Women aren't seeking help

Health: Living in Depths of despair: Some health-care officials are worried women suffering from post-partum depression aren't seeking help

Caroline is thinking hard, staring off into the distance, gripping the arm of the overstuffed couch with both hands.

She looks confused by the question that Paula Bodnarek has just asked her: ``Are you enjoying life?''

Caroline struggles to surface with her answer. She is wedged tightly in the corner of the vast beige, otherwise empty, sofa. She can't seem to find her voice.

``I don't know. That's a hard question,'' she says, before her eyes flicker to the floor. She seems overwhelmed -- by the request for information, the sofa and the depths of her depression.

Paula understands. Being overwhelmed and without energy for the simplest task are symptoms of the profound despair that strikes at least one in 10 new mothers.

Paula understands Caroline's condition, called postpartum depression, not just because she's a public health nurse in Edmonton and volunteer co-leader of The Family Centre's postpartum depression support group. But she also relates to Caroline's despair because she struggled with it herself.

The depression that hit her after the birth of her daughter, now three, made Paula incapable of caring for her new baby and young son. She confides this to Caroline.

``I was so ill I couldn't function in even the simplest way I I needed a lady to come in and help with the children,'' she explains.

``It wasn't until I got on medication that, wow, I actually fed the kids a can of Campbell's soup myself. That was a real accomplishment.''

On this day, only Caroline, whose name has been changed, has turned up at the support group meeting with Paula at Amity House. In the past, as many as 14 women have shared their pain weekly and helped each other find solutions. But participants have dwindled to half that number recently, Paula observes.

Cathy Harlan, who oversees the support group's operation, is one of a handful of Edmonton health officials who are worried that women aren't finding the help that's available to them in the community.

Harlan says she has about 100 new mothers on her case load each year, but there are probably 10 to 20 times that many in the Edmonton area who aren't accessing her services.

``The problem is that if these women don't get treatment and support early on, then their depression often gets worse. They might need hospitalization, their marital relationship or relationship with their baby and other children can be adversely affected. The condition can become chronic.''

Domino effect

Studies have shown that depressed mothers raise depressed babies, and this stress can spawn clinically depressed fathers.

To help avoid this, Harlan, along with officials from Alberta Mental Health, Edmonton's Capital Health Authority and a community public health centre, began meeting once a month to design a new screening program to better identify women suffering from postpartum depression.

They're creating an information package to be handed out by public health nurses making home visits immediately after a baby's birth.

The group also plans to start a pilot project to have new mothers who bring their babies in for their two-month immunization complete a 10-item questionnaire designed by psychiatrists to detect postpartum depression.

Called the Edinburgh Postnatal Depression Scale, the questionnaire has been used with success internationally. In Edmonton, the hope is that it can eventually by applied at all public health centres, with modifications for those who don't speak English as their first language.

Postpartum depression is a condition that has been a well-kept secret for centuries. And it hasn't received much attention until the last 15 years, says Harlan.

Now experts agree postpartum depression usually begins with a milder form of the condition, known as the baby blues. The baby blues are experienced by as many as 75 per cent of women, usually in the first week to 10 days following birth. For most new mothers, the crying jags, anxiety, and irritability, which are thought to be caused by a sudden drop in estrogen and progesterone after delivery, gradually go away by themselves.

But as many as one in four of the mothers go on to develop postpartum depression. People of all ages, cultures and social backgrounds are affected. The illness doesn't discriminate.

The symptoms can include behavioral changes such as a desire to sleep constantly or insomnia, hopelessness and disinterest in daily life, feelings of deep sadness, mood swings, irritability, extreme anxiety or feelings of being trapped and isolated.

Those who don't understand that the condition is a disease affecting brain chemistry have been guilty of suggesting that sufferers ``probably just need a night out with the ladies to snap out of it,'' says Harlan.

In the most serious cases, women can lose contact with reality, and have episodes of paranoia, delusions and thoughts of harming themselves or their babies.

In Caroline's case, she says that she sensed trouble when she started yelling at her three-year-old daughter for no reason.

