We Need To Talk

I am humbled by the emails and messages I've received from women (from all over) sharing their stories of Postpartum Depression.  Over the last few days, I've read each one and have mourned for the months and, in some case, years, these moms have lost to the darkness.  Some of the stories have haunted me and I've found myself crying for them and what they are suffering through.  One mom shared that she was contemplating and arranging her own suicide when she happened to read the Scary Mommy article, and that she was writing me, in tears, because she knew she needed help but just didn't know where to turn.  Several people, including friends, shared how their loved ones took their own lives due to their PPD struggles.  And yet there are more emails from survivors, telling me that my words defined their lives for a period and that they are grateful to finally be on the other side, whether just stumbling forward into the light or basking in its warmth.  Family members have opened up about their journeys- things that, from the outside looking in, I never saw, that none of us did.  And perhaps that is the most telling.  Friend after friend telling me how sorry they are for what I went through because they never knew... They never saw me struggling, that they thought I was doing a great job and had no idea that I was barely holding on.

This, I think, is one of the saddest things of all.  When we need help the most, we hide that from the world.  We suffer in silence, alone, when there are those who would throw us the rope, drag us into the light, or even sit in the darkness with us, convincing us to walk forward.  When you think of how much effort goes into the face we put on for fear that someone- anyone- might see the cracked façade and how much our PPD is destroying us, it becomes all the more sad to realize that by putting that effort into reaching out, we might be saved.  But in the trenches, it is impossible to see.  Now, I can say, "yes, I should have reached out.  I had so many  people who would have helped me."  Yet, months ago, that thought was unthinkable.  All I knew was that they would judge me, think I was weak, think I was an unfit mother, want to take my children from me.  And, even though I felt worthless and not good enough for my kids, the idea that I wouldn't have them... that they would be taken from me... that thought was too much to bear.  It doesn't matter that the thoughts were unfounded; those were the reverberating, echoing thoughts in the pit and, surrounded by that voice in my mind, there was nothing else.  There was no choice but to soldier on, to struggle, to nearly lose both the battle and the war.

Another comment that I've received by more women that I want to believe is that they did reach out to their care providers.  They called OBs and GPs; they told their doctors that they were struggling and wanted to self harm, and they were turned away.   Let me say that again: these women went to their care providers with their PPD and they were sent home.  They were told that, because they didn't want to harm their children and only wanted to hurt themselves, that it wasn't really Postpartum Depression and that they needed to take a break and get more sleep.

This.  This is appalling.  It makes me sick to my stomach.  What an everlasting failure- and not just to these moms, but also to their babies, their older children, and their spouses and partners. 

I have felt enormously lucky to have an OB who follows up and calls to check in during the postpartum period, and that wasn't enough for me to reach out, even though I know that I could have and he would have helped me.  We've been together nearly ten years now and, in addition to trusting him with my care (and that of my children), I have seen a doctor who really cares.  He knows Peter and I- our interests, our likes, even our drink preferences.  Seeing and talking to him isn't just another doctor's appointment, and it makes a huge difference, both in the level of care but also in the level of comfortability with my care and the decision making process.

I feel fortunate enough to be part of a community of wonderful midwives and mothers who care and reach out, not just to bring meals when someone is sick or to get together for playdates, but to be those hands that link together to pull you out of the black hole.  Having a baby with the practice isn't just another day at the office; these midwives reach out over and over throughout the mother's postpartum and the monthly mother's groups give moms a time to come together, to share their happiness and fears, and to have a safe place to share the ups and down of motherhood, parenthood, wifehood, and life.  These communities exist all over, and yet, for many women, they are nonexistent. 

We are not meant to birth in a vacuum.  We are not meant to be home alone, days after bringing new life into this world, trying to figure out how to exist with a completely dependent newborn and a body that is rapidly changing.  We are social creatures, meant to be surrounded by loving companionship.  50% to 85% of new mothers in industrialized nations experience the “baby blues,” and 15% to 25% (or more) experience postpartum depression.  This article goes on to cite major differences in how mothers in other countries are expected to rest, to be secluded from and cared for by others, and how the postpartum period is recognized as a distinct part of womanhood that is meant to be restorative for the recuperating mother.  In the U.S., however, we not only expect women to go home, usually to little or no help and, in some cases, to return to work right away, while also expecting them to entertain guests who come, not necessarily to help, but to coo and play with the new baby.

