The arrival of a new baby can be a time of great joy. But for many new mothers, it can bring on overwhelming dread and fear. Postpartum depression—PPD—is a crippling state that can transform the thrill of motherhood into a near-constant state of anxiety and fear. And it’s more common than anyone may know. A our site survey of more than 1,400 pregnant and new moms found that 21 percent of moms – 1 in 5 – were diagnosed with postpartum depression. And more than half of women who were not diagnosed with PPD said they felt sad, miserable, or very anxious following childbirth.
That may not surprise many moms out there, but this should: 40 percent of women who experience the severest forms of these difficulties do not seek treatment. Even as awareness grows, the stigma of mental illness – the belief that new moms should be happy and smiling – keeps them from reaching out for help and support.
The good news: Growing awareness
BabyCenter’s survey found that nearly 90 percent of women know what PPD is, and most believe it can be treated through counseling or medication. “It’s great that there is such high awareness for PPD,” said Alison Stuebe, an associate professor of maternal-fetal medicine at the University of North Carolina School of Medicine and a member of the Society for Maternal Fetal Medicine who consulted on the study. “The first step to destigmatizing it is knowing that it’s common.”
And yet, 2 in 5 women in the survey who reported being diagnosed with PPD did not seek treatment. This is the frustrating paradox of improving maternal mental health, experts say: If so many women know about PPD, why are there still so many that don’t get help? Our survey offers some answers – and some compelling insights into the lingering stigma.
Embarrassment, guilt, pressure: Why some women don’t reach out
According to the survey, the biggest roadblocks keeping women from seeking treatment were the belief that they could overcome PPD on their own, and embarrassment and guilt over the way they were feeling.
Even with a greater societal awareness of PPD, when it comes to the day-to-day reality of life with a newborn, moms think they should be joyful and grateful. Anxiety, depression, and dark, invasive thoughts don't fit into the picture of modern motherhood. So some moms still hesitate to talk to anyone – their partner, their healthcare provider, a family member – about how they're feeling.
"It's the biggest obstacle to treatment," says Wendy N. Davis, executive director of Postpartum Support International, which provides education to healthcare providers, and peer support and referrals to women and their families. "Women put so much pressure on themselves to be perfect that even when they find themselves having difficult symptoms, they put pressure on themselves to get over it."
Davis suffered from postpartum depression after the birth of her first child, and understands that reaction on a personal level. "I'm a therapist," she says. "And I didn't know I was depressed. I just thought I was failing."
Tabloids and headlines: Misinformation that hurts
Katherine Stone, a nationally known advocate for women with PPD and the founder of Postpartum Progress finds the disconnect between awareness and treatment disturbing, and lays some of the blame on media hungry for attention-grabbing headlines.
Brooke Shields’ 2005 memoir Down Came the Rain garnered a lot of sympathy for its candid portrayal of her struggle, says Stone. But news outlets also zero in on high-drama tragedies such as that of Andrea Yates, a Houston mother who drowned her five children in 2001. "So the portrayal of PPD in the media began to revolve around the idea that women who have it hurt their kids," says Stone.
In fact, Andrea Yates suffered from postpartum psychosis, a very rare condition that requires immediate treatment. In that state, a woman "believes the anxious thoughts she is having and believes she has to act on them," explains Melinda Gallagher, a senior psychotherapist at the Seleni Institute, a nonprofit mental health and wellness center for women and mothers in New York City.
But the confusion around PPD and postpartum psychosis has percolated into everyday awareness, even among moms. BabyCenter's survey found that 77 percent of women thought having PPD meant you were a risk to your child's safety.
The fact is that "women with postpartum depression do not harm themselves, and they do not harm their babies," Gallagher said. In fact, women with PPD often feel tremendous distress that they could accidentally harm their children. "We call these thoughts 'intrusive' because they're difficult to dismiss – but the fact that they are distressing to the mom actually decreases any chance of acting on them," says Gallagher. "There is usually a big sigh of relief when a new mom learns that these thoughts are common."
The misperception that all women with PPD harm their children is damaging from both angles: Women might avoid getting help, because they fear being seen as a threat to their baby, and women who have other symptoms of PPD but aren’t thinking about harming their children might conclude they don’t have it – and not seek help.
The challenge of identifying PPD
Some of the symptoms of PPD, such as anxiety and irritability, don't fit the stereotypical picture of depression. "Women don't look like the sad, crying woman in the hospital brochure," says Davis. In fact, most women with a postpartum mood disorder predominantly feel anxiety, rather than sadness or other typical symptoms of depression.
Other symptoms of PPD can include:
- Changes in sleep patterns
- Difficulty sleeping even when the baby is sleeping
- Weepiness or sadness that persists all day
- Diminished interest in almost all activities, including sex
- Difficulty concentrating
- Change in appetite
- Intrusive worries or scary thoughts
- Moodiness and irritability
- Excessive guilt
- Panic attacks
- Suicidal thoughts
Some of this is normal baby blues. Where it tips into PPD is when the thoughts start to take over your life. Stuebe will sometimes ask a patient, “Are these thoughts keeping you from having moments of joy with your baby? With sleeping, eating, taking care of yourself, or leaving the house?” Those are signs that a woman might be suffering from PPD and could benefit from professional help. (Women should seek help anytime they are having thoughts of harming themselves or their baby).
Our survey also found that nearly half of women who were diagnosed with PPD had a family history of depression. "It’s fairly rare that PPD comes as a total surprise,” says Stuebe, noting sufferers often had some depression and anxiety before or during their pregnancies.
Talking (or not talking) to your healthcare provider
"A significant number of women are still reluctant to seek help even when they're really struggling," says Samantha Meltzer-Brody, director of the perinatal psychiatry program at the University of North Carolina Center for Women's Mood Disorders in Chapel Hill. "They have to see it as an illness like any other medical illness and get treatment in the same way women get treatment for gestational diabetes, preeclampsia, or any other complication of pregnancy or postpartum."
For women to make that connection, experts say that medical providers also need to treat maternal mood disorders as they do any other condition related to pregnancy. “As a complication of pregnancy, PPD is more common than diabetes and preeclampsia, but we don’t screen for it,” says Stuebe. “We take your blood pressure at every appointment, but there’s not universal screening for PPD or perinatal depression.”
Almost 40 percent of survey participants said no medical professional had talked to them about the condition. And to make matters worse, many of the women who did speak with a healthcare practitioner found the conversation unhelpful. Given moms’ reluctance to talk about how they’re feeling, even the phrasing of a question can make a difference. If a healthcare provider says, "You're not feeling depressed, are you?" a new mom might feel subtle pressure to say, “No, I’m okay,” instead of “Yes, I am, and I don’t know what to do."
A doctor who talks about how common postpartum anxiety and depression are can create a more comfortable scenario, Meltzer-Brody says. And Stuebe makes sure she asks her patients two important questions during their follow-up visits: “Are you having trouble sleeping, even when the baby is sleeping?” and “Are you having scary thoughts?”
What helps: Connection, community, diagnosis
More than half (57 percent) of the women surveyed found that connecting with a friend or family member – usually another mom – about their feelings was helpful. "Women with postpartum depression and anxiety believe they are alone," says Stone. She often hears women say, "I can't believe how many others are going through this. I didn't know."
"And when they get effective help," says Stone, "there's a massive sense of relief: 'Somebody gets me. Somebody is going to help me get through it. I don't have to figure this out by myself. I am not defective as a mom.'"