Friday, October 31, 2008

How to help someone with postpartum depression

Do you know a woman with PPD or think she might have PPD? Here are some tips on how to help:
  • baby sit to give her a break (any amount of time will be helpful)
  • do chores or cleaning
  • cook nutritious meals
  • encourage her to rest
  • keep unhelpful or unnecessary visitors away - extra people may add to the stress. some people, who don't understand postpartum depression, may say inappropriate things that may make her feel worse
  • ask her if she would accompany you on a walk. Getting out, exercise, and fresh air may help.
  • encourage her to talk about her feelings, and of course listen
  • take her concerns seriously. don't be judgemental, or blame her for her problems
  • sit with her when she's feeling bad. you don't have to say anything, just being there can show support. sometimes it may even be better if you don't say anything.
  • let her know that you love and care about her - Proverbs 17:17 "A friend loveth at all times, and a brother is born of adversity."
  • be patient
  • Use encouraging words - Proverbs 12:25 "Heaviness in the heart of man maketh it stoop; but a good word maketh it glad." Some people believe in the tough love approach, but lecturing and trying to get her to "snap out of it" doesn't help.
  • She needs support. Remember that she needs comfort and understanding (which may be hard if she's cranky, irritable,or even combative.) Don't be angry with her or abandon her.
  • Encourage special husband/wife time. PPD takes a toll on the marriage. There's lots of stress and emotions running wild. The marriage needs special attention, so it doesn't fall apart.

Tuesday, October 28, 2008

The problem with discontentment & unfulfillment

Among the problems that can affect mothers with depression is a feeling of discontentment and unfulfillment. It’s easy to look at others and think that their life is so much better. Other women seem happier, have nicer clothes, and cleaner houses. Other women, even those with babies, seem to have their act together and have an easier time. When we start comparing ourselves to this perceived idea, our discontentment grows. We think we are that much more of a failure. At least this is how it was for me. Only God knows what others are going through. Perhaps they are just better at putting on an act for others. At least that’s what I would tell myself to help me feel better. I knew in my head that coveting was wrong and that I shouldn’t compare myself to others. However, the essence of this problem is having thoughts and feelings that you can’t control. I think most depressed people know that they don’t like how they feel. Maybe they even feel irrational, but they’re unable to stop feeling that way.

It gets frustrating trying to do everything. I often feel like I’m being pulled in different directions. My children have so many needs, and I have personal needs (and wants) too. My desires often have to take a back burner to my children’s needs. This was especially hard for me when they were babies. Something that comforts me is keeping in mind that Jesus had very little time to himself. His personal devotions were interrupted. He had to pray while others slept. Jesus’ life purpose was for serving others, full of sacrifices, and ended with the ultimate sacrifice. Sometimes I need to remind myself what my job is now. I am a mom, and I am supposed to take care of my children, even if I don’t always feel like it. Proverbs 31:27 & 28.

I wanted to stay home with my children. I figured God gave them to me to take care of, and they were my responsibility, not a day care facility’s. I wanted to see all their milestones, first steps, first words, etc. Admittedly I hated the word, "housewife," though. Part of the problem is that society has tried to make the definition of mothers’ role blurry. Society often does not recognize motherhood as a full-time occupation. Many women are discontent with "just being a mom" or think it is unfulfilling.

Mothers already have tremendous responsibility and unending chores. They must make sure there are nutritious meals for the family, wash dishes, do laundry, clean the house, bathe the kids, etc. Add to those job responsibilities outside the home, and things get tougher. Even if a woman is blessed enough to have a husband that helps, she still has quite a load of duties and stress to go with it. With all this stress, comes more strife and contention. Whether we like it or not, God’s plan was for women to be a "helpmeet" for her husband, and keepers of the home. It is easy to fall into the faulty idea that this makes women inferior or less important. Fulfilling a particular role that God has for a person is an essential part of any relationship, whether it’s employer vs. employee, laymen in church vs. pastors, man vs. God, pastors vs. God, etc. No one in any particular role has less value in God’s eyes.

Hebrews 13:5&6 "Let your conversation be without covetousness; and be content with such things as ye have; for he hath said, I will never leave thee, nor forsake thee. So that we may boldly say, The Lord is my helper, and I will not fear what man shall do unto me."

