Ripping the edge of the couch with tiny hands, Kira Carrington inched her way over the carpet on bare toes, her blue eyes fixed on Kitty, the family cat. When Kitty spied the baby reaching for her, she slipped around the corner, prompting a grunt and squeal from Kira as she fell back onto her diapered bottom.
Kneeling near her daughter, Kira’s mom, Kathy, grinned. One more gem from the daily joy that is Kira.
As profound as Kathy’s love is for Kira, there was a time when the Simi Valley woman couldn’t enjoy her baby. In fact, from the moment Kira was born on July 23, 2006, Kathy began a descent into a dark place.
“I heard mothers say, ?Oh, I fell in love the moment they put my child in my arms,’” Kathy said. “I was thinking, ?Are you insane? This is the most hellish nightmare I’ve ever been through.’”
Kathy thought she was crazy. A bad mother. A failure. Worthless. She later learned she was none of these things. She was suffering from postpartum depression, PPD, a condition that affects at least 15 percent of new mothers, according to recent studies. And new mothers’ depression is often exacerbated by guilt. After all, isn’t this supposed to be a wonderful milestone in a woman’s life?
“Our society has these grand expectations about what motherhood is supposed to be,” Kathy said. “I kept waiting for that magical ?wow’ to kick in. All I wanted to do was sleep or cry.”
Celebrities such as Brooke Shields and Marie Osmond have gone public with their own battles with PPD but many women still feel ashamed, so they don’t tell their doctors. Even if they do report their symptoms, doctors can still overlook it, according to the director of obstetrics and gynecology at Ventura County Medical Center, Dr. Robert Lefkowitz.
“I think a lot of physicians and healthcare workers really expect young mothers are going to be having a hard time,” Lefkowitz said. “Until you get a complete evaluation, you really don’t recognize it.”
Sometime in May, the Ventura County clinic system will open the Mandalay Women’s Life Clinic in
Oxnard. The clinic will help women with behavioral health issues specific to their stages in life.
“I expect the largest diagnosis we will see will be postpartum depression,” said Lefkowitz, who will be the director of the clinic.
Women will be screened for postpartum disorders with a detailed questionnaire, he said.
PPD on the public radar
Among the lawmakers trying to give the problem national attention is U.S. Sen. Robert Menendez, D-N.J. In May, he plans to introduce a bill called the Moms’ Opportunity To Access Help, Education, Research and Support for postpartum depression, or MOTHERS, Act. The bill would make funds available for PPD research, screening and public education.
In September 2006, California Gov. Arnold Schwarzenegger vetoed a bill that would have required the California Department of Health Services to conduct a PPD community awareness campaign. That bill, AB 291, was the most recent of several introduced by California State Assemblyman Paul Koretz,D-West Hollywood.
His earlier bills failed before reaching the governor’s desk.
“The earlier bills mandated fines for failure to screen for PPD,” said Los Angeles attorney Kimberly Wong, who is the advocacy chairwoman for Postpartum Support International, or PSI. “While well-intentioned, they might have had the unintended consequence of scaring away MediCal providers.”
Schwarzenegger vetoedAB 291, citing technical flaws, but he did direct the California Department of Health Services’ Web site to provide a link to credible national organizations that address PPD.
Also in PPD awareness news is a long-term study out of Denmark indicating that new mothers are at significantly more risk than new fathers for mental disorders such as schizophrenia, depression and bipolar disorder in the three months following the births of their first children. The results, which appeared in the December issue of the Journal of the American Medical Association, were based on a study run from 1973 to 2005 out of the University of Aarhus, Denmark. Of 630,373 new mothers and 547,431 new fathers, about one in 1,000 women suffered postpartum mental disorders severe enough to require hospitalization, compared with 0.37 men per 1,000 births.
The Denmark study reflects the prevalence of postpartum psychosis, an extreme form of PPD, Lefkowitz said. Women with postpartum depression may have thoughts of harming their children, but women who actually may act on those thoughts are most likely suffering from postpartum psychosis.
That disorder received widespread attention when Texas mother Andrea Yates, who had a history of postpartum depression, drowned her five children in July 2001. Lefkowitz pointed out that in extreme cases there are usually a constellation of other predisposing mental problems present.
The percentage of women who suffer from PPD that is severe enough to affect the nurturing of their infants is about 14.5 percent, according to a 2006 report from the Agency for Healthcare Research and Quality, a division of the National Institutes of Health in Washington, D.C.
“We’re doing a better job of detecting it,” Stone said, adding that doctors may mistake it for the more common, short-term depression — the so-called “baby blues” — that affects 70 to 80 percent of women.
Judy Lloyd, 67, of Newbury Park first gave birth at age 19, then proceeded to have two more children before she turned 23. After each birth, she felt a grinding depression. She finally told her gynecologist.
“He told me to go home and ?get myself together,’” Lloyd said. “He said that I had a wonderful husband and family, and I needed to concentrate on them. This added to the shame I already felt.”
Lloyd didn’t link her depression to her pregnancy until years later.
