'I couldn't stop crying': Life with a perinatal mood disorder
Jen Wilkinson can picture her funeral.
She can see her children crying. She imagines what her husband might say, explaining to their young boys that their mother is gone.
These scenes, or intrusive thoughts, are the result of anxiety and hypochondria, which intensified after she had her first baby. Her mother died when she was 6 years old. Now that she's a mother herself, she's afraid of leaving her children like her mother left her.
Her four boys range in age from 1 to 10. Wilkinson, 34, said she never thought she would suffer from a perinatal mood disorder — a range of mood disorders that occur or are heightened after giving birth — but has experienced symptoms after the births of each of her children.
She was sure her second birth would be easier than her first.
After the birth of her oldest son, she stopped sleeping. She was anxious about his health. About her health. About not being able to shut her brain off.
“I couldn’t stop crying,” Wilkinson said.
Her doctor recognized the symptoms of a perinatal mood disorder and prescribed medication.
Years later, during her second pregnancy, she was confident she would be OK. She told herself it would be different. But within 48 hours of giving birth, she knew something wasn't right.
"I just literally shut down," Wilkinson said.
The spectrum of perinatal mood disorders includes postpartum post-traumatic stress disorder, anxiety, obsessive-compulsive disorder and depression. At a time in which a family is going through a life-changing transition, a perinatal mood disorder complicates an already emotional time.
Wilkinson reached out to her doctor when she felt she needed help. She calls herself an "open book" and said she never thought about a stigma. She wanted to get better. So she joined a new-mom support group.
But not all women are able to voice their struggles. Due to the stigma attached to mental health disorders and a lack of resources and awareness, many women suffering from perinatal mood disorders do not seek treatment.
1 in 7 women
Each case of a perinatal mood disorder is different.
Women with perinatal mood disorders often experience frequent crying, feelings of anger and isolation, and they withdraw from loved ones, feel disconnected from the baby, worry the baby will be harmed, feel they're being a bad mom or doubt their ability to care for the baby, according to the Centers for Disease Control and Prevention.
After the birth of her second son, Wilkinson's anxiety was so severe she confined herself to her bedroom while her husband and family took care of the baby. She was worried something would go wrong with her health. She went into hiding.
“I didn’t even feel like I could care for my child,” she said. “I couldn’t care for myself."
Birdie Meyer is an obstetrics nurse with a master’s degree in counseling and the coordinator of the Perinatal Mood Disorders program at IU Health Methodist Hospital. She's also a past president of Postpartum Support International, where she gained international notoriety as a top perinatal mood disorder educator.
In her 40-year career, she has worked with women suffering from a range of perinatal mood disorders, including Wilkinson. But she knows there are many more suffering who cannot ask for help.
One in 7 women suffers from a perinatal mood disorder, Meyer said. But less than 50 percent of women who are suffering come forward and seek treatment.
And it's not a problem exclusive to mothers: 1 in 10 men will suffer from postpartum depression or anxiety after a new baby arrives.
But those numbers aren't all-inclusive. Statistics regarding postpartum depression, perhaps the most discussed perinatal mood disorder, are typically collected from mothers who have live births and do not include women who have experienced miscarriages or stillbirths, according to Postpartum Progress, a nonprofit working with mothers with perinatal mood disorders.
Mothers are typically screened for perinatal mood disorders at the hospital after they give birth and at their six-week postnatal visit with their obstetrician. In some cases, pediatricians will screen a mom at the baby's appointments because the baby sees the doctor more often than his or her mother will.
It's not unheard of for obstetricians to not ask mothers if they are experiencing symptoms because the physicians don't have the time or resources to help, Meyer said. They also might not want to risk the liability if the mother says she's suicidal.
“If she’s sitting in your office and she is suicidal and you’re not asking her about it or doing anything for her, that’s beyond irresponsible,” Meyer said. “But that’s the state of where we are.”
Doctors spend about 20 minutes with mothers at the six-week postpartum visits, said Julie Lund, an obstetrician with IU Health.
Seeing about 70 patients a week, Lund has a lot to discuss in those initial postpartum visits. Is mom healing OK? Is she breastfeeding? How is it going? Are things getting back to normal for her, physically, mentally, emotionally? Is there a birth control plan in place?
"You’re covering a lot of ground in a small amount of time," she said. "Depending on how their day is going, if you’re running behind, or if the patient’s late or if you have other stressful things going on that are intruding upon your day, it kind of shortens that window of time."
Lund said she tries to ask every mom about depression or anxiety before they give birth, but acknowledged it's not always possible to catch a perinatal mood disorder at that postnatal visit.
"I have patients that come back that seemed like they were doing OK at six weeks that come back sometimes a year later that have been mired in postpartum depression for the previous six months," she said.
A more appropriate schedule would be to meet six weeks but also follow up with moms every two months through the first year postpartum, Lund said.
