TIPS FOR POSTPARTUM DADS and PARTNERS

Pregnancy and postpartum mood and anxiety disorders affect the whole family. Here are some tips that
might help you along the way. Remember that you will get through this with help and support. There is no
magic cure, and sometimes recovery seems slow, but things will keep improving if you stick to a plan of
healthcare, support, and communication.

COMMON SYMPTOMS of PERINATAL DEPRESSION & ANXIETY:

• Feeling overwhelmed, exhausted and insecure

• Crying spells, sadness, hopelessness

• Anger, irritability, frustration
• Repetitive fears and worries

TAKING CARE OF YOUR STRESS AND EMOTIONS:

• Ask for help, information, and support for yourself. Call 1-800-944-4PPD.
• Develop a support team for your family. Ask for help. Say YES when they offer.
• Take time for yourself. Talk to your partner to arrange a good time to be away.
• Talk to other families who have come through this.
• Spend time with your baby to develop your own confidence.

HOW TO HELP MOM:

• Reassure her: this is not her fault; she is not alone; she will get better.
• Encourage her to talk about her feelings and listen without judgment.
• Help with housework before she asks you.
• Encourage her to take time for herself. Breaks are a necessity; fatigue is a major contributing
factor to worsening symptoms.

• Don't expect her to be super-housewife just because she's home all day.
• Be realistic about what time you'll be home, and come home on time.
• Help her reach out to others for support and treatment.
• Schedule some dates with her and work together to find a babysitter.
• Offer simple affection and physical comfort, but be patient if she is not up for sex. It's normal for
her to have a low sex drive with depression, and rest and recovery will help to bring it back.

DEALING WITH HER ANGER AND IRRITABILITY:

• Help her keep track of eating regularly, because low blood sugar results in a low mood and
frustration. Have healthy and easy snacks on hand.

• Do your best to listen for the real request at the heart of her frustration. Reduce conflict by telling
her, "I know we can work this out. I am listening."

• Keep the lines of communication open. Verbalize your feelings instead of distancing from her. It is
helpful to take a break if your tempers are hot, but do get back to communicating.

• If she is expressing anger in such a way that you can’t stay supportive, you might say something
like, "I want to listen to you. I know this is important, but I’m having a hard time because you’re so
mad at me. Can we take a break and talk about it later?"

• Ask her how you can help right now. If she doesn't know, make some suggestions.

Wendy N. Davis, PhD

wdavis@postpartum.net
Postpartum Risk Assessment in New Mothers

Questions to ask the new mother:

How are you doing emotionally?
What are you getting to eat? How’s your appetite?
Are you able to go to sleep after the baby does?
Do you have any questions about depression or anxiety?
Is being a mother what you expected?
Who gets up at night with the baby?
Are you getting help with the baby or housework?
How’s the other parent?
Do you talk to friends?

Indicators of Risk:
Previous depression, anxiety, or bipolar cycles
Low social support
Insomnia
Excessive energy, little need for sleep
Repetitive anxious fears
Hx of Thyroid imbalance
Rapid weight loss, no appetite
Missing appointments
Frequent calls or visits to provider
Discomfort or Detachment from baby
Over-concern, hypervigiliant about baby
Mood swings or irritability/anger
Too perfectly groomed
Excessive and unusual fatigue, either intensity or duration
Crying jags

Interventions:
• Recognize and Reassure
She is not alone, it is not her fault, and with help she will get better

• Give Resources in Written Form

Baby Blues Connection 503.797.2843 or 360.735.5571
Postpartum Support International 800-944-4PPD

• Follow up: Chart it and Check back with her.

Wendy N. Davis, PhD
Postpartum Support International
www.postpartum.net
503.246.0941
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 Depression and Anxiety
During Pregnancy and Postpartum

Is it normal to feel sad and nervous after the birth of a baby?

Many new moms feel weepy and anxious. This is normal and is called the “Baby Blues.” It
goes away with rest, food, support, and time.

Up to 20% of all pregnant and new mothers have more lasting depression or anxiety.

Depression or anxiety is not just a mood. If your symptoms are disturbing, get in the way
of your daily life, or last over two weeks, call your health provider or contact PSI.

If you feel that you need immediate care, call 1-800-SUICIDE or your local hospital.

What are some symptoms of Depression?

Sadness, anger, exhaustion, nervousness, feeling out of control or overwhelmed

Difficulty sleeping or eating

Fears or scary thoughts that don’t go away

Feeling anxious or insecure, and nervous about being alone

What should I do if I think I have Pregnancy or Postpartum Depression or Anxiety?

Call your medical provider

Contact Baby Blues Connection at 503.797.2843 for support, information, and resources.

Ask friends or family for help so you can take breaks

Tell someone how you feel and find someone you trust that can help you

What will help me feel better?

Support and reliable information about getting through depression and anxiety

Good nutrition: avoid sugar, caffeine, and alcohol

Rest: Breaks from childcare

Medicine or other treatment from a trusted healthcare provider

Fresh air and movement

Talking to other women and families who have been through it and recovered

AM I AT RISK?
Check the statements that are true for you:
It’s hard for me to ask for help. I usually take care of myself.
Before my periods, I usually get sad, angry, or very cranky.
I’ve been depressed or anxious in the past.
I am been depressed or anxious when I’m pregnant.
My mother, sister, or aunt was depressed or very nervous after her baby was born.
Sometimes I don’t need sleep, have lots of ideas, and it’s hard to slow down.
My family is far away and I feel lonely.
I don’t have many friends nearby that I can rely on.
I am pregnant right now and I don’t feel happy about it.
I don’t have the money, food, or housing that I need.

Checking more than two items in the above list suggests that you have risk factors for
depression or anxiety during pregnancy or postpartum. With help, all of these
symptoms are temporary and treatable.

You can prevent a crisis by reaching out.

Baby Blues Connection: 503.797.2843 www.babybluesconnection.org

Postpartum Support International: 800.944.4PPD www.postpartum.net

Leave a message. We will call you back.

¿CÓMO SE SIENTE AHORA?
Mientras muchas mujeres experimentan
trastornos leves en su estado de ánimo

Santa Barbara, CA 93160

P.O. Box 60931
Postpartum Support International
(depresión), o se entristecen después del
nacimiento de un hijo, entre 10% y 15%
de las mujeres muestran síntomas mucho
más severos de depresión o ansiedad.

A LA MADRE:
¿Se siente triste o angustiada?
¿Le es difícil sentirse bien?
¿Se siente más irritable o tensa?
¿Se siente ansiosa o con temores?
¿Tiene dificultad para acercarse a
su bebé?
¿Siente como si todo estuviera fuera de
control o se estuviera volviendo loca?
¿Tienen miedo de lastimar al bebé o
a Ud misma?

A LA FAMILIA:
¿Siente que algo no está bien pero no
sabe que hacer para ayudar a la
nueva mamá?
¿Cree que ella tiene problemas para
hacer frente a esta situación?
¿Piensa que ella no va a mejorar?

Cualquier mujer puede sufrir depresión

o ansiedad en el embarazo o el posparto.
Sin embargo, con la información debida,
Postpartum Support International
se puede prevenir que los síntomas
empeoren y lograr así una recuperación P.O. Box 60931 / Santa Barbara, CA 93160
total. Es esencial que se reconozcan Support Warmline 1-800-944-4PPD (4773)
estos síntomas lo antes posible, para Office Phone: (805) 967-7636
que la madre reciba la ayuda que Fax: (323) 204-0635
necesita y merece.

Postpartum Support International (PSI)
es la organización no lucrativa más grande del
mundo dedicada a ayudar a las mujeres que
sufren trastornos del estado de ánimo y
ansiedad, incluyendo la depresión posparto,
(complicación perinatal más frecuente). PSI se
fundó en 1987 con el fin de hacer conciente al
público en general y a la comunidad de
profesionales sobre las dificultades que puede
experimentar la mujer durante y después del
embarazo. La organización ofrece apoyo,
información fiable, entrenamiento en las
mejores prácticas y presencia de coordinadoras
voluntarias en 50 estados de la Unión
Americana y en otros 26 países. PSI está
comprometida con eliminar el estigma y
asegurar que las familias reciban cuidados de
calidad y humanos, trabajando en conjunto con
sus coordinadoras, profesionales interesados,
legisladores y otros grupos. Para mayor
información, llamar a PSI al: 800-944-4PPD
o www.postpartum.net.
AYUDA POR TELEFONO
• 1-800-944-4PPD. #1 para el espanol.
PSI Warmline ofrece apoyo, información y
medios de ayuda en la comunidad, en inglés o
español; Puede dejar un mensaje en cualquier
momento del día.
• Chat with an Expert”(“Hable con un experto”) en
sesiones telefónicas todos los miércoles; hable
anónimamente y sin cargo alguno con otras
mujeres o con una persona de PSI. Detalles en
www.postpartum.net.
PÁGINA WEB (WEBSITE)
• Información sobre trastornos del estado de
ánimo (depresión) durante el embarazo y el
posparto.
• Extensa lista de grupos de ayuda.
• Comuníquense con nuestros coordinadores
locales especializados, quienes le ayudarán con
apoyo e información.
• Ayuda por correo electrónico (e-mail) de
voluntarias.
• Guía de ayuda en Internet
• Calendario de eventos en la comunidad de
personas con depresión en el periodo perinatal.
• Ultimas noticias e investigaciónes.
• Sección para ingreso de nuevos miembros y
para consultar nuestra página de Internet
PSI NOTICIAS
• Boletín de noticias cada trimestre, con
información sobre las actividades del PSI
• Intervenciones efectivas, casos sobre historias
de mujeres y temas legislativos.
• Eventos de carácter global y noticias.
ENTRENAMIENTO
• Congreso anual para discutir las últimas
investigaciones científicas sobre tratamientos
y sistemas de apoyo social.
• Entrenamiento estandarizado, manuales y
cursos certificados para profesionales,
voluntarias y grupos de apoyo
Become a PSI Member - Help Build Healthy Communities
Membership and Donor Form
La misión de Postpartum Support
Internacional es promover la conciencia,
prevención y tratamiento de los asuntos
mentales de salud relacionados con la
maternidad en cada país en todo el mundo.
(Please check all that apply)
❑ Yes, I wish to join PSI $
❑ I also wish to support PSI with a donation of $
❑ No, I don’t wish to join at this time, however
I wish to support PSI with a donation of $
Name
Profession Date:
Address
City, State, Zip
Country
E-mail Address
Phone
(include area code and country code)
❑ VISA ❑ MC ❑ AMEX ❑ Check (made out to PSI)
CC # Exp Date
Signature
Total Amount Charged or Enclosed $
INDIVIDUAL (NON-PROFESSIONAL) $60 US
SUPPORT GROUP $75 US
PRACTICING PROFESSIONALS $150 US
FOR-PROFIT ORGANIZATION/BUSINESS $250 US
FULL-TIME STUDENT $25 US
Postpartum Support International
P.O. Box 60931 / Santa Barbara, CA 93160
Phone: (805) 967-7636 / Fax: (323) 204-0635
E-mail: psioffice@postpartum.net / www.postpartum.net
Join Online at www.postpartum.net/become-member
Or send the form below to the PSI Office
We welcome you to join us as PSI spreads awareness!
 TEN FACTS ABOUT DEPRESSION and ANXIETY in pregnancy and postpartum
1. You are not alone. You are not to blame. With help, you will feel better.
Anyone can become depressed or anxious during pregnancy or after the baby comes. It is not your fault.
It is caused by many stresses happening at the same time. Many women develop depression or anxiety
because of changes in our hormones, our feelings, our relationships, and sometimes in stress about work,
housing, or money. No matter how sad or scared you feel, you can get through this with help.

2. You need regular breaks from taking care of your children and your house.
You need to get breaks to feel good about the hard work of being a mother. Taking a break will help you
do a better job of being a mother, and it will help you feel better.

3. PPD does not go away fast: there is no quick fix or cure.

You WILL feel better if you keep taking steps to get help and to take care of yourself. It is hardest in the
beginning, and it will get easier. Find a healthcare provider you like, people who can help you at home,
and friends that listen. Don’t give up.

