353 SelfWork: But I Can't Be Depressed: Understanding Post Partum Depression

There are many times that work with my own clients sparks a podcast episode – and this time, I needed to look at what had been discussed in the literature since I saw my last client with postpartum depression. Because I had another – and her depression was severe.

The moms I’ve seen with PPD have all been different. Some highly anxious but unable to function due to that anxiety along with a bad depression. Some who had histories of depression and some who didn’t. Some who had had previous children with no problem and some who’d prepared for PPD since they’d experienced it before. And some who were almost dissociative – meaning that they were going through the motions of motherhood but felt very little about it. They “loved” their baby but having one seemed unreal – as if it hadn’t happened.

So today we’re going to get the facts out about postpartum depression and of course, what you can do about it.

Our listener voicemail is from a woman whose mom was an alcoholic and got sober, but who also appears to have borderline traits or BPD. – and who is viewing her daughter’s choice to set boundaries as cruel and punitive. You can hear the poignancy in this mom’s voice as she wants so to protect her children – but is she really protecting them by setting the boundary and thus, from her perspective, “creating” her mom’s reaction and other difficult family dynamics. The point is she’s NOT the one creating the dysfunction – or it certainly doesn’t sound as if she is.  What would you say?

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Symptoms of Post Partum Depression

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Episode Transcript/Intro

This is SelfWork. And I'm Dr. Margaret Rutherford. At SelfWork, we'll discuss psychological and emotional issues common in today's world and what to do about them. I'm Dr. Margaret and SelfWork is a podcast dedicated to you taking just a few minutes today for your own selfwork.

Hello, welcome or welcome back to SelfWork. I'm Dr. Margaret Rutherford. I'm a psychologist. I've been in private practice for 30 years now and have decided to extend the walls of that practice to those of you who might be very interested in hearing more about mental health topics, maybe you're in therapy, maybe you've just been diagnosed with something or you have some kind of problem that you just want some help seeing through different eyes... and of course to a third group of you - those of you who think mental health treatment and maybe even therapists are just a little wacky and a little strange . So we're here together and I'm so glad we are.

There are many times that my work with my own clients sparks a podcast episode, and this is one of them. I have someone with pretty severe postpartum depression, and so I wanted to look more into it, especially the recent research.

The moms I've seen with postpartum have all been different. Some have been highly anxious and unable to function due to that anxiety along with a bad depression. Some had histories of depression, some who didn't, some who'd had previous children with no problem, and then some who prepared for postpartum depression since they'd experienced it before. Some were almost dissociative, meaning that they were going through the motions of motherhood, but felt very little about it. They loved their baby, but having one seemed unreal. They sort of felt dissociated from the whole experience. Detached is what that means  - as if it hadn't happened.

What the general public doesn't realize is just how many miscarriages actually occur or how many problems there can be with pregnancy. For example, in 2020, there were 21,000 stillbirths that occurred in the US and the majority of those occurred among non-Hispanic, native Hawaiian or other Pacific Islanders and non-Hispanic black women.And this rate is more than twice the rate for non-Hispanic white women.

So today we're gonna get to the facts out there about postpartum and of course what you can do about it.

Our listener voicemail is from a woman whose mom was an alcoholic and got sober, but who also appears to have borderline traits and who's viewing her daughter's choice to set boundaries as cruel and punitive. You can hear the poignancy in this mom's voice as she wants so to protect her children. But is she really protecting them by setting a boundary, and thus, from her perspective, creating her mom's reaction and other difficult family dynamics? The point is, she's not the one creating the dysfunction, or it certainly doesn't sound as if she is. What would you say? We'll delve into that more later.

As always, we wanna thank our generous sponsors. And if you've noticed, there's a fairly new arrival in SelfWork's queue of podcast listens, and that's an announcement about the Jordan Harbinger Show. You can support me and SelfWork by listening into my intro on Jordan's podcast. It'll appear second in your feed, as well as hearing a short message from Jordan himself on how he shapes his podcast. I actually listen to him on my walks. It's very different from SelfWork, but I like his style. Give it a listen when you can because it will support SelfWork..

