps mentality is one that many women feel and are also told by family members and doctors. This message is maybe the least helpful when someone is fighting postpartum anxiety and depression. Believe me, every day a woman gets out of bed and cares for her child during this time, she is committing a courageous act. So Irene slogged through and eventually had another son, Bailey.
Irene knew what depression and anxiety felt like as she’d struggled with these symptoms for several years pre-pregnancy, but she never learned any tools to help her; she’d only been given medication as a tool. While many women want and need medication to recover from postpartum mood disorders, Irene wanted an alternative plan this time. She had accepted anxiety and depression as “a way of life” and a way of mothering, and it wasn’t until she began her own sleep coach training, at five years postpartum, that she recognized what she’d experienced and put a name to it. Irene was taking a workshop with Shoshana Bennett, a clinical psychologist and pioneer of advocating for women’s mental health, when she had her “ah-ha moment.” Bennett was discussing postpartum depression as it would pertain to Irene’s sleep coach experience, and Bennett’s words hit to directly to what Irene had experienced but could never fully verbalize. That was the beginning of Irene’s healing process. As Irene told me about the moment she realized what Bennett’s description of postpartum depression “was me,” she began to cry. It was a cry that held both sadness and relief. I compare this feeling to someone who has been suffering from chronic physical pain, and after searching and going from one doctor to another, the pain is finally diagnosed. It doesn’t take away the pain, but now the person has a direction to follow and resources to seek out.
New research from Australia points out “mothers are more likely to suffer depression when their child is four years old than when they are babies,” which means the medical field needs to change its approach to maternal mental health. A common statistic is one in seven women will experience postpartum depression in the first year, but this study found that “Almost one in three first-time mothers reported suffering depressive symptoms at least once between pregnancy and four years after birth.” This means we could be missing half of the women who experience depression or anxiety in the first few years of motherhood, because many women no longer have regular check-ups with their OBGYN after six-weeks postpartum. They found that “the strongest predictor of depressive symptoms at four years post birth were having previously reported depressive symptoms either in early pregnancy or in the first 12 months after childbirth.” This statistic is directly linked to Irene’s story and so many woman’s stories based on the evidence. If we don’t diagnose women early on and we don’t give them resources, postpartum mood disorders will not just go away, but continue to affect mothers for years and years.
“We’re not stuck.” This was one of the main mantras I walked away with after speaking with Irene. She believes we have to face our shame when it comes to postpartum mood disorders, and then we can begin to move forward. But the shame leads to silence and denial, which is a recipe for sinking deeper into mental illness. “I was supposed to be supermom,” Irene said, “but you can’t be your best self when you’re just going through the motions. When I began equipping myself with strategies and not just medication, I began to feel unstuck.”
Irene’s journey continues as she helps guide parents through sleep coaching, using a very gentle method. The main service she provides is sitting down and problem-solving with parents; this is exactly what Irene wish she’d had during those first years with her sons: “My own depression and anxiety kicked off my passion and love for understanding family dynamics and problem solving with families. We’re not stuck.”
Irene is adamant that moms must know that resources, like Postpartum Education and Support, are available: “I needed to know that there were others who were going through this. My other mommy friends didn’t talk about this. That’s why I felt like I really just needed to get it together that first year. Just get it together, make it happen, I would think to myself.” This type of thinking, which isn’t abnormal at all, caused Irene to suffer for five years. I think her experience speaks to the need for doctors, pediatricians, nurses, and friends to speak up and get educated. We know that postpartum mood disorders are the number one complication due to childbirth, and we need to start treating it that way, right from the start. We need follow-up care much sooner than a six-week visit with our OBGYN, and much longer than just one year, and we need pediatricians to treat mothers like they are just as important as babies.
If you’re reading this and going through a postpartum depression, whether it’s at four months or four years after your birth, remember you are not stuck. This is treatable. Reach out and ask for help.