4. You will feel better if you reach out to understanding people and say how you feel.
Women who go through depression without help are more unsure about themselves as mothers. Talking
to other women who have recovered will help you a lot. It is normal to feel shy and embarrassed at first,
but it will help you to talk to someone who understands.

5. You will feel worse if you judge your life on a bad day.
On a bad day, we see things negatively and feel worse by judging our lives and ourselves. Make a rule
that you will not judge yourself on a hard day. Instead, fill your day with things that help you: get active, go
outside, express your feelings, have a good cry, or listen to music. Do not compare yourself to other
women, and try not to compare your partner, your body, your home, or your children to others.

6. You will find what works for YOU. It might be different from what works for other women.
Remember that different people need different solutions. This is true about medication, herbs, nursing,
where the baby sleeps, how you teach your children, and where you get support. Be open to changing
your plans so that you can find the things that work best for you and your family.

7. You will feel better if you get outside as much as you can. Even a little bit helps.

8. Recovery from Postpartum Depression or Anxiety has ups and downs.

There are good days, bad days, and boring days. If you keep to a plan of self-care, breaks, support, and
remedies, you will keep feeling better. It is normal to worry if you have a bad day after you’ve been
feeling better. Don’t give up. You will get through this. When you have a bad day, think about your last
few days. Did you get any time to yourself? Did you do too much? Are you angry? Is your period
coming? Did the baby grow a lot or make a change in nursing? Have you been eating well?

9. Be true to yourself, and trust that you will find your way.
Your feelings or thoughts do not hurt your baby. How you act does matter. It is normal to cry and feel
mad, frustrated, scared, or to feel nothing inside. But try to focus on what you are doing on the outside.
Children feel good when you look in their eyes, let them know they are safe with you, hold them and smile
when you can. Take breaks so that you will be more relaxed when you are with them.

10. Good mothers can get depressed.

Depression can make women feel bad and afraid about motherhood. They get afraid that they will never
be happy. But that is the depression, and when it gets better, you will feel better about being a mom. Be
kind to yourself. See if you can accept ALL your feelings and remember that good mothers can feel sad,
scared, or bored sometimes. Depression will not last forever. Spend time with people who make you feel
good about yourself and hopeful about the future. You will feel better, and you are not alone.

Wendy N. Davis, Ph.D. Counseling and Consultation wdavis@postpartum.net

 WAYS OTHERS CAN HELP A NEW MOTHER

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

1 2 3 4 5 6 7
Rock the baby. Do the laundry. Go grocery Dust the house. Bathe the other Pay the bills. Rent a funny
Shopping. kids. movie.

8 9 10 11 12 13 14
Bring her flowers. Order a pizza for Take mom & Clean the Make a pot of Give her a Give her time for
dinner. baby for a ride. bathrooms. soup. massage. a bubble bath.

15 16 17 18 19 20 21
Let her take a Call her during Change the linens Put on a relaxing Have someone Read to the other Go for a walk
nap. the day. on the bed. tape. take her to lunch. kids. together.

22 23 24 25 26 27 28
Take the baby Make a pot of Give her a foot Let mom take a Listen to her. Sandwich hug the Give mom
with wherever spaghetti. rub. 15-minute baby between you exercise time.
you go. shower. and mom.

29 30 31
Restock the Iron or mend any Clean out the -- TELL HER YOU LOVE HER!! --
healthy munchies. clothes. fridge.
http://postpartumprogress.typepad.com/weblog/infanticide/

January 26, 2009 - And now for the bad news ...

Sanity alert: If you're feeling vulnerable, do not read the rest of this post. It's a bummer. I don't
always report this kind of news anymore, mainly because I myself don't like reading about it, but since
there seems to be several unhappy things happening at once I thought it important share them. So
proceed at your own risk.

A judge has ordered psychiatric reviews for a 25-year-old Stamford, CT, woman charged with
killing her newborn son. Angelina Sarmiento has been found competent to stand trial in the death of her
newborn son on Oct. 29, 2008. Her attorney says the exams may help determine if she was experiencing
postpartum psychosis after the boy's birth. She has pleaded not guilty to charges of murder and is being
held on $1 million bond.

In California, Kristina Fuelling has been sentenced to more than 6 years in prison, with at least 6
months to be spent in a psychiatric facility, for killing her infant daughter. Two separate medical
evaluations found 27-year-old Kristina Fuelling was suffering from severe postpartum psychosis and was
legally insane when she drowned her 8-day-old daughter in January 2008. Her attorney, Tom Johnson,
said Fuelling will spend at least six months in a psychiatric facility, then be reevaluated. Then, she would
either serve the rest of her sentence in state prison or be held indefinitely in the psychiatric facility. Her
husband and family are fully supportive of her.

Meanwhile, in Ft. Carson, Colorado, a new mom who is the wife of a soldier serving in Iraq
disappeared last Friday and is considered missing. The woman's mother has said her daughter has
postpartum depression and was not taking her medication.

January 08, 2009 - Alisa Lorraine Evans Acquitted in Milwaukee Infanticide Case
Alisa Lorraine Evans was just acquitted in the drowning death of one of her infant twins. She
will be committed to a mental institution with the possibility of supervised release.
Diana Lynn Barnes and Ruta Nonacs served as consultants to Alisa's attorney and testified in the
case in Milwaukee. Diana believes this verdict shows the progress being made in the postpartum mood
and anxiety disorder arena.

Here is the original news report on the case from the Milwaukee Journal Sentinel.
Mother charged in drowning case Two counts filed in death, injury of infant twins
By Jesse Garza of the Journal Sentinel

Posted: Jan. 22, 2008

A woman accused of drowning her two-week old son and attempting to drown his twin brother told
investigators that she only wanted the infants to go to heaven, according to a criminal complaint filed
Monday.
Alisa Lorraine Evans, 38, also told investigators that she wished she could have saved her 18-year-old
son, who was shot to death last year in Waco, Texas.
Evans, of the 3200 block of W. Senator Ave., was charged with first-degree intentional homicide in the
death of David Smith and with attempted first-degree intentional homicide for trying to drown Josiah
Smith.
According to the complaint, David was pronounced dead Friday at Wheaton Franciscan Healthcare-St.
Joseph hospital in Milwaukee, and his brother was taken to Children's Hospital of Wisconsin.
Monday night, a hospital spokeswoman said she could not confirm that the baby was ever admitted to the
facility, but over the weekend police said Josiah was expected to survive.
According to the complaint, Evans' mother told police her daughter had been separated from her husband,
who lives in Waco, Texas, and had been despondent over the death of her son John David Alexander
Smith, who was killed in October. Evans had recently talked about hurting or killing herself, her mother
told police.
Evans' mother told authorities she came home from an errand Friday afternoon and found the two boys on
a bathroom floor and their mother sitting on the edge of the tub.
She asked her daughter what was wrong, but Evans did not answer. Instead, the complaint says, she
"raised her arms as though she was in some type of distress."
The boys' grandmother dialed 911 and carried the twins to another room.
Evans told police that she had earlier been talking out loud with the hope "that by talking about it, things
might get better," the complaint says.
She said she had filled the tub with water but then drained it. She then filled it up again, about halfway to
the top, and placed the twins in it, the complaint quoted her as saying.
According to the complaint: "Defendant did not want a temporary solution, she wanted something
permanent. She wanted the children to go to Heaven."
Evans was in the Milwaukee County Jail Monday with bail set at $500,000.

Iowa Supreme Court Awards New Trial to Convicted Mom

On Friday, the Des Moines Register reported that Heidi Anfinson was awarded a new trial after the Iowa
Supreme Court ruled that her initial lawyer was ineffective in failing to submit evidence of depression and
odd behavior prior to her 2-week-old son being found drowned. The decision means Anfinson, now
serving 50 years in state prison for the second-degree murder of her two-week-old son, Jacob Anfinson in
1998, could be free on bail as early as next week.

Alfredo Parrish, Anfinson’s new lawyer, said the ruling is good news for women because it means
defense attorneys now are obligated to examine all possible cases of postpartum depression before
deciding on a defense.

Anfinson’s family later argued during a post-conviction relief petition that Heidi's original lawyer
rebuffed their wishes before the murder trials and refused to pursue evidence of postpartum psychosis and
Anfinson’s history of childbirth-related mental problems.

“We find a reasonable probability that if a reasonable investigation had been undertaken, evidence would
have been developed and presented at trial tending to establish Anfinson’s conduct from the time of
Jacob’s birth until his death was profoundly affected by postpartum depression,” the justices wrote.

Here's another story on this:

http://iowaindependent.com/7208/anfinson-relative-this-has-been-a-long-road
I was at the Jennifer Mudd Houghtaling Postpartum Depression conference in Chicago when I got this
news. Then I ran into George Parnham, Andrea Yates' lawyer, and shared the news with him as well. He
was on his way to speak to the law students at Northwestern, and he took a copy of the Des Moines
Register article with him. It's SO important for all members of the legal system to be educated on mental
illness. I'm glad we have compassionate people like George who understand that sometimes horrible
things happen to people who are terribly ill. I'm grateful that he is willing to share his experience with
others.

July 28, 2008

To Blog or Not to Blog? Writing About Tragedy on Postpartum Progress

I want to highlight an interesting comment on Postpartum Progress this weekend from a reader
responding to a news story I posted a while back about a woman in Iowa who killed her baby and then
herself:
"How can these stories not cripple and terrify the many women on this site currently experiencing
perinatal mood disorders? This is probably the most difficult part of the illness ... hearing these stories
and believing you are insane and have no control over your actions. Why doesn't anyone make any posts
about dealing with these feelings? How can you ever start to bond with your baby while getting treatment
if you hear these stories and believe they are about you?"

I struggle with this as well. I don't want to upset the readers of Postpartum Progress. I know exactly how
it feels to be so vulnerable and confused and afraid of yourself. And it is true that stories of infanticide
can make you feel worse because you're so worried that you're capable of doing the same. What women
need to do in this case is reach out. Talk to your doctor about your concerns and your fears. Listen to
what they say. Treatment at the hands of professionals is the answer. If your trained therapist and/or
psychiatrist is concerned that you are at risk of harming yourself or someone else, they will hospitalize
you and help you stabilize. If they aren't concerned, they'll tell you. You'll still be afraid, of course,
because that is part of our illness. The truth is, even if you didn't read or hear scary stories in the media,
you'd still be afraid of what you might do.

I feel that we're victimized by the fact that people gloss over perinatal mood disorders as though women
can't handle the truth. As if it's just too touchy a subject. I'd rather err on the side of being completely
truthful than pretending bad things don't happen.

I made the decision to tell the stories, although I try to leave out the scary details. I tell them because they
are the truth, though thankfully just a small part of the truth. Such tragedy is among the consequences of
our illnesses. People need to know that so they will take us seriously and educate themselves about
perinatal mood disorders and take action to make sure women have the services they need. If society can
convince itself that postpartum depression is just a temporary setback and no real strategic plan of attack
is necessary, than it will take that path of least resistance. We can't afford that.

July 08, 2008 -

Jennifer Gibbs Bankston's Sister Alternate on U.S. Olympic Triathlon Team
 Here is an article from the Mercury News about Becky Lavelle, twin sister of Jennifer Gibbs Bankston,
who has secured a spot as the alternate on the 2008 US Olympic triathlon team. As I know you're aware
if you read this blog, Becky's sister killed her baby and herself while suffering from a postpartum mood
disorder. Her family's nonprofit organization is Jenny's Light. March 13, 2008

Jenny's Light Foundation Launches New Website

Jenny's Light, the foundation created in memory of the loss of Jennifer Gibbs Bankston and
her newborn baby Graham late last year to postpartum depression, has relaunched its website with more
resources, including information on suicide support and postpartum support. The organization will focus
on providing postpartum support and education in the states of Alabama, California, Louisiana and
Minnesota.

