074: Baby Blues

On perinatal depression

The Edinburgh Postnatal Depression Scale is a questionnaire that screens for perinatal depression. Predictably, there is not quite a lot of literature about the Scale, but a preliminary search online produces links to the questionnaire on the Utah dot gov website, as well South African Depression and Anxiety dot org. It is not unlike a multiple-choice quiz one may find in Cosmopolitan magazines of yore, but instead of being directed on how to sizzle up your sex life, it determines if one is depressed or very depressed during or after pregnancy.

I learned of the Scale while checking in for an appointment with an obstetrician I was meeting for the first time at 30 weeks as part of my hospital’s “OB rotation”. The OB rotation is a practice where the patient must meet – just once – the obstetricians or nurse practitioners who may potentially deliver the baby in the event that one’s own obstetrician is unavailable at the time of the blessed event. It is what I imagine speed dating to be like, in how fruitless it is trying to establish a connection with a stranger in 10 minutes or under. But I digress. While checking in the night before, I was prompted to take the questionnaire in preparation for the next day’s appointment. Upon completion, I was not given results, but received a message that the doctor would discuss them with me. I went to bed wondering if I would be committed the following morning, and whether my consent was required to do so.

The next morning at the appointment, once the introductory pleasantries were dispensed with, this new obstetrician announced matter-of-factly that I was depressed. “It looks like you’re depressed,” she said, with a hard emphasis on the final word. It embarrassed me and I solemnly nodded as if this was news to me: I have experienced depressive episodes on and off for years, and had just come out of one a day or two before. I was anticipating a brief talk on antenatal or prenatal depression, which I had not heard of before, or the increased susceptibility to postpartum depression. Maybe I would be handed a pamphlet with the image of a distressed but attractive woman looking forlornly out of a window, a baby in her arms. The woman would be white and the baby biracial, to indicate that this was a progressive pamphlet, hip and unafraid to tackle the bullet points of antenatal and postpartum depression.

I was asked how I experienced “it”: good days and a few bad days, highs and lows, I mumbled, cringing as the cliches came out of my mouth. Next, the obstetrician asked if I needed any recommendations and whether I felt I had it under control. I have a therapist, I told her, not entirely sure of how to assess whether the depression was under control. After a quick check of the fetal heart-rate and a suggestion that I add B12 to boost my low iron reserves, the appointment was over. Once the doctor left the room, I turned to face my husband, dumbstruck. Where was my pamphlet?

Untitled, from Etel Adnan’s Mount Tamalpais series

At the top of my first trimester, I felt hopelessly depressed. If I had the strength, I would have climbed the walls. Pregnancy sickness made me feel so unwell that I could hardly get out of bed for nearly three months. Time passed by and the world continued to turn, yet I remained incapacitated. The lack of independence, over-reliance on my husband, and total isolation terrified me. No matter my desperation, the common consensus was that it would pass and everything would be fine, that once the baby was born it would all be a distant memory. I couldn’t seem to convey that I was afraid of the now. In private, I cried, miserable over what I had wanted so desperately, certain I was a monster, a terrible human being for hating the situation I was in. I submitted to what was regarded as normal, comes with the territory, and grew listless, waiting for it to pass.

In time, the depression passed, but it also didn’t. It took a new form. I have a string of good days, and on those days I am like a woman possessed, trying to accomplish as much as I can and burning through any and all energy I have, afraid of the moment when I would be overcome. And then the first bad day arrives, like a massive swell. When trying to search for words to describe what I feel, insurmountably overwhelmed is somewhere in the vicinity, but still insufficient. A light goes out and terror, anxiety, and sadness move in, and happiness seems far from reach. Tired of being told that this is normal, entirely expected, it will pass, I do my best to hold it inside.