The Episode

For now, let's get into a discussion about what is a very painful subject when you're not supposed to be depressed -  'cause you just had a baby,

It seems that finally postpartum depression is getting attention and that attention is long overdue. Some celebrities have been talking about it through the years revealing what an extremely tough time they had for the months after their child's birth. Marin Morris, for example, the country singer says "You're trying to become a new mother and good parent and do everything right". She added of the drowning feeling, "You just feel like you suck at every level".

The actress Reese Witherspoon gave testimony to this kind of depression sneaking up on you. She said she felt completely out of control after the birth of her first child. And now I quote, "We don't understand the kind of hormonal rollercoaster that you go on when you stop nursing, and no one explained that to me. I was 23 years old when I had my first baby, and nobody explained to me that when you wean a baby, your hormones go into the toilet.I felt more depressed than I'd ever felt in my whole life. It was scary."

And there's another, Serena Williams had her baby in 2018, and she said, "Honestly, sometimes I still think I have to deal with it". Her daughter was born by emergency cesarean section, and the athlete also had a near death experience involving pulmonary embolism. So you can see why that is really trauma and that happens. So I quote her again, "I think people need to talk about it more because it's almost like the fourth trimester. It's part of the pregnancy. I remember one day I couldn't find Olympia's bottle and I got so upset I started crying because I wanted to be perfect for her."

If you wanna hear more celeb stories, I've got a link for you in the show notes.

So what are the most recent statistics and facts about postpartum depression?

Here's what a New York Times article had to say. "In recent years, mental health struggles have become the leading cause of maternal mortality in the United States, primarily due to suicides and drug overdoses. It's estimated that one in eight new moms experience postpartum depression and some research has suggested that the prevalence climbed as high as one in three during the early days of the pandemic. Yet roughly half of the women who are struggling with their mental health after pregnancy don't receive treatment. Barriers to care include a lack of awareness about symptoms and treatments and inability to access resources and of course stigma."

So now I move away from that article to say there's increasing awareness that maternal deaths don't just happen during pregnancy or within the first few weeks after birth. This is going to surprise you. It was a stunning revelation to me. The new figures come amid a troubling rise in deaths of pregnant women and new mothers in the United States, which has the highest maternal mortality rate in the industrialized world.

The figures soared during the pandemic to 32.9 deaths for every 100,000 live births in 2021. Rates for black and Native American women are two to three times higher than those for white women. It seems that the rates for black and native American women may be more equivalent to white women when the deaths are about depression or suicide.

So now we know that there's danger to mom and baby for quite a long time. I'm going to quote one more article, summing up the findings from the CDC and I quote, "A fuller extent of the problem came to light in September when the Centers for Disease Control and Prevention took a more expansive look at mother's deaths analyzing them for a full year after childbirth and including deaths resulting from mental health conditions based on data provided by 36 states on 1018 pregnancy related deaths from 2017 to 2019."

The CDC concluded that about a third of them occurred during pregnancy or on the day of delivery, and roughly another third before the baby turns six weeks old. But a full 30% occurred from that point until the baby's first birthday, a period that had not been a focus of maternal mortality research. I mean, I think this is incredible.

Of note, most pregnancy related suicidal deaths occurred in the postpartum period with 62% of pregnancy related suicides occurring between 43 and 365 days postpartum, followed by 24% during pregnancy, and 14% within 42 days postpartum. So we don't have to just worry about postpartum in the first few weeks. We actually have to be very tuned into its presence even a year after the baby is born. The data have led to calls for closer follow-up care and more support for new moms during what has been called the fourth trimester, as Serena Williams called it, with special attention given to the women most vulnerable.

I love this quote from Allison Stuby, an OB GYN professor at the University of North Carolina School of Medicine. She says, "Our approach to birth has been that the baby is the candy and the mom's the wrapper. And once the baby is out of the wrapper, we cast it aside. We need to recognize that the wrapper is a person. Moms are getting really sick and dying."

