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

Courage, (Insert your name here)

When I was diagnosed with bipolar disorder, I was 23 years old.  That was 12 years ago.  Although it was an intense situation and I had a lot of fear, it was my first time facing an episode like this.  My main struggle was just figuring out what it was and getting the appropriate treatment.  I was young and optimistic and ready to figure things out.

I eventually did get things figured out and, with the help of good doctors and a wonderful support system, I got through it.  It took about 2 years to get to a place where I felt like me again, but what is two years to an optimistic person in the prime of her life?  It was a steady improvement that led me to a good place emotionally.  In fact, for the first time of my adult life, I truly felt good.  I didn’t experience any depression during this time, and because of my medications, I was able to stay feeling well for many years.  I still did struggle with anxiety and stress a lot, because I had not learned the value of taking care of myself, but overall, I would say this was a really great period of time for me emotionally.

This lasted for about 4 years, during which time we had another baby, a girl.  She was born in 2009.  I continued with my medication during this pregnancy and postpartum, was carefully monitored throughout and all was well.

But I was foolish.  I was itching to get off of my medications entirely.  I only took a small dose of one medication daily at this point for maintenance purposes.  I was doing well.  I didn’t like the idea of chemicals influencing my brain.  Did I really need this medication anymore?  I tried to cold turkey myself off several times (which was extremely foolish–don’t every do that!!)  I never could get off of it without symptoms returning.

Finally, however, in 2013 my husband and I were ready to have another baby, which would be our last.  With the help and support of my psychiatrist, we weaned me off the last of my medication so that I could be medication free for the pregnancy.  This was also extremely foolish!  The process was rough, but I was determined.  I finally got completely off of my medication.  I ended up experiencing depression immediately, but didn’t recognize it for what it was.  I ended up at my PCP office several times complaining of extreme fatigue and weakness thinking there was a physical problem.  They investigated and found nothing.  I know now, looking back, that it was my depression.

Then, I got pregnant as planned and everything went haywire emotionally.  I was a mess.  Huge emotions took over my life.  I did all the self care and lifestyle changes I could think of but nothing helped.

To shorten the story, I had complications in my pregnancy that caused me to have to be on bed rest.  I remained in my recliner, on bed rest for around 9 weeks.  Although I had amazing support to help our family at this time–this was the hardest thing I had to live through up to this point.  My emotional state was constantly on the verge of breakdown, on top of the depression and emotional upheaval.  By the time I got off of bedrest and before I had my little guy via emergency C-section, I could feel that I was having some significant depression symptoms.  I knew things had gone from bad to worse.

The hormonal shift after my son was born was the hardest I remember, out of all of my children.  Even after returning home, I was a mess, constantly.  I was having difficulty because of the circumstances of my emergency C-Section that affected my physical health.  I also had extreme fatigue and weakness that hit so hard and suddenly, that I thought I might be dying.  I had lab work done and all kinds of things checked but everything came up normal.

I remember the moment, after my son was born, that I finally realized what was happening to me.  I was out for a short walk, with my son in the stroller, enjoying a beautiful day.  I could, emotionally, feel something that felt horribly familiar–I was starting to have mood swings again.  I pushed the stroller home in a state of horror and fear and shock.  How could this be happening again??  After so many years of being well, I didn’t really believe that my bipolar diagnosis was correct.  In fact, I had multiple doctors tell me just that.  Yet, here I was, going down this same road again.  I had been headed down this road ever since I got off of my medication, but I had been in denial.

I knew what would happen if I didn’t get into a doctor and get some meds right away–I would be back in an inpatient facility.  I called several psychiatrists and got an appointment to the one who could see me the soonest.

This episode was a lot harder for me to face.  I wasn’t young and fresh and optimistic anymore.  I had gotten a little older, and I was no longer young and naive about my circumstances.  I had been here before and I had a good idea of what was coming.  I was scared for just that reason.

And I didn’t feel like I could face it.  I felt I didn’t have it in me.   Already in a state of depression and emotional illness to significant degree–I could not face things getting worse than they currently were, nor could I face going on in my current state.

I had two friends stop my to visit me and my new baby, as I was just figuring all of this out.  They were from church and offered to say a prayer with me.  My friend prayed that I would have the courage to face this trial.  In that moment, I knew that was what I needed: courage.

Courage!  I did need it.  That day and everyday, because this was the deepest and darkest depression I have ever experienced and it has been the most difficult to come out of.  I needed to muster courage when I felt drowned in hopelessness.  I needed courage to get back on medications.  (This seems silly to me now, but at the time, my mind was so mixed up I wasn’t sure what to do).  I needed courage to live each day when I felt like I was stuck in a dark nightmare, or some kind of living hell.  I needed courage to keep trying, as I came out of the deepest black and into an endless state of gray–with life stretching on before me– constant depression as my companion and no end in sight.

Eventually, incrementally, I started to come out of it, a tiny bit week by week.

I’ve never done anything so difficult as live through this last episode of depression.  But live through it, I did.

In fact, I am at the tail end of year 4 and just finally feeling like me again.

Have you seen the movie, Willow?  It’s a cult classic from 1988.  There is a scene near the end where Willow (played by Warwick Davis) is making his final stand against the evil Queen Bavmorda’s army.  He is very small in stature and standing with only one companion, out in the open, waiting for this evil army on horseback to come and attack.  If you’ve seen it, you know what I’m talking about.  Willow says to himself in that moment, as the horsemen approach his position, “Courage, Willow.”I thought of this as I got ready to write this post.

I know it is excruciatingly hard, but in those moments where you feel ready to give up, or feel like you can’t do it alone– Find your courage.  And don’t try to do it alone.  Get help now.  Call a friend, tell them what you are feeling, now.  If you don’t have a friend, and you are considering ending your life, call the National Suicide Hotline at 1-800-273-8255, now.  Get help from a medical professional, a counsellor, anyone, now.

Life is hell now, but it won’t always be that way.  Find hope, like I talk about in this post.

I am living proof that things get better.

Courage, (insert your name here).

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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