Monday, May 6, 2013

Rose: A postpartum depression success story

The phone rang early one Sunday morning. I often volunteer at a women’s shelter run by Mother Teresa’s nuns, the Missionaries of Charity Shelter. There are 7 beds, ready at a moment’s notice for any woman who is homeless and pregnant in Minneapolis. Sister Rosetta was calling to ask me if I could come and decide what they should do for one of their guests who had recently had her baby. They didn’t know what they were seeing, but wondered about postpartum depression.
            I visited later that morning and tapped on Rose’s* door. She called for me to come in. Her 2 year old Elizabeth was bouncing up and down in her playpen, grinning from ear to ear. Rose had Luke in her lap and was giving him a bottle. He looked washed and had on a clean little outfit. Rose was dressed and her hair looked nice, too. Not quite what I was expecting.
            I had met Rose before Luke was born at least once when I worked at the shelter earlier that fall. She was usually upbeat and friendly. Hannah was a handful but awfully spunky and bright. I picked her up and sat down on the end of the bed and asked Rose how things were. She told me about the birth, how he was such a good baby, how she was looking into a permanent situation for her little family with her social worker, and so on. She mentioned that she didn’t want to go back east to an abusive father and addicted boyfriend. She really wanted to go back to school and get her life back on track. I encouraged her and told her that she was still so young and could do so much. I had returned to school after five children, so she should be able to manage with two.     Elizabeth: right
I finally said I wanted to talk about what we call ‘baby blues’ or depression, because it is very real and especially after birth with all the other things going on in her life that made it frankly very stressful. I knew she had a history of mental issues, though I didn’t know specifics. She admitted that she felt frustrated trying to keep her kids quiet at bedtime and that she couldn’t always let Elizabeth run loose when she had to feed the baby so Elizabeth would scream. Then she just mentioned in passing that they had not given back her meds after the birth, even though she had asked for them at her postpartum appointment. I asked what they were and it turned out she had been treated for bipolar disorder. I could not believe she had fallen through the cracks in the system just like that. Of course she had agreed to try to hang on without the meds during pregnancy if at all possible, and it had been OK, but as soon as she delivered, she knew she should go back on the program she had been on which had worked so well for her. Yes, she was depressed now but felt that this could all be sorted out. She was also prepared not to breastfeed her baby, though she would have liked to, knowing the medication was not good for him. She was willing to forego nursing in order to be a more together mom who needed to take care of her kids and happened to needs meds.
            Sometimes women only exhibit symptoms of bipolar disease for the first time after having a baby. If they are referred they can work with a doctor and have it under control quickly. We have all these fears about sharing our feelings when they don’t seem to be in line with what is going on in our lives: we’ve just had a beautiful, healthy baby. Shouldn’t I be happy? Grateful? Cheerful? I shouldn’t be crying all the time, or having scary thoughts or flipping out, should I? No one would understand if I told them even half the things I am thinking, right? Will they take my baby away and put me in a hospital?
            Postpartum depression is actually 100% curable. Research has now found that the flood of hormones released immediately during and after birth account for much of the mood swings and problems women run into. The sooner you get help, the shorter the time it will take to overcome this period. If we didn’t talk about it, it would remain a taboo subject. And women would believe that they are the only person to ever feel this way. The fact is that it is far more common than we thought before. And there is more help than there ever was, too.
            Postpartum depression can occur anywhere from the first days or weeks after birth to anytime during the first year after having a baby. If not treated, the symptoms can get worse or postpartum psychosis could become an issue. What is crucial to remember is that 1. It is 100% curable, 2. That you must seek help early, and 3. That no one is going to fault you for not being cheerful and happy or having it all together. We simply aren’t made that way. I personally think this has become even more prevalent in our Western society because we don’t have an intact extended family system any longer. In other cultures women are cared for after they’ve had a baby and are never left alone. They are free to rest as much as they need and don’t have to cook, clean, tend other children, do laundry, or lose sleep much less go back to work within weeks of delivering. We are doing a disservice to our mothers in this country by ignoring this important aspect of care. Many countries -- France, England, Denmark, Sweden and Holland to name a few -- offer all mothers a helper for up to a year in the home paid for by the government to take the work off of new mothers so they have the time needed to bond with their babies and recover. These governments understand that this investment will pay off in the long run with healthier, happier families.