June 02, 2008

Mother Kills Baby, Self in Iowa

Shannon Elizabeth Steinbach, mother of two and resident of Schleswig, Iowa, killed her infant child and
then killed herself on May 19. The case has tentatively been ruled a murder-suicide. Authorities say it
appears that Shannon hanged herself in the basement of the family home. Four-month-old Hope was
found drowned in an upstairs bathtub. There are, of course, questions as to whether Steinbach was
suffering from a postpartum mood disorder. Her family members have said she was a very loving
mother, and had just spent thee months visiting her newborn daughter every single day at the hospital,
where she had been born prematurely. They believe Shannon was experiencing postpartum depression.
This story was reported by WOWT in Omaha, Nebraska:

January 24, 2008

More Deaths Reinforce Need for Screenings

Last week in Milwaukee, Alisa Lorraine Evans, 38, attempted to drown her 2-week-old twin boys in the
bathtub, killing one and leaving the other hospitalized. According to WTMJ-AM in Milwaukee, "Issues
of postpartum mental illness will figure significantly in the case ... Authorities said the woman had lost an
adult son in a Texas shooting incident last fall, and she told police she only wanted the babies to go to
heaven."

Of course I won't go into any details here, but the WTMJ story states:

"Joyce Smith told investigators her daughter was depressed and had said Jan. 10 she didn't want to live
anymore and talked about 'hurting or killing herself.' She had been living in Milwaukee about six months
and was separated from her husband in Waco, Smith said. Evans, who was a licensed vocational nurse,
told police she wanted a permanent solution to her problems and 'only wanted the children to go to
heaven'..."

Additionally, last Sunday a mother in Sacramento apparently drowned her 8-day-old daugther. Kristina
Feulling of Granite Bay faces murder charges. According to News10 in Sacramento, "Kristina Fuelling's
psychological condition was being investigated late Sunday and there was no indication that drugs or
alcohol were a factor in the child's death."
Fuelling's family and friends issued the following statement:

Kristina is known as a loving and caring person and we have only witnessed Kristina showing affection
and care towards her baby. Kristina stopped work months ago only to take care of her pregnancy and
baby. She has called the doctor numerous times for every little concern since the baby was born. Her life
has been completely dedicated to caring for her child. It seems illogical that such a loving mother would
harm her baby and we hope officials will find the same to be true. It does not seem real that baby Faith is
not alive and with us. Our prayer and support are united for Kristina.

More women who have slipped through the cracks. We need postpartum mood disorder screenings in the
hospital and at the 6-week postpartum checkup period.

January 19, 2008

Family of Young Mother in SC Believes Daughter Charged With Murder Has PPD

Here is a link to a story from NBC-affiliate WYFF in South Carolina about a young mother accused of
killing her child. Her family believes she was suffering from PPD.

Let me say something about these suicide/infanticide stories I share with you:

1) These stories aren't meant to scare you, but they are reality though thankfully rare. From the
beginning, I made a commitment that this blog would never gloss over the true experiences of people with
postpartum mood disorders -- I try to be as up front and honest as can be, because so many of you say
they wish they had been told everything before they went through it. Rather than freak you out, such
stories should encourage those out there who haven't sought treatment to do so for your own health and
the health of your families.

2) Also, when I share these stories, it doesn't mean I am confirming that the cause was postpartum
depression. As I'm sure you well know, some people use the postpartum depression defense who don't
deserve to use it. I have no idea whether the person in this particular story was or was not in fact
suffering from PPD.

December 27, 2007 -

Chicago Tribune Columnist Asks Why Mother Remains in Prison

The following commentary on Debra Gindorf appeared on December 23 in Eric Zorn's blog on the
Chicago Tribune online edition:

"Gutlessness leaves governor open to scorn

When people ask me why I have such a cranky attitude about Gov. Rod Blagojevich, I'm happy to tell
them the story of Debra Gindorf.

Gindorf had a hearing in front of the Illinois Prisoner Review Board in early 2003. The board was clearly
sympathetic to her lawyers' contention that she was in the grips of post-partum psychosis in 1985 when
she killed her 3-month-old baby and 23-month-old toddler before trying to kill herself and that she was
sentenced to life in prison before this condition was properly understood.

Not even the Lake County state's attorney's office, which prosecuted Gindorf, objected to her release.That
was more than 1,700 days ago. Gindorf, 43, is still at Dwight Correctional Center with a bum heart and a
broken spirit, according to her assistant state appellate defender Kathleen Hamill.

Not only has Blagojevich not had the guts to release this poor woman and explain to skeptics why it's the
right and compassionate thing to do, he hasn't even had the guts NOT to release her -- to deny her petition
for commutation.

Instead, it sits somewhere in the stack of 1,445 other pending parole and pardon requests on the desk of
our state's invertebrate hockey-fan-in-chief.

Remember that next time you hear him preen about women's health issues, about his courage and about
how other lawmakers need to buckle down and get to work."

December 19, 2007

Informative First Thursday Teleconferences Offered By MedEdPPD

I think I've written about this before -- at least I hope I have -- but Dr. Ruta Nonacs was kind enough to
remind me of the First Thursday teleconferences held by MedEdPPD. Here's a link to her post on A
Deeper Shade of Blue about these informative sessions. The next one is Thursday, February 7, and will
feature Dr. Margaret Spinelli of Columbia University discussing postpartum psychosis and infanticide.

December 12, 2007

One Mother Sentenced to Prison, Another Found Not Guilty By Reason of Insanity

This week, according to the Springfield [Ohio] News-Sun, " ... a west-central Ohio mother who attempted
to drown her infant daughter in a bathtub has been sentenced to seven years in prison. Twenty-one-year-
old Heather Nicole Dean, of Springfield, pleaded guilty to attempted murder this week in Clark County
Common Pleas Court. Prosecutors say Dean was suffering from postpartum depression when she
attempted to kill her baby last spring by holding her under running water in the bathtub. Court records
show Dean called 911 after the drowning attempt and then performed CPR on the baby. The child made a
full recovery."

Meanwhile, in a nearby state, another mother this week was found not guilty by reason of insanity for the
murder of her two children. According to the Lancaster [Pennsylvania] New Era, "A Mount Joy woman
who killed her two young sons in 2004 has been found not guilty by reason of insanity. Meghan Lippiatt,
32, smiled when Judge James P. Cullen announced his verdict ... The verdict means Lippiatt avoids prison
and the potential for the death penalty and will instead be treated at a psychiatric facility to be determined
later ... Lippiatt killed her two children, 4-month-old Myles and 2-year-old Silas, on April 18, 2004 ... Her
defense team argued successfully that she was suffering from schizoaffective disorder and didn't know the
difference between right and wrong when she killed the children." The paper stated in a previous article
that " ... while living in England in early 2004, Lippiatt was diagnosed with psychosis and postnatal
depression after telling doctors she was hearing voices telling her to harm her children."
June 04, 2007
Houston Chronicle Editorial on PPMD

Here's a link to the great editorial written by the editorial board of the Houston Chronicle about the recent
infanticide/suicide in Texas. This is an awful, awful tragedy, of course. I'm glad the Chronicle
commented on the work that needs to be done to help these women.

This is a link to a good article that just came out of the annual meeting of the American Psychiatric
Association this week. No real new news, but it's nice to see the recognition of perinatal mood disorders
as a spectrum disorder, and the fact that onset can occur anytime throughout the first year postpartum.

This is a link to a new book called "Crazy In America: The Hidden Tragedy of Our Criminalized
Mentally Ill". It sounds like it could be good, and similar to Pete Earley's book called "Crazy", which I
absolutely loved.

Here's a link to a great editorial from Newsday by Sandra Wolkoff. One highlight that reminds us we
just don't get over this in a day:

"Frequently, women convince themselves that any slight improvement is a sign that recovery is around
the corner. When the black clouds of despair return hours or days later, or another medication seems to
prove ineffective, they feel like failures."

Here's a link to a recent story that appeared on the NBC affiliate in San Diego about the Michael
Spangler, husband of Annie who committed suicide three years ago after suffering from postpartum
depression. I'm so sorry for his and his little boy's loss, especially when we all know these tragedies are
completely unnecessary.

Here's a link to a story from last week in Chicago about Tonya Vasilev, who was found mentally insane
for the killing of her two children. She had suffered depression since childhood, and had been diagnosed
with postpartum depression. The judge said he felt comfortable finding her insane because of the expert
medical testimony, thus Tonya will now receive lifelong commitment to a mental health facility rather
than prison or the death penalty. (Trust me, this doesn't mean I'm comfortable with those sweet children
being killed. I can think of nothing more awful and tragic. But we need to work harder to treat and
protect the mentally ill so that things like this don't happen.)

Margaret Trudeau, the ex-wife of the late prime minister of Canada Pierre Trudeau, spoke up about
mental health recently and the importance of mental health check-ups to all Canadians. Trudeau herself
suffered from postpartum depression. Here is a link to the story.
May 07, 2007
Parnham Receives Award for His Work

George Parnham, the lawyer who represented postpartum psychosis sufferer Andrea Yates, recently
received the Jefferson Award from KPRC-TV in Houston. The award, which is part of a national
program of the American Institute for Public Service, honors unsung heroes and their personal
contributions to public and community service. Parnham was recognized for all the awareness he has
brought to the issue of postpartum mood disorders and his work on behalf of the Yates Children
Memorial Fund and other related organizations.

According to KPRC-TV, two bills sit before the Texas Legislature this year -- one seeking better
insurance coverage for those with postpartum depression and another seeking a change to the insanity
plea that would cover those with postpartum depression.

April 12, 2007

San Diego Mother Gets Five Years Probation
Here's a link to an article from the San Diego Union-Tribune about a mother with postpartum
depression who attempted infanticide but was (thankfully!) unsuccessful. These types of stories are tough
to read, but they help reinforce the importance of treatment.

December 03, 2006

Another Great Piece from MomSquawk about PPD

The following is a great post called "The Shame of Postpartum Depression" written by
Momma Steph over at MomSquawk:

According to an article in Psychiatric Times, postpartum depression and psychosis are often missed by
practitioners. Around 10-15% of new mothers will be diagnosed with postpartum depression (not to be
confused with “baby blues”, which affects around 80%), and less than 1% of new mothers reportedly
experience postpartum psychosis.

But postpartum depression may be more prevalent than thought, because women are reluctant to reveal
the symptoms, Dr. [Phillip J.] Resnick said. Fearing of falling short of society’s ideal of motherhood,
women may hold back from telling their husbands. And many fear that if they tell a doctor or social
worker about their depression, their baby might be taken away, he said.

Gee… women who are blindsided by postpartum mental disorders aren’t likely to fill anyone in
voluntarily? YA THINK?! “You know, honey, I can’t seem to stop obsessing about putting the baby in
the dishwasher. Isn’t that odd? I guess we should get takeout. Why are you looking at me like that?”

I wonder if other undiagnosed women got hit with PPD as I did - in such a bizarre and scary fashion that
it didn’t even occur to me that I’d been hit. I thought women with PPD hated their babies, or cried all the
time, or didn’t feel like leaving the house. I loved my baby fiercely, didn’t cry much at all, and didn’t at
all shy away from leaving the house - many evenings I headed down the road, clutching the baby, making
a beeline for my husband’s office, if only to intercept him partway through his walk home and hand off
our spawn so that I’d know he was safe. Safe from the dishwasher.
Had I known that intrusive thoughts are a fairly common symptom of PPD, I probably would have told
someone. And I’m certain that the obsessions would have been much less severe, more easily laughed off
and dismissed. As it was, I just thought I was going crazy, and that admitting it would make it worse, and
might cost me my child. So I decided to just use all my mental strength to keep it together. And I made a
pact with myself that if I ever found myself in real danger of harming the baby, I’d kill myself first, as a
pre-emptive move.

Yes, the unclouded bliss of new motherhood, indeed!

Some facts on infanticide, from the article:

About 40% of mothers with postpartum depression have thoughts about killing their child, Dr. Resnick
said. And for depressed mothers of “colicky” babies-babies not soothed even when fed, changed, and
held-that figure climbs to 70%, he said.

Of the mothers whose depression develops into psychosis, as it did with Yates, about 4% will harm their
children if the psychosis is not treated, Dr. Resnick said.

This is why education and screening are so important. I’m a well-read person, I pored over all the
pregnancy books I could get my hands on, but nothing prepared me to recognize PPD. For me, bad
thoughts = Andrea Yates. My only available coping mechanism (so I believed) was denial.

