Jackie Fletcher, who has suffered from postpartum depression, talks with her sons Calvin, 6, left, and Connor, 2, as they play in their kitchen at their home in Penngrove, California on Monday, February 11, 2019 . (BETH SCHLANKER/The Press Democrat)

‘No one can do this alone:’ Postpartum depression clouding motherhood draws new concern, treatment

Postpartum depression and related mood disorders are pervasive, affecting one in five expectant and new mothers, yet many suffer in silence, undiagnosed and untreated. Some have come forward to share their stories.

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L ike most new mothers before and since, a Geyserville woman named Chelsea imagined the first year of her son’s life as a period of sweet cuddles, rapturous discoveries and cherished milestones.

It was instead a time of anxiety, guilt and despair so profound she struggled to survive.

She sought help from seven therapists, two psychiatrists and a variety of prescribed medications, but her mental health deteriorated for months.

She had quit a job she loved in order to stay home with her newborn, but about eight weeks after his birth, the risk she might harm herself grew so pronounced that she and her husband knew he couldn’t safely leave her alone.

So they found child care for their son, and Chelsea spent months going out on the road each day with her salesman husband, waiting in the car while he called on clients and clinging to hope she might eventually find a way through the darkness.

“I put on myself to be the perfect mother. And having these preconceived ideas of what motherhood would be and what it would be like to have a baby,” she said. “I didn’t have any idea what it would be like with the sleepless nights. I didn’t have any family around to help or any friends with babies. I felt really isolated.”

She is one of what are likely thousands of local survivors of postpartum depression and related mood disorders that strike one in five new mothers in California during pregnancy or the first year of their baby’s life, turning the early days of motherhood into harrowing nightmares.

Experts say most women, about 80 percent, will experience the so-called “baby blues” in the first week or two after childbirth — when plummeting hormone levels and related shifts in brain chemistry, abetted by sleep deprivation and other physical changes, cause mood changes, fatigue, weepiness and worry.

Postpartum depression is something different — more severe and persistent — set off by the same biochemical shockwave but to a more dangerous effect.

Along with related disorders, it is the most common complication of childbirth, one exacerbated by emotional stressors such as a high-risk or traumatic child delivery, financial or marital difficulties, social isolation, domestic violence or family substance abuse — though no such hardships may be present.

The depression often comes with extreme anxiety, panic attacks, obsessive-compulsive symptoms, sleeplessness and terrifying, intrusive thoughts, in addition to despondency so debilitating women often come close to giving up. Occasionally, they do.

The death of a young Mendocino County mother who took her own life earlier this month after what her family said had been a prolonged postpartum depression struck a painful chord with women across the region who identified with the apparent depth of her suffering.

Many came forward to say they had contemplated suicide themselves, sharing stories of their illness and recovery to help other women feel less alone in their own journeys and to urge them toward help.

“I wish more people would come forward, because it is so taboo,” said Kristin Ell, 33, a Santa Rosa mother of two. “No one can do this alone.”

Yet, many try.

Resources for parents

Support group: Free postpartum depression support group with marriage and family therapist Lily Rossman meets from 10:30 a.m. to noon on the second and fourth Friday each month at the Santa Rosa Birth Center, 583 Summerfield Road.

Stress management: The Child Parent Institute, Perinatal Mood Disorders, in Santa Rosa offers bilingual in-home and group stress-management programs designed to support the infant-parent bond. Its low-cost program Mothers & Babies was recommended last week by the U.S. Preventive Services Task Force as an effective preventive intervention for women at risk of postpartum mood disorders. For information, visit calparents.org or call 707-585-6108.

Screenings and counseling: Mothers Care of Petaluma offers screening, assessment and counseling — with up to two free sessions, for qualifying Petaluma residents — maternal mental health education and resources. For information, visit mothercaresupport.com or call 707-776-0959.