Just to let you know, the other deaths that were not mental health conditions, the most frequent is hemorrhage, cardiac conditions, infections, thrombotic embolism and cardiomyopathy in that order. And they accounted for over 75% of pregnancy related deaths. And actually the figures show that 84% of those deaths were preventable. Let me say that again. 84% of those deaths were preventable. But people aren't paying attention. Moms don't wanna complain. Families are in denial. They don't know about this information.

That's why it's so vital, and we're featuring it here on SelfWork. So is it that women didn't complain or that somehow mothers signs of illness were overlooked, somehow seen as weakness or that pregnant or new moms weren't counting their blessings?

In fact, I will remember that when I finally became pregnant through I V F, that's in vitro fertilization. I was in my OBs office complaining about how much my feet had swollen. Now, I liked my OB, but he said, "Now, Margaret, you're so lucky to be pregnant. You shouldn't complain" in this kind of patronizing voice, I looked straight at him and said, "I couldn't disagree with you more. You're right. I worked hard to get pregnant and I am lucky. But that hard work gives me all the room in the world to complain. This was hard from the very beginning." He apologized, which was one of the reasons why I liked him so much.

But somehow, women are supposed to handle the very difficult and at time frightening aspects of childbirth while either parenting other children or working full-time for a salary or whatever, without complaining, without receiving support, or more importantly, without being listened to for what are very real problems.

In my research for this episode, I also came across a story about just this attitude toward women that truly shocked me to the core, at least rationally as a woman. However, I sadly got it. After we hear from BetterHelp who can help you through depression of any kind, I'll tell you this story and talk more specifically about the symptoms of postpartum depression.

I recently heard a fascinating reframe for the idea of asking for help. Maybe you view asking for help as something someone does, who's falling apart or who isn't strong. So consider this. What if asking for help means that you won't let anything get in your way of solving an issue, finding out an answer or discovering a better direction? Asking for help is much more about your determination to recognize what needs your attention or what is getting in your way of having the life you want better help. The number one online therapy provider makes reaching out about as easy as it can get. Within 48 hours, you'll have a professional licensed therapist with whom you can text, email, or talk with to guide you, and you're not having to comb through therapist websites or drive to appointments. It's convenient, inexpensive, and readily available. Now you can find a therapist that fits your needs with better help. And if you use the code or link Betterhelp.com/ selfwork, you get 10% off your first month of sessions. So just do it. You'll be glad you did. That. Link again is betterhelp.com/selfwork to get 10% off your first month of services.

Okay, first, let's talk about the symptoms of what's called PPD or postpartum depression. It's very different than the baby blues. Baby blues are very, very common, similar to what things are going on in other life transitions, they are mood swings, anxieties, sadness, irritability, feeling overwhelmed, crying, trouble with thinking and concentration, trouble sleeping. But that tends to go away when the new mom or maybe the mom with two or three other children settles down. But if the baby is sick or colicky or is born with some kind of problem, who knows what will happen. And yet, even if the baby seems perfectly normal, postpartum depression can happen and you can place huge shame onto yourself because somehow you're not grateful or happy. It basically is the same as a major depressive episode. In fact, that diagnosis has to be there with huge hormonal changes occurring.

I worked with a woman who developed major depression after an adoption, not because there was anything wrong, but 'cause she'd gone through years of infertility treatment and failed adoptions and had never grieved the loss of those dreams. Her grief was waiting for her, and her experience was that she had very strong depression after she got her child. And let's say the mother herself had serious medical trauma during the birth or the pregnancy, and now she's supposed to be able to snap back from that and parent or nurse. Maybe she nearly died herself, but there's no time to grieve... or so she can tell herself and others can feed her that line as well. So in that instance, talk about complication!. She may be dealing with post-traumatic stress alongside trying to care for a child and becoming depressed herself.

Now, what are postpartum depression symptoms? It's very similar, if not the same with major depression, except there are unique things that have to do with hormonal changes and being a mom. You're depressed, you have severe mood swings, you cry too much. You have difficulty bonding with your baby. You withdraw from family and friends. You can't eat, you can't sleep. Or sometimes you sleep too much. You don't enjoy what you used to enjoy. You can be very angry and irritable. You fear that you're not a good mother. Feel hopeless, helpless, worthless. You can have severe anxiety and even panic attacks. You can have thoughts of harming yourself or your baby and recurring thoughts of death or suicide.

