This Isn’t What I Expected – Overcoming Postpartum Depression (1)

One of the requirements for the Postpartum Doula Certification is to read six books from the Postpartum Doula Required Reading List and submit two book reports totalling 3500 words.  One book must deal with breastfeeding.  I have already finished my first book, The Birth Book, for this requirement. 

Since May is Mental Health Awareness Month, I have decided to read This Isn’t What I Expected – Overcoming Postpartum Depression written by Karen R. Kleiman, M.S.W. and Valerie D. Raskin, M.D.  This book has been proclaimed as “The definitive book on postpartum depression.”  I am also going to write one of my book reports based on this book since this is something that I have faced myself.  We are required to take notes chapter by chapter, so I will be posting chapter by chapter.

I read the first chapter on Saturday.  It is titled “I Haven’t Been Myself Since My Baby Was Born”:  Recognizing Postpartum Depression.  Here are my notes for the things that stood out for me in this chapter:

– “Fortunately, PPD is now more commonly diagnosed than ever before in this country.  For the past twenty-five years, a few pioneering professionals have been working to have PPD recognized and accepted as a legitimate illness, as it has long been in England and other parts of Europe.  Depression After Delivery, a self-help group founded by Nancy Berchtold in 1985, has been instrumental in educating the public about PPD and receives over 3,000 information requests from new mothers every year.  (I was unable to find a current website for Depression After Delivery; however, it appears that there are still several active groups around the world.)  There are now two national organizations composed of professionals who specialize in PPD, the American Society of Psychosomatic Obstetrics and Gynecology, and Postpartum Support International.  We are delighted to see that PPD is coming out of the closet and that more and more women and their families are seeking help for PPD.”  I turned to my OB-GYN when I needed help.
– “The term depression has two precise meanings when used by physicians and mental health professionals:  It refers either to an incessant and intense sad, empty feeling, or to the mood disorder called clinical depression, which is characterized by this feeling for two or more weeks.  Postpartum depression means that, after childbirth, a woman exhibits the emotional and physical symptoms of the syndrome of clinical depression.”  I was diagnosed with clinical depression in 2000 and with postpartum depression in 2008.
– “PPD is a syndrome that does not have one single cause.  The fact that depression and anxiety after childbirth are a syndrome and not a specific disease is a major reason why PPD often goes undetected or is misdiagnosed.  It is also often a major source of frustration to those suffering from PPD, who would understandably like to have a specific blood test or something like an x-ray to confirm the diagnosis.”  This section includes a Postpartum Depression Symptom Checklist.
– “Women who have never suffered from PPD or any other form of depression often ask us:  “How can I know if I’m experiencing postpartum depression?”  The single best way is to trust your own instincts.  If you feel that something is wrong, chances are very good that you are right.  You know best whether you have experienced a significant postpartum change in your mood, personality, functioning, or ability to cope.  Trust yourself, and don’t let others dismiss or minimize your situation.”  I was doing research on PPD long before I ever asked for help.  I knew something was up … I was just hoping that it would get better on its own.  It didn’t.
– “At the present time, we cannot say for certain what causes PPD.  Most likely, it is caused by a number of factors that vary from individual to individual.  Factors that are believed to contribute to PPD include the following:  genetic predisposition (i.e. presence of depression in a blood relative); chronic sleep deprivation and fatigue (this is what happened to me while trying to implement “on-demand” breastfeeding); colicky, hard-to-care-for babies; dramatic hormonal changes; medical complications in either mother or infant; a predisposition to self-criticsm (I have done this my entire life); previous postpartum (I did not have PPD with my first child) or other type of clinical depression (diagnosed in 2000); absence of support from family or friends (I am a SAHM, my husband works to provide for our family, the closest family to me were three hours away); and/or isolation.”
– “Many studies have documented low levels of the metabolites (the breakdown by-products) of these neurotransmitters in clinically depressed people.  Unfortunately, these tests are only in use for research purposes at present and cannot be used to make a clincial diagnosis of PPD.”  I sure would like to see this blood test available to the general public.
– PPD typically occurs one to three months after childbirth.  However, PPD can emerge any time from immediately following the birth of the baby until a year after.  I asked for help the day after my daughter turned one month old.  Some postpartum specialists expand the range up to three years after giving birth, emphasizing the stressful role that caring for young children plays.  Sometimes, when PPD is identified in the latter part of the first postparum year, it is discovered that the mother actually had some symptoms earlier that were denied, ignored, or misunderstood.  There have been cases in which PPD surfaced many months postpartum without previous symptoms, sometimes but not always around the time of weaning (I actually think that my PPD resurfaced when I weaned my daughter at 15 months) or resumed menses, both events associated with major hormonal changes.  In some cases – in retrospect – the first symptoms of PPD may have started during pregnancy, but were either mistaken for physical discomforts of pregnancy or minimized as “just moodiness.”  (I actually spoke to my midwife and OB-GYN about PPD while I was still pregnant.  I just had a feeling that it was going to happen.  They prescribed meds for me to take to help lessen the blow after giving birth; however, I chose not to take them, not knowing what the side effects for my daughter would be.  And, after reading this article today, I am glad that I chose not to.
– “Clinical depression is only one of a variety of conditions that may cause depression and anxiety after childbirth.  The most common of these is “baby blues,” but this is usually short-lived and mild.  Another condition is postpartum stress syndrome, which is the single most common cause of persistent depression and anxiety after childbirth.  Finally, there are two postpartum anxiety syndromes called postpartum panic disorder and postpartum obsessive-compulsive disorder.”  I had clinical depression, baby blues with my first daughter, stress, anxiety, and obsessive-compulsive disorder.  No wonder I was doomed!
– “The phenomenon of postpartum stress syndrome is marked by feelings of anxiety and self-doubt coupled with a deep desire to be a perfect mother.  This enormous expectation of being a perfect mother, perfect wife, in control at all times, combined with very real feelings of inadequacy and helplessness, can create unbearable stress.”  Seriously?  Was this book written about me?
– “PPD most often occurs as a primary illness – by itself, without other emotional syndromes.  However, two related anxiety disorders can either accompany or follow PPD.  While the postpartum anxiety syndromes are not as well studied as PPD, both panic disorder and obsessive-compulsive disorder (OCD) are present at a rate of about 2 percent each in the general population, and both may be first diagnosed after, or exacerbated by, childbirth.”  This section includes a Panic Disorder Symptom Checklist, an Obsessive-Compulsive Disorder Symptom Checklist, and a Postpartum Emergency Symptom Checklist.

Okay, so there you have my notes from Chapter 1.  I have already completed Chapter 2 and Chapter 3 … will, hopefully, update on those tomorrow.

~ by cmb0414 on May 4, 2010.

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