            So I suggested a plan for Rose. I asked her to call her local church ladies and find someone who could watch her children for a few hours later that evening. Then I told her I would go with her back to the hospital and we’d ask for her meds. I suggested she try to ‘keep it together’ because I told her if they decided to admit her and I had to refer her babies to foster care then I would be depressed, too. I was hoping that they would believe me that I would be in contact everyday with Rose and she wouldn’t be alone at the shelter at any time either. Supervision is important for someone using strong medications, but I reasoned that she had been on it before and tolerated the meds well then. She readily agreed and started calling. I went home and took care of what I needed to finish up there (including doula backup for the night for my other clients) and then later that day I picked her up and we went to the hospital. I had packed some snacks thinking we would be in the emergency room for hours, waiting our turn. This was one of the biggest medical centers in the city and known for waiting room marathons.
            Rose had delivered there earlier that month so I knew her records were there. When we got to the emergency department we settled in on a couch for the long haul and I went up to the desk to register. I couldn’t believe it when the receptionist told me they would call the resident doctor on the psych ward and had a room we could wait in all ready, please come right this way. Wow, talk about service! So we picked up our coats and snacks and bags with magazines and followed her to a little room. We didn’t wait very long there, chatting about some of the funny things Elizabeth has come up with since Luke was born. Then Rose asked me if I noticed anything funny about the room. I looked around and said, first, there weren’t any cupboards with meds or equipment. Right. What else? I noticed the two chairs were bolted to the floor. Oh, I see. What else? Well, there’s a window in the door. That’s right, she agreed. You couldn’t hurt yourself in this place. Oh, I get it, I said. She explained that she was a veteran of the psych wards and could spot the program a mile away. I told her that I was glad she wanted to get her life back on track and that I really admired her for setting goals like school for herself. We agreed that Minnesota had more programs than most states for scholarships and other possibilities. We talked about some of her ideas about different colleges and how to find out more information.
            Then a nurse from ‘upstairs’ came and introduced herself. I was immediately impressed by how respectful yet straight forward she was. Rose talked about not being able to get a new prescription even though she had asked for one and said she was more than willing to be compliant, take her meds and attending therapy or whatever else they recommended. Therapy could address many of her problems and give her the help and support she needed during the time ahead. Then I told her about Rose’s living situation and that I thought it was an ideal arrangement for her to start back on her medication there. Soon a doctor came in and introduced himself. The nurse filled him in and he readily agreed that our plan sounded fine to him, too.
            We both thanked them profusely. They were really concerned, respectful and listening. I don’t know what I expected, but this was amazing. We were a really great team, all rooting for Rose to do well, all doing what we did best and coming together to support her. I was so grateful. It changed my perception of the big, impersonal medical center.
            Rose returned to the shelter and I checked in with her by phone daily. When it warmed up finally, I met her and took her along with Elizabeth and Luke out to lunch. It was scattered, like any meal with two little guys vying for attention is, but we did manage a nice visit. Rose still has her ups and downs, but I don’t know if I have ever been so proud of a young mom before. I know I haven’t met many with as many obstacles in front of them and yet could overcome so much. We are still in touch. She has her own apartment now. She is truly another amazing woman that I have been honored to know.

Steps to take if you have symptoms of depression or anxiety during or after pregnancy:
1.      If you are having thoughts of harming yourself or your baby, it is very important to get support immediately. Call 911 or go to the nearest emergency room.
§  Though it can be scary to ask for help, they can help keep you and your baby safe and help you take the first steps towards getting better.
2.      Tell someone you trust how you are feeling. It is important that you feel safe with the person and that they support you in a non-judgmental way. Ask them to help you find support. Examples of someone you can tell:
§  Your partner
§  A family member
§  A friend
§  A healthcare professional
§  A pastor or someone at your church

Other Resources:
Hennepin Women’s Mental Health Program, Minneapolis, MN, Dr. Helen Kim, MD

*Not her real name. All names and identifying characteristics have been changed.

COMING SOON: This and other stories will appear in one of these books soon: Call The Doula! a diary© and Stone Age Babies in a Space Age World: Babies and Bonding in the 21st Century© pending by Stephanie Sorensen

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