Now, I do think to argue that other countries have nonexistent PPD, as the above link describes, is unfair to the mothers all over the world who struggle with the hormonal crashes that are likely to blame for the initial step into Postpartum Depression.  As we know from more current research, PPD is a worldwide epidemic.  Citing a report from the WHO, the aforementioned site makes note that "Perinatal depression is one of the most prevalent and severe complications of pregnancy and childbirth."

What I do think is key can be summed up in this article, which states: "“A culturally accepted postpartum period sends a powerful message that’s not being sent in this country,” said Dr. Margaret Howard, the director of the Day Hospital for Postpartum Depression in Providence, Rhode Island. “American mothers internalize the prevailing attitude—‘I should be able to handle this myself; women have babies every day’—and if they’re not up and functioning, they feel like there’s something wrong with them.”"

I think that we have a serious attitude problem and it is one that is coming at the cost of new mothers and, in some cases, newborn babies as well.  We are a country that has long forgotten the "lying in" or "mothering the mother" model that used to be present.  We are a country that not only expects new moms to do it all, but we tell them that too- with our magazines and our commentaries on what they should  be doing and how they need to do this or that.  It isn't just the money making, have-the-baby-and-GTFU model of hospitals that's to blame; we as a society are to blame.  The problem is that no one recognizes the new mother as a recuperating person, and she does not see herself as one. For the mourning or the injured, we will activate a meal tree. For the woman who is torturously fatigued, who has lost one 10th of her body’s blood supply, who can scarcely pee for the stiches running up her perineum, we will not.

Did you know that death by suicide and homicide are more common than “traditional” causes of maternal mortality in the U.S., such as infection or hemorrhage?

• A mother kills herself 3 months postpartum
• A mother hangs herself while her baby sleeps
• A mother of two leaves behind a devastated husband and family
• Mom commits suicide four months postpartum
• Military wife loses battle with PPD

I really could go on and on and on.  That should be terrifying.  These are just the 'mother only' top death stories in a quick search.  These don't include the mother and baby stories, which seem endless, or the stories where mothers kill their children.  Those mothers, especially, we want to throw the book at while completely missing the fact that they are possibly in need of serious help.

I don't know the answer, but I know that we aren't asking the right questions.  A questionnaire before hospital discharge is a joke; perhaps it will pick up something (and for that, wonderful) but most cases of PPD don't start in the hospital. By the time the depression hits, moms are in their own space, often well before their standard 6-8 week FIRST postpartum checkup.  By that time, it  could be too late; by that time, defense mechanisms by mothers afraid their depression would cost them their babies could be well in place, all the while these moms don't realize this could cost them their very lives.

This is a conversation we need to have.  It is one we have to have if we have any chance of getting these numbers down.  Can they be eradicated?  Probably not.  But it is lunacy to accept the current statistic that 2 in 100,000 births will end in maternal suicide.  To put this into perspective, each year, around 1,200 American mothers die in childbirth—meaning about 28 mothers die for every 100,000 live births.  That's death while birthing- 2 in 100,000 will die at their own hand after . 

It's not enough to say "I won't be a statistic".  We owe it to our daughters that they will not be a statistic.  We owe it to our sons that they wont be mourning the mother of their child.  We owe it to our grandchildren that they won't grow up without a mother who felt like she couldn't reach out for help.  Our generation has seen a massive increase in maternal mortality; this is a talk we can have.  We can reach out to the new moms in our community and, instead of telling them how great they look or how much they have it together, we can wash a load of dishes, bring a meal, soothe a baby so that they can shower and sleep- and then, perhaps most importantly, we can do it over and over again.  We can ask "How are you?  Really..."  and mean it.  We can look for the signs that something just isn't right and, should we see them, we can share our own struggles so that moms don't feel alone and encourage them to seek out help.  We can assure them that no one will think poorly of them or take their children; that, instead, these moms will find love, compassion, and understanding. 

If we are unwilling to do this, then we bear some of the responsibility every time we see an article of a PPD related homicide or suicide.  We have lost the village; it's time to build it back.