I’m praying that the MOTHERS Act gets out of committee and onto the floor of Congress. Its stated
purpose:

To ensure that new mothers and their families are educated about postpartum depression, screened for
symptoms, and provided with essential services, and to increase research at the National Institutes of
Health on postpartum depression.

I had great healthcare, by all obvious standards, and I was in the dark about the signs of postpartum
depression. How many other women are uninformed? How many mothers and babies are at risk?

If and when the legislation makes its way onto the floor, we should be ready for idiotic hissy fits like this:
“PPD is made up by whiney mothers and screening is a grand conspiracy by the patriarchy” essay (link
courtesy of Katherine at Postpartum Progress). Debate over the proposed law is one thing. But denying
the existence of PPD, and further shaming women who may be suffering from it by calling them weak, is
unconscionable.
November 30, 2006
More Sad News & Something You Can Do About It
More sad news to share. But first, let me explain something. I don't share this news with you to
make you feel bad or scare you when it comes to your own situation. If you're reading this blog, it
means you're doing something to get yourself better. You're reaching out to learn more, and
hopefully you're getting treated. At minimum, I'll be here for you if you need me. I share sad news
because it's extremely important that everyone be informed about the most dire consequences of
our illness. This is real life, and people need to be confronted with it so that they might be urged on
to act, and act quickly.

PLEASE write your senators and congressmen and women and tell them to pass the MOTHERS Act. I
know it seems futile - I myself had never done it until now. But we've got to do something. Click here
and look on the left side of the screen where you can enter your zip code. Feel free to print out my story
from the other day and this one so that you have proof to share that more people could get harmed if
something isn't done.

Here's the news, from yesterday's Fayetteville Observer (NC):

"By the time detectives got to the two-story brick home in northern Cumberland County on Tuesday,
Faye Johnson Vick and her two children had likely been dead for several days.

Detectives found their bodies inside Faye Vick’s vehicle, which was parked in the two-car garage and had
run out of gas.

On Wednesday, investigators said Faye Vick killed herself and her children, 2-year-old Jason Vick and 3-
month-old Madison Vick. A state Medical Examiner’s Office report said the three died of carbon
monoxide poisoning.

No one can be sure what went through Vick’s mind before she climbed inside the vehicle with her two
children and turned on the engine.

Debbie Tanna, a spokeswoman for the Cumberland County Sheriff’s Office, said Faye Vick, who was 39,
had a history of postpartum depression ..."
features

The
Postpartum
Brain
New research
casts light on
the depression
and troubling
thoughts
many mothers
experience after
childbirth. And it
may help erase
some of the
stigma they feel.
Don Baker

By Anna J. Abramson

w h e n d aw n r o u s e wa t c h e s t h e h o m e of sadness or irritability. A mother likely has

video of her daughter’s third birthday, she sees
the familiar details of a child’s party: family,
friends, cake. But something is painfully wrong
with the picture. Dawn appears detached and
vacant onscreen, and ultimately she wanders off
while the party goes on without her.
That’s because for years after her daughter
Emily’s birth, Dawn struggled with a debilitating
depression that kept her from enjoying even the
presence of her own little girl. Sometimes she felt
sad and distant; at other times she was haunted
by anxieties she couldn’t control. On one occa-
sion, she remembers pushing Emily’s stroller
and suddenly thinking, “I could drop her to the
bottom of the lake and it would be at least four
hours before anyone would know. Then at least I
could get four or five hours of solid sleep.”
Surveys show that many mothers—even those
not diagnosed as depressed—experience simi-
larly disturbing thoughts, images, and fantasies.
Research has found that 85 percent of new moth-
ers experience the “baby blues,” a passing period
postpartum depression, a serious condition that
affects about 15 percent of new mothers, when
her depressed mood persists, intrusive thoughts
become increasingly distressing or frequent, and
other symptoms of major depression arise. Many
of these mothers imagine horrifying scenarios
involving their newborns and, sometimes, suf-
fer from tremendous guilt and fear as a result.
Like Dawn, the vast majority would never act
on these frightening impulses. Only exceedingly
rare cases, termed postpartum psychosis, lead to
actual violence against infants.
Yet despite the prevalence of these thoughts
among new parents, mothers rarely feel comfort-
able enough to discuss them. Instead, afraid or
ashamed, they suffer in silence, confused by
what’s going on in their minds and terrified that
it means they’re unfit mothers.
New research findings may offer some
consolation to these mothers. For the first time
ever, scientists are using specialized techniques
to examine the postpartum brain. Their findings

36 Greater Good Spring 2008

 are honing in on physiological and evolution-
ary explanations for why so many mothers are
prone to intrusive thoughts, and why this normal
level of postpartum anxiety might, for mothers
like Dawn, escalate into a serious illness. In the
process, this and other research could serve as
a catalyst for more open discussion and, even-
tually, a better understanding of postpartum
depression.
Scanning the postpartum brain
At Yale University, researchers recently completed
a groundbreaking study of new moms and dads.
Leckman and They used functional magnetic resonance imag-
ing (f MRI)—a technique that tracks blood flow
Swain’s research and related patterns of activity in the brain—to
see which neural circuits became active when
suggests there healthy parents saw and heard their babies. Prior
studies had examined parents’ brains as they
may be a very looked at photos of their babies, finding activity in
brain areas associated with pleasure and positive
fine line between mood. But when parents in the Yale study heard
their babies cry, the researchers observed activ-
healthy changes ity in neural networks closely associated with
obsessive-compulsive disorder (OCD), as well
in new mothers’ as in brain areas associated with social emotions
such as empathy. Strikingly, it seemed that listen-
brains and ing to their babies cry triggered a deeply anxious
neural response even in parents who hadn’t been
changes that diagnosed with a psychological problem.
OCD is a psychiatric condition characterized
can become by highly distressing thoughts (obsessions) and
ritualistic behaviors (compulsions). OCD patients
disruptive. experience a heightened sense of anxiety and
a corresponding need to compensate for those
distressing thoughts with compulsive behavior,
which could include incessant hand washing,
praying—or constantly checking on a newborn
child.
The researchers offer an evolutionary hypoth-
esis for the neural signs of anxiety they saw in
these parents. They believe that, after the birth
of a child, a period of high alert may have helped
parents protect their babies from environmental
harm in times when this was a treacherous and
all-consuming task. “Those mothers who were
more careful with the baby were more likely to
have a baby live,” and thus pass on this obses-
sive-compulsive tendency, suggests James Swain,
a psychiatrist and neuroscientist who worked on
the project.
James Leckman, another investigator on
the project and the research director of the
Yale Child Study Center, says he’s found that a
certain level of elevated anxiety and distress is
normal in parents. In fact, in an earlier study, he
and other researchers found that 30 percent of
healthy parents reported having thoughts that
they themselves would harm their newborns. In
the weeks before delivery, 95 percent of mothers
and 80 percent of fathers reported OCD-type
thoughts. In this healthy population, obsessive
thoughts are fleeting and only mildly distress-
ing. The Yale researchers hypothesize that the
healthy maternal brain is hardwired for a period
of “transient OCD.”
But, says Swain, once mothers are endowed
with this kind of neural “machinery,” there’s a
danger they “could connect up OCD behaviors
with irrational things not for survival.” In a
paper on their research, the Yale scientists write,
“Perhaps evolution is not a perfect editor.” In
other words, sometimes certain behaviors persist
beyond the point that they’re useful.
Their evolutionary hypothesis suggests it is
critical for mothers to respond emotionally to
their newborns but, the researchers write, “Too
much or too little primary parental preoc-
cupation may be problematic.” Some mothers
with postpartum depression feel emotionally
numb and cannot care for or interact with the
newborn. These mothers report a disorienting
sense of detachment and apathy. On the other
hand, mothers with a more anxious depression
feel emotionally charged and cannot inhibit
thoughts and impulses concerning the baby’s
care. And for many mothers, the symptoms of
depression and anxiety overlap. The researchers
suggest that while very mild OCD might be
adaptive in healthy mothers, a lack or an excess
of this obsessive emotional vigilance could play a
role in postpartum depression and anxiety.
Ruta Nonacs, a psychiatrist at the Women’s
Mental Health Clinic at Massachusetts General
Hospital, says the Yale study’s findings resonate
with her clinical experience. “Both depressed
and nondepressed mothers have a heightened
sense of vigilance, the tendency to obsess, but
then you have this proportion of women who
go way beyond,” she says. “There’s no squelch
mechanism. Those impulses just go on and on.”
Katherine Stone, who was diagnosed with
postpartum OCD after giving birth to her son,
was one of those mothers who didn’t have that
squelch mechanism. “I was supercharged—
hypervigilant,” she says. “I kept having thoughts
about dropping him down the stairs, drowning
him. You get to this point where you don’t trust
yourself because the self you knew would never
have that thought. It’s a vicious cycle.”
Leckman and Swain’s findings add to a
substantial body of research that has uncovered
specific biological mechanisms associated with
parental care and postpartum depression. Leck-
man says that postpartum depression likely has a
genetic basis In fact, research has already identi-
fied 10 distinct genes associated with parental
behavior. In “gene knockout” studies of rodents,
he says, researchers have removed entire genes
associated with maternal care; in some studies,
those rodents responded by ignoring their pups
or losing the aggressiveness needed to defend
Spring 2008 Greater Good 37
features
Claudio Calligaris
Dawn Rouse struggled with depression
in the years after her daughter’s
birth. She’s now pursuing a Ph.D. in
child development and has become
committed to raising public awareness
on postpartum illness.
38 Greater Good Spring 2008
them. In humans, Leckman explains, the issue is
not a complete absence of certain genes, but may
instead involve genetic variations that influence
maternal behavior.
Nonacs also suggests that some cases of
postpartum depression may be linked to changes
in women’s hormone levels after they give birth,
particularly in mothers who are already vulner-
able to depression. These women might have
prolonged hormonal imbalances after childbirth,
causing them to respond with excessive emo-
tion to stressful events. For instance, following
a distressing incident, they might experience a
rapidly beating heart or intense concentration,
but then lack the hormonal responses to crank
these physiological changes back down to nor-
mal levels. As a result, they find themselves in a
perpetual state of high arousal.
Social factors probably exacerbate these
biological underpinnings of postpartum illness.
Prolonged sleep deprivation, for example, is a
known risk factor for psychiatric illness and may
help explain why, for many mothers, the onset
of postpartum depression is gradual rather than
sudden. Sandra Poulin, a mother in Dallas, Texas,
says she was overjoyed after the birth of her
daughter. But as months passed without sleep,
she found herself becoming more and more
depressed. “I couldn’t move—I was just lead. I
was exhausted to the core.”
Lifting the silence
New studies on the biology of postpartum ill-
ness may help remove some of the stigma and
silence surrounding depression after childbirth.
Combined with the statistics on the prevalence
of postpartum depression, the Yale study’s results
indicate that a considerable number of new moth-
ers experience some sadness or anxiety in addi-
tion to the often-reported elation or fulfillment
of having a child. Indeed, Leckman and Swain’s
research suggests there may be a very fine line
between natural, even healthy changes in new
mothers’ brains and changes that can become
disruptive and dysfunctional. This finding could
help bolster advocates’ efforts to open up public
discussion about the complexities and difficulties
associated with early parenting.
These advocates claim that contemporary
public discourse emphasizes the joys of mother-
hood while downplaying the natural anxieties
that come with it. Jane Honikmann, the founder
and former president of Postpartum Support
International, an organization that promotes
research, advocacy, and support groups for
postpartum depression, calls this “the myth of
motherhood and the fantasy of fatherhood.” The
skewed representation of what it’s like to be a
new parent leaves some women feeling that they
are bad mothers. “Nobody talks about it,” says
Sandra Poulin, “they’re frightened to death.”
Katherine Stone says she lived in fear that
her son would be taken from her if she disclosed
what was going through her mind. “I didn’t tell a
soul,” she says.
Stone believes silence takes its toll on moth-
ers like her, who feel they have no choice but to
remain quiet. Social norms dictate that mothers
be “supreme and wonderful, and sacrifice,” she
says. If they suffer from negative thoughts about
their child, she adds, they fear how they’ll be per-
ceived by others. “You’re like a defective woman.
You don’t work properly.”
The scientists at Yale say it might help new
parents to know that having disturbing thoughts
does not mean they are bad parents. By showing
the complexities of postpartum illness—that
even the healthy maternal brain is wired for a
certain level of anxiety—the Yale research might
help remove some of the stigma around those
willing to speak up about what they’ve been
through, and encourage others to seek help.
For women who do seek help, common
methods of treatment include psychotherapy
and postpartum support groups, as well as anti-
depressant medication. Some mothers benefit
from the aid of “postpartum doulas”—helpers
who come into the home to assist with both the
new mother and child’s health and well-being.
Mothers also say that the support of family and
friends and the chance to catch up on sleep help
alleviate the exhaustion and sense of isolation
that can worsen the illness.
But advocates also say that the medical system
needs to do a better job appealing to mothers
and training health professionals to recognize
signs of depression. Sandra Poulin of Texas says
that current efforts to reach mothers have the
timing all wrong. Some hospitals give out packets
on postpartum depression, but in the excitement
and disorientation of new motherhood, she says,
that information usually ends up in the trash. It
is after several months of sleep deprivation that
such information would be more useful, accord-
ing to Poulin. She says she would like to see the
routine “well-baby” visits reconceptualized and
renamed “well-baby, well-mommy visits.”
Poulin also wishes that all pediatric offices had
the Postpartum Support International’s poster
hanging directly above the infant scale. The
poster reads, “Depression is the #1 Complication
of Childbirth.” That poster—with information
on how to get help—could save lives, she says.
Indeed, some anthropological studies have found
that in cultures that provide extensive postpar-
tum support, there are lower rates of depression
among new mothers.
Steps toward reform
New Jersey set a national precedent in 2006
by approving a law that makes screening for
postpartum depression mandatory. The driving
force behind the law was New Jersey’s then-first
lady, Mary Jo Codey, who had suffered from
postpartum depression herself. She decided to
come forward with her experience in the hopes
of effecting positive change for others. Legisla-
tors and advocates in a number of states are now
pushing for similar reforms aimed at education,
screening, and prevention.
Swain says the Yale study may serve as a first
step toward understanding the differences
between healthy mothers and those with an ill-
ness—and eventually improving treatments for
those mothers who need it. He and Leckman cau-
tion, though, that it is too soon to say for certain
what OCD circuits will look like in mothers with
a postpartum illness. The next phase of Swain’s
research will involve scanning the brains of
depressed mothers immediately after childbirth,
then again after they receive different forms
of treatment. Together, the studies of healthy
mothers and of mothers with an illness will help
researchers construct a more precise neurological
picture of the postpartum brain.
Swain hopes that one day brain imaging on
mothers will help them get preemptive treat-
ment. “A lot of this is about prevention,” he says,
“about knowing who gets better. Then we can
hopefully start to sort this out and say, ‘Chances
are, you’ll benefit from this kind of therapy.’ It
would be great if we could do such a brain scan
and tell someone that they are at risk long before
they’ve even noticed [symptoms of depression].”
Better treatment of mothers has direct
implications for infants and children, as well.
Research has consistently shown that children
of chronically depressed mothers have greater
emotional and cognitive difficulties as they
grow up. But the outlook for these children isn’t
bleak at all if their mothers receive treatment. A
recent Columbia University study found that the
children of depressed mothers showed signifi-
cant improvements in mental health when their
mothers were treated with antidepressants.
“Mothers getting treatment helps kids go on
to live healthy, happy lives,” says Ruta Nonacs
of Massachusetts General Hospital. She adds
that treatment for mothers is only one part of
what children and families need. “There are
many things that make kids resilient, like having
other care providers who are not depressed—a
husband, extended family.”
Perhaps some of the greatest advocates and
resources for these families are those mothers
who have recovered and gone on to tell their sto-
ries. After years of suffering, Dawn Rouse saw a
therapist who described some of the biochemical
mechanisms involved in postpartum depression.
As she listened, Dawn suddenly realized, “Oh
my God, I am not an evil, horrible mother.”
She started taking medication but then learned
therapeutic strategies so that she was eventually
able to cope without it. Her relationship with
now-nine-year-old Emily has been transformed. “Mothers
getting
Finally, she says, “I am finding joy in my daugh-
ter.”
treatment
Dawn’s recovery inspired her to speak out
about her experience. She started a popular blog
called “I’m doing the best I can,” and is now pur-
suing a Ph.D. in child development. She’s become
committed both to raising public awareness on
helps kids
postpartum illness and to broaching the topic
among her own circle of friends.
go on to live
“I tell them, ‘I am the girlfriend you can
call. I will not judge you. I will be your venting
healthy, happy
space. When your baby has woken up and your
husband is snoring or you hate your baby—you
lives.”
can call me.’”
Anna J. Abramson is the staff writer for the Russell
Sage Foundation and a former Greater Good edito-
rial assistant.
 