Indianapolis moms are lucky, Lund said, because there are more resources available in Marion County than in other areas. She said she thinks every mom could benefit from going to therapy or a new-mom group.
"I think it’s probably the single most beneficial thing that a woman can do," she said. "It helps dispel some of that guilt or the sadness that this isn’t exactly what they expected it to be."
Meeting emotional needs
Mothers and their babies slowly file into conference room K130 at IU Health North Hospital before Meyer's new-mom support group. It's silent for now, but the babies will soon conduct a symphony of their own.
Short-but-rhythmic breaths float through the air. The entire room moves to the beat of the hushed breathing.
Suddenly: A squawk.
With lungs not quite big enough for wailing, one of the babies erupts into a series of cadenced cries almost as rhythmically as she breathed just moments before. Her mother nervously scans the room.
"Sorry, guys," she said. "She decided to stay up all night last night."
But the other women in the room meet her gaze with a smile and wave away her apology. They've all been there.
"You forget how small their cries are when they're that young," one of the mothers says.
Common topics of discussion include sleep patterns, eating habits, alone time and marital and intimacy issues. At group, mental and emotional needs are just as important as physical needs.
“We always have this stigma between physical versus mental illness and the stigma of shame that goes around any kind of emotional illness,” Meyer said. “That stigma is increased in pregnancy and postpartum, especially, because now we’ve got a baby involved and a mother and a father who are supposed to be happy.”
The stigma, however, is just the tip of the iceberg.
A failing system
The lack of depression screenings gained national attention earlier this year when the U.S. Department of Health and Human Services released a report calling for more depression screenings for the general population, specifically mentioning pregnant and postpartum women.
Georg’ann Cattelona is a Bloomington-based doula with 20 years of experience. During that time, she's worked primarily with women before, during and after their births to provide emotional and practical support. She ran Bloomington Area Birth Services, which offered resources and education for local mothers before it closed in June 2015 to restructure financially.
As experts work to increase awareness of perinatal mood disorders, the bigger obstacle is access to mental health care and the associated stigma. Getting diagnosed through a screening does not automatically mean treatment, Cattelona said.
A mom is still going to have to devote time to finding a provider and figuring out insurance coverage for visits or prescriptions. That’s difficult enough for any new mom, Cattelona said, let alone one who is struggling.
“There are a million ways that the system can still fail and it still puts the responsibility largely on the mother to access those resources,” she said. “That’s really, really hard for most women.”
Cattelona said the conventional thought in the U.S. is that you have a baby and you get on with it. There’s no time to think about the mother’s needs.
“We barely make room for families to have a baby,” she said. “So here she is, saying: ‘I’m struggling,’ and she looks around her and everybody else seems to be coping because, frankly, they have to.”
'Happily ever after'
Wilkinson's struggle with anxiety began when she was young, putting her at risk for a perinatal mood disorder in adulthood. But she never knew that.
“It’s never how you think it’s going to be,” she said. “You’d never expect it to happen and nobody talks about it before it happens."
Plus, she said, new moms should know not everything is going to be picture-perfect.
“You think you’re going to have a baby, and it’s going to be literally the happiest time of your life and you live happily ever after,” she said. “But in reality, it’s just chaotic and crazy and sleepless. Of course, there’s a lot of love there, there’s a lot of amazingness, as well. But there are a lot of things that can creep in and destroy that.”
After her second pregnancy, she knew she needed to develop plans for subsequent births. She knows her anxiety can keep her from spending time with her babies — time she'll never get back.
“I don’t want to risk it,” she said. “Once you’ve been down in that dark, dark hole, in that terrible place, the one thing that you do know is that you don’t want to get back there again.”
Now she can talk herself down on days when anxiety creeps back in. Yesterday was good, she tells herself. She’s fine. The kids are fine. Today is just bad. But tomorrow will be better.
It's going to be OK.
Call IndyStar reporter Holly Hays at (317) 444-6156. Follow her on Twitter: @hollyvhays.
Finding help
Are you or someone you know experiencing the symptoms of a perinatal mood disorder? Visit Postpartum Support International or Postpartum Progress for more information. Here are resources you can use to find local support groups or treatment:
Indiana University Health
Birdie Gunyon Meyer, RN, MA, bmeyer2@iuhealth.org, (317) 962-8191.
Franciscan Health
Jean Crane, MA, LMHC, 610 E. Southport Rd. Suite 100, (317) 782-6503.
St. Vincent Carmel Women’s Center
13420 N. Meridian St., (317) 582-7150.
St. Vincent Women’s Hospital
8111 Township Line Road, (317) 415-7676.
St. Vincent Primary Care Center
8414 Naab Road, (317) 338-7516.
Community Health Network
Gallahue Mental Health Services, 6950 Hillsdale Court, (317) 621-7675.
Hendricks Regional Health
Brittany Waggoner, RN, BSN, CNS, (317) 718-4018, bswaggo@hendricks.org.