Perinatal Depression Doesn't Always Look How You Think
I'm disconnected, I'm anxious, and I'm constantly afraid my baby is going to die. I struggle to stay focused on a task, I don't want to talk to anyone, and I can't sleep. But the dishes are washed, my kitchen is clean, and dinner is simmering in the crockpot. I know I'll remember my 4-month-old's wellness check later in the week, and I already have dinner planned through Sunday. My perinatal depression and anxiety symptoms, coupled with post-traumatic stress disorder, don't interfere with my day — an "indication," I'm told, that would warrant therapeutic help. I can begin each day promptly at 6:00 a.m. and tend to my children and make it to work and keep the kitchen clean, so the ongoing conversation surrounding postpartum depression and anxiety tells me that I'm not "really" depressed or anxious or struggling or in need of support.
But I am.
I'm organized, I'm punctual, and I have no problem getting out of bed every morning. I'm also depressed, anxious, and navigating PTSD triggers on an exhaustive, daily basis. And I need help.
One out of every nine women in the United States experience postpartum depression, according to the Centers for Disease Control and Prevention (CDC), with some states seeing statistics as high as one in five women. A reported 10 percent of postpartum women will develop anxiety, according to Postpartum Support International, and while only 4 to 6 percent of postpartum women are diagnosed with PTSD, more than 16 percent experience PTSD-like symptoms at least two weeks after giving birth, according to a 2017 study published in the journal Frontiers in Psychology.
In fact, some experts say we may underestimate how prevalent these conditions are, in part due to outdated ideas about what mental health issues look like. Postpartum depression, for example, often conjures up images of a disassociated mother, unable to get out of bed let alone bond with her baby or manage to take a shower. She's disheveled, missing work deadlines, and swimming in a sea of dirty laundry. But rarely are we walking stereotypes of depression. For this reason, many experts prefer to talk in terms of "perinatal mood and anxiety disorders" (PMADS), which encompass a wider range of emotions. PMADs are relatively common, impacting an estimated 950,000 women every year and present in subtle but powerful ways, leaving moms suffering through anxiety, isolation, irritability, sadness, and mood swings to feel as though what they're enduring isn't "bad enough" to warrant help, professional or otherwise.
"Sometimes [moms] minimize their feelings because they don't want to say they have postpartum depression, because there are biases," Dr. Rosana Marzullo-Dove, a reproductive psychologist in Tampa, Florida, tells Romper. "[The idea is] if you have postpartum depression it means you're not connecting with the baby, but it's not just about connecting with the baby: it's about connecting with yourself."
According to Marzullo-Dove, diagnosing postpartum depression or any other mood disorder is less about what a person is capable of accomplishing and more about the behaviors of that person.
"You can see [postpartum depression] more in their behaviors," she says. "[A mom will] have feelings of being overwhelmed, and sometimes they think that they're being functioning but when they're doing chores — going to work, taking care of the baby, taking care of the chores in the home — they're still overwhelmed. Because there's so much they have to do they cannot see a future with brightness."
On my bad days I feel like the remainder of my life will be an exercise in treading water: I'll work tirelessly to keep my head just above water. But even on those bad days I don't dip below the surface — so my hair is perfectly styled and my eye-liner is aptly applied — so I struggle to ask for help or discuss my mental state. I can laugh with a fellow parent at drop-off, my 4-month-old strapped to my chest as I help my 4-year-old son put his coat in his cubby, while pushing down an overwhelming, omnipresent feeling of simultaneous dread and detachment. If anything, my propensity to remain in control of my family's schedule, our meals, our home, and everything in between is an attempt to white-knuckle my way through extensive episodes of depression and anxiety. I can't control the feelings of fear, helplessness, or overwhelm, but I can control the temperature as I cook my family a meal.
My postpartum depression, anxiety, and PTSD don't manifest themselves in missed showers or canceled playdates, but materialize in internalized feelings no one could possibly notice without extensive discussions I honestly don't have the willingness or the energy to undertake. No one can tell my self-worth has tanked. Not when I'm comfortably wearing my pre-pregnancy jeans a month after having a baby. No one can tell I'm deathly afraid I'm failing my baby as a mother. Not when I'm posting smiling pictures of us at our latest family outing. No one can tell I'm missing meals or feeling fatigued. Not when tired tropes about exhausted parents and moms living off their kids' leftovers are regurgitated ad nauseam.
By our social standard and what society requires of parents, I'm doing well. Or at least well enough.
I can't control the feelings of fear, helplessness, or overwhelm, but I can control the temperature as I cook my family a meal.
"[Moms with postpartum depression] worry about all the things that'll go wrong," Dr. Marzullo-Dove says. "They worry about work, the baby care, money, housework, and it becomes more stressful for them to care for everything because they're fatigued and they're exhausted." A mom's ability to complete a task or not isn't always a solid indicator that she's suffering from depression, but rather how she feels when she is completing a task. "People have many different symptoms [of postpartum mood disorders] and not every person gets every one of them. That's the point."
I know how my new life as a mom of two looks — my clean house, my smile at kindergarten drop off, workplace punctuality — which is why I'm struggling to admit that I need help. On my good days I feel as though my experience simply doesn't warrant the "all hands on deck" support moms deserve post-pregnancy. And on my worst days I can simply point to the number of tasks I've accomplished as to why even my "bad" isn't "bad enough."
But the truth is, I do. I am struggling, even if my calendar is on point and I'm 15 minutes early to my son's pediatrician appointment, I am butterfly-stroking my way through a sea of fatigue, insomnia, stress, fear, and self-doubt.
I might not look like I have postpartum depression, anxiety, and PTSD, but for right now, all three of them look like me. And that's OK.
If you or someone you know is experiencing depression or anxiety during pregnancy, or in the postpartum period, contact the Postpartum Health Alliance warmline at (888) 724-7240, or Postpartum Support International at (800) 944-4773. If you are thinking of harming yourself or your baby, get help right away by calling the National Suicide Prevention Lifeline at 1-800-273-8255, or dialing 911. For more resources, you can visit Postpartum Support International.