"I Wasn't Excited About My New Baby"

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The Counselor's Turn

Dealing with PPD

"I quickly surmised that Amy was suffering from postpartum depression (PPD) but because of all the misconceptions surrounding this condition, she and her husband didn't recognize it," said the counselor. "Amy told me her doctor had misdiagnosed her PPD; many women never get the help they need. Yet PPD is treatable with medication and counseling. But until it's treated, it can be hard for a couple to communicate healthily. That's why Amy needed to feel better before we tackled marital issues.

"My first step was to educate the couple. The 'baby blues' -- the period of weepiness, exhaustion, or mild anxiety that many women experience for a few days after birth -- tend to get lumped together with the more serious PPD, which affects 10 to 15 percent of new mothers. PPD can happen any time within the first year after childbirth and it can last longer if left untreated. Uncontrollable crying, feelings of worthlessness and isolation, anxiety, irritability, inability to sleep -- all symptoms Amy described -- are common.

"Amy also had several risk factors for PPD: a complicated pregnancy, loneliness, and a tendency toward perfectionism. She had high expectations of motherhood. When reality fell short, she became despondent. 'This is not your fault!' I reassured her. Turning to Sean, I said, 'You can't "fix" PPD; you just have to continue to be there for Amy.' Amy first consulted a psychiatrist specializing in PPD, who prescribed an antidepressant. Amy was reluctant to take medication -- 'I feel like a failure,' she said -- especially since she was nursing. Doctors differ on this point, but several studies have shown that some antidepressants are safe and effective both during pregnancy and while nursing. (In fact, for a severely depressed woman, it may be riskier not to take them.) After discussing her options, Amy decided to wean Ian, who was 4 months old, and start the medication. She felt better within weeks. With encouragement she joined a support group of mothers with PPD and has become friendly with two women who now join her with their kids for playdates.

"Having calmed down, Amy could then focus on her marriage. Neither Sean nor Amy understood why they had gotten along so well before marriage and so poorly afterward. 'New couples don rose-colored glasses that filter out traits that later prove problematic,' I explained. 'When you factor in young children and a stressful job, you have the ingredients of a marital meltdown.'

"Like many couples, these two had gotten into the habit of responding time and again with irritated voices, angry rants, and lots of blaming. They needed to find ways to speak to each other in a calm 'pass-the-butter' voice -- quietly, without criticism or judgment -- and recognize when they were slipping into accusations and name-calling. Sean, especially, had no model for discussing issues and resolving conflicts without yelling or throwing things."

Continued on page 5:  The Counselor's Turn, continued


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