Greater Good magazine is published by the Greater Good Science Center
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Depression and Anxiety: What do women and their families need to know?
Up to 20% of all women experience some depression or anxiety in pregnancy or in the first year after birth.
If you do feel down, angry, confused, or anxious -- start talking about it as soon as you feel able. The
sooner you reach out to supportive people, the sooner you will feel better. There are many resources to help
you understand and recover from depression or anxiety. Ask your provider for a list of resources so that you
will have it if you need it. Contact Postpartum Support International at www.postpartum.net or
1.800.844.4PPD for helpful links or resources near you.

If you do become depressed, anxious, or overwhelmed, remember that there are resources and support that
will help you recover, no matter how bad you might feel at first. There are several different kinds of mood
reactions in pregnancy or postpartum, which are sometimes called perinatal mood disorders (PMDs). You
might have one or more of these symptoms: sadness, anxiety, exhaustion, numbness, anger, physical
symptoms, confusion, insomnia, or disturbing thoughts or fears. You might have only anxiety, only depression,
or a mix of symptoms. None of us expects to have them, but none of us needs to be unprepared for them.

Every pregnant or new mom needs to rest, eat well, get emotional support, and take breaks. Cultures that
support new moms, allowing them rest and recuperation, have less postpartum depression. Traditional
cultures provide the support of the village for new parents; modern culture tends to encourage isolation and
self-reliance. This makes it hard for mothers to take care of themselves. Find people to talk to, and people
who can give practical support, and let them help. You will recover better if you get both practical and
emotional support. Get extra support, especially if you find you have a hard time coping with your moods or
the baby. Getting breaks from babycare is not a luxury -- it is a necessity for all mothers.

All of the symptoms of pregnancy or postpartum mood disorders are temporary and treatable. Some
women treat depression and anxiety with medication, some with natural remedies, some with diet and
exercise, some with counseling, support groups, or spiritual practice and support. Many use all of them. Find
what works best for you, make a plan of self-care, and stick to it. Learn about how to cope with depression
and anxiety, and keep reaching out until you find the help you need. Make calls, read what feels helpful,
talk to women who have recovered. Pace yourself as you gather information. If you feel overloaded, take a
break from the input -- but not from the support.

Considering that about one in five women become depressed during pregnancy or postpartum, it seems that
you should have heard more about it by now. Because people hesitate to talk about it, many women end up
feeling embarrassed and scared that they are alone. You are not alone. There are informed people to talk
to who will support you and help you. It may be hard at first, but your greatest achievement may be
learning to reach out.

Risk factors include previous PMS or reaction to birth control pills, stress and isolation, and a personal or
family history of depression, anxiety, manic-depressive illness or PPD. It is not a failure to be depressed or
anxious. Ease up on your expectations of yourself. Moms with depression often hinder their recovery
because they feel guilty and then over-do it, neglecting their own needs. Find your own way to take care of
yourself as a mother, and learn to honor it.

Having pregnancy or postpartum depression does not mean that you are failing as a mother or that you will
always feel depressed about being a mother. It does mean that you are going to recover from a
challenging, temporary condition that will teach you a great deal about yourself, the strength of women, and
the power of reaching out.

Wendy N. Davis, PhD

Postpartum Support International
www.postpartum.net
Listening to Families: The Wild Ride of Pregnancy and Postpartum Emotions
Wendy Davis, PhD

Do families help when a mom has postpartum depression or anxiety? How a family responds to a
new mother’s emotional and mental health will affect her through her pregnancy, life with a new
baby, and her developing self-image as a mother. Women who are depressed or anxious during
or after pregnancy tell us that friends, family, and perfect strangers at the store directly influence
how they feel, whether they reach out, and even how they communicate with their partners.

Here’s a good illustration. I am standing in line at the grocery store and overhear a conversation
between the two women in front of me. One is there with two children – a baby in the cart and an
older child who calls her grandma. She is taking care of the little ones and talking to the silver-
haired woman behind her, comparing notes about grandchildren. I hear the woman with the
children mention that her daughter-in-law has “Postpartum Depression.” They pause and look at
the kids. I wait...I wait for the inevitable: the rolling of the eyes, the talk about how women these
days just want the easy way out, how everyone and her sister seems to have “postpartum
depression.” I ready myself, getting ready to tell them that it is real, it is rough, and that we are
lucky in Portland to have great resources. I want them to understand, to know that they should
not judge. I want to tell them that it is actually almost true that everyone and her sister has it, and
that we need to listen to them and help. I’m ready for them.

They surprise me.

The woman in front of me shakes her head. “I sure wish that we had help back in my day. I
wish...She’s a lucky girl, your daughter-in-law. If I had been able to ask for help and have
someone take the kids to the store....She’s lucky to have you.” They smile at each other, and look
down at the children. I feel like crying. If the grandmas at the store understand, then we might
have a chance.

Times have changed, and they will continue to change. Although another day could have brought
an insensitive conversation about depressed new moms, this day in this store reminded me that
our families and communities are beginning to understand. New moms do get depressed and they
get anxious. Pregnant women have as much chance of becoming depressed or anxious as their
postpartum peers, and teenage moms have a greater chance than any. Even adoptive Moms and
sometimes Dads become depressed after a new baby arrives. We have been ignoring it and as a
result families have suffered. Fortunately, Portland is one of a growing number of communities
that is creating a real safety net, a system that includes raising awareness, educating providers,
and making professional connections as well as supporting families.

Since 1994, Portland has had a peer support organization called the Baby Blues Connection that
exists to provide support, information, and resources to pregnant and postpartum women, their
families, and the providers who serve them. Baby Blues Connection (BBC) is affiliated with a
larger group called Postpartum Support International, which is a clearinghouse for global
perinatal support and resources. (Perinatal means the period through pregnancy and through the
first year postpartum.) Baby Blues Connection and Postpartum Support International are both
not-for-profit organizations run on volunteer power, fueled by dedicated and caring women and
men who know that they can make a difference. Many of those volunteers have recovered from
perinatal distress and want to give back, but there are also volunteers who are motivated by the
experience of loved ones, of past generations, or simply by an interest in helping childbearing
women and families.

BBC provides phone, email, and group support in Portland and Vancouver by trained volunteers
who work every day to make sure that women and their families don’t feel alone. Their message
is clear: You are not alone, you are not to blame, and with help, you will get better. The first
step is to reassure with solid information and a listening ear, then to help distressed moms
connect to other women and providers that will give them reliable care.

As BBC supports families and providers, it has been helped by donations from friends and local
providers, by a few community foundations, and throughout its twelve years by the donation of
group space from a church, four hospitals, and most recently a spa designed for pregnant and
postpartum women.

The earliest references to depression, fears, or psychosis around childbearing were recorded in
the 4th Century BCE! In modern times, we stopped talking about them. Acknowledgement of
despair seems to have been replaced by pretty media pictures of mommies and babies and
shallow reassurances by families and doctors who tell mom to get a haircut, buy a new dress, or
wean the baby. Traditional rituals to support new mothers and fathers were replaced by baby-
shower games, and built-in help for new parents gave way to expectations that one parent will go
to work and the other stay home to keep up with housework, her appearance, and the bliss of new
motherhood. In this modern world, where is the language to describe mornings filled with
anxious fears, dinner that remains uncooked, and nights disrupted by Mommy crying as much as
the baby?