Weekly group: Weekly sessions for pregnant women and new mothers who are members of Kaiser Permanente Santa Rosa take place from 10 to 11:30 a.m. Thursdays at 2235 Mercury Way. For information, visit https://k-p.li/2GQt89Q.

How To Get Help

North Bay Suicide Prevention 24-hour hotline: 855-587-6373

NAMI Sonoma County warmline: 707-527-6655

Sonoma County Psychiatric Emergency Services: 707-576-8181

For information on Sonoma County support groups, call 707-527-6655 or go to namisonomacounty.org

Online resources

postpartum.net

thebluedotproject.org

American College of Obstetricians and Gynecologists

World Health Organization

National Institutes of Health

postpartumprogress.com

2020mom.org

A surge in focus on maternal mental health is beginning to change the landscape of care, nationally and globally. But despite its pervasiveness, awareness of postpartum depression and its many expressions is generally low among both patients and even some practitioners, clinicians say.

Routine screening for new mothers is not entirely consistent, though in recent years it has become the recommended standard. Overall, too many people are suffering unnecessarily because of a lack of awareness and stigma, advocates say.

“The community needs to do more,” said Julie Clark, a doctor of obstetrics and gynecology with St. Joseph Health Medical Group in Petaluma. She has gone so far as to contemplate billboards to raise awareness of the subject.

In addition to putting women at risk, studies show a mother’s unaddressed mental health issues can impact how she interacts with her baby and how well they bond. It can affect a child’s cognitive, social and behavioral development, experts say.

“Postpartum depression is a very real issue in America, and it’s often underdiagnosed and overlooked and minimized to a degree,” said Jonathan Kurss, an OB-GYN with St. Joseph Health Medical Group in Santa Rosa.

The fact that sleep deprivation from nighttime feedings can look so much like depression in new mothers also may cause some doctors to overlook signs of a serious condition that can benefit from medication and talk therapy, especially in combination, he said.

But even where proper diagnosis is made, resources are lacking in a region where already scarce mental health providers are in high demand, especially after devastating wildfires struck the North Bay in 2017. Some obstetricians have described counseling a few mothers themselves from week to week while their patients sought appropriate help elsewhere.

“The services are pretty scant, to be honest,” Kurss said. “That’s a huge gap.”

A common theme in the experience of postpartum depression is the crying for moms. Weeks and months of it. Uncontrollably, desperately. Not all, but most mothers interviewed for this story said they just felt overwhelmingly sad during the time they were unwell, except if they were numb.

Penngrove mother of two Jackie Fletcher, 27, remembers trying to adjust to life as the parent of a newborn with her oldest son. She would take him to her daytime job as a nanny, tend bar at night, keep house and care for her husband.

“All of a sudden you realize you’re drowning,” she said.

She remembers one night when her husband was working out of town and she was rocking her crying baby, sobbing herself, and counting the hundreds of times the same scene had played out. She rocked and counted and thought, “I can’t do this anymore.” She did, though, with a second child, as well.

For Vanessa Kinney, 39, of Santa Rosa, it was days in bed, nursing her daughter, weeping and wondering if the bleakness she felt was punishment for turning to fertility drugs to become pregnant. “Maybe I’m not supposed to be a mom,” she thought.

Everyone’s experience is unique, but that despair is a classic symptom, along with difficulty concentrating or making decisions; disturbances in sleep or appetite; persistent crying; irritability; loss of interest or enjoyment; withdrawing from friends or loved ones; as well as physical aches and pains, stomach problems or headaches.

Women at particular risk include those who have experienced previous episodes of depression or other mood disorders, or those with family members who have; those who have gone through recent stressful life events or personal losses, including deaths, domestic violence or medical complications during childbirth; those who had mixed feelings about the pregnancy, lack strong emotional support at home, or have a history of substance abuse problems.

New fathers can experience postpartum depression, too, and do at a rate of about 1 in 10, according to some experts. They are particularly prone if their female partners suffer as well.

