“Nobody would believe what an effort it is to do what little I am able” – Charlotte Perkins Gilman, the Yellow Wallpaper, 1892
It is wonderful to see the birth of a child greeted with warm enthusiasm and support. We celebrate the joy of a growing family, and the excitement of a new life. Relatives and friends often provide gifts and extra help. But for some new moms, motherhood brings on many complex emotions besides the happy ones.
While we may greet a new baby with happiness and delight – not every woman will experience these emotions after childbirth. New mothers need understanding and support for ALL their emotions after the baby arrives. These feelings include the ambivalent ones, the unexpected and confusing ones – and for some, the exhaustion, numbness and frightening thoughts that can come with postpartum depression or perinatal mood disorders.
More People Need to Know About PPD
I started working with women experiencing postpartum depression – or PPD — in graduate school. I was lucky enough to get some career training from a postpartum support program and more recently from the Postpartum Support International and 2020 Mom Project. I realized then, and still feel now, that this mental health issue does not get the attention it deserves. All of us – from doctors to therapists to family and friends — can learn something to help.
Training with Karen Kleiman, Clinician, Author and PPD Expert
Meeting PPD expert Karen Kleiman, LCSW had been on my agenda for a long time. She is the founder of the Postpartum Stress Center, and is a dynamic author, speaker and educator based in Philadelphia. I’m near Washington DC, so I took a weekend and traveled with a friend and colleague to attend her recent workshop.
What an experience to be in a training session with Karen! She brings authenticity, excitement, brilliance and rich discussion to a topic that very much needs and deserves greater awareness.
Signs and Symptoms of Postpartum Depression
PPD is not the same as the “baby blues” – which are mood changes and adjustments during the first two weeks after childbirth. Research finds that 85% of women experience these normal and expected symptoms after childbirth. They usually resolve on their own.
Karen shared research that found:
- 91% of new moms experience frightening or scary thoughts and feelings about caring for their newborn
- 88% of dads also experience fearful or scary thoughts such as anxiety especially around the ability to care for their baby
It is normal to worry about the way you feel toward a new baby at first. But if your concerns last longer than two weeks, that is good reason to seek help from a doctor or therapist.
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 see it as 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? This can’t 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.
Favorite Books for New Parents
There is a great older book called Women’s Moods (see Resources) and I strongly urge the expectant moms and dads I work with to read it (you can find other good books and web resources listed on our website and below). I also encourage people to read Karen Kleiman’s books (also in Resources below) because this is her primary specialty and her information is expert, extensive and helpful.
We Can Address Postpartum Depression Successfully
I hope we can talk more openly about the reality of postpartum depression and other perinatal mood disorders (PMADs) – and that they are treatable and can be managed successfully. Awareness of PPD does not mean we should give up or even hold back our elation and joy over a new baby. We just need to be aware that sometimes, new mothers may struggle with real depression, and those who do need greater awareness and support. PPD is an underserved health issue that we need to know about and address in healthier ways.
We can make life better for people with postpartum depression, just by understanding some basic information about it, and being willing to help loved ones with PPD find the care and attention they need.
Books by Karen Kleiman, LCSW
Tokens of Affection: Reclaiming your Marriage After Postpartum Depression
Therapy and the Postpartum Woman: Notes on Healing Postpartum Depression for Clinicians and the Women Who Seek their Help
The Postpartum Husband: Practical Solutions for Living with Postpartum Depression
What Am I Thinking?: Having a Baby After Postpartum Depression
This Isn’t What I Expected: Overcoming Postpartum Depression by Karen Kleiman and Valerie Raskin
Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood, by Karen Kleiman, MSW and Amy Wenzel, PhD
Cognitive Behavioral Therapy for Perinatal Distress (for clinicians) by Amy Wenzel with Karen Kleiman
Women’s Moods: What Every Woman Must Know About Hormones, the Brain, and Emotional Health by Deborah Sichel and Jeanne Watson Driscoll
Organizations and Articles
Depression among Women of Reproductive Age, CDC
Postpartum Support International – including their list of Useful Links for Help
Postpartum Education for Parents (PEP)