Groups like Baby Blues Connection and Postpartum Support International believe that we can
prevent a crisis if new parents receive reliable information, resources, and adequate support
before the baby arrives. If families learn that symptoms of emotional and mental distress during
pregnancy and postpartum is common, treatable, and temporary, then they will not be consumed
by fear or shame if it occurs. They might take more breaks, reach out sooner, and engage with
informed providers and support services to prevent their distress and facilitate their recovery.
Most importantly, by reaching out to a group like the Baby Blues Connection they will make
contact with real mothers, fathers, and grandparents who have gone through their own
difficulties around childbearing, and they will learn that they are not alone and not to blame.

Recent research tells us that up to 20% of all pregnant or postpartum women will have
significant depression or anxiety and that there are predictable risk factors such as a history of
PMS, depression or anxiety, recent loss, or life stress. The next time you are near new mothers,
look around: about one out of five of them has enough disruption in her mood, her sleep and
appetite, her confidence and her ability to function that she could be diagnosed with a clinical
mood disorder. You can’t tell who it is by looking. Moms will smile on the outside while they
are feeling lost, scared, and numb. In England, they have called postpartum depression the
“smiling depression” because women hide how they are feeling due to their fear that they are
failing. Shame is the biggest obstacle to recovery.
If she is fortunate, a mom will have people around her that remind her that she is worthy of care,
treatment, and help. They will tell her that her difficulties are symptoms, not a sign of her
inadequacy. Having negative feelings about becoming a mother is a symptom of depression; it is
not a cause. Next time you talk to a new mom or dad, take some time to listen. Be open to the
truth about the difficult adjustment of becoming a parent. Can we accept that depression, fear,
anger, and loss might exist side by side with love and attentive parenting? If we can become a
culture of truth-tellers and fair listeners, we will make our families stronger and healthier, and
change the environment into which children and their parents emerge.

So, let’s hear it for the grandmothers in line at the store. Thank you for listening and telling the
truth.

Wendy Davis, PhD, provides counseling, training, and consultation for pregnancy, birth and
postpartum health. She was the founding director of Baby Blues Connection, and is an Oregon
Coordinator for Postpartum Support International.

To learn more about support, becoming a volunteer,

or making a donation, please contact:
Baby Blues Connection
www.babybluesconnection.org
503.797.2843
360.775.5771

For global support, information, and links:

Postpartum Support International
www.postpartum.net
1-800-944-4PPD
Myths and Facts about Perinatal Mood Disorders
MYTH: Postpartum depression can be defined as the “baby blues” that does not resolve.
FACT: Symptoms may begin weeks after the early baby blues has resolved.

MYTH:
MYTH A woman is not clinically depressed if she is not lethargic -- if she is able to clean house,
take care of her child, or present herself well.
FACT: Women who have prenatal or postpartum depression or anxiety will mask their symptoms,
going to great lengths to appear well, and are often driven by agitation and worry about
appearances.

MYTH: Postpartum depression is usually caused by ambivalence about motherhood. If a woman

has wanted and waited for a baby for a long time, she will not be depressed after birth.
FACT: Postpartum depression is not caused by any psychological conflict. Feelings of
disconnection from the baby are a result of the depression, not a cause.

MYTH:
MYTH Postpartum mood disorders will always begin in the first four weeks postpartum.
FACT: Symptoms of a postpartum disorder may begin any time in the first year postpartum, e.g.,
after sudden weaning, at resumption of periods, after a significant stressor, or after beginning
hormonal birth control. Depression, anxiety, and obsessive reactions may also begin in pregnancy.

MYTH
MYTH: Pregnancy protects against depression and anxiety.
FACT: Studies have shown that rates of depression and anxiety increase during pregnancy.

MYTH: Postpartum mood disorders can be described as essentially one illness that exists on a
continuum of symptom severity.
FACT: There are several perinatal mood disorders that need to be understood and treated
differently. For example: Postpartum OCD and postpartum psychosis are separate conditions.

MYTH: Postpartum psychosis occurs so quickly, there is no way to identify risk before occurrence.
FACT: There are risk factors and warning signs that can be identified with a thorough medical
history and assessment before a woman has a crisis related to psychosis.

MYTH: Women who report repetitive, intrusive images of harm and violence to their children are
always at significant risk of carrying out that violence.
FACT: You must assess the woman’s reaction to these obsessive symptoms. Women with
postpartum OCD find the thoughts and images of danger or harm abhorrent and make great effort
to avoid the possibility of acting on them. Women with postpartum psychosis, on the other hand,
believe that the fantasies, images, or delusions are essential to their reality and are at great risk
of carrying them out.

MYTH: We will unduly scare pregnant women by giving them information about depression and
anxiety. They don’t want to know about it.
FACT: Women will make better choices and avoid crises if they receive information, reassurance
and resources before symptoms ever occur. You can give resources and reassurance at the same
time you discuss risks and signs of perinatal mood disorders. Interventions and reassurance are
more effective if given to families before they are trying to make decisions through the veil of
depression or anxiety.

Wendy Newhouse Davis, Ph.D.

7239 SW 34 AVE
TH
• PORTLAND OR 97219 • 503-246-0941
WDAVIS@POSTPARTUM.NET
 Baby Blues Connection
PO Box 1122, Portland, OR 97207-1122, Phone: 503-797-2843 or 360-735-5571
Email: info@babybluesconnection.org Visit us online at www.babybluesconnection.org

Recommended
Recommended Books
Perinatal Mood Disorders
This isn’t What I Expected by Karen Kleiman & Valerie Raskin
Bantam Books, 1994
Pregnancy Blues by Shaila Kulkarni Misri
Delacorte Press, 2005
Mother Nurture by Rick Hanson, Jan Hanson & Ricki Pollycove
Penguin Books, 2002
Women’s Moods by Debra Sichel & Jeanne Driscoll
William Morrow, 1999
Postpartum Depression and Anxiety: A Self-Help Guide for New Mothers
Pacific Postpartum Support Society, Vancouver B.C., 1994, 2001
To order call 604-255-7999 or www.postpartum.org

Mothering the New Mother, 2nd Edition by Sally Placksin

Newmarket Press, 2000
The Hidden Feelings of Motherhood, 2nd Edition by Kathleen Kendall-Tackett
Pharmasoft Publishing, 2005
What am I Thinking? Having a baby after Postpartum Depression by Karen Kleiman
Xlibris Corporation, 2005
Overcoming Postpartum Depression and Anxiety by Linda Sebastian
Addicus Books, 1998
Postpartum Survival Guide: It Wasn’t Supposed to be Like This by Anne Dunnewold & Diane Sanford
New Harbinger Publications, 1994
Women’s Bodies, Women’s Wisdom by Christiane Northrup
Bantam, 1998
Postpartum Depression, Every Women’s Guide by Sharon Roan
Adams Media Corporation, 1997
I Wish Someone Had Told Me by Nina Barrett
Fireside, 1990
When Words are Not Enough, The Women’s Perspective for Depression and Anxiety by Valerie Raskin
Broadway Books, 1997
Conquering Postpartum Depression: A Proven Plan for Recover by Rosenberg, Greening, & Windell
Perseus Publishing, 2003

Page 1 of 2
Last Updated 2/3/2009
 Books for Family Members
The Postpartum Husband by Karen Kleiman
Xlibris, 2000
Moody Blues: One Family’s Journey Through Postpartum Depression by Tara Dupuis
Relationship Series Publishing Co., 2005 Written for children

Personal Stories
The Mother-to-Mother Postpartum Support Book by Sandra Poulin
Berkley Trade, 2006
Down Came the Rain: My Journey Through Postpartum Depression by Brooke Shields
Hyperion, 2005
Behind the Smile by Marie Osmond
Warner Books, 2001

Clinical Books
Postpartum Psychiatric Illness: A Picture Puzzle by James Hamilton & Patricia Harbarger
University of Pennsylvania Press, 1992
Postpartum Depression – A Comprehensive Approach for Nurses by Kathleen K. Tackett
Sage Publications, 1993
Evaluation and Treatment of Postpartum Emotional Disorders by Anne Dunnewold
Professional Resource Press, 1998
Beyond the Blues: A Treatment Manual by Shoshana Bennett & Pec Indman
Moodswings Press, 2002 Available in Spanish, order at www.beyondtheblues.com
Medications and Mother’s Milk by Thomas Hale
Pharmasoft Publishing, updated yearly. Available at www.ibreastfeeding.com
Postpartum Depression & Child Development by Lynne Murray & Peter Cooper
The Guildford Press, 1999
Depression in Mothers: Causes, Consequences, and Treatment Alternatives by Kathleen K. Tackett
Hayworth Press, 2005
When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on
Childbearing Women by Penny Simkin
Classic Day Publishing, 2004
Postpartum Mood & Anxiety Disorders: A Clinician’s Guide by Cheryl T. Beck
Jones & Bartlett Publishers, 2005

Page 2 of 2
Last Updated 2/3/2009
TIPS FOR POSTPARTUM PARTNERS

I got a crash course in PPD after the birth of my first child. I remember clearly how my husband
helped, and much of that has been incorporated into the suggestions I give to others. There were
many times that I was in despair in spite of his help, but I cannot imagine where I would have
been without it. Everything was leading me toward recovery, even when I couldn't see it. I know
that I was buoyed up every time he acknowledged that I was working hard, told me that he
thought I was a good mother, or that he loved me. I felt so relieved by his helpfulness around the
house, his readiness to take care of the baby, and his suggestions that I take a walk or see a
friend. I also felt remarkably better when I felt taken care of -- when he took charge of dinner,
stroked my hair, bought me some new music, and asked how I was feeling. I always felt that he
believed in me and trusted that I would get better with time, confidence, and support.

• A postpartum mom needs verbal reassurance, affection without the expectation of sex,
listening, and a partner in housework. She needs to hear that she is doing a good job. You can
remind her of the realities you learned about in before the baby (e.g., it's normal for
postpartum life to be hard, but it will get easier.) Don't expect her to be super-housewife just
because she's home all day. You are probably going back to work; she has a brand new job at
home. Spend time alone with your baby, to develop your own confidence. Use the phone
numbers for postpartum support if you have questions. Talk to others who have been through
this. Find ways to take breaks and develop support for yourself. If you can, be flexible with
your schedule. Be as realistic as you can about when you will be home, and come home then.

• Difficulty with anger and irritability are common symptoms of postpartum depression. If how
she is expressing anger is making it hard for you to stay supportive, you might say, "I want to
listen to you. I know this is important, but the way you're talking to me isn't working. Can we
take a break and talk about it later, when it is easier for us both to talk?" Don't just shut
down; real damage will be done to a relationship if you stop communicating. Verbalize your
feelings instead of distancing from her. Tell her, "I know we can work this out. I want to."

• Ask her how you can help right now. If she doesn't know, make some suggestions. Give
practical as well as emotional support. Encourage her to take breaks. If it is hard for her to be
away from the baby, start with short breaks and build up. Breaks are a necessity; fatigue is a
major contributing factor to worsening symptoms. Schedule some dates with her.

• You will get through this. She will get better. It won't be all at once or right away, but if you
stick to a plan of healthcare, support, and communication, things will keep improving. Expect
that she may have rough days for a while, even after she looks like she is "on her feet again".
The graph of recovery is not a straight line; it has ups and downs that get easier with time.

• Postpartum depression or anxiety will not last forever, but neither will it go away quickly. Just
because she is not all better does not mean that you are not helping. Unfortunately, there is no
quick fix. It is very frustrating when a mom remains distressed even after your support and
encouragement. Even if she has not recovered yet, you are helping her with every kind word,
every turn with the baby or the dishes, every time you remind her that she will get through
this.

How can you help?

1. Encourage her to talk about her feelings, and do not judge them.
2. Help her reach out to others. Help her find support and healthcare.
3. Help her cope (practically and emotionally). Pitch-in before she asks.
4. Offer reassurance, positive feedback, and patience.
5. Have confidence in her strength and recovery.

