Will It Ever Get Better? Depression and Anxiety in Mothers

by Alicia Schuster-Couch, guest blogger

Over five years ago when my first baby was born, I expected to be a happy mother with a happy baby. And, why shouldn’t it all be happy and great? Seemingly, parents’ posts on social media portray pure happiness and joy surrounding their children. Movies and stories are filled with tales of mothers being completely fulfilled and satisfied with motherhood. And  well-intentioned friends and family endlessly reminded me to enjoy every sweet moment of babyhood. Unfortunately, I was struggling as a new mother. More accurately, I felt like I was drowning. My baby was perfect but I was not. The guilt of not being perfect, of not enjoying every moment, of not being satisfied only served to exacerbate my depression. I never felt like hurting my child, but I frequently wondered if she’d be better off without me and sometimes thought about how much better everyone’s life would be if I ended mine.

How could this happen to me? I have a masters’ degree in counseling and years of experience in mental health. How could I be suffering so badly? When I went to my six week follow up OB appointment I had planned to bring up my feelings. Unfortunately, I was met by my overbooked and rushed OB who quickly wanted to make sure that my stitches were healing, wanted to talk about birth control, and needed to rush out the door. I also wanted to tell my husband, my friends, my family, my old coworkers that were still in the mental health field, but I couldn’t. I didn’t have the courage to tell anyone. I felt embarrassed. So, I retreated into isolation with my baby and wondered if I would ever get better.

Of course I got better, but it was a painful journey. Now with three babies and one pregnancy loss under my belt, I feel strong and have a sense of contentment. I did get depressed again after my second child, but not as severely as with my first. Then, when I was devastated by the loss of my third pregnancy, I reached out for help (finally!) and was quickly able to get back on track after some counseling. Thankfully, after my third baby I didn’t have any clinical depressive symptoms. I still don’t know what I’m doing half of the time as a parent and feel like I’m winging the roller coaster ride of motherhood. But, thankfully, I’m out of my depression. Now after my journey through depression and anxiety as a parent of young children, I feel compelled to use my formal education and professional experience to try and reach out to other mothers who may being sharing my past struggles.

 I frequently wondered if she’d be better off without me and sometimes thought about how much better everyone’s life would be if I ended mine.

I was surprised to find out that post-partum depression is the number one complication of pregnancy. There are higher incidences of post-partum depression than preeclampsia and gestational diabetes. How many times did your health care provider check your blood pressure? Check for swelling in your feet? Screen your urine? And, remember that tasty beverage you had to choke down to screen for gestational diabetes? Now, how many times did you get a mental health screening? How many conversations did your healthcare provider have with you about mental health or about treating mental health complications? Although all of the above mentioned screenings are important to your health and your baby’s health, I find it odd that we are screening mothers for preeclampsia and gestational diabetes, but not for depression, or anxiety, or other mental health diagnoses. Moreover, if you are one of the few that were screened by your healthcare provider for depression or anxiety, did they provide adequate referrals and follow up? After three births and one miscarriage, I never once had a conversation about my mental health with an OB, nor did they ever offer any referrals to mental health treatment. I am not bashing OB’s. They have a challenging job and have an enormous amount of responsibility when it comes to the physical health of not only mother, but baby as well. However, I think there is a dangerous void in screening for mental health. I’m not sure why there is a huge gap in offering mental health services specifically to pregnant women and to mothers. Nevertheless, this very vulnerable population deserves better.

I could write pages and pages of all the variables that contribute to mental health disorders in pregnant women and mothers. There are organic factors and family history; there are interpersonal and social factors, and many, many more. Regardless of the cause, it’s painful. It creates difficulty in accomplishing day to day tasks. It creates difficulty in parenting children. It can facilitate isolation, guilt, intrusive thoughts, and a litany of other symptoms that make life a struggle. Just like words can’t adequately describe love or joy or grief, I don’t think that words can actually capture the pain of living with a mental health disorder while concurrently trying to care for a baby or child(ren).