Many women experience grave doubts about their ability to care for their babies, or have overwhelming worry about the infant’s safety or about pulling off the miracle that is parenting a tiny, defenseless child.

Some also have frightening or strange thoughts about an ill fate or accident befalling their babies, or fears about harming their children or themselves.

New mothers can experience postpartum bipolar disorder and, in very rare cases — about 1 to 2 out of every 1,000 deliveries — postpartum psychosis can occur, generally in the first few weeks after childbirth with an extremely rapid onset, medical agencies say. Symptoms include delusions, hallucinations, paranoia, rapid mood swings and difficulty communicating.

Many who suffer postpartum disorders start out having difficulty breastfeeding their newborns, and as their health and ability to function declines, the widening gap between their expectations of motherhood and their own sense of failure leads to a spiral of self-loathing and guilt.

“You beat yourself up because ‘I’m supposed to be feeling so much love and joy as a mother, and I’m not feeling that,’ ” said Chelsea, whose last name was withheld to preserve the privacy of her son, now a teenager.

Alyson Bailey of Willits said her newborn just seemed “so unbelievably fragile” and “the margin for error just so — oh my God!” She felt as if she were melting inside and her marriage failing.

“I never didn’t want him,” Bailey, 37, said of her son, now 9. “I never wanted him to die or go away. I didn’t know what to do with him. And I felt perpetually guilty, and everything I was providing, and everything I had intended for him was falling apart. I cried all the time. I just felt terrible.”

Many new mothers find themselves unable to sleep even when their newborn does, often because they are so anxious about their newborn’s well-being.

Lori Edwards of Sonoma suffered postpartum depression with her first child, as well as panic attacks and anxiety so severe there were times she couldn’t relax enough to urinate, let alone produce breast milk. She would have visions of tripping and falling with her baby in her arms. She held herself so tensely that it sometimes hurt to be touched.

She began to feel inadequate as a mother, became increasingly nervous and frightened and seldom slept. She paced through the nights, checking frequently to see if her son was OK.

When an emergency room doctor whose wife had just delivered twins thought he recognized her problem, it led her to getting help, finding a psychiatrist and trying medications until she found the right one.

But even getting a diagnosis, “There was such a relief in it,” said Edwards, who braced for another round with her second child but was symptom-free. “It was really life-changing for me.”

Another Sonoma County woman, a mother to twin girls, was on her way home from the hospital with her babies when an odd thought passed through her mind upon seeing a brown bag on the freeway. She wondered for no particular reason, “What if someone’s baby were in there?”

It was 14 years ago, but she remembers how other dark, obsessive thoughts began emerging amid her growing exhaustion — like the idea that one of her babies hated her, and if she took it too near the washing machine, she just might put it inside.

“It still kind of chokes me up, how intense and scary those thoughts were,” the woman said. The Santa Rosa mother asked that her name not be used in connection with memories she has never shared before.

Many who have suffered have done so in isolation, unaware there was a diagnosable condition or treatment for feelings they couldn’t explain and, in some cases, dared not utter.

Some women said the dark and frightening visions and thoughts they sometimes experienced were simply not shareable. “I was positive they would put me in jail and they would take the babies away,” said the Santa Rosa mother. “I didn’t even tell my husband.”

Others said their struggles were not something anyone else wanted to discuss anyway. Even loved ones would sometimes dismiss their deepest agonies.

“It’s such a hush-hush topic,” said Arlette Ortega, 24, of Santa Rosa, who is working her way through depression and anxiety with her 8-month-old son.

She said most people, especially in the Latino community, are uncomfortable discussing maternal mental health, even in a family where others have experienced problems. “Women are just supposed to accept it and get over what they’re feeling,” she said.

But women across the spectrum said much the same thing.

