Why Didn’t I Get Help for Postpartum Depression Sooner?

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Three months after my daughter’s birth, my husband comes home and finds me kneeling in the garden. Things are supposed to have gotten better, but they haven’t. The baby is sleeping peacefully in the moses basket, her face dappled in the shade. This would be such a great photograph. Except that I’m ripping the beets out of the earth with unhinged fervor, leaves flying, my hands red from wiping the dirt off the root.

“Wow,” he says.

Don’t cry, I think. I am so sick of him seeing me cry. But I do. I have been crying for the last three months. This time it is a muddy affair. Dramatic, with the pile of beets at my feet.

“Okay,” he says, taking the beets out of my hands. “You need to call someone.”

Whatever the reason, this is the time I do.

For me, postpartum depression manifested partly as an obsession with my own body. I was dizzy and disoriented, and my heart beat so fast it required an echocardiogram. My body felt like it was on the verge of some sort of impressive collapse, right when I needed it most. Physical exhaustion developed into a looming fear, a persistent and pointless panic. Still, I didn’t think I was exceptionally depressed or anxious, and I’m still trying to figure out why that is. The most likely reason for my ignorance: Despite the fact that postpartum depression is one of the most common complications of childbirth, very few of us know enough about it to recognize it when it appears.

One of our only methods for talking about postpartum depression is through celebrities who “admit” to having suffered from it. Last month, in an honest and candid essay in Glamour, Chrissy Teigen addressed her struggle with postpartum depression and acknowledged her shame at being sad when she “had everything I needed to be happy.”

I’m not a celebrity, but I am privileged. I’m white, middle class, and insured. I am in a stable relationship. I live in a small, affluent community and have access to excellent medical care. I chose to get pregnant and wanted to become a mother very much. But postpartum depression is not a first-world problem, nor is it a problem of middle- and upper-class women. In fact, it’s much more common among low-income women. The discrepancy, of course, isn’t in who gets postpartum depression; it’s in who has access to the necessary medical care.

Unsurprisingly, even those with access to treatment hit plenty of roadblocks. To treat postpartum depression, most experts recommend a combination of antidepressants and therapy. While antidepressants are often cheap when covered by insurance, Americans seeking talk therapy (which averages at about $150 an hour) frequently pay large sums out of pocket. Part of my reluctance in seeking professional help was the guilt I felt knowing one month of therapy would add upwards of $500 (not including the child care) to the already astronomical medical bills my husband and I — like most new parents in the U.S. — faced after the birth of our daughter. It was one more difficult choice I wasn’t equipped to make, especially following two months without an income (not unexpectedly, my job as an adjunct professor had no maternity benefits).

It was hot the summer my daughter was born; we spent a lot of time outside. A constant stream of visitors came through our garden, admiring the baby, admiring the kale. These are the golden years, they said wistfully. The perfection of the scene made the glaring unease of my mind even harder to ignore.

But it wasn’t until October that I went to therapy, scheduling the appointment right before work so I could tell the babysitter I had an early meeting. Watching the rigid hunch of my body, the way my eyes refused to rest, the therapist brought up adrenaline: “You’re running from a lion.” I pictured this faceless lion, stalking gracefully across a savanna somewhere, and it seemed so much less intimidating than the workings of my own mind. When the therapist suggested medication, I was surprised — her office was covered in Buddha figurines.

Still, as soon as I left, I called my doctor, and left a vague, apologetic message. She called me back immediately and enthusiastically prescribed Zoloft and Ambien. “You’ll feel better,” she said. She sounded confident and calm, and I believed her, wondering what took me so long.

But then came the dread of actually holding the pills in my hands. I was terrified of what they could do to my breast milk but took them anyway. As soon as I swallowed the Zoloft, I Googled its compatibility with breastfeeding, choosing only the smuggest natural child-rearing sites available. Try everything else first, advised Dr. Sears. I had tried everything. Had I tried everything? Dr. William Sears has never given birth.

We continue to view postpartum depression as a “woman problem,” an out-of-control version of PMS. At its most benign, it’s perceived as complaining, inappropriate, a weakened resolve, like the inability to control oneself around chocolate or shoes. At its worst, it’s dangerous, psychotic, as illustrated by extreme tragedies that make any mother with even a whiff of sadness terrified to admit it.

The day I left the hospital, a nurse gave me a survey about postpartum depression. I filled it out, with either dishonesty or denial. I would feel better, of course. I was exhausted, not depressed. No need to be dramatic. I wonder, now, what would have happened if we treated postpartum depression as more routine than taboo. Had I known how common it is and how varied, had I been more thoroughly screened, and less afraid of the stigma and the outward cheapening of devotion to my daughter, would I have been honest about my situation earlier?

Before I sought treatment, I appeared fully functioning in a lot of ways. I nursed my baby studiously, dressed us both presentably, went on walks, learned to use the breast pump, went back to work, wrote thank-you cards, dragged myself to a mother-baby group where I sat on the dirty floor of a hospital conference room and learned to decode baby cries (hunger, pain, discomfort, stress, boredom, repeat). I hid expertly behind this functionality, refusing to talk about my feelings, afraid of the labels that, as a woman, I have learned to diligently avoid: whiny, demanding, ungrateful, hysterical.

Perhaps it’s the desire to avoid these labels that forms our collective caricature of pregnancy, childbirth, and early motherhood. We turn away from the animal truths of the female body, focusing instead on a sketch of charming, feminine messiness: I’m covered in milk and vomit, and I got pushed out of my job, but at least there’s coffee! Obviously, I could do without the memories of secret-crying, the roving all-night terror, the hollowly detached and wobbly sound of my own voice singing “Tender Shepherd” in the middle of the night. Was it terrifying only to me? (My husband confirms that it was not.) But the uncomfortable reality is, for many women the postpartum period is more Jane Eyre than Bridget Jones.

The Zoloft worked, somehow. I took it for a year. When I stopped, I was afraid of what might happen, though nothing did. During the last of our sessions the therapist looked pleased, like I’d passed a test. Winter came, and it was a relief, the hot sun a reminder of my sweating, stirring brain.

The website Postpartum Progress refers to all women who have had postpartum depression as Warrior Moms. It’s a corny title, but it feels accurate. Getting out from under that weight was the first thing I really, really did as a mother, for my daughter. I held her close, with a primal ferocity. She was what made the rest make sense. I should be proud, but I’m not. Instead, almost two years later, I can’t deny that I am ashamed.

My daughter was 1 when the New York Times reported that pregnancy changes a woman’s brain for up to two years after giving birth. It didn’t surprise me: I swear I felt my brain reshape, growing thinner in some places, thicker in others. Though the study does not try to explain postpartum depression, I hold it close. I mention it obsessively, righteously, whenever I get the chance. My brain changed. Our brains change. Had I known this, back in those months of lying awake, sweating and listening to everyone sleep, I wonder if the science might have been soothing; if instead of the terror and shame I might have seen a clearer way out.

Why Didn’t I Get Help for Postpartum Depression Sooner?