Let's Talk About Peripartum Depression
Updated: Dec 21, 2018
While not as widely discussed as Postpartum Depression, Peripartum Depression affects up to one in seven women and is associated with significant maternal and neonatal morbidity if untreated according to the American Family Physician. Peripartum Depression refers to depressive episode or illness while a woman is pregnant, while Postpartum Depression (PPD) refers to depressive episode or illness post-pregnancy. Women affected by PPD are estimated at similar numbers as Peripartum Depression, but for some reason, PPD gets a lot more press.
I don't really have anything scholarly or scientific to add to the discussion of Peripartum Depression... but I do think that talking about it is important. I believe talking about ALL mental health issues are important. Mental Health is human health, after all. There is a stigma or uneasiness that surrounds discussion of mental health... like it's not something that's okay to talk about... people have opinions on whether or not it's a disease or a mindset. Until we can normalize the discussion and treatment of depression and other mental health disorders, we can't progress with helping people who need it.
I suppose I didn't even realize it was a thing to be depressed during pregnancy. Having suffered with depressive illness for my entire life (depression and mental health disorders run strong in my family), I was very concerned about Postpartum Depression and was vigilant about speaking often about my depressive illness and how I was feeling and trying to normalize the topic of depression for the people in my life whom I trust. I have spoken very openly about the fact that our pregnancy was an accident. There are so many mixed emotions with repeating that sentence, even now. So many couples are trying so hard to become pregnant... many of whom have given up or had to explore other methods of becoming parents. To say that my pregnancy was an accident carries a lot of shame and guilt. But that's my truth... I wasn't trying to be a mom. Not now... maybe not ever. When I took the pregnancy test... I was devastated. My husband was so excited but tried so hard to conceal his excitement because he could see how crushed I was. He was comforting and supportive and said wonderful things to me about the kind of mother I would be... but I was at a loss. I wandered in a daze for weeks. I felt hopeless. I kept thinking it would get better... that the excitement would kick in... but instead of excitement I only got morning sickness. Except not just in the morning. All the time.
I remember telling my in-laws we were pregnant... choking back tears. They were so excited they were crying tears of joy... and I was fighting tears of heartache. I felt so ashamed. I felt like such a disappointment of a daughter-in-law. I felt embarrassed. I remember telling my own parents over the phone... in the car, by myself, so angry. So hurt. I remember my mother apologizing to me. She was sorry that this happened. In retrospect, the greatest weight of shame of my entire life was the moment I deprived my own mother of the experience of elation that we should have been sharing over such a tremendous gift... but she was apologizing to me for my grief. The weight of that moment will probably never leave me. I am so embarrassed by it. I feel so much shame over it.
I thought it would get better once the first trimester was over... it didn't. It got worse. There were times I thought about killing myself. No lie. I certainly don't bring it up in an attempt to dramatize this story or add some kind of chaos that would make this post more compelling... I'm simply speaking my truth. And those that know me who read these thoughts might be completely shocked or alarmed at reading that... but it must be said. I remember every doctor visit where I fought through tears trying to convince everyone in the room I was okay... I remember multiple doctors asking me if I was sure I wanted to "keep" the pregnancy. I remember my husband asking me the same thing. I contemplated what it would be like to abort a pregnancy. I felt even MORE shame for having those thoughts.
I avoided telling people I was pregnant. I forced my husband to keep a secret from his friends and family... and then once I finally agreed that we could share the news... I asked him to politely ask those that he told to not ask me about the pregnancy or talk about it around me.
I deleted my facebook. I deleted my instagram. I hid from the world. My co-workers were not aware of my pregnancy until I was planning time off for my maternity leave which was just a few months away. I hid under baggy sweaters and coats and did everything I could to keep attention away from my midsection.
I thought things would get better during the third trimester... I thought the excitement would kick in at some point. Instead, reality set in. Anger set in. I refused to purchase the items we would need to bring a baby home. I refused to buy a crib. I refused to buy baby clothes. I refused to order a pump. In some cases, I simply put off the purchase to another day... and in other cases... I would tell myself that "the baby doesn't need that." "Babies don't need real outfits. They just sleep all the time." "Babies don't need their own towels. He can use our towels." For some of these statements, this was true. Babies don't need 90% of the elaborate baby stuff that the industry leads us to believe we need. We don't need a boppy for every floor of our home... we don't need a crib mobile... our infants don't need shoes or special props for milestones or colorful montessori toys at 1 month or 2 months or EVER. But many of the things I refused to buy were things we did need. A car seat, for example. Diapers. A swaddle. I refused to buy just almost anything that created a permanence to this event. Somewhere along the way, we decided to give the baby a temporary name for his in-utero time. We named him "Leroy" at the suggestion of my father... because "le roi" in French is "the king". We thought the suggestion by my dad to name our baby Leroy was so funny because it was so random... and I thought it was hilarious to refer to my growing belly as Leroy. Part of me felt like if I could make a joke out of it, I might be able to handle the thought of it a little easier. Deep down inside I knew I was trying to humanize this blob of cells that was so foreign to me... yet was changing my appearance and my life a little more each day.
(A tiny piece of advice... don't name your baby in the womb with a name you don't intend to keep. I had a REALLY difficult time letting go of the name Leroy once he was here.)
