How the @BostonGlobe got Postpartum Depression Wrong


With more news stories mentioning Postpartum Depression these days, it is becoming painfully obvious that reporters are scrambling to get their facts straight. Bless them for trying but sometimes, even with the best of intentions, they fall short. Like Karen Weintraub’s article “When the ‘baby blues’ are something more” at the Boston Globe on October 21, 2013.

Karen defends herself in the comments (all two of them at time of writing) about the term “baby blues” by saying that in her researching for this piece, she discovered there is such a thing as baby blues:

Boston Globe Comments

Kudos to Ms. Weintraub for doing enough research to realize that baby blues ARE distinct from depression.

BUT.

There are a multitude of omissions and errors within the article as it stands right now. Let’s go through them:

Ms. Weintraub breaks the Perinatal Mood & Anxiety Disorder experience into only three groups:

  • Baby Blues
  • Postpartum Depression
  • Postpartum Psychosis

Immediately, sirens sound. Particularly because the case study, a Nicole Caligiuri, a first time mother, states she felt “angry and anxious” all the time. While anger/irritability is a sign of depression, anxiety combined with anger is typically (in my non-professional opinion) more closely related to an anxiety disorder. Ms. Caligiuri, however, was diagnosed with Postpartum Depression.

By ignoring the additional facets of the PMAD spectrum, Ms. Weintraub does a severe disservice to those mothers who may be suffering from Postpartum Anxiety, Postpartum Post-traumatic Stress Disorder, or Postpartum OCD.

Weintraub states that 50-85% of new mothers experience baby blues, 14% experience postpartum depression, and a “fraction of 1 percent of new moms” experience Postpartum Psychosis. If you go by those numbers (at the higher levels), nearly 100% of all new mothers experience one of these three phenomena and none experience Postpartum Anxiety, Postpartum Post-traumatic Stress Disorder, or Postpartum OCD.

According to Postpartum Support International’s Get the Facts page:

  • Approximately 6% of pregnant women and 10% of postpartum women develop anxiety. Sometimes they experience anxiety alone, and sometimes they experience it in addition to depression. 
  • Postpartum Obsessive-Compulsive Disorder (OCD) is the most misunderstood and misdiagnosed of the perinatal disorders. It is estimated that as many as 3-5% of new mothers will experience these symptoms.
  • Approximately 1-6% of women experience postpartum post-traumatic stress disorder (PTSD) following childbirth.

But in Weintraub’s scenario, there isn’t room for the nearly 20-27% of women who develop these particular Perinatal Mood & Anxiety Disorders. As a survivor of Postpartum OCD, I find this troubling. Particularly because OCD can scare a new mother into thinking she is experiencing a form of Psychosis due to the horrific intrusive thoughts.

As I have mentioned multiple times, it is beyond important to differentiate the varying aspects of a Perinatal Mood & Anxiety Disorder. Why? Because when you lump Postpartum Psychosis sensationalism in with Postpartum Depression, things get murky. You scare new mothers who may be a bit depressed into thinking if they go get help, they will be thought of as potential criminals and have their babes ripped from their arms the instant they admit to feeling anything less than happy.

An additional issue with this article is the strong focus on early motherhood. The logic of this focus is evidenced by the study on which it is centered but a quick mention that PMAD can persist beyond early motherhood would have been a quick fix for this bias.

Why is it important to emphasize that PMAD onset can extend beyond early motherhood?

Often, many mothers do not realize they have issues until they are well into the 6th month or more. I have had mothers contact me at almost a year postpartum to share that they think something has been deeply wrong since the birth of their child but they did not recognize it until now. Many Perinatal Mood & Anxiety Disorders crop up within the first 2-3 months, often immediately after the period of baby blues, but some mothers do not recognize them or even get hit with them until much later. PMAD’s can crop up  within the first 12 months after birth and even then, may not be recognized until much later. But this information is not mentioned anywhere in the article nor are we ever told at what point Ms. Caligiuri sought help.

