Postpartum Depression: Why Mental Health Surveys Suck

I had a baby recently. It’s been a while since I popped one out, so all the hospital stuff was new to me and my postpartum short-term memory.

One BIG thing I noticed was the addition of questions regarding mental health. I not only filled out two questionnaires, I also verbally answered a survey the nurse gave. My obstetrician went over concerns at discharge. Then, two weeks later, the pediatrician’s office (read: at the appointment for the baby) included a typed survey in their New Patient paperwork.

Wonderful, I thought. But, also, Not really helpful.

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Why?

For anyone who’s fighting the Mental Illness Fight, you know that a simple, typed questionnaire is not sufficient. Theirs included questions like:

How often do you feel hopeless?

Have you cried uncontrollably in the last week?

Have you ever had thoughts of hurting yourself?

Great questions, yes? They’re almost as good as the responses you can choose from: Not very often, Often, Sometimes, No more than usual.

That final phrase is the one I chose most, and one that keeps flitting through my mind: No more than usual.

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No, nurses-doctor-pediatrician, I am not experiencing Postpartum Depression. It’s regular, run-of-the-mill Depression for me. Just hand me the baby, and we’ll (hopefully) make it through. Don’t worry -it’s no more than usual…

What’s the solution, then? Should the clinics not bother? Pretend these things don’t exist?

No, of course not.

When I first went to my obstetrician’s office, I saw a few papers taped to the back of the bathroom door. One encouraged women who felt they were in an abusive relationship to get help, and had tear-off phone numbers. Another paper discussed which contraceptives were most effective. The final flier caught my eye first: a bright, informative piece explaining that Postpartum Depression included things like anxiety or OCD or physical ailments as well, and to talk to your doctor if they cropped up.

At the time I saw that paper, I felt touched. I felt like dropping my urine protein test right away and giving the whole office staff a hug for including that information.

Since birthing and experiencing ‘usual’ symptoms, however, I’ve felt each nurse and doctor needs a short lecture. I’d begin with, “Make eye contact with your patient and ask them ‘yes-or-no’ questions.” Like:

Did you feel hopeless in the last week?

Did you cry?

Did you feel like hurting yourself?

Instead of Often, Usual, Never, etc., try a scale from 0-10. Or, try sitting and LISTENING sincerely to the woman’s responses.

Another helpful tip would be to explain what might happen if the answers are alarming. I don’t know about the rest of you, but I don’t need the staff committing me to a psych ward because they don’t understand. I mean, maybe I just need a hug and a nap.

And medication.

The point is that mental health surveys are a good step in the right direction. With a little tweaking and lot more human interaction, they could even be helpful.

Let’s try it, and help those of us trying to fight mental illness. We might just ‘usual’ly beat it.

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©2019 Chelsea Owens

Photo Credit:
Liv Bruce
Zach Lucero
Jenna Norman
Kelly Sikkema

The First and Last of the Dark Days

I learned from another blogger that May is Mental Health Awareness Month. I think many of us with mental health concerns find the stigma around it to be truly terrifying. It can push us inward and leave many of us feeling unwanted or hushed. Suffering in silence and alone is not healthy for anyone, including those around us. Today, I wanted to share with you a quick glimpse of my first darkest of days and my last. There have been many times in between, but consistently I pull myself through, and each time I do, the darkest days come less frequently, and are not as dark as the previous.

September 1996. The pressure to choose a major, before I returned for my third year of school, was being hammered upon me. The weight of this decision was unbearable. I saw many friends easily sticking with a major, planning out projects, collaborations, and internships. The feeling of not belonging created a snowball effect and caused me to fall into classic avoidance behavior.

On the first day I was late to class, probably not by accident. I can’t remember what class it was, but I do remember the feeling of standing outside the door, hearing the professor already speaking, that hallowed silence from the rest of the students, and I knew I couldn’t go inside. My first panic attack occurred outside of that room. I felt like a heavy blanket was thrown over me, I couldn’t breathe or concentrate. My legs felt weak, thoughts in my head were disjointed, and flight or fight kicked in. Flight won.

I dropped out of school that week. This was the beginning of the anxiety and panic attacks that I kept hidden from friends and family. I choose at that time to suffer in silence because I was confused, scared, and embarrassed. The darkest days turned into months and years, eventually it seemed I grew out of it, and was hopeful it was behind me for good. I think what occurred was I learned to avoid triggers and found confidence in areas I didn’t have before through life lessons and eventually returning to school.

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May 2017. The last time I felt this way was after my third child was born. By now I had learned some coping methods and found professional help on and off, though the feeling of shame still prevented me from being open with loved ones. I had this beautiful healthy baby, and I’d done this two times before. This should be easy. So, why was it so hard? Lack of sleep, constant breast feeding, and lack of overall care for myself, all played into my downward spiral. I was becoming very short tempered with everyone around me, I insisted on keeping my house spotless, and controlling every detail of the family. I believe I was on the borderline of OCD, accompanied with postpartum anxiety.