So who's more at risk for postpartum? One, someone who's had depression in the past. Two, if you have a partner with an untreated mood disorder or substance abuse and three, lack of social support. Now what does that last one mean? Maybe you have little to no maternity leave. Maybe you're on your own with no friends or relatives to help you adjust. Untreated postpartum depression may last for many months or longer.

Now, there is a thing called postpartum psychosis. Just like in any depression, a deeper depression can devolve into psychosis where you feel confused and lost. You hallucinate -meaning you see things that aren't there or hear things that aren't there. You have delusions. You can feel paranoid, and you may even hear voices telling you to harm your baby. You've got to tell people if that's what's happening. It requires immediate treatment.

I'm gonna touch on the fact that fathers who are young, have a history of depression, experience relationship problems, or are struggling financially are also candidates for a certain kind of postpartum depression, sometimes called paternal postpartum depression. It can certainly have the same negative effect on the mother and father's relationship and their child's development. So we must become more aware of this. And if you have a daughter or a sister or a friend who's struggling, what's the best thing you can do?

Before I answer this question, I wanna bring up perfectionism. Just think what happens when a woman who's perfectionistic and needs a lot of control has a baby. Everything that was in her control suddenly isn't. This can be a highly dangerous time for her. It can be a pressure cooker, and friends can really help out by affirming what is a difficult transition for anyone, but especially if you need a lot of control.

So I told you about a story I was gonna tell you that I was shocked by. I discovered a podcast called The Retrievals that is a part of the Serial series. Now, I haven't listened to it all, but what I heard was shocking. Basically, an employee, a nurse from the Yale Infertility Clinic stole pain meds that the women undergoing egg retrieval procedures were supposed to get in their IVs, pain meds that would normally have made the procedure perhaps uncomfortable, but that would be it.

And yet, several of the women having these egg retrievals, which is an operation basically were screaming that they could feel everything and that the pain was unbearable. And this happened to multiple, multiple people and went on for several weeks. But the women just bore the pain because they were told, "Well, we've given you all the pain medicine we can." The producer of this program stated that they did what women often do, which is to make up a story that would somehow lead them to blame themselves for their horrific experience. And that's what women tend to do. We tend to find fault with ourselves.

But listen to this... Even after the facts were discovered, the crime was discovered that the nurse had basically replaced the pain meds with saline solution. So some women only got one to 10% of the pain medicine needed. Even after that had been discovered, all of the women got a statement from Yale that basically said, "We're sorry, but you know, there was no harm done." What?No harm?

So the women felt relief that their realities were validated but also very disrespected. I'm anxious to hear the rest of the program. Maybe they did something about that. I'll have the links to the entire podcast for you in the show notes.

So women's pain is often overlooked. We are seen as complaining or whining when it's really very real. And this has just got to stop. Postpartum depression is a very real and dangerous form of depression. So we must make sure we listen and pay attention. And rather than saying, "Well, I don't wanna tell my daughter who's about to have a baby that this might happen to her, you know, I don't want to worry her. I don't want her to be afraid." Myself. I'd rather someone know that this is what to watch for. In fact, that would be a wonderful gift to give someone who's just discovered she's about to have a child - Sso they can prepare and be alert. That's what you can do about it. And then support them getting the help that they need.

You'll be excited to hear. I'm excited to say that later on this week, it will be a midweek episode. I'm gonna have Dr. Zenobia Harris on who heads up the Arkansas Birthing Project. My state of Arkansas leads the nation in maternal mortality rates. And Dr. Harris is gonna talk to us about that as well as what's going on in the field so that we can prevent those deaths. So tune in again this week to hear more about that

Speak pipe message from dr margaret rutherford.com.

Listener Email

So now let's get to our weekly voicemail.