Not much was known about PPD back in the 1950s and ‘60s, Lefkowitz agreed. “We know so much more now biochemically,” he said. “Depression is as real an illness as pneumonia.”
A misunderstood condition
When she had PPD after her first child was born 23 years ago, Wendy Landis, 46, of Thousand Oaks wound up in a psychiatric ward in Washington state, where she was living at the time.
“I just had sheer terror inside of me at all times,” she said. “When my husband would go to work, I would go over to my mom’s house and just sit there.”
She finally checked herself into the psychiatric hospital. She avoided antidepressants because of the side effects, but things got so bad she finally relented, and she improved. When she finally shared her agony with her mother-in-law, Landis was disappointed by her reaction.
“She said something like, ?In my day, we didn’t have time to be depressed,’” Landis said.
If she was suffering from PPD, a woman generally didn’t have much support, according to Mary Arnold, 54, of Thousand Oaks. Arnold experienced PPD after the birth of her second child at the age of 26.
“We weren’t as open 25 or 30 years ago,” she said. “We didn’t have ?Oprah.’”
Arnold began to panic when she fantasized about hurting her baby.
“I’d envision throwing him against the wall, which I never would do,” she said. “I would think: ?I’m so lucky to have these beautiful children. Why am I so sad?’”
She tried hypnosis. She consulted a psychologist.
“They would look into your childhood and your marriage,” Arnold said. “It turned into this whole psychological thing. Back then they didn’t have the antidepressants they do now.”
Even with modern treatments, there are barriers. Her doctor recognized that Nancy Perez, 43, of Oxnard was having postpartum depression after the birth of her third child three years ago, but Perez had never heard of the disorder. When her doctor suggested an antidepressant, she resisted.
“In my mind, I wouldn’t take it. I said: ?That’s for crazy people. I’m not crazy,’” she said.
Her doctor was finally able to convince her to take the medication and within six weeks, she said, “I woke up one morning and it was like a whole fog had lifted.”
The biology of PPD
According to http://womenshealth.gov, a U.S. Department of Health and Human Services Web site, two female hormones, estrogen and progesterone, spike in a woman’s body during pregnancy. During the first 24 hours after childbirth, these hormones plummet to their pre-pregnancy levels. Researchers believe this hormone dip may trigger depression, not unlike a severe form of premenstrual syndrome.
“Generally you can make a diagnosis of ?baby blues,’” Lefkowitz said. “After 10 or 14 days, it’s usually gone. After two weeks, if they still have it, it’s probably postpartum depression.”
There are risk factors for PPD, such as poverty and biological factors.
“Poverty itself is a risk factor because of the psychosocial stressors it brings to a woman in pregnancy,” Stone said. “You can imagine trying to anticipate how you’re going to raise a child without money.”
There may be cultural barriers to recognizing and getting help for PPD, too. In her New Jersey practice, Stone has observed that family-oriented cultures are less likely to look outside the family for help.
“Some Asian populations are very closed in their community,” Stone said. “Hispanic and black populations can also be very family oriented.”
Stone said women with biological tendencies toward depression or anxiety are also at risk for PPD, especially if a few more life stressors are piled on, such as: a difficult pregnancy; a bad spousal relationship; moving; illness; financial problems; substance abuse; or social isolation.
Lasting scars
Mothers are not the only ones affected by PPD. If mothers suffering from PPD are not diagnosed and treated, the long-term effects on the babies can be profound. Not having an attentive, responsive mother at this tender time of development can set a trajectory for problems later on.
“Babies, their whole raison d’e^tre is to get their mother’s attention,” Stone said. “If you can’t get your mother’s attention, you’ll die in the baby world. If your mother is not responsive to you because she’s depressed, it affects the chemistry in the baby’s still-developing brain.”
“Kids have conduct problems in preschool,” Lefkowitz said. “They are more withdrawn and there is a very limited spectrum of emotional responses.”
Wong became active with PSI after suffering from postpartum depression following the birth of her daughter four years ago. Having worked as an attorney for 12 years, she said her life came to a complete stop.
“I was suicidally depressed. I was a shell of myself,” she said. “I was convinced I was never meant to be a mother.”
As an attorney in the Los Angeles Public Defender’s office, Wong often sees the human toll of PPD. “What we see in our office are women who are suffering from untreated mood disorders who then go on to affect their children and their children become our clients,” Wong said. “We have thousands of juvenile clients. Some of them have suffered from severe neglect.”
Mothers with postpartum depression need support, education and, Stone hopes, changes in the law. “We need federal mandates so that the screenings and treatment will be covered by public and private insurers so that all women will have access to this treatment.”
Support from other survivors is crucial to recovery, Stone said, which is why PSI was formed in 1987 by a PPD survivor named Jane Honikman. Headquartered in Santa Barbara, PSI is designed to eradicate ignorance about perinatal mood disorders and provide support and information. PSI has coordinators in 48 states and 26 countries, including Iran.
“This is apolitical,” Stone said. “The experience of motherhood is worldwide.”
By Kim Lamb Gregor
Ventura County Star