One day my parents and my sisters were being indecisive about something, what it was I can’t recall. I screamed at one of my sisters over the phone, something I never do. My blood pressure must have been through the roof, something rose up inside of me and clicked, I have a problem! This is not normal. I need help.

Being that it had been 20 years since my first panic attack, anxiety was not new to me. I recognized that I needed help ASAP and if I didn’t get it all of those around me would be feeling the brunt of my actions. It wasn’t fair to them. I found a new therapist through postpartum online hotline, one within my insurance network. I did research online to my symptoms, read articles about diet and supplements that would be helpful; I researched other medications as well, continued with acupuncture, started to be more physically active. Most importantly, I caught myself when my temper was rising. I knew it was due to anxiety, just knowing this helped me curb it.

The first of the darkest days was the hardest for me, it was so new and confusing. Over the years I have learned to overcome so much. The journey is ongoing. Anxiety is a part of me, but I fight it. It doesn’t control me like it used to, and I will take that as a WIN.

Giving Birth Was Supposed to be the Happiest Moment of My Life

After giving birth to my first child 25 years ago, I was diagnosed with postpartum depression and was treated with antidepressants until my OB doctor realized he could not help me. He referred me to a psychiatrist who diagnosed me with bipolar 1 disorder, as my primary mental illness.

When I was first diagnosed initially with postpartum depression and soon after with bipolar disorder 25 years ago, postpartum bipolar was never heard of or discussed at the time. Back then postpartum bipolar was not diagnosed much or at all that I am aware of.

Even today, postpartum bipolar is often mistaken for postpartum depression. The severe low mood pole of bipolar is not recognized as bipolar, but is misdiagnosed as postpartum depression instead. Confusing bipolar disorder with postpartum depression can result in devastating consequences. The wrong medications can cause a new mother’s symptoms to worsen, and in some cases require hospitalization. The frequency of misdiagnosis has led a few health professionals to suggest that all pregnant women be checked for bipolar disorder during their first trimester. This will allow physicians to have a baseline in which mood swings after pregnancy can be measured.

Postpartum bipolar is more common than people realize. Each year 15% of all postpartum women in the US, which is approximately 950,000 women, suffer with postpartum mood disorders. Postpartum mood disorders include postpartum depression (PPD), postpartum anxiety/OCD, postpartum bipolar and postpartum psychosis. These illnesses get much less funding and attention than so many of the other prevalent illnesses that strike Americans.

In fact, more mothers will suffer from postpartum depression and related illnesses this year than the combined number of new cases for both sexes of tuberculosis, leukemia, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease and epilepsy. I am not in any way minimizing these other terrible diseases, of course. I simply want to illustrate how prevalent postpartum mood & anxiety disorders are.

According to Dr. Ruta Nonacs of Massachusetts General Hospital and Harvard Medical School, “Postpartum depression is far more common than gestational diabetes. All women receiving prenatal care are screened for diabetes, but how many pregnant and postpartum women are screened for depression? PPD is also more common than preterm labor, low birth weight, pre-eclampsia and high blood pressure; in other words, PPD is the most common complication associated with pregnancy and childbirth.”

Again, each year 15% of all postpartum women in the US, which is approximately 950,000 women, suffer with postpartum mood disorders. Compared to the much lower incidences of:

  • Approximately 800,000 women will get diabetes according to the Nat’l Diabetes Information Clearinghouse
  • Each year about 300,000 women suffer a stroke. (Centers for Disease Control)
  • Each year approximately 230,000 women are diagnosed with breast cancer. (National Cancer Institute)

Additionally, approximately 9% of women experience postpartum post-traumatic stress disorder (PTSD) following childbirth. Most often, this illness is caused by a real or perceived trauma during delivery or postpartum. These traumas could include:

  • Prolapsed cord
  • Unplanned C-section (which I had)
  • Use of vacuum extractor or forceps to deliver the baby
  • Baby going to NICU
  • Feelings of powerlessness, poor communication and/or lack of support and reassurance during the delivery (I had this throughout my 3 weeks of bedrest and pre-labor and labor)
  • Women who have experienced a previous trauma, such as rape or sexual abuse, are also at a higher risk for experiencing postpartum PTSD. (I had this)
  • Women who have experienced a severe physical complication or injury related to pregnancy or childbirth, such as severe postpartum hemorrhage, unexpected hysterectomy, severe preeclampsia/eclampsia (I had that), perineal trauma (3rd or 4th degree tear), or cardiac disease.

During my first pregnancy, I had pre-eclampsia and was put on strict bedrest of laying on my left side, for over three weeks. Strict bedrest is not the best medicine for a pregnant mother and can cause adverse reactions, such as depression. I began becoming depressed, while I was on bedrest.

