Shining a Light on PPD
The stigma surrounding postpartum depression (PPD) still prevents many mothers from receiving treatment and recovering from the disorder, says Christine Kowaleski.
So Kowaleski is doing what she can to reach out to new mothers and let them know that help is available, and they are not alone. She has 21 years’ experience as a nurse practitioner in the neonatal intensive care unit at Crouse Hospital in Syracuse, and she is also a psychiatric nurse practitioner specializing in reproductive mental health with a local private practice. In addition, she leads a postpartum support group for parents at the Women’s Information Center in Syracuse.
The need for support, and treatment options, is huge. While many women experience the “baby blues” in the first three weeks after delivery, Kowaleski says about one out of every eight mothers suffers from PPD. Symptoms can come on at any point in the first year after childbirth, but PPD is most common in the first few months. Depending on the severity, mothers with PPD can find the many aspects of caring for their babies overwhelming, but they are often too embarrassed to seek help.
Kowaleski says despite the advances in treatments and general awareness about depression, PPD is rarely caught by the new mother’s doctor. “The obstetrician generally sees mom just one time during the postpartum. They may not pick up on anything. But the baby’s pediatrician may see her more often. I would say that, locally, pediatricians are more involved and open to talking to families about postpartum depression than they were in the past.”
For all the good that has come from women being able to have some say in their childbirth experience, Kowaleski says in some cases, women become too fixated on their plans and have difficulty changing gears if something unexpected occurs during delivery. “Some women find it very difficult to move past that,” Kowaleski says. “When you have an expectation, you’re set up to be disappointed. The truth is, there’s no planning birth and death. So, we need to help mothers be more open to the idea that changes may have to be made in their care. Ultimately, what is our end outcome? A healthy baby.”
But there are some things that can be done before birth to help new mothers avoid contracting PPD. “Many doctors are now screening prenatally, for depression,” she says. Establishing a broader, family-centered birth plan could also help.
“Sleep deprivation is a huge problem for new parents and it adds to depression,” Kowaleski says. “A family-centered birth plan can be helpful; maybe it can be expanded to include help from grandparents or friends. We have to help new moms let go of the idea that they have to do everything themselves. Very often, grandparents or extended family members want to help. If they plan ahead, new moms may be more likely to accept that help.”
Kowaleski acknowledges that it is hard for women in particular to avoid societal pressures. “We feel like we have to be the perfect mother, and keep a perfect house, and do all the cooking. But having a baby is a lifestyle change.”
“Mother’s guilt” can take many forms, Kowaleski says. In a person predisposed to depression, the guilt can take root quickly, growing more oppressive as the baby grows.
In the NICU, Kowaleski sees all kinds of scenarios that cause new parents to feel guilty. “They blame themselves, even though there is usually no way they could have prevented the situation,” she says.
Barbara Greene, Ph.D., a Fayetteville-based clinical psychologist in private practice, says that guilt is very common in the patients she sees. “They come in feeling guilty because they have this new baby and they don’t understand why they feel the way they do. I help them understand that it’s not all in their head—what they’re feeling is very real.”
Kowaleski says some mothers are reluctant to ask for help because PPD sometimes reminds people of an extreme case from more than a decade ago. “People still think of Andrea Yates when they hear the words postpartum depression,” says Kowaleski, citing the 2001 case in which an apparent psychotic manifestation of PPD led a Texas mother to kill her five children. “That’s not something a new mother wants to be associated with.”
While very few cases approach anything that serious, Kowaleski says she has had patients who were afraid of hurting their babies. They were treated early enough to prevent any danger of abuse. “None of my patients have had to be reported to (social services) or be hospitalized,” she says.
Because of the stigma of a PPD diagnosis, Kowaleski says she prefers to concern herself with the symptoms of each individual patient, as opposed to being stuck on labels.
And PPD is not just a mother’s issue: Kowaleski says about 10 percent of fathers suffer, too. Their symptoms seem to be less obvious. Perhaps they start working more hours, or bury themselves in video games. “Men tend to show PPD through detachment,” she says. “They find reasons not to be home.”
Kowaleski says treatment has two clear goals: supporting the growth of a healthy baby and establishing firm bonds between baby and parent. While not all patients need medication to manage their condition, and others may be reluctant to try it, Kowaleski says the right medication combined with therapy can get patients on the road to recovery faster. Today, there are medications for treating PPD that are safe for breastfeeding mothers.
Private therapy may not be an option for all families. The Women’s Information Center’s postpartum support group was introduced last September. Kowaleski says it has been a wonderful way for families to share their concerns, discuss their progress, and reach out to others who may share similar feelings about new parenthood.
The group is also economically diverse. Kowaleski says support groups like this may be particularly helpful to lower-
income families, whose PPD may be more likely to go undiagnosed. “A lot of times, they just suck it up.”
Although she is the facilitator, Kowaleski doesn’t attend every meeting, preferring instead for the parents to make their own connections. “It kind of makes my heart smile,” she admits. “I have seen people from all kinds of backgrounds form these common threads and find healing. That’s what I want it to be, a peer-led group. They are going to help each other more than I can help them.”
Kowaleski says she now sees more couples coming in for treatment together than she did years ago. And fathers are more often recognizing PPD in their female partners and convincing them to get treatment.
Kowaleski, a mother of four adult children, suffered from PPD herself. She was diagnosed about six months after the birth of her second child. She draws on her own experiences at times when helping patients.
“I share my experience with my patients when appropriate, but I don’t dwell on that,” she says. “This isn’t about me. When I had PPD, it was a different time and a different place.”
Because of the variables associated with every case, patients can be frustrated by what they see as an uncertain route to recovery. Kowaleski encourages these mothers to take the first step: seeking help.
“The huge difference I’ve experienced between medical vs. psychiatric practice is that emotional pain is overwhelming and response to treatment is variable. For example, if you break your arm, you know how long you will be in a cast. It’s not so easy with depression. So it is very important for parents to be told that, with treatment, they will get better.”
Award-winning writer Tammy DiDomenico lives in DeWitt with her husband and two sons.
Photo above: Michael Davis Photo