So, what are some important things for pregnant women and mothers to know about mental health? Let me quickly break it down into symptoms, treatment, and prevention. For the purpose of this article, I’ll stick with depression and anxiety, although I realize that some mothers experience other mental health symptoms.

Symptoms of PPD

What does depression look like? It’s not as simple as being sad. Sometimes people who are clinically depressed show symptoms of appetite changes, sleep changes, fatigue, low self-esteem, difficulty making decisions, feelings of hopelessness, feelings of irritability, thoughts of harming themselves, and decrease in pleasurable activities. Now, some of these are a natural part of having a brand new tiny human move into your house, but these symptoms cause problems when they are pervasive and do not seem to get better. Anxiety can look like perfectionism, excessive worry, intrusive thoughts, panic attacks, and obsession. Neither of these symptoms lists is provided with the intent for you to diagnose yourself with depression or anxiety. They are simply some of the common symptoms associated with depression or anxiety. If you feel like you’re experiencing some of these symptoms, I hope that you seek a professional diagnosis so that you can receive proper treatment.

Treatment of PPD

Treatment for depression and anxiety begins with a diagnosis. To receive a diagnosis, you’ll need to visit with your health care provider or with a mental health provider. Mainstream treatments include therapy and medication. I believe that treatment should also include education because after all, knowledge is power. Other important factors during treatment include nutrition, exercise, social support, and self care. These treatment factors are ones that should also be considered for prevention. Although it’s impossible to prevent a mental health disorder if you are predisposed to it, there are things that you can do to insulate yourself from the blow of having a mental health disorder. I am not a nutritionist or a personal trainer, but I do know that a healthy diet and regular physical activity make a world of difference. In our era of processed and dyed foods there are a lot of things in our food that negatively impact our bodies and have an effect on our biochemistry. Therefore, it’s important to eat a healthy and varied diet. Exercise is also important. I’m not recommending that you get an expensive gym membership or start training for a triathlon, but it is important to be active. This can mean going for a walk or jog in your neighborhood. This could also mean gardening, or riding a bike, or playing with your kids outdoors. We know the importance of Vitamin D (sunshine) on our physical wellbeing and the importance of hormones that are released through exercise. We all know how important nutrition and physical activity are, but it can be difficult to be motivated to partake in those healthy behaviors if you’re overwhelmed with depression or anxiety.

From RockYourormomes.com

Another important treatment factor is self care. What is self care? It is whatever it means to you to maintain your wellbeing. For some women it can be reading or writing. It could be yoga or meditation. It could be a glass of wine and your favorite television show. Self care is completely subjective and individualized. The important point is that self care is crucial. Your kids and significant other and life are demanding of you; nevertheless, you also need time to decompress so that you are able handle day to day stressors.

Easy enough, right? Nutrition, exercise, self care, social support, and therapy will set you up for a healthy and happy life. I realize that this is easily stated advice. I know how hard it is to just get one of those things on the list done. I also know that when you’re wading through the mud of depression and anxiety, all of those things seem totally impossible. It seems like you have no options, no time, no motivation, and no money to make any of those things happen. All of those feelings of doubt are normal and even expected. However, if you find yourself struggling, I hope and I pray that you can find the courage to reach out for help. Whether you reach out to your significant other, your sibling, friend, or professional, please reach out. Once you reach out you can begin to release the burden that you’ve been carrying around. You can begin to make a plan to address your symptoms and make your life enjoyable. I once wondered if things would ever get better for me. They got better, much better and I’m confident that things can get better for you, too.

I just want to acknowledge that this article does not capture the depth of mental health issues in pregnant women and mothers. The article needs to be ten times as long to adequately address all of the issues. For instance, I didn’t even address issues relating to the role that trauma plays. I didn’t address thoughts of harming others or thoughts of harming your baby or many of the other symptoms that mothers experience. This was meant to be an introductory overview of the issues. If you feel like you want to learn more about mental health in pregnant women and in mothers, please contact me. I’m a local counselor who is passionate about helping mothers and their families. I think mothers deserve better and more comprehensive treatment.

