Delivery from Darkness
Bringing postpartum depression out of the closet.
I was irritable; I cried; I was exhausted, yet had trouble sleeping. Getting through each day seemed nearly impossible. My own children avoided me; my husband tiptoed around me. I was convinced that my family and the world would be better off without me.
Although I was a certified nurse midwife at that time, my lack of experience and understanding of postpartum depression (PPD) matched that of the average layperson and, unfortunately, most medical professionals. PPD was something that happened to "other" women who already had psychological problems.
Anyway, PPD would never happen to me. I was too "happy!" I was always the type of person that people viewed as so capable, energetic, and positive. But I suddenly realized that if PPD could happen to Michal Finkelstein, it could happen to anyone.
After my sixth child was born over 15 years ago, I suffered from PPD. It was only after this birth that my doctor and I realized that I had probably suffered from PPD after the birth of my five other children. I had found it difficult to cope, but had chalked it up to having many children close in age, to being overwhelmed, to lacking household help. I didn't even know that my extreme frustration and anxiety weren't a "normal" part of being a young mother. Thankfully, I had a good marriage, good friends, and a cohesive community. This support, along with my sheer will, helped me to pull myself out of these milder episodes of depression.
However, this time, after number six, I was feeling really bad. I still shudder as I think back to those horrible, lonely feelings. I felt so alone. We had just moved, and my familiar support systems and dear friends were far away. I imagined that my husband, my children, and the whole world were against me. Intellectually, I knew that the thoughts going through my head were unrealistic, but I could not control them. At the same time, I was mortified at the thought of discussing the ferocity of my anger and bitterness with anyone.
Finally, four months postpartum, an older friend suggested I see a therapist. Thank God I did.
The past remedies – cleaning help, proper diet and exercise – were not sufficient this time.
The dark, heavy cloud slowly lifted during the following months. It was a hard process over time, with many ups and downs. At first, I tried talking with a psychologist. However, we soon realized that the remedies that had worked in the past – cleaning help at home, proper diet and exercise – would not be sufficient to improve the situation this time.
The psychologist referred me to a psychiatrist, who prescribed an antidepressant. Medication, along with counseling, provided the relief I needed. It took a few weeks for the medicine to kick in, and I felt worse before I felt better. It was so frustrating until the old me slowly returned. I can honestly say that it took up to a year until I felt 100% better!
I can offer three practical suggestions to get through this difficult time: first, focus on accomplishing only the most important task(s) of the day; second, keep the lines of communication open with your spouse, family, and friends; and third, speak with an objective third party who can help you direct your thoughts in a more positive and realistic manner.
A Common Crisis
We all know of someone who has suffered from PPD to some degree. Just mention postpartum depression and you will get an onslaught of reactions and personal confessions.
Postpartum depression is a pervasive and poorly understood phenomenon, not only in the medical world but also in Jewish circles. Many women are afflicted with some level of emotional distress after childbirth. There are varying shades of this "darkness?' A woman may not be suicidal or dangerous to her children; she may even get up and go to work every day, make dinner for the family and put on a happy face, but her internal sadness and despair are eating her soul away. She lives with these feelings in solitude.
We have to talk about PPD, discuss our stories, and share our experiences. The more we research, discuss, diagnose, and treat PPD responsibly, the more we can improve the quality of life for countless mothers and their families.
It took an American movie star, admitting she suffered from postpartum depression to make this issue front-page news. Only a year later, in 2006, the international edition of Newsweek magazine featured postpartum depression on its front cover. Finally postpartum depression is getting the attention it deserves. In the United States, Israel, and England, PPD screening and intervention are becoming an' integral part of pre- and postpartum maternity care.
In the state of New Jersey, a first-of-its-kind law was signed in April of 2006 requiring doctors to educate expectant mothers and their families about postpartum depression and to screen new moms for the widespread condition. Several other states have launched awareness campaigns on television and radio. These initiatives have trained health professionals to provide screening, referrals, and treatment for PPD.
Bracha & Zvi's Story
When we saw our little baby's heartbeat on the ultrasound at only eight weeks, we were so excited. We'd been married for only eight months, but the idea of having children was so important to us. We both came from large families, and we were hoping to be blessed as well. There was a scary moment in the eleventh week due to some bleeding. It all worked out, but for a few weeks I became quite apprehensive with every trip to the bathroom.
My husband Zvi learns Torah fulltime and I am studying for a degree in special education. Time flew and before we knew it, I was taking a childbirth class and making birth plans. My mother is an overwhelming and nervous type, so Zvi and I decided not to tell her when I was in labor. My older cousin Leah, herself a mother of four, agreed to accompany us. The birth was amazing, though the pushing was tough. What a big, beautiful boy! It was so special to think of all the celebrations ahead of us – shalom zachor, bris milah, and pidyon haben.