Eating habits

Explaining slowly, Caroline says she isn't enjoying her maternity leave with her baby son. Sometimes, she can't stand her husband. Even the way he eats his supper is annoying. One minute she is happily cracking jokes, the next minute, she's furious.

Most recently, she has had no energy. Just taking the kids to the park seems like a herculean task, she says. Once, she managed to juggle a full-time job with a financial institution and take care of her first child. Now she can't get out of bed.

``It really scares me, not having the motivation to do things. Now I feel guilty because I can't even get my kids to the park I I love my kids. I wish I felt differently,'' she tells Paula.

``It's not your fault,'' Paula assures her.

The pair discuss treatment options including anti-depressant medications, many of which can be safely used even while breast-feeding.

Paula recalls that when she was ill, her attendance at the support group, which she now leads, helped her recovery. Now she tells her children that she is helping other ``sad ladies'' in return.

``Try not to worry. In time, you will feel better. With help, 90 per cent of women recover. I'm here,'' Paula says.

- CONSULT A DOCTOR: If you suspect that you have PPD, discuss this with your doctor to rule out other complications such as thyroid conditions, anemia etc. If your doctor confirms PPD, she may wish to prescribe medication, as PPD responds very well to anti-depressants.

- SEEK EMOTIONAL AND PHYSICAL SUPPORT: Try your family or an outside agency for emotional support. Physical assistance may be available through family or a homemaker service.

- SLEEP AND/OR REST IS ESSENTIAL: Realize that you are more important than a sink full of dishes. Don't feel guilty about resting.

- ATTEND A SUPPORT GROUP: Talking with other mothers will help you realize that you're not alone. Together, you may discover alternative ways to cope.

- INDIVIDUAL AND MARITAL COUNSELLING: Counselling plays an important role in treatment, as PPD often causes friction between couples.

- LOWER EXPECTATIONS: You are not superhuman and no one is the perfect mother and homemaker.

- ACKNOWLEDGE YOUR FEELINGS: Anger is often associated with PPD. Learn to control your anger before it controls you. Talk to a supportive person to put things in perspective.

- BE SELFISH: Take time to take care of yourself, get your hair done, buy new clothes, take a bubble bath.

If a woman suffering from postpartum depression doesn't get the support and services she needs, the condition can lead to:

- Substance abuse as an attempt to escape.

- Family breakdown, including separation and divorce.

- Suicidal tendencies. About 60 per cent of mothers with PPD experience mild to strong feelings of suicide. A small percentage attempt it.

- Physical abuse of children.

- A lack of healthy bonding with the baby.

Moms' postpartum upheaval ranges from baby blues to psychosis

Once lumped under the heading of ``baby blues,'' the post-partum change affecting new mothers is now known to have a wide range. Consider:

* A 37-year-old career woman on her second maternity leave who bursts into tears every time she tries to discuss the division of household duties with her husband.

* A 25-year-old mother who beats her five-month-old daughter and throws the child to the floor, causing massive, fatal head injuries.

The first is a case of mild depression that affects up to 80 per cent of all new mothers. The second is post-partum psychosis, an extremely rare and dangerous condition in which the new mother is at great risk of harming her child or herself.

Mild depression, often called baby blues, is marked by a tendency to burst into tears at the drop of a hat.

In reality, the first few weeks after childbirth is a time of great emotional swings for new parents, researchers have found.

Happy moods are punctuated with periods of fatigue and tearfulness.

Baby blues quickly disappears. But if sad feelings persist or worsen, postpartum depression may be diagnosed. This condition, which can be long-lasting and have serious ramifications for the entire family, strikes about one in 10 new mothers -- 300,000 a year in the United States. The period after having a baby is when American women are at highest risk for suffering depression.

Major life changes such as childbirth can trigger irrational behaviour, said the Rev. John Spiker, pastor of the Cridersville (Ohio) Church of the Nazarene and facilitator of the Above the Moods depression support group.

``Their body chemistry changes and they could be affected. People who didn't have a problem at first can have their whole system thrown off,'' Spiker says.

The cause of postpartum depression is not well understood. Emerging studies tend to point to several factors that converge in susceptible women. The factors can include a family history of mental illness, hormonal changes following childbirth, and lifestyle or cultural factors such as loneliness, isolation or financial problems, according to a new book Postpartum Depression: Every Woman's Guide to Diagnosis, Treatment & Prevention, by Sharon L. Roan (Adams Media, 1997).

