One in seven new moms struggle with depression after giving birth. This happens in those early days, during what many new parents expect will be the happiest time of their lives. Depression related to having a baby isn’t rare, yet moms across the nation continue to struggle.
Inside Lindsey Love’s house in South Philadelphia, it’s pin-drop quiet. That silence is intentional: her one-year-old son is upstairs napping.
She remembers how she felt during those early months, during what many new parents describe as the happiest time of their lives. One big challenge was getting her son to sleep well. A sleep therapist helped Love figure out a napping schedule and Love says she clung to it so tightly that anytime he went off-schedule, “I would lose it. I mean, I was inconsolable, I was angry, I mean I would scream at my husband, I would scream at my son, and then I would hate myself for having screamed at them.”
Love remembers sobbing in the shower at one point. She had no idea what was wrong. She remembers talking on the phone with one of her girlfriends and breaking down.
“[I was] saying ‘I can’t do this’ and she’s like, ‘What do you mean, where’s the baby?’ And I said ‘Well, he’s on the floor in front of me and I just want nothing to do with him. Like, he’s screaming, I’m crying and I’m done. It’s 8 a.m. and I can’t go on with this day.'” Before the pregnancy, Love had never had depression or anxiety — after, she had both.
Depression and the challenges of modern parenting
Barbara Lewin is the Clinical Director of the Center for Postpartum Depression in Philadelphia. “In my mind, giving birth to a baby in this culture, at this time, is an act of courage for mothers and fathers.” Lewin says that’s because there are poor social supports and maternity leave policies. Financial, emotional and other stressors can weigh on anyone, especially a new mom, who’s already dealing with so much.
Lewin says, it’s like a fabric. “Postpartum depression is a very complex weave between the biological, and what we call the psychosocial. It’s referred to as a bio-psychosocial crisis. And there are elements of environment: what kind of baby she has, is she, or he, a sleeper, and for some women there is a very strong biological, biochemical component.”
Lewin says postpartum depression continues after the so-called baby blues, which go away after two weeks. It can be difficult to name a woman’s struggle in the beginning — is it depression or simply the ‘baby blues?’ But as the months go on, it grows more obvious. Like in Lindsey Love’s case. Her struggle continued until two friends eventually intervened and connected her with a therapist.
Love’s situation could have been much different if she lived just a few miles away: in New Jersey.
New Jersey offers first-in-the-nation support for new moms
A decade ago, New Jersey became the first state in the nation to require doctors to screen new moms for postpartum depression before they leave the hospital and again, at their six-week post-birth visit with their OB-GYN.
Robbenmarie Insogno is a counselor in the outpatient counseling program at the Center for Family Services in Voorhees, NJ. She says when a mom is identified as having postpartum depression, the goal is to make sure she has as much of a seamless experience as possible.
Insogno says moms who are identified by doctors as having depression are given the number for a statewide family healthline, where they can get connected with support groups and counseling. The hotline is their gateway to a system of public-private health resources available for New Jersey parents through the state’s ‘Speak Up When You’re Down’ campaign.
New Jersey’s system is relatively supportive — with mandatory screening and the hotline — thanks, in part, to a woman named Mary Jo Codey.
“I’d be giving him a bath and I would see a glass on the sink that I used to use to brush my teeth and the intrusive thought would say: cut the glass and you can cut his throat. They were terrifying.”
Codey described her experience in a video from Johnson and Johnson. After three months of struggling with the intrusive thoughts 15, 20 times a day, she handed her baby to her husband.
“I gave him the baby and I said, ‘I’m going to a psychiatric hospital for life. You just have to find somebody good to be the mother.”
Codey prayed that if she got better, she would do what she could to help other women. New Jersey’s ‘Speak Up When You’re Down’ campaign was created, thanks to Codey and her husband, former New Jersey Governor Dick Codey.
The hotline helped Ava, a 29-year-old New Jersey resident, get help. She has a two year old and an eight-month-old son, and for privacy reasons, asked that we not use her last name. After screening her for depression, it was Ava’s gynecologist who told her to call the hotline. She says she doesn’t know what her life would be like now if she hadn’t received help.
