Speaking Up About Postpartum Depression

Amie Newman

What new mothers don't know can hurt them. Postpartum depression can have a devastating effect but these women prove there can be a way out.

Tom Cruise's take?

"You can use vitamins to help a woman through those things."

Cruise told Brooke Shields, after the birth of her first child, that "she should have used vitamins" to get over her postpartum depression; adding that he was, in fact, "disappointed" that Shields chose to use the anti-depressant Paxil to alleviate some of the symptoms of her postpartum depression.

You can't really blame Tom Cruise for his perspective. You can get angry at his pompous statements. And, as a mother who experienced PPD and survived because of an extraordinary husband and the miracle of anti-depressant intervention, I did – as did Rosie O'Donnell and Brooke Shields herself. But the general public has tended to lump postpartum depression (PPD), until very recently, under the catch-all "new mother issues" to describe what many women experience after the birth of a baby. And there are still far too many women who are caught unaware, without preparation, support or understanding of what is happening to them.

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Sure, if you're lucky enough to have access and means to attend a childbirth education class prior to the birth of your baby you're likely to receive some information about the subtle differences between the cute-n-cuddly-termed "baby blues" and the more severe "postpartum depression."

But this is clearly not enough to help the millions of women and their families who have suffered through (and some who haven't made it through) a very real mood disorder.

Just ask Thomas Soukakos, owner of Vios, a café in Seattle, and the father of Alexander, now almost five years old. Soukakos' wife, Carol, committed suicide just months after Alexander's birth in 2002 while suffering from severe post partum depression.

Soon after her death, he was quoted in The Seattle Times as saying, "I've lost the love of my life, my soul mate and my friend and I look toward my son, Alexander, for inspiration now. I'm so grateful I have him."

Soukakos decided, however, not to let his wife's death go unnoticed. After receiving letters from around the country from other women and families who had been touched in some way by postpartum depression, he decided to embark upon a mission to help educate not only women about this condition – but everyone.

Christin Jamieson, communications director for the Washington state "Speak Up When You're Down" postpartum depression awareness campaign calls Thomas "the father of the campaign." In fact, in 2005 Soukakos provided the testimony to the Washington state legislature that secured the first round of funding to launch the campaign.

"Speak Up When You're Down" was developed with help from the New Jersey PPD campaign – the first in the nation. New Jersey's governor from 2004 to 2006, Richard J. Cody, helped secure over $2 million in funding for their PPD public awareness and education campaign with the help of his wife, Mary Jo Cody, who had suffered from the condition after the birth of their first child.

Jamieson says, "When we decided it was time for Washington state to launch a similar campaign we had only $25,000. We called the campaign folks in New Jersey and they gave us permission to use their tag line, their artwork, everything for free."

The "Speak Up When You're Down" campaign was rolled out in 2005 to shed light on an issue that desperately needed a spotlight.

Jamieson says, "While no one is sure what causes PPD…understanding that this has nothing to do with how good of a mother or person you are underscores the importance of speaking up to your partner or your doctor when you're not feeing like yourself…Having an understanding of the signs and symptoms of PPD can also help loved ones support the mother and encourage her to get the help she needs so she can start to feel like herself again."

And while "Speak Up When You're Down" was developed strictly as a public awareness campaign Jamieson notes that, "When you increase awareness without the resources to meet the needs, it's not as helpful. We need to train and educate health providers and increase knowledge as well. There is a delicate balance that needs to be reached."

A delicate balance that strikes many as crucial.

"It felt like the medical profession wasn't aware – that question wasn't asked: Does my family have a history of depression? My family does have a history of anxiety and depression…" Monica Lopez shares.

Monica is a Parent Educator for Parent Trust for Washington Children, the organizational leader of the "Speak Up When You're Down" campaign. But Lopez was once a new mother herself, angry and confused, suffering from PPD.

"As a first-time mom, I wanted to read it all. To know as much as I possibly could. It would be nice if there was more information out there from medical professionals so women can be as educated as much as possible."

As an example, she points to the book "What to Expect When You're Expecting" – a handbook for so many soon-to-be new mothers over the years. "The book is like an inch thick. I read it like a bible when I was pregnant. But there is not even a half of a paragraph in there about postpartum depression – it's a small, little blurb!"

Monica received relatively speedy relief from her PPD symptoms but the experience was traumatic.

"I first realized something was wrong when I brought my daughter home from the hospital and she needed to be nursed. I didn't even want to look at her. I back-pedaled when my husband walked towards me holding her in his arms."

"I said, ‘No – I don't want to. Keep her away from me.'" He knew something was not right and he immediately called 911. The paramedics had some sort of an idea of what I was experiencing so I got dressed and they took me to the hospital. There they told me it was common and with the right medication I'd get back on track."

Monica says she was lucky. "My husband was so patient and understanding and knew to call 911 when something wasn't right. But what about the women who don't have that support?"

And Monica notes, her mother was her rock. "In the Hispanic culture, mothers are right there after childbirth, like a right arm. They come in and make tea, encourage you to nap and help you self-soothe." But, she says, when a new mother is experiencing symptoms of PPD, "you need medical attention. You need to hear that you're not alone from a health professional."

Monica says that increasing public awareness and letting women know that they are not alone is crucial to helping women. "We need to educate our neighbors, educate each other." But, she stresses:

"Doctors need to make sure and tell women: this is normal. It occurs. It's more common than you think. If this should happen, this is what I'd recommend. If it comes from a doctor, you'll be more successful in treating the symptoms."