“There’s an immense amount of pressure on women feeling that they’re supposed to glow through the whole experience,” said Natasha Kahl, director of high-risk obstetrics and chief-of-staff-elect at Sutter Santa Rosa Regional Hospital. “Sometimes just acknowledging that as much as they’re adorable and they’re wonderful and we’re lucky that we get to do this, it’s not all sunshine and roses.”

It’s also important for women to be able to distinguish their experience of depression and anxiety from their love for their babies, which becomes an unnecessary and inappropriate source of guilt and shame for some mothers, clinicians said.

“Many women feel like if you’re sad — you’re struggling — that people will think that you don’t love your child,” said Petaluma marriage and family counselor Allison Murphy, who specializes in maternal mental health.

Murphy, founder and director of Mothers Care, which provides mental health screening, assessments and treatment for new and expectant mothers in the Petaluma area, is a vocal advocate for expanding treatment for women, but said more robust funding is the necessary key.

“This is an entirely solvable problem,” she said. “We know how to address this problem. That’s not the issue. And that’s what I think is so frustrating, as someone who is in this field. We know that screening works. We know that if you screen and you follow up, and if you provide women services, we know that they’re going to respond.”

There are signs of progress toward improved outreach — what Kurss called “a buzz” in the medical field as a result of increasing awareness and interest in early intervention.

Last week, the U.S. Preventive Services Task Force recommended preventive interventions for expectant and new mothers who are at increased risk for depression because of a previous history, depressive symptoms or other socioeconomic factors, including cognitive-behavioral and interpersonal therapies that have shown success.

The panel specifically called out a low-cost, bilingual program called Mothers & Babies available locally through the Child Parent Institute in Santa Rosa. It can be offered through home visits or in group settings, said Deborah Burg-Schnirman, the institute’s perinatal mood disorder coordinator.

Kahl said she thinks American society was nudged forward in part by the 2005 publication of Brooke Shields’ memoir, in which she chronicled her crippling postpartum depression, shedding light on an illness shared by many. But Kahl said the past five years have seen particular focus and progress.

A new state law that takes effect in July requires obstetrics providers to ensure that all women are screened for maternal depression at least once during pregnancy or the postpartum period, as well as to create mental health programs for new mothers. Another law mandates mental health training for clinical staff who work with expectant and new mothers, as well as education for women and families about signs and symptoms of postpartum disorders.

The American College of Obstetricians and Gynecologists last year recommended its members approach postpartum care as an “ongoing process,” increasing the frequency of contact with patients, timed on an individualized basis and involving a team of practitioners, if needed.

Doctors said there are challenges associated with insurance reimbursement and other factors that in the past have set the spacing for post-delivery visits at six weeks postpartum, in the case of an uncomplicated vaginal birth. If there are going to be mental health issues, they often turn up at two or three weeks.

Drugmakers are investing in postpartum treatments as well. A new 60-hour infusion designed for postpartum depression has been shown in clinical trials to provide a rapid response, particularly compared with standard antidepressant drugs, which generally require several weeks to take effect. Sage Pharmaceuticals, which developed the drug, has a pill form in trials.

For Chelsea, whose only experience with childbirth was traumatic and complicated on many levels, it took two years before she felt fully herself again.

She credits a step-by-step cognitive-behavior multimedia self-help program her husband heard advertised on AM radio, with a workbook to fill out and an online community of participants that rounded out the program.

A therapist in Ojai, her step-grandma’s best friend, provided support over the phone as well, but something about having specific steps to accomplish “just made me feel better.”

“I guess I treated it almost like I was going to college,” she said.

Several other women, informed by their own suffering and isolation, say they’re very conscious now of checking on new mothers they know just to offer support.

If they’re struggling, said Ell, the 33-year-old Santa Rosa mother, her message is always to reach out for help, even if they feel scared.

“What you’re doing,” she said, “is you’re preserving your children’s future by coming forward and getting help so that you can be whole for them.”

You can reach Staff Writer Mary Callahan at 707-521-5249 or mary.callahan@pressdemocrat.com. On Twitter @MaryCallahanB.

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