Wednesday, October 22, 2008

Postpartum depression is not a moral weakness

There is a really good post over at the Postpartum Progress blog & at Out of the Valley's blog

check'em out. I found it encouraging because I was in the same spot a few years ago, feeling ashamed for a condition that I was not in control of, nor that I brought on myself.

Is a fast paced Society to blame? (part 2 of 2 of causes of PPD)

The expectations of the mother or the society she lives in can play a part in causing postpartum depression.

A few years ago I read an article that said the instances of PPD was lower or non existent in 3rd world countries. The author wrote that it was due to large, extended families and the community coming together to provide care and support for the mother and new baby. "Families" are larger, consisting of grandmothers, aunts, sisters, and cousins. When a baby is born, everyone comes together. They all help with household chores and emotional support. The older women teach the new mothers about what to expect and mothering.

When I was in college (which was admittedly 15 years ago,) I took an anthropology course. In other cultures the mother and infant are often in seclusion for a particular amount of time after birth. This is to give them time to recuperate. Admittedly some cultures shroud this with superstition. Maybe these customs don't affect whether a woman gets postpartum depression, but it would provide rest, recuperation, and time to adjust. Personally I think there would be a different atmosphere and attitude concerning having a new baby. There wouldn’t be the same "life must go on," push to get back to normal life. Relatives come in and care for other children, do housework, and care for the mother. For example traditional Brunei Malay custom says new mothers must rest for 40 days, then there is a ceremony on the 40th day. Native Americans, like the Hopi had a 20-day seclusion with a ceremony on the 20th day. In India women, under
Ayurveda, are secluded for about 6 weeks after giving birth. They are instructed to rest, avoid housework, given massages, have a special diet, and meditate. In the Old Testament, in Leviticus chapter 12 women who had just given birth were required to be in seclusion for 40 days. Although this related ritual cleanliness and the purification custom of the time, I think this served a greater purpose. It provided formal recognition of a life change and transition time.

In our modern culture there is no formal transition for women who have just given birth. There is an attitude that "life must go on. Women have babies all the time. It’s no big deal." There is a lack of meaningful help for new mothers, unless a woman has the finances to hire appropriate help. It’s common for a first time mother to be inexperienced caring for a baby, or to have never changed a diaper before. Their own mothers or other relatives may live far away (or be emotionally absent) therefore unavailable for helping.

Personally, I do think that some these issues could have been a factor in my PPD. There was little support, as far as anyone teaching me about baby care or help around the house after I had my first son. I had little experience with babies. I had no clue what to do with a crying baby. When my husband and I got home from the hospital, We looked at each other and said, "what now?" We were both in shock. My husband, baby, and I were shut in the house for 2 weeks living off pizza delivery and heating up microwave dinners. I was scared to death to be left alone with the baby. I didn’t know what to do. I could barely change a diaper.

Just yesterday I met a woman who was waiting to pick up her kids from school. She was standing in the office, holding her little baby. She said the baby was less than 24 hrs old. She was standing there, dressed, awake, and acting like it was no big deal. My jaw dropped. I couldn’t believe it. I didn’t know whether to feel sorry because she had no one to help her or not. 24 hrs after I had given birth, I was exhausted. I looked like a zombie, and could barely walk.

With urbanization and "westernization" there are also changes taking place abroad. Studies in the 1980's suggested that depression at the time was rare in China and postpartum depression was non existent among Chinese women. However subsequent studies show depression may no longer be rare. A study published in 2001 among 959 Chinese women showed 13.5% suffered from 1 or more forms of psychiatric disorder in the first 3 months postpartum. In another study of PPD in China at http://wvuerin.blogspot.com/2008/08/postpartum-depression-in-china-vs.html is said that China is just beginning to learn about mental health issues, and the country lacks the resources to combat PPD. China has comparable rates of PPD to that of the us. Contemporary Chinese women face more isolation and less support that their counterparts of the past. They also lack role models, like the us has celebrities that come out in the media like Brooke shields.

On the other hand, another reason that PPD could be nonexistent or lower in some other cultures is that the culture just doesn’t recognize it. For example, the Chinese language supposedly doesn’t have a word in the language to separate "depression" from "sadness." Some places women are taught to not discuss their feelings. There could be a stigma attached to mental illness, so it no one talks about it. Some cultures attribute illnesses (physical and mental) to spiritual forces, and treat illness with magic, spells, amulets, etc. Are women in these other cultures suffering from something that could be PPD but suffering in silence and fear? Or is it being attributed to something else?