My name is Alicia Schuster-Couch and I am the owner of New Leaf Counseling Services of the TN Valley, LLC. I can be reached by phone at (256) 755-4599 and by email at alicia.newleaf@gmail.com . I am passionate about working with women to help them achieve their goals. I am currently an Associate Licensed Counselor (ALC) under the supervision of Liz Howell, LPC-S. I hold a Master’s degree in Professional Counseling from Texas State University and two Bachelor’s degrees in Social Work and Women’s Studies from New Mexico State University.

Please feel free to contact me or another professional if you feel like you need help. I wish you peace and grace.

Surviving Postpartum Depression, Round 2

By Teresa Fleischmann, Guest Blogger

Have you ever experienced something terrible and assumed you had “paid your dues"? Despite all of my head knowledge about the likelihood of experiencing a postpartum mood disorder a second time, my heart was convinced that my first experience was a fluke. There were warning signs. With Ian I had struggled through miscarriage, infertility, difficult pregnancy, traumatic birth, and he was my first baby. After having an amazing delivery with my second child, my daughter Cora, and experiencing no anxiety or depression postpartum, I figured “been there, done that!” What I failed to recognize, was that every pregnancy and postpartum experience is unique.

In August of last year, 2015, I gave birth to my third child, Luke Jeremiah. To be completely honest, I was not super excited when I found out I was pregnant again. After the birth of my daughter we knew our family was not quite complete. We could see God revealing to us that there was another child in our future. Unfortunately, in 2013/2014, we suffered two consecutive miscarriages, with the later one requiring a D&C. Seeing that second line on a pregnancy test had become terrifying, instead of exciting, as if I was just waiting for something to go wrong. I remember telling my doctor that if we lost this one, I was done. My faith had become fleeting, and I was not sure how much more I could take, emotionally, or physically.

God is Faithful and Luke grew healthy and strong. Aside from the annoyance of Gestational Diabetes, my pregnancy was complication free. Delivery went a little awry when I experienced a repeat shoulder dystocia (I had that with Ian as well), but by and large it was nowhere near as complex or traumatic as my first birth. Luke came to us at a hefty 8lbs 15oz, and instantly I knew our family was complete. The first few days at home where enjoyable, but on day 3 I felt the onset of anxiety, OCD and insomnia. I quickly filled my Lexapro prescription, and within 4 days, I was sleeping well again (at least as well as you can with a newborn!) My husband and I clumsily settled into our new life as a family of 5.

Several weeks later, when Luke was 6 weeks old, I got very, very ill. It’s a long painstaking story, but in summary,  I had a stomach and intestinal parasite that led to a bacterial infection. I could not keep anything down, and within 2 weeks I had lost more than 30 pounds. I looked sickly; I was weak. My muscle was deteriorating. The doctor threatened to hospitalize me. It was scary. The stress on my immune system caused me to break out in the shingles. I quickly started spiraling downward. We decided it was time to ask my mother to come stay with us to help with the kids. She got there just in time.

Have you ever experienced something terrible and assumed you had "paid your dues"?

Within a few days of her arrival, the intense insomnia began. I started having flashbacks to my postpartum period with Ian. I became terrified and detached. My anxiety and OCD became more crippling, and my antidepressant wasn’t cutting it anymore. By the time we put all of our “if the crap hits the fan again” plans into place, I was experiencing full blown paranoia and horrible, horrible intrusive thoughts.

My psychiatrist added an antipsychotic medication to my treatment plan, and within a week or so I became stable. My mom stayed for about 6 weeks to help me get my feet back under me. I attended weekly counseling sessions diligently, and my AMAZING support system of family and friends surrounded me and helped in any and every way possible.

