The Mother's Load: A Journey into Postpartum Depression

by Becky Hart

Postpartum depression afflicts about 10 percent of women who have just given birth. It is a little-discussed ailment with devastating effects.

Mona Goddard cradled her 1-day-old daughter wrapped in a dark blue blanket.

The Eau Claire woman gazed at the tiny, sweet face smiled and said that during delivery it felt like little Madeline had the shoulders of a linebacker.

"I'm on a mother's high right now," said Mona, the sun streaming in the windows of her room at Sacred Heart Hospital.

Mona and her husband, Rob, have three children: Michael, 7, Maggie, 2, and Madeline, born Feb. 6.

The day after Madeline's birth, the whole family spent time with Mona and Madeline in the hospital. Maggie wanted to take the baby home right away, but Mona needed time to recover while she had nurses around to help.

"It will be the real test when we get her home," Mona said.

The 28-year-old has been tested before, having gone through postpartum depression with Michael and Maggie.

Her experience has given her sympathy for Andrea Yates, the Houston woman on trial this month for drowning her five children last summer.

Yates has pleaded not guilty by reason of insanity. Her attorneys say she suffers from a severe form of postpartum depression.

"Any mother who has gone through postpartum depression can understand -- while not condoning -- how she felt," Mona said.

For Mona, bringing her first child home from the hospital left her tired, stressed out and down right miserable at times. But she didn't question her feelings and continued living, as she described, as though behind glass, watching the rest of the world go by.

After Maggie was born and Mona experienced similar low feelings, Dr. Jad Roeske, her family physician at the time, diagnosed her with postpartum depression at her two-week check-up.

Dr. Melissa Emmerich, Mona's current obstetrician and gynecologist at Marshfield Clinic, said Mona is among about 10 percent of women who experience postpartum depression.

"It's this dirty little secret that no one wants to talk about," Mona said. "It's not realistic to get home with the baby and have a perfect world."

Women usually are diagnosed with postpartum depression two to six weeks after delivery. Loss of self-esteem and persistent low feelings are what distinguishes postpartum depression from the less severe baby blues, Emmerich said. Symptoms of postpartum depression include lack of interest, trouble sleeping, fatigue, sadness, irritability and loss of self-esteem.

"It interferes with their ability to do what they are expected to do," Emmerich said.

At the time of Maggie's birth, Mona's close family had moved out of town. Her husband was driving a truck that the two of them own and was only home on weekends to help with the children. Mona did the accounting for the trucking business.

Working and taking care of two kids, Mona found herself falling asleep sitting up and easily irritated.

"You bring the baby home, and all of a sudden you're not this cute pregnant woman anymore," she said. "You hardly have time for a shower, your breasts hurt, you're tired, miserable and everything falls on your shoulders."

She recalled one night that she asked her husband to make a sandwich while she was watching the kids. When he still hadn't made the snack five minutes later, she became angry with him.

"The simple things every day become more stressful," she said. "I wasn't myself at all."

No one really knows the cause of postpartum depression, Emmerich said, but she thinks it has to do with the added stress Mona described and with the fluctuation of hormones involved with a pregnancy.

"Women are so busy taking care of others that they forget to take care of themselves," Emmerich said.

Mona's situation echoed that. Focused on everyone around her, she said she didn't realize she was losing herself.

As she sat in her hospital room holding Madeline, Mona expressed her fears about what might happen this time. Her husband still is gone during the week, and now she will have three children to take care of while doing their business accounting.

"It's scary because I know it is coming," she said. "It is just a matter of how bad it is going to be."

But awareness of the problem helps sufferers take control of the situation. Yates, however, probably was a victim of postpartum psychosis, a more severe form of depression in which women have delusions and unreasonable thoughts, Emmerich said. Only about one out of every 1,000 mothers experience it.

Emmerich and Mona said they don't think Yates should receive the death penalty because of her postpartum condition and mental state.

"It is something that you come out of, and she'll come out of it," Mona said. "And there is nothing they can do punishment-wise that is going to hurt her any more than to have her spend her life knowing she did this."

The people in Yates' life should also share blame, Emmerich said.

"It takes someone around them to recognize and see that they need help," she said. "Others around her failed her."

Mona, for example, expressed appreciation for her own "wonderful, supportive" husband during her bouts of postpartum depression.

Having a good support group is one of the best treatments of postpartum depression, Emmerich said. In addition, Emmerich recommended serotonin specific reuptake inhibitors, a class of anti-depressants, for women experiencing postpartum depression.

Those medications, particularly Zoloft and Paxil, are considered safe for breast-feeding mothers, according to the American Academy of Family Physicians.

"Usually postpartum depression can be managed by the obstetrician or gynecologist. Only in extreme cases are the patients referred to psychiatric help," Emmerich said.

Most women can see results with the medication after two to four weeks but need to stay on it for six to 12 months, Emmerich said.

Mona began taking an anti-depressant two weeks after Maggie was born. The medication helped even out her moods by preventing low lows and high highs, she said.

"Medications can't make a baby stop crying, and nothing will tighten your belly or make your breasts not hurt, but they can help you cope with it a little better," she said.

After seeing the results of her medication, Mona said she became angry for all the time she lost after her son was born. Doctors need to ask the right questions so they can diagnose a woman who is not feeling like herself after having a child, she said.

Mona was thankful to find Emmerich, who was not her obstetrician for her first child.

"She seems more focused on (diagnosing postpartum depression) than other doctors," Mona said.

As Mona begins raising Madeline while taking care of Michael and Maggie, she said she will look to her husband and friends for support, along with her medication. She is going to try to take time to herself to catch her breath and begin riding her horse again when she is physically capable.

When the kids are older, Mona said she would like to go back to school to become a doctor.

"I'd love to be an obstetrician someday so somebody remembers to ask the right questions," she said.

Copyright © Becky Hart. Permission to republish granted to Pregnancy.org, LLC.