Recently, I took a class offered virtually through my hospital called Understanding Childbirth. We were shown videos from the early 2000s of women in labor and giving birth, from which I gathered very little about their experience; an hour was spent deterring parents-to-be from accepting epidurals; and finally, we sped through a slide titled, “Baby Blues”. The heading made me laugh, until we were informed – to my surprise, alarm, and confusion – that Baby Blues is the term used to describe the onset of depressive symptoms experienced by 70-80% of women around three to four days postpartum, and which can last up to two weeks. The cause is – of course – unknown. Any longer than two weeks, and it is the new mother’s responsibility to inform her doctor; any worse and she must take herself to the nearest emergency room. What can the expectant and postpartum mother do to manage her Baby Blues? Deep breathing, exercise, and maintaining a healthy diet.

In a video demonstration of Postpartum Depression, which affects 1 in 7 new mothers, and this section even more abbreviated than the one on Baby Blues, a woman wearing an exaggerated dejected expression was shown sitting on a sofa under a blanket, watching a man who plays her spouse gleefully engaging with a child playing the role of their baby. The following video depicted a woman surrounded by tissues cocooned by a sofa (prime real estate for postpartum depression, it seems), removing a tissue from a box to dab at her nonexistent tears.

Women’s mental health in the perinatal period has long been fodder for comedy, a source of asinine jokes, all raging hormones and hysterical fits of tears. Or it plays into stereotypes. Even when sincere attempts are made to communicate baseline education about perinatal depression, it falls prey to tropes: the forlorn woman looking out a window, the tissues, the sofa. Perinatal depression is rife with shame and stigma due to a societal inability to reconcile with the notion that a mother, or expectant mother, is capable of sadness. And as someone who has felt depressed on and off throughout pregnancy, it is not something that occurs conspicuously, sprawled out on a sofa, surrounded by tissues, crying seen and heard, but in isolation, behind a mask, deep down inside, often entirely undetected.

Based on the rudimentary information provided on baby blues and postpartum depression, and the absolute nothing on antenatal depression, the onus is on the mother to call to attention and ask for help in navigating what continues to be an incredibly taboo and oft-dismissed subject. In practice, this is an enormously difficult task because of how uncomfortable it makes people to listen to and be accepting of conversations about mental health. Throw giving birth into the mix, and it becomes even more daunting. Those who are depressed must summon the gargantuan strength it takes to reach out in these moments, but there is little emphasis on the collective need to be more compassionate and attuned to the needs of the mother.

Growing a life within myself has been both magical and terrifying. Our interconnectedness, how much my wellbeing continues to be bound to that of his, is an incredible bond that takes my breath away. When I think there is simply not enough room left in me for my son to grow into, my body finds away. Every turn, kick, spin, hiccup, and somersault is a reminder that we are, for now, one. He enjoys Italian disco and surf rock, and grows fussy at the movies. On the surface of my skin, I can see his trajectory along and across the circumference of my belly. We are like a mythical creature, one life folded into the other, one body in the physical world with two beating hearts.

But our interconnectedness is an immense responsibility. Over the past seven months, when I have felt low or overwhelmed or tired, codewords to disguise reality, I have also, in parallel, felt profoundly guilty. Can the baby feel what I’m feeling, I worry. We are a shared space, after all, and there are limited studies that indicate adverse outcomes for mother and child. Have I already failed to protect him? Does he know that it has nothing to do with him and evades my own comprehension? I should be gratuitous and overjoyed, I shame myself, not be impervious to it.

Despite how ubiquitous perinatal depression is, and certainly Baby Blues, resources on how to support women through these periods is minimal, and the topic, when broached, whether medically or societally, is approached with reluctance. Instead of treating it as a rite of passage, it should be one of the first things the expectant mother should be educated and informed about from the very beginning of pregnancy, given as much emphasis on the importance of prenatal vitamins, regular exercise, and proper diet. That a woman growing and caring for a new life is tasked with navigating care of her mental health largely in the dark and alone, and must report on herself what too many people are afraid to talk about is absurd.

But for now, to care for my mental health, the time has come for me to breathe in deep the wildfire smoke, take a walk in the heat I have been advised not to expose myself to, and balance my diet without contracting explosive diarrhea. A mother’s work is never done!