If you have any comments, I'd love to hear from you.
next blog, I will be discussing disconntment & unfulfillment

Thursday, October 16, 2008

Causes of Postpartum depression (part 1 of 2)

I touched a little on causes of postpartum depression in my last post. I would like to go into that subject more in depth, as the causes can be varied and complex. After I realized that I had a serious problem, I sought treatment. How do you begin to treat something if you don't know what the problem is?

I was brought up being taught that people with "mental problems" had a spiritual problem. They needed to "get right with God," repent, or read their Bible more. This belief made me feel like I was more of a failure. I grew more ashamed and didn't want to admit that I had a problem. I felt that my faith should be enough. What I wanted to do was avoid taking a pill to mask the symptoms, while there was still an underlying problem that needed dealing with.

The medical community teaches that there is an underlying physical condition that requires medical treatment, like medication. I was in a quandary. In reality I needed educating about postpartum depression. I went for a visit with my ob/gyn and began researching postpartum depression to find out more about it.

From what I can tell the exact cause is unknown, with the generally accepted cause having it's root in hormonal imbalance. Various studies have been done with inconclusive results. There are lots of theories about causes:
  • hormone changes - after delivery estrogen and progesterone levels in the body drop. Hormones can greatly affect mood, causing irritability, anxiety, depression and affecting reaction to stress (as in PMS, teenage females, and menopause.)

  • stress - being on duty 24 hrs a day, baby waking up every couple of hours, an unpredictable schedule, and an increased workload.

  • Feeling overwhelmed - feeling like you have to be superwoman; doing chores, laundry, dishes, calming a screaming baby, maybe balancing employment outside the home, etc.

  • unrealistic expectations - trying to live up to society's standards when it's not possible

  • lack of support from family and friends

  • marital problems - which can be a vicious circle because the stress of new parenthood combined with any of the other stressors on this list

  • financial strain

  • sleep deprivation - being deprived of sleep wreaks havoc on the human body. It lowers your resistance to fight sickness, affects your thinking ability and memory, affects your motor function, and affects your mood. Just think it has been used as an interrogation tool on prisoners of war.

  • birth of multiples - more work, more crying, and often they are born premature and via c-section

  • unexpectedly difficult delivery or c-section. labor is quite tiring, leaving you emotionally drained, and c-sections require longer recovery times. There is also a feeling of lost control when things don't turn out the way you planned.

  • pre-term birth or delivery of a child with birth defects - this may catch you off guard and involve emotional ups & downs, and worrying.

  • family history of depression, bipolar disorder, OCD, or anxiety/panic disorder
    traumatic family history. I came across this interesting article:
    http://www.psycheducation.org/mechanism/1MoralityorGenes.htm . This article states that the depression is caused by a gene. The reading gets rather technical with research data. This is the first chapter of a 12 chapter book about brain chemistry and depression found at www.psycheducation.org.

  • women who experience severe PMS are more likely to suffer from PPD, according to the American Psychological Association

  • difficulties at job

  • history of abuse

  • poor nutrition - This could be from an eating disorder, severe morning sickness that increased malnutrition, or poverty.

  • personality - the way one handles problems. Some people react to stress well, while others struggle.

  • expectations of mother or the society she lives in/role expectations (I will cover this in my next post)

Each woman is different. There could be any combination of causes that have been listed. Environmental factors exacerbate an already existing hormonal imbalance. One or more of these conditions might be present, and they build upon each other. People with depression drop deeper and deeper into the pit. Once a person gets in to the pit of depression it is very hard to get out. There is no quick and simple way out. That in itself is depressing. It's easy to get discouraged and give up.

There definitely is a spiritual aspect that is becomes quite important. I do know that in my own life, at the time, there was certainly a war going on. Satan can tell when you having a hard time, and he likes to kick people while they're down. Satan doesn't want people to have a joyful and victorious life. He wants people to be miserable and suffer. Often I felt too weak to fight. It was a fight that I couldn't win. Sometimes it felt better to give up. I remembered Job's wife, "curse God and die." In times like this I needed prayer, christian fellowship, and to read God's word. Bible reading was one of the hardest things for me to do. I was so exhausted and my list of chores was endless. If I got a spare moment, all I wanted to do was sleep. Getting fed spiritually is akin to getting fed physically, though. If all you eat is junk food, then you will become unhealthy. The same is true for spiritual food. So Bible reading and hearing the preaching of God's Word should be a priority.