When my headaches became too severe, I was hospitalized and was given three days of prostaglandin, a hormonal gel, used to ripen the cervix and make it favorable for delivery. This gel caused mild contractions for three days straight. I was given eight doses of prostaglandin gel, which I was told by my OB doctors was a record and they thought it was quite amusing. My body and my mind did not.

After three days of gel, I was given three days of Pitocin until finally after three more days of continuous contractions, my water broke. After three weeks of bedrest, 3 days of being given 8 doses of prostaglandin gel causing contractions, 3 more days of Pitocin and harder contractions and over two hours of pushing, I had an emergency c-section to finally deliver my beautiful baby.

At the exact second the doctor pulled my beautiful new baby out of my uterus, he also removed me, my identity, my reality, all my emotions and seemingly my brain from myself.  I was expelled in the afterbirth of my delivery and was never the same again. At the time of my delivery, I felt a severe sense of detachment and unreality, which is called depersonalization.

Depersonalization disorder is sometimes described as feeling like you are observing yourself from outside your body or like being in a dream. I felt like I was not there and as if I had died inside. These are some symptoms and signs of postpartum PTSD and the beginning signs of my peripartum onset, postpartum bipolar, as well.

Symptoms of postpartum PTSD:

  • Intrusive re-experiencing of a past traumatic event (which in this case may have been the childbirth itself)
  • Flashbacks or nightmares
  • Avoidance of stimuli associated with the event, including thoughts, feelings, people, places and details of the event
  • Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response)
  • Anxiety (I had severe anxiety) and panic attacks
  • Feeling a sense of unreality and detachment (symptoms I had, plus more)

I had severe feelings of numbness, unreality and detachment from myself and my surroundings. These feelings lasted beyond my hospital stay. I had PTSD prior to my childbirth due to childhood abuse. Having PTSD prior to childbirth also left me more vulnerable to getting postpartum PTSD, besides my traumatic birth experience.

Risk Factors for bipolar disorder are family or personal history of bipolar disorder. I have a large family tree full of mental illness, and have mental illness on both sides of my family. My aunt has bipolar disorder with psychotic features, great Aunt Lilly was put in a Psychiatric Hospital for her entire life and I had two relatives that have died by suicide and there are more people in my family with mental illness, too many to list.

Bipolar 1 Disorder Symptoms

I bolded all the symptoms I had after giving birth. I never had these symptoms prior to giving birth.

  • Periods of severely depressed mood and irritability
  • Mood much better than normal
  • Rapid speech (I have always spoke a lot and fast, but not that fast)
  • Little need for sleep
  • Racing thoughts, trouble concentrating
  • Continuous high energy
  • Overconfidence
  • Delusions (often grandiose, but including paranoid – I didn’t have paranoia)
  • Impulsiveness, poor judgment, distractability
  • Grandiose thoughts, inflated sense of self-importance
  • In the most severe cases, delusions and hallucinations

After returning home from the hospital, my symptoms became mixed where I felt depressed and manic at the same time. I had racing thoughts, severe anxiety, excess energy, agitation, rapid speech, flight of many different and grandiose ideas, but felt I was worthless, sad and lost at the same time. My mind was fighting with itself. I had all this excess energy inside, but my mind was sad at the same time, causing me to become frozen at times.

I knew something was very wrong with me, but I didn’t know what and I was afraid to tell anyone. I was supposed to be the best mom in the world and I felt like I was failing. Each second was difficult for me to function. Each minute was a battle to exist. I needed help and I needed it quickly.  I was quickly becoming undone.

Twenty-five years ago, during my pregnancy and after my delivery, no one ever asked me about my mental health, not one time. I never had a baby before. I knew nothing about how I was supposed to feel. I knew I was not feeling well or normal, but I couldn’t tell anyone. I was too embarrassed. I was supposed to be strong and I was going to be the best mom in the world. I couldn’t tell anyone my true feelings,  my secret, the secret that I felt beyond sad and felt like I had died inside.

I had (and still have) mixed episodes and ultradian rapid cycling which makes my form of bipolar much harder to treat. I was hospitalized too many times to count, put in halfway houses, was homeless for three months and had over one hundred ECTs to treat my bipolar disorder and other mental illnesses. ECTs were the only treatment that was effective for me. My many ECT treatments were over a period of many years. I still have memory loss due to my ECT treatments, but the memory loss and ECT treatments were worth it. ECTs saved my life.

Childbirth has an important influence on the onset and course of bipolar disorder, other mood disorders, depression, anxiety and PTSD. Pregnant women with a history of mood disorders, PTSD and any mental illness should be monitored closely throughout pregnancy and especially in the postpartum period.

It is time we start increasing awareness, educating and spreading the word about postpartum bipolar, postpartum PTSD and other postpartum illnesses.

It is imperative that all women are screened properly and treated compassionately and soundly before, during and after pregnancy and childbirth.

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Copyright © 2018 by Susan Walz | myloudbipolarwhispers.com | All Rights Reserved.