I deeply appreciate Ms. Weintraub’s effort to reach out to Dr. Katherine Wisner and Dr. Michael O’Hara, respected experts in the research field of Perinatal Mood & Anxiety Disorders, however, I wish she (or her editor) had taken the time to allow this article to be a bit more clear regarding the wide scope of Perinatal Mood & Anxiety Disorders. I also wish a side bar had been included to resources for women and families who are struggling with these issues, particularly given that Ms. Weintraub included this quote from Dr. O’Hara:

Social support is probably the most important thing to provide a new mother, who is at a particularly fragile point in life, said Michael O’Hara, a professor of psychology at the University of Iowa, who has been researching and treating postpartum depression for three decades.

 

Postpartum Support International will connect new mothers with social support. Also, specifically in Hadley, Massachusetts, there is Mother Woman, a fabulous organization who is making fantastic strides toward improving access to support and care for struggling women & families. Advocates in the trenches, such as the volunteers with PSI and Mother Woman, recognize how important it is to have peers support each other so they do not feel all alone in the dark. It is an oversight that neither of these organizations are mentioned anywhere in Ms. Weintraub’s piece.

Overall, Ms. Weintraub, despite making a few blunders, seems to handle the issue at hand with a respectable grace. The study at the heart of the article focuses on the development of depression in children born to mothers who struggled with depression but Ms. Weintraub is fabulous in her handling of this issue, particularly with this paragraph:

But parents shouldn’t feel like they’ve ruined their child’s life if they go through a period of depression, Pearson said. The increased risk of depression in their children is small. Overall, 7 percent of teens are depressed, compared with 11 percent of teens whose mothers were depressed early in their children’s lives.

She side-steps the potential onslaught of guilt and gracefully allows parents to breathe a sigh of relief by including this information from the study’s co-author.

As I stated in the opening, coverage of Perinatal Mood & Anxiety Disorders is greatly improving. But we still have a long way to go to get to fully informed reporting. For the most part, Ms. Weintraub’s article is generally free of sensationalism, includes quotes from respected experts, and manages to allay any potential guilt a new mother with a PMAD may feel in reading it. However, it is still just a few small adjustments away from being truly spectacular and informative.

Saturday Sundries 03.05.11: Husbands and Baby Blues


Welcome, y’all!

This morning I jumped out of bed, thinking I only had 20 minutes to get dressed and travel to my church for a Women’s Brunch. Turns out I had 50 minutes. I took the time to do dishes before I left. Once I arrived, I felt so blessed and loved. Women of all ages sat together at tables and shared their inspirations for daily faith and Christ-like living. One of the older women at my table cried as she shared her story. I left filled with a sense of camaraderie and connection with several new women in my Church. I am so grateful for the ability to meet in the open with people of the same faith – to be able to speak freely of my beliefs and of Christ’s power within my own life. There are so many places in the world where if you even mention Christ, you will be put to death. But not here.

I spoke of my Postpartum Depression and how God has used that to change my life and allow me to reach out to several women on a daily basis. You know what y’all? Not ONE woman at that table judged me for my hospitalization. Not one woman at that table loved me any less or told me I failed as a mother because I had Postpartum Depression. I know I speak about Postpartum Depression all the time online but I don’t get the opportunity to talk about it in person very often. To sit in sisterhood at a table with other mothers and not be judged for my experiences – WOW. So very grateful and blessed.

Today, I don’t have specific questions to answer. The questions I’ll be addressing are based on search terms which led people to my blog within the past seven days. If people are looking for these topics, I want to provide information to answer their unasked questions.

I wish every one of you a wonderful Saturday – one filled with insight, peace, and happiness.

And as always, take care of YOU first.

*The answers given here are written by me, a non-health care professional. I’m a mom who has been through hell with Postpartum twice, ante-natal depression once and has dedicated her life to learning all there is to know about Postpartum Mood & Anxiety Disorders. Please check with your healthcare provider prior to implementing any of the information you may find below. It is NOT meant to be and/or replace professional advice or orders.

 

1) Should baby blues last for more than 4 weeks?