Everyone was excited, but I could tell my mother was hurt that we hadn't asked her to come to the birth. I felt a little guilty but decided to deal with it later. I was feeling so out of it from the birth and I knew from past experience that it's better to deal with my mom when I have my wits about me.
I checked his I.D. bracelet every hour in case someone had switched my baby with another one.
The nursing didn't go well in the beginning, but I assumed that after a little rest and some assistance, it would be fine. It was very noisy in the hospital; I couldn't sleep even though I was exhausted. My mind was racing and I kept seeing my mother's face, imagining she was really upset. Finally dozing off, I dreamt my mother had taken the baby to sell him at the market because I wasn't a good mother. I woke up in a cold sweat with my heart pounding. Maybe the dream was a sign that I wouldn't be a good mother or I didn't deserve a healthy baby. I told Zvi, and he said I was just being silly and chalked it up to exhaustion. It's a good thing there was rooming in, so I could keep an eye on the baby.
I couldn't sleep and I remember checking his I.D. bracelets every hour in case someone had switched my baby with another one. I kept a list of everyone coming in and out of my room, so we would have a record of any foul play. I even asked Zvi to bring the small tape recorder I used to tape classes so I could record incoming phone calls. I recall tasting the baby formula to make sure it wasn't poison and I insisted on going to the nursery when they weighed and bathed the baby before discharge. The nurses just laughed and patted me on the back, saying I was already an overprotective mother.
No way did I want to go to my mother's house from the hospital, though we originally had planned it that way. I suspected a plot, so we headed to our own home instead. Zvi said he thought that maybe I would be more relaxed at home, just the three of us. However, he was looking at me kind of weirdly; I started to get nervous, thinking that perhaps he was plotting something. Everything after that was a blur.
We were told in the childbirth class that being emotional and teary after delivery was normal, but Bracha was unusually anxious and started to act strange. She wouldn't let anyone hold the baby and, when we got home, she locked all the doors and pulled the shades down. She had this wide-eyed look on her face and paced around the house. I became frightened and called her doctor. He said to meet him in the emergency room. I felt horrible, but I had to make up an excuse that we forgot something at the hospital in order to get her into the car. It wasn't pleasant once Bracha realized her doctor was there to meet us, and the medical staff had to forcibly give her an injection to calm her down. She was hospitalized in a mother-baby psychiatric unit specializing in postpartum psychosis.
I never knew something like this could come about after childbirth; I felt as if I had been hit by a ton of bricks. Who would've thought that something like this could happen! The doctors explained that postpartum psychosis occurs once in every thousand women. Who cares about odds: when you're the one, you lose.
I wondered if our lives would ever be normal again.
Bracha's treatment was divided between physical and mental health care. She was given many types of medication while being encouraged to reconnect to reality. She seemed disconnected from her surroundings, including the baby and me. She did respond to the drugs fairly quickly and was much calmer within the first week. By the second week she started expressing interest in the baby but could not be left alone with him. It was as if she was afraid of the baby and was apprehensive about taking responsibility for his care. The nurses gave him formula and would encourage Bracha to assist with the feeding. Often Bracha would stare blankly into space, as if she was deep in thought. But if I asked her what she was thinking, she always said she didn't know. Her levels of medication were lowered after her condition stabilized, but breastfeeding was out of the question. I didn't care; this was the least of our problems.
Finally after a month, she started smiling when I came to visit. Her doctor dissuaded other family members from visiting. Her mother was pretty annoyed at first but accepted it after talking to the doctor. It was important for us to work with the staff as a team and not against the doctors. It was hard at first because we felt that we knew Bracha better than they did. But during this process, we learned a lot of new things about depression and how to respond to this situation. The doctors, nurses, and social workers explained the situation not only to me, but also to Bracha's family. Their direct contact with Bracha's mother made the difference in my mother-in-law's acceptance of the situation, including the doctor's limitations on visits. It also made it easier for us to calm down and deal with this crisis and the rest of the family.
The staff constantly reassured me that I was not at fault, though when I was at home alone without my wife and baby, there were difficult moments. "What could I have done differently?" I would ask myself. Of course there was no answer, but I would recommend that anyone in my situation get some counseling. I'm embarrassed to say that I selfishly worried at times that I would be saddled with a mentally ill wife for my whole life.
Even when I was angry at the world, my heart was breaking! I wondered if our lives would ever be normal again. Every day dragged on and was difficult. At first I didn't know what to say to people. Mental illness is usually kept hush-hush, but we decided to tell a few close friends and relatives the truth. Since we live in the city, most of the neighbors just thought Bracha was recovering from the birth at her mother's house.