Somewhere in the middle of my third trimester... maybe the middle of March... I can't remember for sure... I had prenatal visit at my normal doctors' practice and I encountered a provider I had never met with before. A nurse practitioner named Jennah. I had not seen her in that office previously for any reason... and wasn't even sure about seeing a nurse practitioner in lieu of a doctor. I remember the conversation with the nurse leading up to meeting Jennah for the first time. Sort of. I don't remember the subject of the conversation exactly, but I do remember I was choking back tears per usual. We weren't discussing anything of tremendous moral value... we were simply discussing pregnancy symptoms I had been having or something along those lines. I think I was talking about how bad my heartburn was... and was met with very little empathy from the nurse... and the tears just started flowing. The nurse quietly left the room... and although I tried to pull myself together, by the time Jennah opened the door to the exam room, I was choking hard on my tears and my face was wet.
Jennah wasted very little time getting to the bottom of what I was so emotional about. Unlike any provider I had seen previously, she didn't tiptoe around the depression. She addressed it face on. Looking back, I remember talking to my other doctors about the depression.. and many of them suggesting anti-depressants (in the OB-GYN practice I am a patient at, there are multiple doctors and patients are encouraged to visit all of them during pre-natal visits). I always declined. Perhaps I thought that accepting a drug would put me on some kind of watch list for depressed moms... or add a wash of reality to the situation. And I was ashamed of myself that I wasn't excited about my pregnancy. I felt guilt and heartache and devastation and shame... and the idea of anti-depressants only exacerbated these feelings.
But Jennah pushed. I politely declined anti-depressants when she initially recommended them... but she wasn't interested in that answer. She calmly informed me that "it's really what's best for your health at this point." I remember asking "what about the baby?" And she responded "what's best for the baby, right at this moment, is that YOU'RE healthy." I'm not sure what it was about her words that sank in... but I accepted the prescription. Of course, I cried through the entire exchange... but somehow when I left the office that day, I felt like I could breathe a little bit easier. I had hope. I called my husband and explained the situation to him... and that I had accepted the prescription.. and he was very thankful that I had. I called the same day and made an appointment with a counselor to begin weekly sessions for psychotherapy that would last through the end of my pregnancy, with the intent of continuing the sessions postpartum if I felt they were warranted.
While I didn't feel better right away, the impact of the prescription was fairly immediate as far as those things go. Within a couple of weeks, I could feel myself accepting my life and what was going on inside my womb, and within 4 weeks I started to experience a glimmer of excitement about meeting my son. By six weeks after beginning the prescription, I was shopping for car seats and strollers. I never fully became the excited expectant mother you see all over instagram. I never truly "celebrated" my pregnancy. I didn't do maternity photos or excitedly share pictures of a nursery waiting on a baby. I just quietly prepared my home and my mind for an infant.
Pregnancy is supposed to be this amazing, beautiful experience that ANY woman should be SO grateful to receive... and while the woman I am today agrees with that statement wholeheartedly, depression changes your brain. I was in the throes of despair during my pregnancy, as terrible as that sounds, and there was nothing about my pregnancy that I appreciated or celebrated. For SO MANY women, pregnancy is not what you think it is. It's incredibly hard. In addition to being physically challenging and emotionally overwhelming, there are thousands of women who are suffering far beyond this. According to this article, maternal suicide is a more common cause of peripartum mortality than postpartum hemorrhage or hypertensive disorders.
I'm not sharing my story to push anti-depressants toward any expecting or new mothers. Quite the opposite, actually; I think anti-depressants should be very carefully considered and the risks weighed heavily against the benefits. In general, I think a person should try every natural alternative available to them when approaching mental illness before turning to medicines (and this is coming from a person who has spent more than 30 years struggling with depression and who comes from a long line of individuals who have suffered and battled depression). It used to fire me up so badly when someone would say "well you ought to just work out more... get more physical activity... that is supposed to help with depression..." or "depression is the devil at work". It completely undermines the person who is suffering and invalidates the individual's struggle with disease. Depression is a true illness. Just like any other autoimmune disease. To undermine someone who is suffering causes anger and shame. In my case, in addition to being too depressed to discuss my pregnancy, I was too ashamed to discuss my depression. As a mother, it would be irresponsible of me to choose to ignore my own health when it will ultimately impact my ability to care for a child who is completely dependent on me. This is true of any illness or disease, mental, physical, or otherwise.
Hindsight is 20/20, of course, but my shame and guilt about my depression robbed me of the joy I should have experienced. I should have been celebrating this amazing gift the whole time, and sharing my journey with the people I love and allowing them to feel the excitement along with me... but instead I suffered in silence. I allowed the social stigma of depression and opinions I assumed others would have about me keep me from talking openly about my illness. It's clear to me now that I wasn't going to heal on my own or through prayer or through exercise or any other thing that people so frequently recommend for depression. In truth, I will probably never "heal" the depression, but I can heal my shame and my guilt. I can heal my soul through speaking about my experience. And I can empower pregnant women and new mothers and ANYBODY ELSE OUT THERE who suffers in silence and who is too ashamed to talk about how they feel... to speak up. Your illness is real. And perhaps I can encourage EVERYONE to take the time to learn about how to respond and BE THERE for someone who voices feelings of hopelessness or emptiness or the desire to end things. Perhaps I can prevent this illness from robbing someone else of experiencing the joy that is pregnancy. The joy that is LIFE.
Do you know someone experiencing depression or thoughts of suicide? Don't wait to act.
National Suicide Prevention Hotline: 1-800-273-8255