“All the thoughts and everything I was going through, it just took me to a whole other place. I was having like suicidal thoughts, I never had thoughts of like hurting my kids or anything. I just had thoughts of getting up and leaving.”
It’s not a perfect system. One weakness, says counselor Robbenmarie Insogno, is that the New Jersey law doesn’t specify exactly how doctors screen new moms for postpartum depression.
“There are still some providers who will do, ‘So how ya feeling?’ Not actually doing the assessment. And if the mom says ‘okay,’ they’re like, ‘yeah, we screened her for perinatal mood disorder.”
Insogno and others in the field prefer screening with the Edinburgh Postnatal Depression Scale, which involves 10 questions including, ‘Have you looked forward with enjoyment to things?,’ and ‘The thought of harming myself has occurred to me.’
Even for moms who recognize their own symptoms, it can be scary to ask for help. Some worry they’ll be labeled as an unfit mother either by child protective services or by friends and family. And the stigma and shame of being a new mother diagnosed with depression can be paralyzing.
Katherine Stone, the CEO of a national nonprofit called Postpartum Progress, says women are falling through the cracks.
“If you start looking at some of the other women’s health issues that we really pay attention to in this country, things like breast cancer for instance, almost three times as many women will have PPD, so why is it that we don’t talk about it enough? Why is it that we really aren’t investing the kind of funds into attacking this issue that other countries are?”
After her own struggle with postpartum depression, Stone was determined to educate others and encourage them to get help. She applauds a recent recommendation by the U.S. Preventive Services Task Force that pregnant women and new mothers be screened for depression. She says every woman should be screened multiple times over those months and, in some cases, obstetricians could even catch the problem early. Part of the challenge is taking ownership of screening.
“The interesting thing about postpartum depression is that no one medical speciality owns it, if that makes any sense? So we have women who are obviously, for a while, in the hands of an OB and OBs don’t have specific training in psychiatric medicine. And then you have the pediatrician. But the pediatrician’s patient is the baby, not the mom, and they don’t have specific training in psychiatry either or psychology.”
And Stone says many women who get these illnesses don’t have a relationship with a mental health professional whose trained to treat their concerns.
For women suffering the most serious symptoms, there are few in-patient options tailored to meet their mental health needs, as well as their maternal needs. But that may be changing.
Giving women with depression a place to heal, and bond with their baby
Imagine a living room with comfy chairs and a TV, with calming photos of the beach and flowers on the walls. There’s the sound of a breast pump making its trademark swooshing noise, and imagine a mom in a rocking chair smiling and talking with her tiny baby.
It’s a calm, almost domestic, scene. This is what it’s like at the perinatal psychiatry inpatient unit at the University of North Carolina at Chapel Hill. This is the first perinatal psychiatry inpatient unit in the United States.
Perinatal psychiatrist and medical director Mary Kimmel says the place is designed to the needs of the women, right down to the furniture.
“We have these chairs that are more like rocking chairs, we have a bassinet in the room so that she can lay her baby down. So we really try to make it feel like a comfortable environment for the women, where they can really work on their relationship with the baby.”
Here, treatment is tailored for pregnant and new moms and it emphasizes the mom’s relationship with her baby, and her entire support system. She says it’s not always easy to have a baby on a general psychiatric unit, where a woman might end up, so this safe, comfortable place allows moms to be able to see their baby more often.
Kimmel says that’s why this perinatal psychiatry inpatient unit is different. “It’s an important thing that you address both mom and baby together. And that is something that we’re talking about on rounds in the morning, they’re talking about in their psychotherapy groups during the day.”
Kimmel says since the North Carolina center opened in 2011, pregnant and postpartum patients have come from across the country, about 100 each year.
For these patients, baby steps are important.
New Jersey mom Kristen’s new baby is squirming in her car seat, eager to get out. Kristen says she’s making progress with her anxiety.
“I went grocery shopping today and I have, you know, the baby carrier and I thought, ‘there’s no way, you know, eight weeks ago I would have been able to do this. ‘Cause I had so much anxiety about taking her out of the house.”
Kristen and other moms hope their stories will motivate fellow new moms to seek treatment for depression.