"When I saw a nurse, after I was diagnosed with PPD, she told me she had gone through the same thing. I said to the nurse, ‘How can I feel this way? My daughter is healthy, beautiful – and I want nothing to do with her.' It was so helpful to hear a nurse say that it was okay. What I was experiencing was normal."

And now, as a woman who has experienced PPD and come out the other side, Monica is committed to helping other women who experience the same thing.

"We need to get in the faces of OB's and pediatricians. We need to approach gynecologists with a card – like the breast-check self-examination shower card – but for new mothers: If you're feeling this, this and this you might be experiencing postpartum depression. If you're a first time mother, you may not know the difference between the baby blues and PPD," says Stefanie Pistole-Mangum, a first-time mother and volunteer for Postpartum Support International's (PSI) Washington chapter.

Pistole-Mangum gave birth last year to a beautiful baby girl. She says, "Today, I can't imagine my life any other way. It's absolute bliss. But a year ago, I didn't know how I would possibly imagine having a normal life ever again."

Stefanie is a phone volunteer for the Washington chapter of PSI's "Warm Line." Once every three weeks she is the assigned volunteer who checks messages and returns calls to new mothers, their family members or even providers who call the hotline needing help and resources from other mothers who have experienced PPD and recovered. The "Warm Line", according to Kathleen Pantoja, Volunteer Coordinator for PSI of Washington and herself recovered from PPD, is "an exceptional first step to initiating recovery" for a new mother who recognizes that something is wrong and needs help.

Stefanie has a questionnaire with a check-off list of symptoms: Are you experiencing loss of appetite? An inability to sleep? Severe or higher than normal levels of anxiety? What does your support system look like? After hearing answers to these and other questions, Stefanie can provide them with referrals to a doctor or a support group for postpartum depression, if there is one in their area.

But, Stefanie says, "If you've been through this, you know that just hearing someone say ‘I've been there too and I got through it and you can too' and then helping to eliminate the chasing around to find a doctor can help a woman immensely."

Stefanie prefaces her story of her experience with PPD by saying "Postpartum depression wasn't even on my radar screen before I became pregnant. I didn't know what PPD was. It's not something I even thought about. If I would have thought about it though, I probably would have said Tom Cruise is right – people shouldn't take drugs. I would have told a new mother who told me she was depressed to go get a pedicure or listen to some happy music."

Which makes some of what she relays about her depression that much more crushing.

"For me, it was gradual but once I hit the bottom I couldn't believe it. It was hell and it was grueling. I remember sitting in my car with my dad soon after I had my daughter thinking: ‘You know, we're on a freeway. If I just open the door and fall out, it would kill me. How would me being gone affect my daughter? Wouldn't it be better for her? I just don't want to be here.' It was just complete apathy for me. Now, I realize, hell isn't fire and brimstone. It's just an empty place filled with apathy."

But Stefanie is also quick to say that she too had a great deal of support from her family. She had everything in her favor: an understanding and "unbelievable" husband who was quick to act, good health benefits and access to quality medical care.

So, what about single mothers who may not have a partner or friend readily available to recognize symptoms and provide crucial support when it's needed? Or more marginalized populations of women who do not have access to care or resources because of income or language barriers?

Stefanie says, "For me a lot of it is about the state of health care. Who doesn't have the access, the benefits or the support? Because with no support or access to care, I wouldn't have made it through."

Christin Jamieson says that, "PPD…can affect a woman no matter her age, income, race or level of education. It's not enough to assume that it only happens to a small number of women – it doesn't."

Kathleen Pantoja says that social isolation and chronic stress are major risk factors for developing PPD and says that the "Speak Up When You're Down" campaign as well as PSI of Washington "feel strongly about reaching out to diverse populations at risk for PPD."

In addition to printing pamphlets in Spanish, there are Spanish-speaking "Warm Line" volunteers. Also, Kathleen notes, "We help bring awareness of PPD to low-income families by supplementing community service organizations with the latest PPD educational and informational materials."

And Jamieson is hopeful that a new web-based tool being developed for health care providers (including social workers and mental health providers) will help them "gain a better understanding of cultural impediments to relationship building with clients."

There is reason to be extraordinarily hopeful.

Almost all of the women I spoke with – Monica, Stefanie, Kathleen and Christin – have come through the tunnel of PPD and want nothing less than to see it conquered in their lifetimes. Kathleen is clear: "We save lives with the work that we do…and it gives me great joy!"

Monica finds comfort in the knowledge she can now pass down to her own daughter: "My daughter knows all about my experience with PPD because I want her to know that she's at risk and what she can do if she does suffer from PPD. She knows that mom had PPD and she got medical attention."

Stefanie offers it straight: "I crave this campaign works. I want to help others who are going through this. I want to tell them: you're not alone, you're not weird and you won't always feel this way."

She continues, "You know when you're on a plane and they tell you to put an oxygen mask on yourself before placing one over your child's mouth? That's what seeking help for PPD is about. My own oxygen mask needs to be on before I put my child's mask on."

For a woman who just one year ago had "active suicidal thoughts", the peace and clarity evident in Stefanie's voice is startling – and comforting.

If you, or someone you know is suffering from PPD or may be experiencing some of the symptoms, you can call PSI's toll-free line at 1-888-404-7763.

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