No. The blues should not last for more than 4 weeks. It may take up to 4 weeks for the blues to dissipate completely but if you are consistently experiencing what you feel are the blues for a solid 4 weeks, you really should talk with your doctor. Postpartum Depression also does not just manifest as “the blues.” There are other issues which are also included in the Postpartum spectrum. Anxiety, irritability, anger, intrusive thoughts, and obsessive-compulsive behavior are all symptoms that may manifest in an episode of a Postpartum Mood Disorder. Up to 80% of all new moms experience the blues. As many as 20% of those who experience the blues go on to develop a Postpartum Mood Disorder. Just because your symptoms of the blues are continuing past 4 wks does not mean you are developing a serious case of Postpartum Depression. But you should absolutely go see a health professional to explore what’s going on with you. Be sure to ask for a thyroid panel, an iron level check, and a Vitamin D level check to rule out any health issues for your continued struggles. It’s beyond important to get the Thyroid panel as Anti-depressants will NOT help with a thyroid issue – and may actually make things worse for someone with a severe thyroid issue, therefore delaying successful treatment and recovery. It’s also very important (and hard) not to blame yourself for Postpartum Depression. You have not done anything to deserve this or to cause this to happy. There is help, there is hope – and you are absolutely not alone as your journey toward recovery.

2) How does husband cope with postpartum?

There are several ways in which a husband copes with postpartum. The answer to this question really lies in what the person asking meant.

Does she mean if HE has postpartum? Or does she mean if SHE has postpartum? And then – does she mean What’s the best way for him to cope? Or how do most husbands in general cope with postpartum? I want to address all of those below in as succinct  a manner as possible.

If HE has postpartum: Men & women exhibit different symptoms when it comes to depression. Men keep quiet. They will stay at work longer, avoid home, self-medicate, get angry and irritable, shift blame, shirk responsibilities, blame themselves for the failure. If your husband is suddenly not at home as much, angry, frustrated, and not smiling or as easy going as usual – it might be time to try to get him to a healthcare professional. A great website to learn more can be found at Postpartum Men. It’s run by Dr. Will Courtenay, who is an expert in Male Depression. Dr. Courtenay is amazing and truly knows the male psyche. If you suspect your husband is struggling with depression, visit Dr. Courtenay’s site and then sit down to talk with your partner. Let him know you won’t judge him and encourage him to get help for himself and for his family.

If SHE has postpartum: He needs to avoid telling her to snap out of her depression first and foremost. Dive in with the chores, housework, and baby duty. Take older kids out to play. Change diapers before mom nurses at night or if she’s sleeping (those precious extra moments of sleep are heavenly). Also, he should read this cheat sheet for a fabulous list of things to say to his wife. Support her going to doctor’s appointments but don’t force her UNLESS she’s clearly expressed intent to harm herself or others. Never every sneak attack a psychiatric appointment on your wife. Bad juju.Very Bad juju. Ask how you can help. And then do it. Don’t wait for her to ask – because she won’t. Bottom line, love her, support her, and help with the work around the house. Give her time to heal and recover. It’ll be a thankless job but one day, she’ll tell you thank you. Trust me. I’m eternally grateful for the support I received from my husband during Postpartum. (This also covers the BEST way for him to cope)

How most husbands cope: The most common gut reaction is to deny there’s anything wrong. Some husbands even believe their wives are faking symptoms in order to get out of parenting responsibilities. Still others tell their wives to snap out of it. Or they believe that medication and doctors can’t do anything to help so they don’t support their wives seeking help, instead telling them that they need to suck it up and just tough it out. Husbands are just as shattered as we are when Postpartum strikes. They are lost – the woman they love with all their heart has faded away. She’s gone. In her place is a new woman, a shadow of the woman she once was – the woman she was maybe even hours before… they don’t know how to fix us. So they get angry, scared, and frustrated. They snap at us, not knowing how else to react. I would highly recommend getting a husband reacting in any of the aforementioned ways to attend a doctor’s appointment with you. A doctor will legitimize your experience for your husband. Many husbands have what we call “White Coat Syndrome,” ie, until he hears it from a doctor, it’s not real. It helps to get him to the Doctor because it involves him in the solution, thereby allowing him to “fix” the situation at hand in some way, which is what men excel at – solving problems. It’s not an easy ride with a husband who is not supportive. You’re also not alone in this – but when you have Postpartum, it is so very important to have support at home – get BOTH of you to the doctor as soon as possible. There is hope, even in this.

Absolutely OUTRAGED


UGH!

