If there was ever a prime candidate for a postpartum depression poster child, Mary (as in “Jesus’ mommy”, which is how my kids describe her) would be at the top of the list. Whether you regard the biblical story as fact or as fantasy, you’ve got to admit: Mary had all the cards stacked against her. Mary didn’t choose to become pregnant. She was pregnant out of wedlock at a time when such a situation was beyond taboo. Mary had to travel for several days – by donkey, for God’s sake – during what I assume was her 40th week of gestation. (By the way, is anyone else unclear as to why Mary and Joseph and the donkey had to travel to Bethlehem? Something about taxes? A sale on frankincense? Palms for Palm Sunday? Religious scholar, I am not.) Mary had to give birth in a stable. Talk about stress. Mary didn’t even get to choose her son’s name. (Jesus, if I may, would not have been my first choice. I’ve always been partial to Robert.) Once Jesus was born, many people came to see him and to shower him with gifts, but Mary? No one seemed to care about Mary’s tremendous efforts to bring Jesus into the world.
I use Mary as a case study because the factors contributing to her (possible) postpartum depression were present both during pregnancy and after birth. (Okay. If I’m being honest, I also used Mary as a case study because it’s that time of year. I don’t think I can write a post about Jesus and Mary and not be 100% honest. See, Mom? I remember some religious lessons.) This is important. Postpartum depression doesn’t necessarily begin after birth; its seeds may be planted during pregnancy. If a woman is depressed during pregnancy, she is far more likely to be depressed after her pregnancy. This seemingly obvious revelation has led some states to have mandatory depression screenings as part of routine obstetric care. The sooner depression can be identified and treated in a pregnant woman, the better her outcome (in terms of mental health) after delivery.
What sort of treatment is appropriate for pregnant women at risk for postpartum depression? The short answer is, it depends. Medication is still an option, though some women may be uncomfortable with taking any medication during pregnancy. (For more information on antidepressants and pregnancy, read this.) Psychological therapy is another obvious treatment option for at-risk, pregnant patients. However, therapy is not without its limitations and disadvantages. Many women who may be depressed during pregnancy lack the financial resources or the insurance coverage to enter therapy. Even if a woman can afford therapy, she may not be willing to sit down with a mental health professional. Why?
You probably already know the typical answer to this question. People don’t want to seek help because they are ashamed of their feelings; they believe they are weak and useless and, if they would just “suck it up”, they would feel fine. However, there is another, equally powerful, deterrent to therapy when you’re depressed. If you are depressed, you may not want to leave your house. You may have to use all your energy to make it through an average day. Now, you have been told to seek counseling for depression. You already are expected to see your obstetrician regularly and now you have to 1) make another appointment with another practitioner, 2) rearrange your schedule for that appointment, and 3) leave your house – again– to meet with a stranger to discuss your feelings. Trust me. When you’re feeling lower than low, another meeting with another new face ranks right up there with weekly dentist appointments or daily colonoscopies. (Side note: I hope there is no actual reason for the former and, dear God, certainly not for the latter.) While I know that the act of leaving your house to seek therapy is in and of itself therapeutic (because it shows a willingness to embrace a better life), I can also understand that someone in the depths of despair may not be able to appreciate the benefits of in-person counseling.
What to do? How about virtual therapy? In Australia (where, by the way, perinatal depression screening is the norm, so a big “Aussie Aussie Aussie Oi Oi Oi” to them), a new program called the MumMoodBooster (love that name) offers online counseling and discussion groups for postpartum mothers. Honestly? This is brilliant. Think of how busy a new mother is with her new baby. If she has postpartum depression and needs therapy, she may be totally overwhelmed by the prospect of even scheduling the appointment…who will watch the baby? How can I learn anything during therapy when I’m so tired during the day? The program’s results are encouraging; in one study, the women who received the online therapy were four times more likely to recover from postpartum depression than those who did not participate in the program. Of course, this program is currently designed only for the postpartum set. However, if it exists for them, it’s only reasonable to assume the program could be expanded to include pregnant women as well.
One last, seemingly unrelated, note. One major risk factor for postpartum depression? Urinary incontinence. (That’s fancy talk for peeing when you don’t mean to pee…during a sneeze or a laugh, for instance. Very common after pregnancy.) It makes sense, doesn’t it? You’ve given birth, your body feels utterly spent, and you’re exhausted. And then, just as you’re starting to get the hang of motherhood and all its joys, you sneeze at the grocery store and wet your pants. It doesn’t take a psychiatrist to tell you that peeing your pants as a grown woman is depressing. So, ladies, as we tell you all the time at WHF…do your kegels. Keep your pelvic floor strong and then you will be in charge of your urine. Prevent incontinence and you might just prevent postpartum depression.
If you celebrate Christmas (and even if you don’t), take a moment and think about Mary, about her struggles before and during Jesus’ birth. If someone can actually prove that she didn’t have postpartum (and perinatal) depression, I’ll eat my hat. (Or, to make my mother happy, I’ll start going to church again. Or at least think about going to church again. Baby steps. Merry Christmas, Mom.)
This blog was originally published on December 9, 2014 on the Women’s Health Foundation Community Blog.
(Image courtesy of wikipedia.org.)