Wendy N. Davis, PhD

Postpartum Support International
www.postpartum.net
 PERINATAL MOOD DISORDERS
DISORDERS

TYPE OF DISORDER COMMON SYMPTOMS PREVALENCE

Found in studies

Sadness and unusual weepiness, lethargy,

Pre-Natal Depression anxiety and panic, insomnia, fear of pregnancy 13% - 15%
or Anxiety or birth, low appetite, rumination, obsessive
thoughts, regret.

Post Traumatic Stress Anxiety, panic, or intrusive thoughts or

flashbacks related to specific event (e.g., birth
or or past trauma.) Recurrent images or
1.5 % - 6%
Acute Stress Reaction nightmares, fears, ruminating, withdrawal and
anger. Dissociation and depersonalization.

Hypomanic, manic, or mixed moods,

disconnected, delirium, periods of delusional
Postpartum Psychosis .1% - .2%
thought. Possible auditory or visual
Or Mania hallucinations, suspiciousness, withdrawal.
Delusions make sense to woman. May be
denial of birth or baby, or glorification.

Major Postpartum Feeling overwhelmed, despair, weepiness, flat

or volatile emotions, detachment and
Depression depersonalization, often with anxiety and
15% - 20%
agitation. Anger and irritability. Difficulty eating,
sleeping, and concentrating.

Postpartum Anxiety or Rapid heartbeat, temp fluctuations, feeling of

dread and apprehension, insomnia, dizziness.
Panic Disorder 10%
Fears of going crazy, of illness, losing sight or
ability to breathe. Fear of being alone.
Fluctuates in intensity and frequency.

OCD is an anxiety disorder, not a thought

Obsessive-Compulsive disorder. Repetitive and intrusive images,
thoughts, fears that are troubling or abhorrent
Disorder to the woman. Anxiety about specific places or
3% - 5%
(Intrusive Thoughts) activity, ritualized avoidance or compulsive
behaviors. Repetitive fears about health and
safety.
Perspectives on Postpartum Depression and the Andrea Yates Trials
by Margaret Spinelli, MD
Margaret Spinelli, MD is an Associate Professor of Clinical Psychiatry, Columbia University
College of Physicians and Surgeons, Director of Maternal Mental Health Program, New York
State Psychiatric Institute, and an expert witness for the defense at Andrea Yates’s retrial.

In my last year of medical school at Cornell University Medical College, I spent a 2 month
clinical clerkship at the Maudsley and Bethlem Royal Hospital in London. I was placed on one
of the mother-baby units. The United Kingdom was my door to the field of perinatal psychiatry
(psychiatry associated with childbirth), a field almost unknown in the United States in the 1980s.
Yet I was keenly aware of the need for such services, having been an obstetrical nurse for 15
years prior to my career as a physician.

The United Kingdom, Australia, Canada and Europe have been years ahead of the United States
in research and treatment of these illnesses, all having mother-baby units. These are psychiatric
units where mothers with postpartum illness are admitted with their babies for treatment. In these
units, mothers continue to bond with their babies while they are treated for their illnesses.
Parenting and infant massage classes play a prominent role in the therapeutic process.

Although the past 10-15 years have seen a growth of research in the United States, education of
families and the public is still severely lacking. In addition, education about perinatal disorders is
often not part of medical education. In recent years, obstetricians and pediatricians have become
more aware of the psychiatric illnesses associated with childbirth. Without this education, the
early identification necessary to provide timely treatment is impossible.

Maternal mental illness not only impacts the mother; it has adverse effects on the infant as well
as the family. Most of all, it impairs the emotional well-being and development of the child.
Mothers who are depressed do not respond well to their infants’ cues. Early identification
through education is the key to discovery and treatment.

What is the difference between postpartum “blues” and postpartum depression?

Postpartum “blues” is not depression. It is a period of mood “ups and downs” that occurs in
almost every woman after birth. It may last for 10 to 14 days. And even though worsening signs
should be monitored for depression, it often abates. The symptoms include feeling overwhelmed,
anxious, having difficulty sleeping and feeling elated one minute, then crying the next.

Postpartum depression is a major public health problem affecting 10-20% of all childbearing
women. It can occur in the first weeks or months after childbirth. The symptoms include
persistent sadness and crying, feelings of guilt and inadequacy about what they see as their poor
mothering skills, inability to sleep even when the baby sleeps, over-concerns about the baby,
anxiety, inability to bond with the baby or even thoughts of suicide.

Sometimes new mothers can be tortured by obsessional thoughts about hurting their babies, but
do not want to hurt them. For example, one woman kept having images about knives and killing

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her baby. These images can occur over and over again throughout the day. She became so
frightened of them that she discarded all of the knives in the house and sat outside of her
apartment every day with her baby until her husband came home. This must be differentiated
from the woman who is psychotic, who may be hearing voices or feels she is under the command
of something telling her to kill her child. Psychotic women can act on their thoughts because
their thoughts may become their reality.

Who gets postpartum depression?

While postpartum depression may be a first episode of depression for some women, it is most
prevalent in women who have had a previous history of depression or have a history of
depression in their family. One of the strongest predictors of postpartum depression is depression
during the pregnancy. Fifty percent of depressed pregnant women will have a postpartum
depression; therefore, pregnancy is the optimum time for treatment and prevention.
Obstetricians, pediatricians and primary-care physicians have become increasingly
knowledgeable about identifying these disorders in their pregnant and postpartum patients.

What is antepartum depression?

Antepartum depression is depression that occurs during pregnancy. Once thought to be a time of
“bliss” for the mother, we now know that more than 10% of pregnant women will have a
depression. Furthermore, one half of these women will continue to be depressed in the
postpartum period. This emphasizes the need and potential benefit of early intervention. Because
the new mother is expected to be unfailingly happy, the stigma of mental illness is even more
pronounced at this time in a woman’s life. Not surprisingly, she often keeps secret any thoughts
and feelings of guilt and failure she has experienced.

Because the pregnant depressed woman may be less likely to eat, sleep or tend to her prenatal
care, the fetus may be placed at risk. Again, the optimal time for early identification is during the
prenatal period.

Do hormone changes at birth really affect your mood?

Childbirth is a physiological event that creates profound changes in the body’s equilibrium. Over
the period of pregnancy, hormones become extremely high (some up to 200 fold). At the time of
delivery, the hormones plummet to very low levels within 24-48 hours. Because the hormone
changes can disrupt brain chemistry, psychiatric symptoms may be the consequence. In addition,
the time of childbirth is one of great stress for the new mother with disruptions in her sleep cycle,
new responsibilities and a new role.

What is postpartum psychosis?

First, postpartum psychosis is not postpartum depression. Psychosis is a loss of contact with
reality demonstrated by hallucinations (hearing voices or seeing things) and delusions (false
beliefs such as believing one is God). The diagnosis is rare, affecting 1/1000 women. Most cases

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of postpartum psychosis are episodes of bipolar disorder (manic depression). Women with
bipolar disorder are at the highest risk for a postpartum psychosis.

When psychosis is present, delusions and hallucinations become prominent. The woman might
feel “taken over.” It is therefore a psychiatric emergency. The woman must be separated from
her baby because her actions are unpredictable and she may not have control over them. The
following vignette describes such a case: I received a call one evening about a patient in the
emergency room. Patient A was a nurse who was 3 weeks postpartum. She was psychotic and
had tried to cut her wrist. The doctor on call wanted to send her home. I disagreed and suggested
that she be admitted. When her brother walked into the emergency room, she attacked him,
which luckily assured that she would be admitted.

Several weeks later, after treatment when she was no longer psychotic, she described what was
going on in her mind. All of her delusions were circumscribed around the number “3″. That night
every car she saw had 3 headlights; her labor was for 3 hours; she was 3 weeks postpartum; there
were 3 voices in her head that said she must sacrifice 1 of 3 generations — her mother, her new
infant or herself. It was at that time that she decided it must be her and cut her wrist. Her mother
walked in just in time and brought her to the emergency room.

Unlike other causes of murder, infanticide has known and identifiable precursors, namely
pregnancy and childbirth. It is therefore predictable and preventable. In my book, Infanticide:
Psychosocial and Legal Perspectives on Mothers Who Kill (American Psychiatric Publishing,
2002), I have attempted to educate the public and professionals about perinatal illness as it works
its way from the mental health system to the criminal court system. This statement is an
overview of my book.

The “Tragedy” of Andrea Yates

In June 2001, the country was riveted when Andrea Yates drowned her five children in the
bathtub of her Houston, Texas home. Perhaps no other case of infanticide (murder of an infant <
1 year) or filicide (murder of a child > 1 year) demonstrates the paucity of our medical and legal
knowledge and understanding of postpartum psychosis and associated infanticide.

Andrea Pia Yates was a devoted mom who home-schooled her children. She remained pregnant
and/or breastfeeding over the course of 7 years. Mrs. Yates had a history of psychiatric illness
and a first reported psychotic episode after her first birth in 1994. She told no one because she
feared Satan would hear and harm her children. Two suicide attempts after her 4th pregnancy
were driven by attempts to resist satanic voices commanding her to kill her infant.

Six months after her 5th child, Andrea Yates became almost mute and walked around the house
like a “caged animal.” After two psychiatric hospitalizations, she continued to deteriorate. When
her psychiatrist discontinued her antipsychotic medication, she became severely psychotic. She
stated that Satan directed her to kill her children to save them from the fires and turmoil of Hell.
This time she could not resist.

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Infanticide; vulnerability or culpability

Mrs. Yates was charged with capital murder. Although Andrea Yates pled innocent by reason of
insanity, the prosecution asserted that she knew right from wrong at the time of the killings
because she called 911 and her husband after the killings. The prosecutor elected to give her the
death penalty if she was found guilty. Before the verdict came in, it was determined that the
prosecution’s psychiatrist gave false testimony. Although Mrs. Yates was found guilty, she was
sentenced to life in prison, then a mistrial was declared. Mrs. Yates was granted a new trial in
July 2006. This time she was found not guilty by reason of insanity and was mandated to a
psychiatric inpatient unit.

In England and Wales, a woman who has killed her infant under a year can be indicted for
infanticide, which is a crime equal to manslaughter. The legislation, which provides for this
charge is contained in the Infanticide Act; in women with mental illness, treatment and probation
are mandated in both countries. Scotland has no such provision, yet rates of infanticide and
features of victims and perpetrators are similar in the three regions. Twenty nine other European
countries, as well as Australia and Canada, also have infanticide laws, which make infanticide a
less severe crime with less severe penalties.

After 80 years of using probation and treatment in lieu of incarceration, the British legal system
has demonstrated that this method is as effective at preventing or deterring infanticide as is
incarceration, while being considerably more efficient and cost-effective.

In the United States, a woman with severe mental illness who has killed an infant is charged with
homicide. If convicted in the American judicial system, she may face a long prison sentence or
even the death penalty. Due to the scarcity of psychiatric treatment in our overcrowded prison
system, these women exit the system in their childbearing years with the same psychiatric
symptoms that brought them into prison.

The question then to ask ourselves is what we seek to gain by this punishment and how can we
prevent these needless tragedies in the future?

The fact that the insanity defense is non-existent in some states and extremely limited in others
speaks to our disregard for mental illness and the rights of those who suffer. Until we treat
mental illness with the same dignity afforded to other illnesses, the course will remain
unchanged.

What can we learn from the Yates tragedy?

A series of errors paved the way to the tragic events of June 20, 2001 when Andrea Yates
drowned her children. The following represent warning signs or missed opportunities for
prevention:

Personal history of psychiatric illness: Mrs. Yates had a series of depressive episodes from the
time of adolescence. She had one episode after her first child was born in which she heard a
voice saying that she should stab her baby. Mrs. Yates then had 2 psychiatric hospitalizations

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after her 4th pregnancy, both for psychosis and suicidal ideation. After her 5th pregnancy she
also had 2 hospitalizations.

Family history of psychiatric illness: Mrs. Yates’ brother had bipolar disorder. Her father, sister
and brother had depression.

Family denial, ignorance or fear of stigma: Family members described her as mute; staring for
hours and scratching bald spots into her head to show “666″ or the sign of the beast. Mr. Yates
described his wife as withdrawn because of her father’s death, and seemed to minimize her
deterioration.

Environmental and social factors: A rigid belief system seemed to dominate the home and
family. The couple had come under the influence of a self-proclaimed minister who preached
about Satan. These beliefs fed into Mrs. Yates psychosis.

