Postpartum Care Needs Dramatic Changes

I breastfed Isla for eight months before I started showing signs of depression again. Pregnancy hormones and breastfeeding gave me a temporary boost, but I could feel the darkness try to creep back in. My doctor (wrongly) told me I couldn’t breastfeed and take antidepressants, so I stopped. (Some antidepressants are safe to take while breastfeeding. Read more here and always consult your doctor if you need medication).

Heather and Eli, 2016

I weaned Isla somewhat abruptly and started my meds, expecting to immediately feel better, but Zoloft was no match for my hormones. I cried all the time. I had suicidal thoughts. I felt out of control and that scared me. I had experienced depression before but not on that level.

After talking to other moms and doing research, I discovered I had post weaning depression, something I’d never heard of, but it’s real. When you stop breastfeeding you experience a drop in prolactin and oxytocin levels, according to Parents.com. Prolactin, needed for milk production, causes calmness and a sense of well-being. Oxytocin, needed for milk ejection, increases relaxation, lowers stress levels and lowers blood pressure.

It’s no wonder that my hormones caused such a violent reaction when I abruptly stopped breastfeeding. I turned back to my doctor but he wouldn’t acknowledge that post weaning depression was real. I got the impression he didn’t deal with pregnant or postpartum patients at all. Later he labeled me “treatment resistant”, which felt like he was giving up on me. So, I gave up on him and found a new psychiatrist — a woman.

I received inadequate postpartum mental healthcare. I’m hardly the only one who has experienced this, which got me thinking — I was able to afford new medication ($300!) to combat my depression. I was able to find a new doctor, even though she lives in the DFW metroplex (near my parents’ house) and doesn’t accept insurance. She charges $125 per hour. I was able to get the help I needed, but there are women who aren’t as lucky, especially women of color. There’s a huge disparity when it comes to the risk of experiencing postpartum health issues. This is likely due to the fact black women are more likely to have traumatic births and other complications, such as maternal hemorrhaging. Read more about that here. Also, black women are less likely to reach out, most likely due to the stigma associated with mental illnesses.

Nationally, postpartum depression affects 1 in 8 women. New mothers of color have rates of postpartum depression close to 38% compared to the 13 to 19% rate all of new mothers, according to the Psychology Benefits Society.

A disproportionate number of women of color are not even screened for depression and don’t receive the services and treatment they need. Up to 60% of women of color don’t receive any services at all. That’s crazy! Proper screening of women of color during pregnancy and postpartum is known to reduce the symptoms of depression, yet there’s still this great disparity.

There’s also this — there are documented racial and ethnic differences in perceptions and treatment experiences of low-income women of color vs. white women, including limited access to health care, a disconnection with providers, lack of access to providers that look like them and unavailability of culturally/linguistically appropriate services, Psychology Benefits Society says.

A study questioned new mothers of color about what they needed in order to access screening and treatment and it shows mothers of coloring lack the following:

  • Access to information and resources
  • Access to services (insurance coverage, transportation, childcare services, etc.)
  • Flexibility when making appointments and flexibility when finding a doctor
  • Community-based support services

This is not OK. All those numbers are probably much higher in reality than what’s being reported. Again, the stigma keeps women of color from reporting and reaching out. It is still common for people — no matter what their background — to view depression as a weakness. New moms could also fear people thinking they aren’t fit as a mother if they are experiencing depression. That was a huge concern of mine.

I’m not trying to make this about me, but I can’t help but think what if I didn’t have the means and flexibility that I do to receive quality mental health care?

What I experienced with postpartum and post weaning depression was not good, and to be honest, it was dangerous (not for my kids, just me) because of my suicidal thoughts. I could have easily killed myself but my support system and options for healthcare saved me.

But there are others who need saving. All women need quality healthcare, and closing the gap between treatment of mothers of color and white mothers should be a priority. It should’ve already happened. The U.S. is supposed to be “best country in the world” but it ranks among the last compared to other first-world countries in terms of healthcare. I love my country, but it’s not the best if the majority of women are receiving little to no healthcare postpartum or otherwise.

Post partum depression, trucks and ponies

I’m cleaning out my car the other day and finding the odd little things moms find in their cars – a pair of shoes, one sock, three My Little Ponies and a monster truck. These make me smile because at one point in my car all that was there was Chick-fil-a trash, which also makes me smile, but for different reasons. I love finding toys here and there, reminding me how lucky I am that I have two beautiful, clever children who love me.

But to be honest, after giving birth to them my depression worsened. My hormones and brain chemistry were altered and I went down dark roads I never imagined existed. Do I regret having babies? No way. Will I have more? No way. But I do want to discuss Postpartum Depression and Post Weaning Depression.

During my first pregnancy, I was happy a lot, albeit anxious, even though my family was facing terrible times – my husband’s dad died and there was chaos within the family. But my hormones wouldn’t let me be sad a whole lot during these times. After giving birth to a girl, I breastfed her for 8 months. I felt the depression creeping back in and I no longer had the protection of pregnancy hormones to keep me happy. I stopped breastfeeding cold turkey, without so much as talking to a lactation consultant or my doctor. I just wanted to get back on meds (at this time I was told by my now former psychiatrist that I would not be able to be on meds and breastfeed, which is not true).

The pain in my breasts was nothing compared to the waves of depression that crashed down on me over and over. I was suicidal. My husband and mom didn’t understand what was happening. My doctors didn’t know what to do so they recommended I go to the local psychiatric hospital, which I didn’t want to do and I found inadequate. I felt my whole postpartum care was inadequate, except for my OB’s care. Once I was on meds, and then more meds, the darkness began to let up. The suicidal thoughts receded.

I was on meds on top of meds and it was then I was labeled “treatment resistant.” I felt brushed off my psychiatrist. This was what it was going to be like forever? When my daughter was about 16 or 17 months old, my husband and I decided I would get off my meds and try for another baby. Secretly I was hoping to feel the happiness I had felt with my first pregnancy but no such luck. I felt anxious and moody, but I could go several weeks without a migraine, so there’s that. It was a difficult pregnancy – I was diagnosed with gestational diabetes at 20 weeks followed by polyhydraminos which led me to give birth to my son at 37 weeks. So I was relieved when it was over and I was prepared for the PPD, asking for Zoloft as soon as I could get it. My OB understood. Nobody wanted a repeat of last time.

And even though I was prepared and on medication, it still hit. It was more than the “baby blues.” I was sad all the time, I didn’t think anyone else could take care of the baby the way I could which led to exhaustion, which led to more anxiety and irritability. I constantly checked on the baby and worried. I was weepy. And worst case scenarios always popped through my head. Plus, I had a toddler to take care of. Whether you have help is irrelevant. You feel so alone and scared.  It’s like someone has taken over your body and brain. When it gets really bad, you have suicidal thoughts. If that happens, you need to tell someone and seek help immediately by going to the ER or calling 911.

The “baby blues” affects up to 80% of births, according to the National Institute of Mental Health (NIMH), but those symptoms are mild and usually go away after about two weeks. The NIMH also says that PPD affects almost 15% of births – that sounds awfully low to me – symptoms are severe and can began between a week to a month after delivery. Because of the severity of PPD’s symptoms, women may have trouble taking care of themselves and the baby, so it’s really important to take note of your symptoms – how long they stick around and just how bad they get.

Postpartum depression is no joke and I had never heard of Post Weaning Depression after breastfeeding before I experienced it. People are starting to learn more about PPD and Post Weaning Depression but it’s still something that needs to discussed. It’s not just a “women’s problem” that should be discussed behind closed doors. Forget that. It really does take a village.