According to the Centers for Disease Control and Prevention (CDC), symptoms of postpartum depression may include:
- Trouble sleeping even when the baby is sleeping
- Feeling numb or unable to bond or connect with the baby
- Difficulty concentrating
- Negative or frightening thoughts about something harming your baby
- Anxiety that you may not be able to care for your baby or may harm your baby
- Feeling ashamed, guilty, or worthless as a mother
What this list of symptoms doesn’t reflect is the overwhelming guilt or shame that most women struggle with, especially if they don’t understand PPD or believe it is a real, treatable condition. These issues – and the stigma we have against talking about mental health — compound the difficulty in getting the help they need.
Admitting to Depression is Hard for Many New Moms
The CDC says that between 8 and 19% of mothers after childbirth report “having frequent postpartum depressive symptoms.” This number is probably low, because it only counts women willing to admit in a survey to having frequent symptoms. What about those who were not ready to share their struggle? “Every woman is at risk,” says Karen.
PPD can happen to any new mother. A new mom can have all kinds of positive support and still feel hopeless and scared. Even with attentive helpers, PPD can lead to overwhelming guilt and anxiety: “Can I really tell my loved ones that I feel so badly – that I just feel terrible inside? Isn’t this supposed to be the best time of my life? How can I say I’m still struggling on a minute-by-minute basis?”
Some women are able to admit to feeling numb toward the baby, or ‘not feeling right,’ while others try to put a happy face over worrisome feelings, and work to keep their turmoil to themselves.
Information and Encouragement Are Needed
While more pediatricians and OB care providers are asking the right questions, it’s still not enough to reach many women in need. New distractions like time spent looking at electronic medical record (EMR) screens can add to the feeling of disconnect.
Too often, the doctor simply asks, “How are you doing?” and the mom says, “Fine,” and everybody moves on.
There are many women suffering with PPD who have told me, ”Of course I said I was fine. What else would I say? I’m supposed to be ecstatic that I just had this baby. Why am I not ecstatic? How can this be normal?”
Those who succeed in getting treatment for PPD are often encouraged to reach out by insightful friends, family or an attuned pediatrician or obstetrician:
- Family members noticed something was wrong and said they were worried
- The mother was able to say she did not feel like herself, despite her shame
- Friends noticed the woman’s withdrawal and reached out
- The OB or pediatrician asked the right questions
These women are the lucky ones. Needed care and healing can reach more women sooner, if they can get the encouragement and connections to ask for help.
Karen is passionate about treating PPD from a strengths-based foundation. She also takes a non-pathologizing approach. This means working with people as individuals struggling with a difficult illness, not as “different” from other people.
I take this stance also – which I hope shows in everything I say and do. We focus on the unique set of abilities and resources that each woman has, and can develop to find resilience and health. This strengths-based approach is one I very much agree with and pursue in my own practice on an every day, every client basis.
Karen describes holding space for the client. It’s the idea of making it safe for clients to be fully open with the therapist. The first task of treatment for maternal mental health — as for any mental health issue — is to “create this space, the sanctuary, the holding environment… that ultimately says, ‘We understand, we know what this is, and we know what to do to help you feel like yourself again,’” she writes in “Therapy and the Postpartum Woman.”
Her healing approach offers women with PPD the warmth, non-judgmental safety, and freedom to say the things they have felt they had to hide – it’s okay to stop hiding those feelings.
This approach is much like the trauma-informed model that I find so valuable in therapy. Information for treating PPD for clinicians deserves its own article (coming soon). The basic approach is to help the client learn how to become more stable, grounded, and able to contain the emotions at levels they can tolerate or regulate and process safely.