Isolation: Andrea Yates home-schooled her children and had little interaction with neighbors and
friends.

Increased number of children: Mrs. Yates had 6 pregnancies and 5 children within the years
1994-2000. One pregnancy was a miscarriage. In addition, she was also breastfeeding between
each pregnancy and even during pregnancy. This disruption in the hormonal environment had
powerful effects on her mental status. Her hormone status had no time to re-establish
equilibrium.

Family and child services intervention: During a 1999 hospitalization, Mrs. Yates reported to the
staff that she was overwhelmed living in a converted Greyhound bus with her growing family of
4 children, 3 of whom slept in the luggage compartment. Mr. Yates told a social worker that he
was training his sons including the 3-year-old to use power drills. The social worker filed the
report with Children’s Protective Services but the state agency declined to pursue the case. The
psychotic mother was sent home to care for her children on her own.

Inadequate psychoeducation: The couple was warned about recurrence of postpartum illness. Mr.
Yates explained that the couple would talk it over when Mrs. Yates felt better and they decided
to have more children. Mr. Yates felt that they should have as many children as they could. Mrs.
Yates was hesitant to take medication during her pregnancies. This thinking has drastically
changed over the years. We now understand that some women must be medicated during
pregnancy and that the risk of medication may be less than the risk of illness. Early
pharmacological intervention during pregnancy would likely have prevented a recurrence of
psychosis.

Poor medical management of puerperal psychosis: For unclear reasons, the treating psychiatrist
discontinued Andrea Yates from antipsychotic medication. In general, she failed to receive an
acceptable standard of medical care.

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Stigma and lack of public education: Her friend wrote in a journal and warned Mr. Yates that
Andrea smelled like she had not bathed in days and paced “like a caged animal.” Unfortunately,
the public is not well-educated about recognizing mental illness and getting proper help.

The Future

The question we must ask ourselves is: why does stigma continue to exist with an illness that has
the same biological underpinnings as any other life-threatening illness for which emergency
services would have been called?

We, as a society failed Andrea Yates. We share equal responsibility for the tragedy. Friends,
neighbors and family watched as Mrs. Yates continued to decompensate. The medical
community failed to provide appropriate protection, social work assistance and child services to
a severely psychotic mother of five children. When the legal community and her state failed to
appreciate the severity of her illness, they eliminated her last opportunity for appropriate
treatment. It was only after the recent trial, in which she was found Not Guilty by Reason of
Mental Illness, that she was mandated to a psychiatric institution where she has been treated
appropriately.

Although stories like those of Andrea Yates are rare, they continue to occur. Many women are
serving life sentences. As a major public health problem, postpartum psychiatric illness is
predictable, identifiable, treatable and therefore, most importantly, preventable.

Those of us who pursue the goal of prevention will be obliged to override any anger or revulsion
we may feel with the compassion and courage to seek a more in-depth understanding of
infanticide. We, as a society, could do a far better job of preventing these tragedies.

What is required of us is to not look away, but to communicate with and learn from these
mothers. The great promise of understanding them better will play out in incalculable saved
lives.

Early Identification:

Women come to us in obstetricians’ offices, prenatal clinics and well baby centers. We meet
their families and children. They complete questionnaires and attend interviews by physicians,
nurses and social workers. How do we miss the warning signs of potential tragedy in one of the
most available populations in health care?

Recognizing antepartum screening as the best intervention strategy to identify women at risk, the
obstetrician’s or midwife’s office or prenatal clinic are the optimum environments to use simple
screening tools to identify women at risk in time for intervention.

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 Postpartum Support International
www.postpartum.net
1.800.944.4PPD

PMD Resources in Non-English Languages

Maternal and Child Health Library, Non-English Languages
www.mchlibrary.info/nonenglish.html

NSW Multicultural Health Communication Service

www.mhcs.health.nsw.gov.au/mhcs/topics/Pregnancy_and_Post_Natal.html

Here to Help. Downloadable brochures from a great mental health website in BC (Brochures in
Spanish, Vietnamese, Farsi, Korean)
http://www.heretohelp.bc.ca/other-languages

Beyond Blue website in Australia has a Booklet called “Emotional Health During Pregnancy and
Early Parenthood" translated into several languages including Vietnamese, Arabic, Chinese, Spanish,
German, Greek
http://www.beyondblue.org.au/index.aspx?link_id=102.944

En Espanol: Depresion Posparto

Maternal and Child Library
Website, publications, and hotline in English and Spanish.
MCH Hotline
http://www.mchb.hrsa.gov/programs/womeninfants/prenatal.htm
Para información en español sobre servicios prenatales en tu comunidad, llama al 1-800-504-7081.
Para información en inglés, llama al 1-800-311-BABY o llama a tu Departamento de Salud estatal o
local.

MedEdPPD.org www.mededppd.org/sp/
MedEdPPD.org es el sitio de Internet desarrollado bajo el auspicio del Instituto Nacional para la
Salud Mental (NIMH, siglas en inglés del National Institute of Mental Health) para educar acerca de
la depresión posparto (PPD, siglas en inglés de postpartum depression). En esta sección, Mamás y los
demás, contiene información para las mujeres con depresión posparto, sus familiares y amigos.

MedEdPPD Patient Brochure en Espanol

http://www.mededppd.org/pdf/brochure_spanish.pdf

JAMA (Journal of the American Medical Association)

Patient Handout
Depresion Postparto www.jama.ama-assn.org/cgi/data/287/6/802/DC1/1

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Mental Health America of Houston
http://www.nmha.org/go/en-espanol

New Jersey Department of Health

www.state.nj.us/health/fhs/ppd/sobre.shtml

US Department of Health & Human Services

http://www.womenshealth.gov/espanol/preguntas/postpartum.htm

Family Doctor
www.familydoctor.org/e379.xml

The Perinatal Project: Mental Health Advocacy for Mothers

www.perinatalproject.com/links_espanol.php

Wisconsin Perinatal Foundation

www.perinatalweb.org/content/view/79/220/

MedLine Plus (NIMH)

http://www.nlm.nih.gov/medlineplus/spanish/postpartumdepression.html

Postpartum Support International Spanish Resources

Apoyo de PSI para las familias hispano parlantes: 1-800-944-4773, #1
Brochure: http://postpartum.net/wp-content/uploads/2008/11/psi-brochure-2008-spforweb.pdf
Spanish Poster: http://postpartum.net/poster/ (select Spanish)
Spanish Fact Sheet: http://postpartum.net/wp-
content/uploads/2008/07/trastornos_psicologicos_perinatales-_fact-sheet-spanish_1.pdf
Updated Resources: http://postpartum.net/resources/#spanish

BOOK:
Mas alla de la Melancolía
Shoshana Bennet & Pec Indman’s book, available in Spanish and English
www.beyondtheblues.com

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Inspiration for Moms -
Below are a list of songs, quotes, poems and other things that are encouraging when going through a
perinatal mood disorder. May they give you strength and hope. If you have suggestions for this page,
email me at stonecallis@msn.com.

QUOTES:

"If God sends us on strong paths, we are provided strong shoes." -- Corrie TenBoom

"Hope is the feeling you have that the feeling you have isn't permanent." -- Jean Kerr

"Strength is born in the deep silence of long-suffering hearts; not amid joy." -- Arthur Helps

"Bless your uneasiness as a sign that there is still life in you." -- Dag Hammerskjold

From reader Molly N.: "New life comes after feelings of being forsaken."

From reader Genara D., said to her by her OB: "You do not have to be the perfect mother - no such thing
exists. You just have to be a "good enough" mother for your baby. And that's all that counts ..."

SONGS: Reader Lauren H. suggests: "Just Breathe" by Anna Nalick

I loved "We Fall Down (But We Get Up)" by Donnie McClurkin

CHRISTIAN INSPIRATION - BIBLE PASSAGES

- From reader Tara M.:

The LORD is close to the broken-hearted, and saves those who are crushed in spirit. - Psalm 34:18

So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help
you; I will uphold you with my righteous right hand. - Isaiah 41:10

When you pass through the waters, I will be with you; and when you pass through the rivers, they will not
sweep over you. When you walk through the fire, you will not be burned; the flames will not set you
ablaze. - Isaiah 43:2

I can do everything through him who gives me strength. - Phillipians 4:13

Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your
hearts be troubled and do not be afraid. - John 14:27

But those who hope in the LORD will renew their strength. They will soar on wings like eagles; they will
run and not grow weary, they will walk and not be faint. - Isaiah 40:31

2 Corinthians 4:8-9
We are hard pressed on every side, but not crushed; perplexed but not in despair; persecuted, but not
abandoned; struck down, but not destroyed.
 POETRY:

The Good Mother by T. McGarrigle

To be a good mother was a priority in my plan,

A painted nursery, tiny clothes and shoes, the safest minivan.
I tried to have it all mapped out so all would flow just fine.
What I didn't realize is that babies don't easily follow along these lines.
Hectic and unpredictable our life has now become.
I envy those Good Mothers -- I wanted to be one.
Now my picture-perfect life seems to unravel before my eyes.
I choke back tears and force a smile. Good mothers do not cry.
Are those good mothers really as all-together as they seem?
Perhaps they are, but to me right now, it only is a dream.
My dream of being a good mother keeps my mind always running wild.
Just for this moment, I need to pause and embrace my little child.
As I look around me, I watch how my standards fall.
Does it really matter if I'm not always on the ball?
The frustration of trying to do it all makes for a heavy laden heart.
Lowering my expectations right now is really very smart.
I know that deep inside of me is the strength to see this through.
For now, I'll do the best I can... for that's what good mothers do.

From reader Kim Rogers:

Be like the bird to the page--a woman

That pausing in her flight her unmother-self never
While on boughs too slight, could have even acted onscreen
Feels them give way She told him off: stick
Beneath her, and yet sings, to fighting aliens, stay away from giving
Knowing she hath wings advice unless your own belly births
-- Victor Hugo a child. You believe only
"Shout Out" in tenet, not in story, not in the bodies of women
By Suzanne Swanson She told, she tells. We tell her back:
She told them Fine, told herself Yes, yes--me, too--and
truth/buttressed by judgment/ No, not like that but every bit as ragged
in a tiny, tinny voice: nothing or not me, but my aunt... my best friend
working, not natural, not normal We say the simple thank-you,
Only later did she tell how shout out a blessing, to Brooke,
she'd lied: flowing silver lies, lied to Marie, to Jane, Wendy, Diana, Shoshanna,
to herself, her husband, brittle Mary Jo.
black-and-white lies to ____________, to __________, to
to her family, to the doctors ___________.
She told it then in print--stripped Insert your names here.
celebrity and image, turned herself over
 From Karen K.:
Deeper
I thought I had been pulled to the deepest parts
with nowhere lower to go
my mind, identity, will and spirit
all challenged like never before
I thought I had reached the ends of this pain
that surely I couldn’t bare more
yet God moved His hand and with purpose and
plan
somehow opened a door in the floor
So I fall deeper
I sink deeper
I cry harder
my strength wanes
I thought that the hard desert floor where I stood
was finally the bottom of levels
But lo and behold I’ve been sucked down a
crack
to be taunted by darkness and devils
When I thought that I couldn’t take any more
pain
being broken beyond repair
the pieces were crushed and became just a
powder
To be walked on and scuffed without care
so I break harder
I sink deeper
I cry harder
my strength wanes
The word overwhelmed doesn't capture this
place
Overwhelmed is passed and long gone
To be misunderstood by the ones that I need
Is a loneliness all on its own
I hadn’t a clue that my innermost parts
could put forth such anger and spite
I break like fine porcelain tender to touch
with a temper fuse nowhere in sight
so I feel guiltier
I sink deeper
I cry harder
my strength wanes
Oh Father, have mercy, I need you tonight
to lift me up out of this hole
My heart knows You’re here and You followed
me in
This all is beyond my control
As deep as You take me I know I’ll survive
I will lift up the wounded with love
No matter the cost I will still hope in You
and I’ll fight to keep looking above
So I’ll fly higher
I’ll float lighter
I’ll cry softer
And my strength will be renewed.