James & Jax

According to Postpartum Support International, the following are risk factors for postpartum depression (PPD):

• A personal or family history of depression, anxiety, or postpartum depression
• Premenstrual dysphoric disorder (PMDD or PMS)
• Inadequate support in caring for the baby
• Financial stress
• Marital stress
• Complications in pregnancy, birth or breastfeeding
• A major recent life event: loss, house move, job loss
• Mothers of multiples
• Mothers whose infants are in Neonatal Intensive Care (NICU)
• Mothers who’ve gone through infertility treatments
• Women with a thyroid imbalance
• Women with any form of diabetes (type 1, type 2 or gestational)

Those I’ve bolded are the ones I realize now, in retrospect, I definitely had. While I was pregnant, I thought about PPD often. I thought I knew the signs. I even coached my husband and my mother in what to look out for. I thought I went into pregnancy prepared, knowing my history of anxiety and depression, as well as my family’s history of both, and my history of severe PMS.

Boy was I wrong!

I thought so much about my history that I didn’t think about my present: For starters, my husband had been laid off from his job of 10 years a month after we found out about our pregnancy, and just after the holidays. We were terrified. I cried so hard the night I heard the news that I think I terrified everyone around me. I even scared myself into thinking I would lose the baby if I didn’t calm down somehow. The sheer panic about the worsening economy (in late 2008) and all the unknowns about the cost of raising a child threw my anxiety into overdrive. I will never forget that night. I count it among the worst I’ve ever had.

Then I got a pay cut a month later. Oy. We all know how money can affect a marriage. Add to that stress the hormonal shifts common in early pregnancy.

So far, we’re up to 5 of the risk factors listed above: history of depression, severe PMS/PMDD, financial stress, marital stress, and the loss of a job. But wait! There’s more!

The pregnancy itself was a joy. I loved almost every minute of it. But the birth? Not so much. If you want to read about it, go here. I don’t even want to write about it again. The gist: I had a long labor & then a c-section I am still unconvinced was necessary. It was the most terrifying experience of my entire life so far. I wonder if I had some posttraumatic stress from it. It wouldn’t shock me.

Make that 6 risk factors: complications in birth.

Yet somehow it still didn’t click with me that I had postpartum depression and postpartum anxiety until 3 or 4 months after my son was born, when I started cognitive behavioral therapy at the Postpartum Stress Center, which was founded by Karen Kleiman. If you don’t know who she is and you have (or know someone who has) PPD, please learn about her & all she has done for moms with perinatal mood disorders like PPD.

I started therapy because I was too anxious to end my maternity leave and place my son in someone else’s care. I was paralyzed with fear that something awful would happen to him if I went back to work. Without help, I couldn’t return to work. But with my husband working only 2 days per week at that time, staying home wasn’t an option for me. Not having that choice, or the time that my husband got to spend with my son while I worked, made me angry & resentful. I was also afraid my return to work would mean the end of breastfeeding, which was the one thing I felt like I was doing right (it didn’t, by the way).

It was in therapy that I realized that the anger, anxiety, fears, resentment, and sadness I felt every day weren’t just normal “baby blues.”

Moral of the story: Know your risk. And seek sources of help even before you need them, even if you don’t think you will ever need them. In hindsight, I probably should have started therapy right after my traumatic c-section. If there is ever a next time, I will be armed with knowledge, my therapist, and my real-life support network months before the baby comes.