Untreated, postpartum depression can linger for as long as a year. However, most women improve dramatically with therapy that can include counselling, antidepressants and family support, Roan said.

Depression usually occurs 10 to 14 days after delivery, said Dr. T. Thomas Lee, a Lima, Ohio, psychiatrist. The problem can't be prevented but it can be controlled and treated.

Ironically, women who breezed through the postpartum period with their first baby can be hit hard with subsequent children.

``It was confusing because I had been a responsible parent in the past. But these feeling were overwhelming. I was just unable to cope with anything,'' said a 43-year-old woman, describing the ordeal she went through after the birth of her third child.

``Postpartum depression is more serious than baby blues. It's the same as clinical depression. It's the result of a chemical imbalance.''

She had few complications after the first two. But after the third, she went long periods without sleep, couldn't eat, lost weight and felt sad and hopeless. Her obstetrician gave her sedatives, at first, thinking the problem would pass. When she still had problems a month later, he referred her to a psychiatrist who prescribed an antidepressant.

Several other mental illnesses also are associated with the postpartum period. These include panic disorder, obsessive-compulsive disorder and postpartum psychosis.

Health-care professionals in recent years have become more aggressive in looking for symptoms of mental illness in new mothers. They are doing so not only because of the success of antidepressants in treating the illness but because research has shown that infants are extremely vulnerable to the impact of being cared for by a depressed mother.

But before the mother can be treated, someone has to recognize she needs help, said Dr. F. Warren Feist Jr.

``I think a lot of doctors and patients don't communicate about what's bothering them. You have to ask patients how they are feeling. Maybe specifically ask them, ``Are you feeling depressed?''' he said.

Feist also recommends that obstetricians make note of their patient's history with depression. If the patient has experienced it in the past, some family members should be notified that she may need help after the baby is born.

Although most cases of depression pass within the first few weeks, the symptoms can be eased considerably if the new mother knows she has the support of others. She also needs a plan to combat feeling of fatigue and isolation, said Kim Flodin, who wrote Why New Moms Get the Blues for Parents magazine.

Attorney William Kluge, who defended the 25-year-old Ohio mother who killed her daughter, said his client had postpartum psychosis.

``All of the indicators are there,'' said Kluge. Prior to the incident, the woman complained of insomnia, fatigue, inability to concentrate, loss of interest in her baby and loss of self-esteem. She saw a psychiatrist, but stopped taking her medication six weeks ahead of schedule.

If she would have continued taking her medication, Dr. Susan Hickman believes the tragedy would have been prevented. Hickman, a San Diego therapist, has treated more than 300 women for postpartum depression, testified that the psychosis made the woman unaware of her actions.

Kluge plans to appeal his client's conviction and likens postpartum depression defence to battered women's syndrome.

That defence was also initially rejected when it was presented in 1981. But 10 years later there was enough scientific evidence to show the battered women's syndrome was valid.

``So they opened the door with the first case,'' said Kluge. ``It eventually got accepted. We're hoping this may open the door for other women who find themselves in this condition.''

POSTPARTUM TROUBLES

When simple moodiness becomes something more serious

Almost all new mothers experience ``baby blues,'' a mild moodiness or feeling of letdown that occurs shortly after giving birth. However, if those feelings persist longer than a few days or begin later in the postpartum period, help should be sought:

Postpartum Depression Symptoms:

*The inability to enjoy things a woman once found pleasurable.

*Sleep problems not related to caring for the baby.

*Thoughts about harming herself, the baby or someone else.

*Nervousness, anxiety or panicky feelings.

*Confusion or problems concentrating.

*Uncontrollable crying or irritability.

*Overconcern or lack of concern for the baby.

*Long-term loss of interest in sex.

Postpartum Psychosis Symptoms:

*Insomnia

*Hallucinations

*Agitation and bizarre feelings or behaviour.

*Mothers may think God is trying to send them messages about their babies.

Postpartum psychosis requires immediate medical help. Both disorders are highly treatable.