Job 39:16 "She is hardened against her young ones, as though they were not her's: her labour is in vain without fear;"

Tuesday, October 14, 2008

Blog Action Day 2008

I just found out about the Blog Action Day 2008. On October 15th registered bloggers are supposed to blog about poverty to "bring awareness and incite action." So with this post I will discuss poverty and postpartum depression.

Postpartum depression can affect anyone, regardless of income level, race, nationality, or religion. However according to the University of Wisconsin School of Medicine and Public Health, depression in the postpartum period occurs in 10-15% of all new mothers (about 1 out of 8), with rates up to twice as high for women living in poverty. Additionally their website states, "Recognition and treatment are important components of improving both the mother's quality of life and that of her baby and family. With treatment, it is shown that the impact of PPD on babies may be minimal. But, if the depression remains untreated and becomes a chronic, recurrent condition, it can impact the mother-infant attachment relationship and can contribute to delays in the child's cognitive and language development, behavioral problems or other psychological issues."

So why are the rates higher for women living in poverty? First let's take a look at some of the factors that go into causing PPD.
  • hormone changes - after delivery estrogen and progesterone levels in the body drop. Hormones can greatly affect mood, causing irritability, anxiety, depression and affecting reaction to stress (as in PMS, teenage females, and menopause.)
  • stress - being on duty 24 hrs a day, baby waking up every couple of hours, an unpredictable schedule, and an increased workload. Also consider worrying. Worrying about all the new stuff the baby needs, like a car seat, crib, stroller, clothes, diapers, etc. What if there's no money to pay for these things? What if you can't pay your utility bill? What if you don't even have a place to live?
  • Feeling overwhelmed - feeling like you have to be superwoman; doing chores, laundry, dishes, calming a screaming baby, maybe balancing employment outside the home, etc.
  • unrealistic expectations - trying to live up to society's standards when it's not possible
  • lack of support from family and friends
  • marital problems - which can be a vicious circle because the stress of new parenthood combined with any of the other stressors on this list, and financial strain can cause marital problems
  • financial strain - This can be especially hard when you are responsible for another little life. You have to keep a roof over your head, keep food on the table, keep the electricity on. Maybe you have hospital bills to pay for the birth. If your baby has special needs then add on more costs. If a new mother is under pressure to go to work, rather that take maternity leave that just compounds the problem. Many employers don't have paid leave, so any time off that is taken means no money. Also keep in mind that she's probably making a minimal amount of money that will have to go to pay for child care and transportation.
  • sleep deprivation - being deprived of sleep wreaks havoc on the human body. It lowers your resistance to fight sickness, affects your thinking ability and memory, affects your motor function, and affects your mood. Just think it has been used as an interrogation tool on prisoners of war.
  • birth of multiples - more work, more crying, and often they are born premature and via c-section
  • grief over an unexpectedly difficult delivery or c-section. labor is quite tiring, leaving you emotionally drained, and c-sections require longer recovery times. There is also a feeling of lost control when things don't turn out the way you planned.
  • pre-term birth or delivery of a child with birth defects - this may catch you off guard and involve emotional ups & downs, and worrying.
  • family history of depression, bipolar disorder, OCD, or anxiety/panic disorder
  • traumatic family history
  • women who experience severe PMS are more likely to suffer from PPD, according to the American Psychological Association
  • difficulties at job
  • history of abuse
  • poor nutrition - This could be from an eating disorder, severe morning sickness that increased malnutrition, or not having the money to buy appropriate food. People affected by poverty don't have the option of fruits, vegetables, meat, and prenatal vitamins.
  • pregnancy being unwanted or unplanned

So for people living in poverty, postpartum depression can be a big problem. They don't have access to nutritional foods and are under more stress due to financial concerns. Women that live in poverty don't have access to proper health care either. If they can visit a doctor, they may walk a way with prescriptions that they don't have money to fill. My prescription for Lexapro was over $100, thankfully my insurance covered half of it. For a lot of people taking medication that costs money is not an option.

