Mamarama: Postpartum Mood Disorders and New Jersey

Last week, 34-year-old first time mom, Miriam Carey was fatally shot following a dangerous car chase in Washington D.C. Following this tragedy, Carey’s mother suggested that her daughter’s irrational and aggressive behavior was a result of untreated postpartum depression. Though this diagnosis is difficult to substantiate, it cannot be entirely ruled out as Carey was said to become emotionally unstable in the months following her August 2012 birth.

Postpartum mood disorders don’t generally make national headlines, unless a woman has done something so unthinkable that the incident is splashed all over the news. Andrea Yates is what we might refer to as the most infamous case of postpartum depression. In clinical terms, she actually suffered from “postpartum psychosis” as well, which is far more rare and inherently dangerous, in contrast to postpartum depression. Yet the public generally has little exposure to the broader concept of postpartum mood disorders which studies show impact up to 85% of all new mothers. The Latin term “postpartum” simply means “after birth” and is so frequently linked to the word “depression” in the media that people often think they are one in the same. Though the term “postpartum depression” or PPD is familiar to many, it remains largely misunderstood.

About ten years ago, Jersey City resident “Lydia” descended down the path of PPD following the birth of her first child. “I had some of the precursors that put me at risk for postpartum depression,” she explains, “including the death of a close family member and some history with anxiety before.”  But what Lydia had not anticipated was how crippled and isolated she felt by the disorder. “Nobody truly understood what I was enduring, not even my husband. My OB couldn’t help because I only saw her once after I had given birth.”  Eventually Lydia reconnected with her former therapist and began sessions again. Her therapist referred her to a psychiatrist who recommended medication to treat her symptoms. A decade ago physicians were less able to chart the effects of anxiety and mood medications on breastfed babies, so Lydia’s situation was made more difficult by the recommendation that she quit breastfeeding in order to take meds that would improve her well-being. “It was a very tough decision to make, but I held out for almost 10 months of breastfeeding, then started with my meds.”  Today, most depression and anxiety medications prescribed for postpartum mood disorders are deemed safe for breastfeeding mothers.

Much has changed in ten years regarding postpartum depression awareness – particularly in New Jersey. In 1984, following the birth of her first son, Mary Jo Codey (our former First Lady of New Jersey) reported feeling completely “out of sorts” and incapable of caring for her child. She let her baby nurse do most tasks, assuming she’d feel better as the weeks passed. Instead, depression and its related anxieties kicked-in, causing her to have horrifying thoughts of harming her baby. When she was diagnosed with “postpartum depression” the term was completely unfamiliar to her. She says that she could not even find a single book on the topic.

Flash forward a couple dozen years to when her husband, Richard Codey, became acting governor for New Jersey. The first item on their mutual agenda was, in fact, postpartum depression and ways to better inform healthcare providers on how to identify and offer help. This led to New Jersey being the very first state to enact legislation for postpartum mood disorder screenings and education. The program “Speak Up When You’re Down” encourages women and their families to speak openly to one another and with their healthcare provider if they’re feeling depressed or anxious after the birth of their child. It also provides a 24-hour live toll free PPD help line (800 328 3838) with postpartum depression resources. Keep in mind that about 85% of all women experience a normal postpartum mood reaction, often referred to as “Baby Blues.” True postpartum depression occurs in about 15% of the population and presents itself differently (and more acutely) than the “Baby Blues.”

Now, every New Jersey hospital must do a screening test, typically they use the Edinburgh Scale, to see if a woman might be at risk for a postpartum mood disorder. (Signs that a woman is at risk include:  Apathy toward baby or hyper-anxiety over baby, debilitating fatigue, insomnia, rapid-weight loss, feelings of hopelessness, inability to socialize with other new moms. If you hear a postpartum woman say, “I just don’t feel right” – take that as a clue and seek help.) This test must be administered before she is discharged from the hospital with her baby. Though this may not catch a case of PPD six weeks into the postpartum period, it at least provides feedback on the woman’s emotional state and allows a behavioral healthcare professional to follow-up with her.

Another way women suffering from mood disorders might seek help is through “New Moms” groups or postpartum depression-specific groups (see resources below.) Hospitals in New Jersey are currently incorporating regular “New Moms” groups as part of their community offerings, along with other prenatal classes, or even postpartum exercise classes. The idea is that a woman at risk might attend these groups and share feelings about her emotional state. The facilitator of the group can then sort out women at risk and refer them to the available resources.

Sounds pretty healthy and positive, right?  When I mentioned these services to a group of postpartum professionals and sufferers in New York City, the idea was met with gasps (from those who were not aware) and affirmative words of acknowledgement from those who knew about this legislature. How could it be, they wondered, that just across the river women in New Jersey had so much more attention and access to care than in New York City? Manhattan has some of the best hospitals and physicians in the country – yet without a system in place, women slip through the cracks and never receive necessary attention.

Last spring, a 44-year-old Manhattan attorney, in the throes of postpartum psychosis jumped from her apartment building window with her baby strapped to her chest. She did not survive, but her baby miraculously did. I can’t help but think that if her friends and family could not save her, some medical professional might have stepped in and recognized the signposts of such a serious disorder. (Sign posts:  Any woman with a history of anxiety, depression, physical or sexual abuse, eating disorders and OCD can be at risk for a mood disorder. Having a traumatic birth experience, a family death, excessive stress, and moving to an unknown community can all accelerate depression or anxiety.) Unfortunately, a woman’s obstetrician or midwife no longer sees her on a regular basis after her baby is born. The only doctor women tend to see with any frequency, after birth, is her baby’s pediatrician; however, she is not the patient in that setting. Without support groups and with little medical attention, many women with depression or anxiety might be similarly undiagnosed and left at risk.

With more resources in place, more awareness about postpartum mood disorders, and less stigma attached, New Jersey is leading the way – setting a gold standard of care that can and should be replicated across the country.

Local Support Groups – All Free of Charge:

Jersey City Medical Center – “The Mommy’s Club” – Every other Thursday, 4 pm – 5:30 pm, no cost. Contact Jenna Whiteside, at 551 226 0420, for registration or additional information. This group is PPD-specific.

HobokenUMC – “The New Moms Support Group”  - Every Tuesday, 11:00 – 12:30 pm, no cost, call 201 418 2690 to receive an announcement confirming the group’s location. Ideal for all new moms.

Palisades Hospital – “Mommy and Baby Care Group” – Every Thursday 11 am – 1 pm, no cost. For all new moms.

The Complete Guide to Medications During Pregnancy and Breastfeeding, by Kate Rope is also an excellent resource.

Editors Note: If you or anyone you know might be coping with a mood disorder after the birth of her baby, don’t hesitate to reach out for help: Call your local hospital or 800 328 3838 for immediate assistance.