I would be lying if I didn’t admit that it is hard to fight the stigma. Hard to admit that I experienced a Postpartum Mood Disorder again. Hard to swallow antipsychotic medication. Insanely hard to remind myself that those horrible, horrible intrusive thoughts were not my own. But, alas, it is only a stigma. I have battled a real, miserable, horrible, monstrous beast named Postpartum Depression AGAIN, and by the Grace of God and the help of my support system, I have come out victorious!

If you or someone you know is experiencing a Pregnancy Related Mood Disorder, please reach out for help. Fight the stigma. Fight for your family. Your family needs YOU! With the proper treatment plan you absolutely will get better!!

I am so very thankful for the two following resources. Both provide free materials, information and social support for women and their families.

Postpartum Support International           www.Postpartum.net

Postpartum Progress                     www.postpartumprogress.com

Teresa Fleischmann is a volunteer at home wife and Mom. She is a Postpartum Anxiety, Postpartum PTSD, Postpartum OCD & Postpartum Depression survivor. She founded the Huntsville Postpartum Support Network providing in person and online support to women experiencing PMADs. If you are a local mom in need of online support, you can email your request here. She is also a state co-coordinator for Postpartum Support International, and co-leads an annual fundraiser for Postpartum Progress called Climb Out of the Darkness. You can register to join her here athttps://www.crowdrise.com/teresafleischmann-COTD2016/fundraiser/teresafleischmann

A Realistic View of PPD from a Mom Who Has Been There

From Chasing Supermom

by Glenni Lorick, IBCLC

Last Monday at our Huntsville Mommy Milk Meet-up gathering, we talked about Postpartum Depression. This subject is so important to me because several years ago I missed the signs in a mom I was helping with breastfeeding. Her PPD went into postpartum psychosis that ended up causing permanent damage to her family and her relationship with her children. I swore to myself then that I would never again let that happen to a mom on my watch. So I am very proactive when I see any signs at all of PPD to encourage both the mother and those around her to make sure she talks to her doctor and gets some help.

Anywhere from 11-20% of women suffer each year from PPD according to Postpartum Progress. Although some do feel like harming themselves or their child, many never have those feelings at all. Rather, like Sabrina in the video below, they find themselves either filled with anxiety or just melting into the couch and unable to do anything, perhaps feeling like they're going crazy!

All the moms in the meeting on Monday shared, but I specifically asked Sabrina Azemar to share her story because I had heard her speak on this topic previously. Sabrina brings warmth, humor and insight into what can be a very dark topic. We have dealt with PPD in our blog previously, but we are excited to offer you Sabrina's insights!

Post Partum Depression is NOT a Life Sentence!

By Teresa Fleischmann, Guest Blogger
The five year plan. That was our goal. Five years of marital bliss, complete with traveling, fun date excursions, late night movie theater outings and fancy dinners. Once we got all of the “fun” out of our systems, we would settle down and start our family. We quickly learned, as many have, that God’s plan was very different than our own.

When I was 15 years old, I found out that I had polycystic ovarian syndrome (PCOS). The doctor explained to me that because of my irregular menstrual cycle, and hormone imbalances, I would likely have a difficult time conceiving. At 15 it fell on deaf ears, but when my husband and I began trying to get pregnant, we were prepared for a lengthy process.  We were completely shocked and obviously ecstatic when we conceived our first baby just 3 months later. I was overjoyed! I remember finding ways to tell random strangers about my pregnancy. I felt different, and wondered if other people could tell I was pregnant.  I avoided caffeine, deli meats, perfectly pasteurized feta cheese, and treated the salad bar at Jason’s Deli like the black plague. We excitedly shared the news with our parents, but withheld the information from our siblings and friends wanting to wait until we cleared the “danger zone” of the 1^st trimester. 

