In this second part of my interview, Katherine Stone of Postpartum Progress offers her unique insight into the growing prevalence of depression/anxiety in pregnancy and postpartum, and the role of childbirth professionals in addressing perinatal mental health concerns. Katherine also speaks to the amazing potential for personal growth through the experience of postpartum depression/anxiety.
Can you share how you have experienced personal growth through your experience of postpartum obsessive compulsive disorder (OCD)?
The personal growth has been amazing. I really think getting through a dark time in your life or tough experience, no matter what it is, helps you to learn more about who you are. It also gives many people a purpose that, until then, they didn't know they had. That has been the case for me. While I loved working in corporate marketing, my life has been enriched in countless ways by the work I do now. I love that technology allows me to reach women anywhere they are and give them the kind of information they need to get help and get better. While postpartum depression is not something that I'd wish on anyone, I think it's possible, once you've given yourself enough time to fully recover, to find some gifts in it, even if that's just knowing that you have much more strength and courage than you ever thought.
Why do you think we have such high prevalence of postpartum depression and anxiety disorders (PPD)?
PPD exists everywhere, not just in the US, or in Western nations. I wrote a story a few years ago on my blog, for instance, about some research that found that PPD is highly prevalent in Negev Bedouins.
I don't believe there's a single reason as to why it exists or is so prevalent. There are many things that can play a part in whether a woman will have PPD, from her family history of mental illness, to her current financial situation, to whether she has diabetes, to what her childbirth experience is like and on and on. Perhaps we're just recognizing it more, I don't know. Plus, I imagine that the way in which we now live plays a part. Most of us are no longer in the proverbial village that it takes to raise a child. We have the baby, we're out of the hospital lickety-split, we have fewer social supports and many of us are back to work in short order. I doubt any of that helps with our emotional wellbeing.
As you know, I focus a lot on the area of stigma for mothers with mental health challenges. Have you had a personal experience of stigma?
I don't think I've personally experienced much stigma, other than what I put on myself in the form of shame and isolation when I was going through postpartum OCD.
I see it quite a bit, though, with the women I speak to all around the world. People have no idea how poorly women with PPD are still being treated. Women are dismissed by doctors, told they can't be helped, told they can't possibly have PPD if they seek treatment past 3 or 4 months postpartum. They lose jobs. Some are told by their faith communities that their PPD is a spiritual failing. If they later divorce, their PPD experiences are sometimes brought up in custody battles. Some lose the ability to get life insurance after being treated for PPD.
I think the treatment that gets to me the most though is the poor treatment by health care professionals. I've had desperate women told they should just take a hot bath or eat more meat and they'd feel better. Women told they should just wait it out and call back in several weeks if things don't get better. Women told by OBs that the OB can't help because he or she is not in the mental health business. Women who finally get the courage to seek help and are told they'll have to wait months to get in to see someone. Those things really make me mad.
How can women with history, risks, or diagnosed depression or anxiety give birth with confidence today? What would your advice be regarding their birth, and after?
I can't say I'm much of an expert on the giving birth part, but at least in terms of the potential for antenatal or postpartum depression or anxiety, my advice would be to know your risk factors and know the symptoms, and make sure your loved ones know them as well. Know that if the symptoms should arise, there are great resources to help you. PPD and related illnesses are temporary and treatable with professional help. Reach out to advocates like myself or the people at Postpartum Support International www.postpartumsupport.net who understand what you are going through and will connect you to that help. You can be confident that you will get well. You will get back to the old you. You will be a good mother. Really.
Where could birth professionals play a bigger role?
I think birth professionals could play a bigger role by being as up-to-date and informed as possible on perinatal mood and anxiety disorders. Know the psychiatric resources in your area. Know that women can get a perinatal mood and anxiety disorder any time in the first year. Know where the support groups are.
I'd also love to see them doing in-depth social histories on women to identify their risk factors for these illnesses from the start, before they ever have the baby. Those with high risk could receive special education and resources in advance, so they'd be more prepared for what might happen and how to deal with it quickly. Imagine the suffering that could help prevent.
Additionally, it seems like I'm hearing from a lot of women who've experienced birth trauma. It is so important for birth professionals to realize that events in the delivery room that they perceive as fairly routine are never routine and often very scary for someone who has never had a baby.
For more information regarding birth trauma, please refer to http://postpartum.net/Get-the-Facts/Postpartum-Post-Traumatic-Stress-Disorder.aspx.
One of the biggest fears I hear from women, is that we will somehow harm our children, either with medication, breastfeeding choices, or depression. How can women transform this fear into confidence in birthing and mothering?
That's a great question. I'm not sure if we can ever fully eliminate the fears or worry over how we might hurt our children, whether related to PPD or anything else we do as mothers. Raising little people is such a monumental job, and most of us take it so seriously that there are always going to be worries about whether we are doing it right and making the right decisions. That being said, we still have to make those decisions. We can't put our heads in the sand. And the truth is that our own mental illness has the very serious potential to harm our children in the long run, so something must be done about it. Women have got to get help. They deserve to be healthy, and their children deserve healthy mothers.
I have learned to focus on making the best decisions that I can, based on all of the information available to me at the time, and then I try to let go and move on to the next thing. That's the very best I can do, and I've become confident that that is good enough.
Katherine Stone is the author of Postpartum Progress (http://www.postpartumprogress.com), the most widely-read blog on postpartum depression and other mental illnesses related to pregnancy and childbirth. Postpartum Progress has been named among the top ten depression sites on the web by PsychCentral, won a 2010 Fit Pregnancy Best of the Web Award, and is a Parenting magazine Must-Read Mom Runner-Up. Katherine is also the founder and executive director of Postpartum Progress Inc., a non-profit dedicated to vastly improving the support and services available to women with perinatal mood and anxiety disorders. Additionally, she writes the weekly column If Mama Ain't Happy on ParentDish, and is a guest contributor for the topic of PPD at BlogHer. She was the winner of the 2010 Bloganthropy Award, given for using social media to make a difference, and was named a WebMD Health Hero in 2008. Follow her on Twitter at @postpartumprogr.