by Karen Kleiman
Understanding Postpartum Depression
- Postpartum depression (PPD) affect 20% of all postpartum women.
- PPD is a medical condition that can be treated successfully.
- PPD is a clinical depression that can occur any time immediately after birth up to a year postpartum.
- If your wife has been diagnosed with PPD, it's very important for you to be informed and part of the treatment.
- PPD can strike without warning -- in women with no history of depression or women who have had it before. It can happen to women who are highly successful in their careers or women who stay home with their children. It can strike women in stable marriages and conflictual marriages, as well as single women, and adoptive mothers. It can happen to women who love their baby more than anything in the world. It can happen after the first baby, or after the fourth.
- It can happen to women who swore it would never happen to them.
- It is not completely understood why PPD affects some women and not others -- why women who have many risk factors may no experience it, and others who have no risk factors may end up with a full blown episode.
- Women are twice as likely to experience depression than men.
- Women are most at risk to experience emotional illness following the birth of a baby than at any other time.
- PPD is a real illness.
- She is not making this up.
- This did not happen because she's a bad mother, or doesn't love her baby enough.
- It did not happen because she's having negative thoughts about herself or about you or about your baby.
- It did not happen because she is weak and not working hard enough to get better.
- She cannot "snap out of it."
- This is not fair. This is not what you expected. But if your wife has been diagnosed with PPD, it will take a while for her to recover. Recovery may take weeks to months.
- She will get better. She will return to her "normal" self. She will begin to experience pleasure again. This will not happen overnight.
- The more supportive you are of her treatment, the smoother her recovery will be.
- PPD is nobody's fault. It is not your wife's fault. It is not your fault.
- Try to reassure your wife that there is nothing she has done to make this happen.
- Often, when we are struck by something we do not understand, we try to cast blame on someone or something. This will be counterproductive.
- Remember that we do not know exactly why this happened. What we do know is what to do to maximize the healing process.
- Do not spend excessive energy trying to figure out what went wrong or why this happened. Your search for reason will frustrate you and it will keep your wife spinning along side of you. Save your energy for navigating through this unfamiliar territory.
What to say
Her moods and emotional vulnerability will get in the way of good communication for now. Here's what you're up against:
-If you tell her you love her, she won't believe you.
-If you tell her she's a good mother, she'll think you're just saying that to make her feel better.
-If you tell her she's beautiful, she'll assume you're lying.
-If you tell her not to worry about anything, she'll think you have no idea how bad she feels.
-If you tell her you'll come home early to help her, she'll feel guilty.
-If you tell her you have to work late, she'll think you don't care.
But you can:
- Tell her you know she feels terrible.
- Tell her she will get better.
- Tell her she is doing all the right things to get better (therapy, medication, etc.).
- Tell her she can still be a good mother and feel terrible.
- Tell her it's okay to make mistakes, she doesn't have to do everything perfectly.
- Tell her you know how hard she's working at this right now.
- Tell her to let you know what she needs you to do to help.
- Tell her you know she's doing the best she can.
- Tell her you love her.
- Tell her your baby will be fine.
What NOT to say
- Do not tell her she should get over this.
- Do not tell her you are tired of her feeling this way.
- Do not tell her this should be the happiest time of her life.
- Do not tell her you liked her better the way she was before.
- Do not tell her she'll snap out of this.
- Do not tell her she would feel better if only: she were working, she were not working, she got out of the house more, stayed home more, etc.
- Do not tell her she should lose weight, color her hair, buy new clothes, etc.
- Do not tell her all new mothers feel this way.
- Do not tell her this is just a phase.
- Do not tell her if she wanted a baby, this is what she has to go through.
- Do not tell her you know she's strong enough to get through this on her own and she doesn't need help.
Things you should know about her treatment
- Good therapy can be expensive. But expensive therapy isn't always good.
- Getting help for your wife has to be the priority here. If you are more worried about how much it costs, she will stay sick longer.
- Her illness is real. She needs treatment.
So, how do you know if her therapist or doctor is good? Ask yourself these questions:
- Did you feel comfortable with this person? (Yes, you should attend a session).
- Does your wife like him/her? (This is more important than you might think. Connecting with this person is half the battle)
- How does your wife feel about her sessions?
- Does she think it's helping?
- Does she feel good about going?
- Does she trust this person and feel comfortable talking?
Try to find someone who works short-term and focuses on the here-and-now, rather than issues from the past. These issues are important, but not necessarily productive at the outset, when we want to manage symptoms.
The cost of treatment is a very real concern. But so is her staying sick, isn't it? Please do not let the financial issues get in the way of her getting the help she needs. There are options. Sliding scales. Insurance plans. Payment schedules. Bringing up your worries about the money can actually sabotage her recovery by making her feel guilty. Be careful how you do that.
Encourage your wife to discuss any financial concerns with her therapist. Contact your insurance company. Depending on your particular plan, find out whether you need a referral from your primary and if so, try to find a therapist who is a provider for your network. If not, find out whether or not they reimburse this particular therapist. Most insurance companies will ask you the therapist's credentials to determine reimbursement. If the therapist is not covered at all, find out what arrangement can be made.
Yes, you should go to a session with her. Some women like their husbands to join them for the first one. Others prefer their husbands wait until a relationship has been established with the therapist. Ask your wife if she'd like you to go with her and when. Then do it.
You are going for a few reasons:
- To show your support;
- To meet her therapist and see who's "taking care" of her;
- To ask questions, to get information, to receive support;
- To provide information to the therapist about your wife, your relationship, relevant history, etc.
PPD becomes a family issue. Do not let your wife carry the load of this illness alone. Supporting her decision to go to therapy is vital for her recovery. Remember, therapy for PPD should be short-term. In therapy terms, this usually means 3-5 months. But she should receive initial relief right away. Depending on the severity of her illness, she should start feeling somewhat better in the first few weeks.
- If your wife tells you she cannot take this pain anymore, it's a very serious statement that means it's time for an evaluation by someone who specializes in the treatment of depression.
- Remember, her thoughts are distorted and it is possible that things feel much worse to her than they appear to you.
- It is not up to you to determine whether she's at risk for hurting herself or someone else. A professional should determine it.
- Stay with her. Ask her if she feels safe from harm. Help her make an appointment with some she feels can help her. Call her doctor. Do not leave her alone.
The following situations are rare, but warrant immediate intervention. Emergency situations mean you should take her to the closest hospital, call 911. DO NOT LEAVE HER ALONE FOR ANY REASON:
- Talk of hurting herself;
- Bizarre thinking patterns, hallucinations, delusions;
- No sleep in several days. This means NO sleep, usually coupled with manic-like symptoms. Sleep deprivation can worse symptoms;
- Noticeable withdrawal from all social contact;
- Preoccupation with death, morbid ideas, or religious ideation;
- Persistent feelings of despair and hopelessness;
- Expressions such as: "My children would be better off without me here."
Karen Kleiman, MSW, Licensed, Clinical Social Worker, co-author of This Isn't What I Expected: Overcoming Postpartum Depression and author of The Postpartum Husband: Practical Solutions for Living with Postpartum Depression, has been working with women and their families for over 20 years. A native of Saint Louis, MO., Karen has lived in the Philadelphia area since 1982 with her two children and her husband. After graduating in 1980 from the University of Illinois at Chicago with her Masters in Social Work, she began her practice as a psychotherapist, specializing in women's issues. In 1988 she founded The Postpartum Stress Center where she provides treatment for prenatal and postpartum depression and anxiety.
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