As if it’s not enough that we already face enough during PPD, the stigma, the refusal of acknowledgement, the confusion over baby blues, postpartum depression, other mood disorders, and Postpartum Psychosis – then along comes an article like this one: Woman found insane in Baby Blues Case seeks Sanity Restoration with the subtitle specifying: Sheryl Massip was found not guilty by reason of insanity 20 years ago for killing her infant son while suffering from post-partum psychosis.

Cover your ears. Prepare your eyes. i’m about to yell. And I mean YELL.

THE BABY BLUES ARE NOT AT ALL SIMILAR TO 

POSTPARTUM PSYCHOSIS!!!!!!!!!!!!!!

 

Get your facts straight Mr. Welborn. (by the way, you can email him and call him (714 834-3784.) Let him know that he is seriously mistaken with his usage of terms.

Let’s revisit the facts, shall we?

According to an article by Helen Jones at the Postpartum Support International website, the baby blues affect up to 80% of new moms and involve crying for no reason or general stress or anxiety that dissipates after the first few weeks.

Within the same article, Jones defines Postpartum Psychosis as:

Postpartum Psychosis (PPP)

The onset is usually sudden, with symptoms including: delusions (strange beliefs) and/or hallucinations; feeling very irritated, hyperactive and unable to sleep; significant mood changes; and using poor judgment in making decisions. Women who are more vulnerable are individuals who have a previous history of psychiatric disorders, previous postpartum mood disorders, or a family history of psychiatric disorders. Women who display any of these symptoms should contact their health care provider immediately. Family members should be alert for these symptoms as well, since they are often able to recognize serious symptoms sooner than the mother does.

 Do these even SOUND like they’re in the same ball park?

NO.

In fact, Baby Blues aren’t even classified as a mental health disorder.

Could referring to PPP as the baby blues scare a brand new mother who may be feeling a little weepy or be starting to become seriously depressed? HECK YEAH.

To make matters worse, Mr. Welborn also later refers to PPP as an extreme form of Postpartum Depression. Let me make one thing crystal clear. POSTPARTUM DEPRESSION IS NOT THE SAME THING AS POSTPARTUM PSYCHOSIS. It’s an entirely different creature consisting of a break with reality. From what I understand, Postpartum Depression cannot develop into Postpartum Psychosis. (I’m doing some checking into that and will get back with you regarding research on that point)

I am very disappointed in Mr. Welborn’s apparent lack of tact and compassion for new mothers struggling with this range of disorders. And even more disappointed that the newspaper he works for would publish this article without such a brazen irresponsibility and lack of concrete understanding into the condition on which they are reporting. VERY DISAPPOINTED. Did I mention I’m pissed too? Or have you already figured that out?

Those of you who either read this blog regularly or know me should recognize that I don’t do this very often but when I do, I mean it and I am truly, deeply saddnened that this is still happening. Media sensationalism of these cases is a barrier to treatment for women – I’ve had many women share with me that they or their husbands are fearful of admitting they have postpartum mood issues for fear that what happens to the women they read about in the paper may happen to them. UGH! I can’t personally guarantee that you won’t develop PPP but I CAN tell you that it is rare – extremely rare BUT these cases are the ones who make the news. Not the positive cases of recovery – no – the ones that end in sheer tragedy and will bring in viewers.

Email Mr. Welborn. Call him. Contact the OC Register’s Editorial Staff and Operating Management. Let them know we won’t stand for this. Let them know that if they’re going to cover a PPD story they need to get their facts straight and focus on the positive rather than the negative. BE SENSITIVE not only to the people in the story but the people who may be reading the story. They owe us that much.

Daily Perinatal Mood Disorders Fact


Defining the Differences:

Baby “blues”: fleeting periods of sadness and mood swings immediately after giving birth. Typically goes away within two weeks or less. Risk rate is 80% of all new mothers.

Postpartum Depression: Continued and deeper feelings of sadness and mood swings. Other symptoms may possibly include increased irritability, decreased appetite, inability to sleep, intrusive thoughts, increased anxiety. Risk rate is 10-15% of all new mothers, regardless of how many children she has.

Postpartum Psychosis: Onset is fast and can include delusions, hallucinations, inability to make any decisions, hearing voices. If suspected, the mother needs to be hospitalized immediately and not left alone until she is under professional care. This is rare, every 1 in 1000 women are at risk for developing this and a family history of bipolar or schizophrenia raise the risk even higher.