Then there is the question of, what happens when the postpartum depression goes untreated? The mother/child bond will be affected. There can be learning disabilities, behavior problems, and other psychological problems for the child. The National Center for Children in Poverty at Columbia University came out with a study in Jan 2008 about Reducing Maternal Depression and It's Impact on Young Children (http://www.nccp.org/publications/pub_791.html) They advise that depressed mothers affect the readiness of young children entering school. In areas where there is a school system that these children, these children will enter school with these problems which will take a toll on their education (as well as the teachers and school system.) In some countries, however, children living in poverty may not ever attend school. These children will grow up with the effects of the learning disabilities, behavior problems, and possibly psychological problems. They in turn will likely pass these traits on to their own children.

If you have any thoughts about poverty and postpartum depression or ideas feel free to comment.


Monday, October 13, 2008

What is Postpartum Depression (PPD)?

So what is postpartum depression? I thought I'd better talk briefly about what it is. Bear in mind that I am not a medical professional. I'm just someone who has been through it and subsequently learned a lot about it.

According to the American Psychological Association 1 in 10 new mothers experience some form of postpartum mood disorder. According to the National Mental Health Association 10-15% of all new mothers get postpartum depression.

Postpartum mood disorders can be classified in 3 categories:

Baby Blues - Baby blues generally don't impair functioning. Symptoms are sadness, crying, guilt, exhaustion, anger, and/or feelings of isolation. Many women will experience these symptoms after birth. If they don't go away in a couple of weeks or are severe it may be postpartum depression.

Postpartum depression - note that it may begin shortly after birth or up to a year later.
Symptoms:
  • crying for no apparent reason
  • helplessness
  • hopelessness/despair
  • anxiety/panic attacks
  • numbness
  • heart palpitations
  • frightening feelings/thoughts
  • over concern for baby
  • no feelings for baby
  • anger
  • lack of interest in sex (as if a new mom has time or energy for it anyway)
  • dramatic changes in sleep
  • dramatic changes in eating habits
  • inability to concentrate
  • impaired memory
  • exaggerated highs & lows
  • sadness or thoughts of suicide
  • thoughts of hurting baby
  • unable to cope

Postpartum psychosis - This is much rarer that postpartum depression, but is much more incapacitating often requiring institutionalization. Symptoms are any of the above in addition to; refusing to eat, frantic energy, sleep disturbances, irrational thoughts, paranoia, extreme disorientation, hallucinations, and thoughts of hurting yourself or baby.

I will close with this final thought from 1 Thess. 5 16&17 "Rejoice evermore. Pray without ceasing."

Thursday, October 9, 2008

Welcome

Thank-you, so much, for stopping by my new blog. I started it as a way to reach out to people affected by post-partum depression. I went through a very dark and lonely time. No one should have to go through those kinds of trials and tribulations alone. There is hope. God is there, ready to take your hand and guide you through.

Babies are such a great blessing from God, but taking care of them is no small task. This responsibility can be very stressful. Motherhood does take a sacrifice. By all means, motherhood isn't all bad. It can be quite rewarding and is an awesome privilege. The challenges of the post-partum period are hidden in a shroud of secrecy. You have a new baby! Yeah, you should be so happy! So when it doesn't go so smoothly, then we fall into falsely thinking that we've failed.


When I was in the thick of my turmoil, there were many things that I couldn't see clearly. Now that I've come through the fire, I can look back and see so much. At the time I looked all over to some Christian resources about post-partum depression and couldn't find any. There was information about regular depression and motherhood, but nothing that seemed specific to my predicament. I wondered if Christian women got PPD. Were my problems due to some weakness on my part? Did I have some unconfessed sin? Did I need to read my Bible more? Pray more? Get right with God? I started to blame myself. I grew ashamed.

After seeing my doctor and hearing stories from other women, I realized that I was not the only woman to go through this. There is no need to be ashamed. I think if more women talked about their experiences, it would help. Through this blog, over the next few months, I hope to share my experience, things that I've learned, and some biblical principles that I've learned. I will be discussing possible causes of PPD, treatment options, sharing some information about parenting, and offering some tips if you know someone with PPD.

"I can do all things through Christ wich strengtheneth me." Philippians 4:13