I took a 3-month leave of absence and became daddy with a capital "D".
After six very long weeks of intensive therapy, Bracha was discharged. She continued with psychotherapy three times a week and was still taking four different medications, including birth control. I was very relieved to have my family home, but now most of the childcare fell on my shoulders; Bracha was still incapable of coping by herself. So I took a three-month leave of absence from kollel and became daddy with a capital "D".
It's been six months since David's birth and he's growing beautifully. Bracha is getting better every day, but there are still moments when she seems distant and anxious and she's still on some medication. My main concern is that Bracha should be 100% better before we would ever consider having more children. I get tears in my eyes in gratitude to Hashem when I see Bracha holding our David and singing to him. We've come such a long way!
I was in a foggy dream for a long time. I remember bits and pieces of being around lots of strangers, with Zvi floating in and out. I didn't really know where I was, but I recall nice people telling me it was going to be all right. I felt very tired all the time. I remember dreaming about a baby and I eventually became aware of the fact that I was in a hospital and no one had stolen him. I felt a sense of peace, like surviving a tornado.
When the doctors and Zvi explained what had happened, I was kind of embarrassed and felt sorry for Zvi and what he must have gone through. But Zvi was so good and kept reassuring me that he loved me and the baby, and we would be a family together. I wanted to get better, but I would get scared every time my mind would wander a bit. When I felt disconnected from reality, my baby David was more insignificant to me. I would feel I wasn't really his mother; he was just some random baby. The feeling was terrifying and my heart beat rapidly. Over time, this feeling occurred less and less.
Finally we were able to go home. I was a bit nervous, but Zvi was a big help. David was an alert, smiling baby. I was tired of being treated as if I were sick, but logically I knew that I had been through a major ordeal. At first I felt that everyone was staring at me and knew what had happened. But every day got easier and I even started to take a couple of classes at the university. David was in half-day childcare to make the transition easier. My parents came to visit once a week as did Zvi's, but they were careful not to interfere.
It's a physical illness, like a heart attack. It wasn't my fault that I got sick.
It's hard to believe I was the unlucky one in a thousand to suffer from psychosis after childbirth. Now that six months have passed, I'm grateful to be surrounded by people who care. When we get together with friends and family, we never talk about the hospitalization and I really hate when people treat me differently. Thank God Zvi and I really communicate well and he's always there when I need him. I try not to feel guilty about the psychosis; it's a physical illness, like a heart attack. It wasn't my fault that I got sick.
I still have hopes for more children, but I know that any future pregnancy will have to be monitored by my psychiatrist. I think I'll just take it one day at a time and be thankful for the blessings I have.
Signs & Symptoms – A Postpartum Continuum
Occurrence: 80% of new mothers.
Onset: Up until third week postpartum.
Signs: Moodiness, weepiness, nervousness, sleeplessness.
Treatment: Resolves on its own, though increased communication with caring people and catching up on lost sleep helps.
Implications for Future: Not an indication as to whether or not a woman will develop PPD.
POSTPARTUM STRESS SYNDROME (ADJUSTMENT DISORDER)
Occurrence: One in five new mothers.
Onset: From birth until about 3 months postpartum.
Signs: Anxiety, self-doubt, helplessness, frequent crying, frustration, irritability, negative feelings.
Treatment: Often considered a normal part of adjusting to parenthood; usually resolves on its own. Recovery is hastened when a woman nurtures herself and reduces her standards of performance and demands on herself during this time.
Implications for Future: Can pass or progress to full-blown depression.
Occurrence: 15-20% of new moms.
Onset: From 3 weeks postpartum to one year; average 3-6 Months.
Signs: Depression, frequent crying, difficulty concentrating, difficulty sleeping, lack of energy, reduced interest in marital relations, reduced appetite or binge eating (carbohydrate craving>i, irritability, anger, yelling, feelings of lack of control and hopelessness.
Treatment: Treatments such as talk therapy, medication, natural remedies, vitamins.
Implications for Future: May recur with succeeding childbirths. tt'eimen should be aware that preventive therapies are needed.
Occurrence: 1 in 1,000 new mothers.
Onset: Within the first 2 weeks postpartum.
Signs: hearing voices or sounds no one else hears. Thoughts of hurting oneself or baby, no sleep in 48 hours, cannot care for baby or self, rapid weight loss without trying. Cannot control thoughts, as if someone else were controlling her thoughts and actions.
Treatment: Hospitalization, medication.
Implications for Future: Should be under joint psychiatric/ obstetric care during next pregnancy and postpartum
Excerpted from Delivery from Darkness, A Jewish guide to prevention and treatment of postpartum depression.