Hi, I'm looking for some advice on how to manage my borderline mom as a grandmother to my six and four year old children. I've been putting in boundaries with her since I became a mom about six years ago. So it's very new in our relationship and she hasn't taken it well. She's playing the victim and that since she's stopped drinking, which she abused alcohol for nearly 20 years of my life, she thinks all the issues are resolved and that I'm being selfish for not forgiving her and that I'm being making things very hard and treating her badly by having boundaries. I'm getting to the point of thinking there's no way forward. But apart from struggling with being labeled as difficult and a problem and not compassionate and attacked by family members for treating her this way, I'm very mindful of protecting my children from this dynamic in my family. But it feels like going no contact and having to explain that to my children is me bringing that dynamic to my children rather than protecting them from it. So how do I navigate this while protecting my children from her, but also from the story of her? I really am lost and worried. So any advice would be so helpful.

You know, there aren't many more problematic family issues than when a family member, whether it's a parent, a child, a sibling, a grandparent, whatever, denies the impact of their behavior on other people. I've often talked with one of my very dear friends who happens to be a psychologist. Think of it like this. Imagine a a fairly small party or gathering where one person doesn't talk, doesn't say anything, doesn't say why they're not talking, just walks around or sits and stares. You can imagine what kind of impact that's likely to have on the others. Some people will try very hard to engage them, some will get mad, some people will ignore them or at least try to, but they have a lot of power, don't they? It's like someone refusing to own their impact on others. So you can have a family member like this mom, who is refusing to own the impact of her past behavior, and in fact wants credit for having changed, which is great that she's quit drinking, but she's still not taking responsibility for the impact of her past behavior and perhaps other characterological issues.

What they don't realize is that they've been hurtful and must earn back the trust of their family members because the family is not supposed to turn the page and pretend it didn't happen. No, that's not the way it works. And especially to call someone setting boundaries, abandonment when the trust hasn't been earned back, isn't fair or right. In fact, from what I know, from what this listener talks about, it seems that the mom just wants her daughter to ignore what has happened and trust her. And yet, I've heard many, many times in my office with people or mothers or fathers, whomever that have had abusive parents, they've said to me, "I can deal with them hurting me, but I'm not gonna let them hurt my child or my children." So that can seem pretty clear, right? The boundary's drawn, the mom gets mad, family doesn't understand, but it's still about," I'm not gonna let you hurt my children."

Yet this listener brings up another difficult point: Is not being involved with her mother going to confuse her children or even more greatly expose them to the pain in the family, especially if it sounds like other members of the family are moving on? Both her mom and some of her family are seeing this as cruel and they may make a big deal about it.

So this is my somewhat painful answer. Yes, it is a difficult issue and in fact, there's probably no total win in this situation, or at least what I've heard from this listener. Being estranged from a parent or a grandparent is going to need an explanation, at least an age appropriate one. But you can prepare yourself for that conversation.

I'd highly recommend that this listener read some Al-Anon literature or join an online or local group. Al-Anon is a group that was formed years ago.They help each other to see how their own behavior or choices could what's called enable the drinker. And remember, stopping drinking alone doesn't fix the problems created when someone was drinking. That's naive and even entitled. But the people who are involved in Al-Anon have a lot of wisdom to share. I've been told their motto is something like "detach with love." I've got the Al-Anon link in the show notes, and there are meetings all over the world in 133 countries. And of course you can join in online.

Perhaps they will give you their own versions of what they said to parents or family and how they explained it to their children. But you must remember as well that children learning that there is a natural consequence to their behavior and others, that's a really important thing for them to learn. I hope this has been helpful.

Thank you so much to those of you who are regular listeners, welcome to new listeners. I got a wonderful review from a listener in South Africa. She happens to be a therapist, so thank you for that. I read that. I appreciate it very much. People ask me all the time, how long have you been doing that podcast? And now in October it'll be seven years. It's just become a part of my life. And I appreciate all of you listening, reviewing, rating, commenting, and sending in your questions and voicemails. Thank you so much. Please take care of yourself, your family, and your community. I'm Dr. Margaret and this has been SelfWork.

 

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