Abnormal behavior after pregnancy should not be
ignored or labeled as attention-seeking.
By SHOSHANNA KEATS-JASKOLLA MOTHER hugs her baby soon after giving birth.(photo credit: REUTERS)“I would not have admitted to anyone what I was going through. I wore my ‘great mother’ face publicly. I admitted to being tired, a bit overwhelmed, but nothing I did not perceive as ‘normal with a small baby.’ The only times I used the phrase ‘postpartum depression’ was to my therapists and to Google... if you admit to wanting to harm your baby or yourself, people judge you. When you say you’re overwhelmed, people understand that.... They don’t get that you feel like you are drowning and can’t see the way out. They don’t get that you literally feel suffocated and are grasping to hang on.”– Naomi, 40, on her experience with PPDIt often takes a tragedy to raise public awareness of many people suffering in silence. The shocking suspected murder-suicide of a mother and her four children in Jerusalem on January 1 brought the words “postpartum psychosis” and “postpartum depression” to the headlines across the country.Approximately one in eight women experience PPD, but the public knows little about it. Like other mental illnesses, few want to discuss it.To break the taboos and open the conversation, I turned to some experts to understand what to look out for and what to do if someone seems to need help.Ahava Winston, the director of Nitza, the Israel Center for Maternal Health, dedicated solely to helping women suffering prenatal and postpartum reactions, explains: “Postpartum psychosis and postpartum depression are only two of the numerous potential reactions related to pregnancy and birth.“The most common is postpartum blues, which affects 80 to 90% of women... and usually resolves on its own within the first two weeks. It can, however, become PP adjustment disorder, which affects one in five women, where a woman functions outwardly but feels anxiety and self-doubt. With support, PPAD can resolve without professional intervention. However, without emotional and instrumental support, it may deteriorate into the more serious clinical reaction, postpartum depression.”PPD is a general term that includes other serious reactions, such as post-traumatic stress disorder, obsessive- compulsive disorder and even psychosis and mania. One may “have fears and obsessive thinking, or suffer headaches, stomachaches, dizziness, heart palpitations, feel faint or that she is going crazy. In psychosis, she can be delusional, hear voices. In mania, she may have excessive energy... or express incomplete thoughts.”Abnormal behavior after pregnancy should not be ignored or labeled as attention-seeking.
When is there a problem, what can we do?As everyone is different, it is sometimes difficult to know whether symptoms (lack of sleep, frustration, weight loss) are part being a new mother or a sign of something beyond the normal upheaval that is having a baby.Historically, women have always helped one another with childcare. Tribal living meant plenty of hands, support and women to learn from. In modern society, a mother may not get the help she needs to heal and adjust to her new reality, especially if she lives far from family.Many mothers experience bad days – even days when they can’t recall their own names. This is motherhood in all its glory – not PPD. However, a long series of bad days compounded by marital strife, economic insecurity, lack of support, illness, a move, or unresolved loss can lead to deterioration.Women with PPD or anxiety have ongoing symptoms like these most of the time, which make it difficult to function.In Israel, nurses are tasked with asking questions and assessing women for signs of depression before and after birth. In addition, the well-baby clinics (Tipat Halav) are supposed to give mothers the Edinburgh Postnatal Depression Scale, a series of questions to identify depressive symptoms.“I would find this questionnaire much more effective if it were given at the six-week postpartum visit with an obstetrician/gynecologist rather than Tipat Halav. There, you’re so involved with your baby that taking a few minutes to fill out the form is incredibly difficult,” said one mom.How can we ensure that struggling moms get the help they need?Prof. Marsha Kaitz, founder of Em L’Em, Mom to Mom, a national organization that trains experienced mothers to volunteer with new mothers for individual support, says it is very possible to know when someone needs help.“Ask the question. Listen to the answer. ‘How do you feel? What’s going on?’ The mom is a person, and she’s just undergone a major life change. We need to check on her. If she isn’t talkative, look around. Does the house seem overly unkempt, beyond normal chaos for a new baby? Does she seem overwhelmed, as though she’s not coping? Does she not want to hold the baby? Is she behaving in a way atypical to herself?”Em L’Em volunteers meet with new moms once a week, voice concern if need be, and assist the mother in getting help if she needs it.We must do the same for our friends and family. We need to ask questions and provide support.If you feel someone might be struggling:Don’t brush off her words or share your own story of baby blues. Do say, “I care about you. How best can I help?” Don’t tell her that everyone goes through it and she’ll be fine. Do tell her about support groups like Em L’Em and Nitza. Offer to collaborate and build a strategy with her.The above advice is for women who acknowledge the need for help. But if a woman shows clear signs of depression, seems to have difficulty functioning, doesn’t get out of bed, doesn’t want to touch her baby, or says she cannot cope, listen, discuss your concerns and suggest professional help.What should you do if you are struggling?Pay attention to changes in yourself. Do you no longer enjoy the things you used to? Does the baby’s smile not make you happy? Have you lost interest in your friends? Do you feel anger when people need you?If so, reach out to friends and family whom you trust, express your concerns and ask for help. Speak to your family doctor. Call Nitza or take advantage of the psychological services provided by the national health clinics and the Briut Hanefesh Network. If you don’t feel that your symptoms are severe, but you still need support, you have options.Many women who spoke up for the sake of this article said that they wish more women would be open about their PPD experiences, so that others needn’t suffer alone. Facebook groups exist where mothers can seek support, share their difficulties and even cry out for help, even anonymously.In one group, a mother openly admitted to having suicidal thoughts and immediately was flooded with real-life offers for help, ranging from babysitting to meals to taking her to a psychologist. The women check in with her on Facebook as well as in person to make sure she is okay.In a message to struggling moms, Naomi says, “Seek help. Find a therapist to help you. Know that it will not last forever. The clouds will part, and you will begin to cope.” RESOURCES Groups: Israel-based English-language groups:• Parents Supporting Mommas in Tough Times• Find a Friend-Happy Jewish Mommas• Never Alone When There is a PhoneRussian:• Molochnoe café, international breast-feeding support group for Russian-speakers• Rodim for pregnancy-related questions For Ethiopian-Israelis:• Little Ethiopia (helps anyone struggling)For French-speaking mothers in Israel:• Les Mams de FacebookOther sources for help include:• Get Help Israel• Counseling Center for Women