One and a half weeks into our new found status of “soon to be parents” we experienced what too many parents have endured, a miscarriage. I was devastated. I felt inadequate as a woman, as a wife. My husband, Derek, and I handled the news very differently. He quietly, keeping himself busy in the garage, while I cried and got angry, not understanding why it happened, almost wishing I had just never gotten pregnant in the first place.  After a couple of weeks of awkwardness, feeling like society told us we must grieve silently, we came to a mutual agreement. As soon as possible, we would try to get pregnant again.

From Kids Health.org

As the months blew past, with one negative test after another, we decided to seek medical intervention. We were already aware of my PCOS, but were dealt another difficult blow when testing revealed male factor infertility. We sought the help of a reproductive endocrinologist, and after 2 years of infertility, which included Clomid, Femara, injectables and 5 unsuccessful intrauterine inseminations (IUIs), we decided we would take a break before one last pregnancy attempt with in vitro fertilization (IVF). The break was much needed. Sex on a schedule had become daunting, and my poor husband had a far too dramatic experience one day when he was stuck in traffic while attempting to deliver his precious, time sensitive, “specimen” to the lab. If you are local, and you recall seeing a fired up redheaded man frantically weaving in and out of traffic, shaking his fists in the air, trust me, you had NO CLUE why he was behaving so erratically! Looking back now, there were so many comical moments during that period of our lives. Well, at least they are comical years later.

This is where our story takes an incredible, miraculous turn. The morning that our IVF deposit was due, I found out that I was pregnant. Naturally. No drugs, no medical procedures, no scheduled intercourse. If my math is correct, it was a couple of drinks and some 4^th of July “fireworks”. This time we decided to shout it from the roof tops. We told everyone. We laughed; we jumped for joy; we cried tears of excitement and also relief! It seemed unreal, and to be honest, I was cautiously excited.

From March of Dimes 

The first half of my pregnancy went well. I somehow avoided morning sickness, and as a larger framed woman, I really enjoyed the freedom to wear horizontal stripes!  Toward my 3^rd trimester I developed preeclampsia, and at 30 weeks I was put on bed rest. The day of my 37 week appointment I went to the doctor and my blood pressure was 150/105. I was already taking 2000mg of blood pressure medication per day, so my OB decided it was time to have a baby. A few short hours later I was at the hospital being induced.

The birth plan that I had prepared was completely thrown out the window when I experienced complications during delivery. I had shoulder dystocia (which lead to an episiotomy and an insane 3 minutes of continuous pushing while a nurse palpated my abdomen) and placenta accreta (which caused hemorrhaging and the manual removal of the placenta by my doctor, which had also broken into numerous pieces.) My baby was born unresponsive, but by the grace of God, regained consciousness 19 seconds after delivery. He was born a hefty 8lbs 1oz, which was quite large for a baby born 3 weeks early! We named him Ian James (after his grandfathers) and our room was quickly flooded with family members who were head over heels for this adorable little boy.

From the Utah Dept. of Health Pregnancy Risk Line.

It wasn’t until later that evening, when our visitors had left and we moved into our recovery room, that we really had a chance to process what had happened. My doctor came and sat with us for a while, and explained both the shoulder dystocia and the placenta accreta. He joked that he was “getting too old for this” and in 20 years of practice he had experienced both complications on several occasions, but never together. We discussed how incredible it was that both Ian and I were completely healthy, and how 50 or 100 years ago we possibly would have both died, or at a minimum, I would have lost my uterus. I felt so incredibly blessed to be holding a healthy, happy little baby!

Our time in the hospital was enjoyable, and we had a constant stream of visitors. I was tired and sore, but also on cloud nine. We were discharged later than expected due to some complications from the circumcision, but we were so glad to return to our own home and our own bed. Our first night at home was hard. Ian slept so well that we had to wake him to feed him and I did not sleep at all.

Nursing was much more difficult than I expected and quickly became a chore. Ian was not gaining weight and scheduled feedings were not going well. I was committed to breastfeeding and had read all the books. Nursing sessions were taking more than an hour and it stressed me out that I didn’t know how much milk he was getting. I started getting irritable and couldn’t sleep. I was in a constant panic that he wasn’t getting enough food, and after four straight nights without a single minute of sleep I called my doctor’s office and told them I needed help. They prescribed me an anti-depressant, and the first night I took it I finally got a few hours of rest. The next day I felt like a rockstar, and even invited a friend over to chat and hold the baby. Unfortunately that only lasted for one day, and by that evening I was back to severe mood swings and insomnia. I was so upset with myself. I prayed and prayed for this baby, why was it so hard? Why did I have this feeling like I wasn’t good enough? Like I couldn’t take care of him?

From Thejoyofthis.com

Exactly one week after Ian was born I had my first suicidal ideation. It hit me like a smack to the face. I was nursing him in his room and out of nowhere I thought “Just do it, kill yourself. Derek can find a new wife and they can raise Ian together. It will be better for everyone that way.” Sadly, I also had thoughts of exactly how I would carry out the action. As quickly as the thought entered my head it also passed. I set Ian down in his crib and went and found my husband in the bathroom. I explained what had happened and told him he needed to take me to the hospital. We went to the ER, but decided, with the help of the my OB, a psychiatrist and the ER doctor that I would go home and attempt to take some sleeping pills to see if that helped. Lack of sleep can cause people to have crazy thoughts. That evening was a little better and I did feel refreshed. As the next day came, the mood swings returned, and so did the insomnia. One week later, I had another suicidal ideation, and after consulting my doctor, chose to be voluntarily admitted into the behavioral health unit of the hospital. I spent 5 days there, and was only able to visit with my baby for 2 hours each evening, in a supervised room. I began taking mood stabilizers, and was forced to discontinue nursing. I was devastated. To this day my heart is heavy thinking about the 5 days of his life that I missed. I still occasionally feel shame that I had to spend time in the hospital, but I remind myself that I am a better Mommy because of it. As a matter of fact, the alternative was leaving my child motherless.

After changing psychiatrists three times, regular counseling sessions, and coming off of mood stabilizers and back onto an antidepressant, my mood finally leveled off. My mother was able to go home (she lived with us for 3 months to help me care for Ian) and we were able to settle into our new life as a family of three. By the time Ian was 6 months old I had returned to my “normal” self. My final diagnosis was severe postpartum depression, borderline postpartum psychosis. I won the honor of being one of 2 patients with this diagnosis in the history of my OB’s career.

So, now that I have pulled you down into the dredges with me, let me offer up some hope. Jeremiah 29:11 says, “For I know the plans I have for you, declares the Lord. Plans to prosper you, not to harm you, plans to give you a hope and a future.” This has become my life verse. As I finish up this post, my now crazy 2 year old son Ian is napping in his room, and so is my adorable 9 month old daughter Cora. I was blessed with a second child (rather quickly after the first) and by the grace of God, I experienced an excellent pregnancy, a complication-free delivery, and most notably, I have not struggled with any depression! I am exclusively nursing Miss Cora, and am thoroughly enjoying being a mother of two. Postpartum depression is not a life sentence! It is also nothing to be ashamed of. If you are struggling with depression, please, please, please, tell someone, and get the help you need.

I may not ever in my lifetime know why I endured miscarriage, infertility and postpartum depression, but I do know that “God causes all things to work together for good to those who love God, to those who are called according to His purpose”. I also know that God specifically chose Ian and Cora as my children, and me as their Mother! Motherhood is not always glamorous, and at times is frustrating and just plain hard. But I promise this, IT IS WORTH IT! It is worth the pain of labor, the risk of complications, and even the deep, dark, misery of depression. This is proven to me daily in every smile, every coo, every giggle from my kids, and even in those shiny silver badges of honor on my belly!!