Blackish Cloud of Depression

In October 2017, the maternal mental health world was atwitter with news that the TV sitcom, Blackish, was going to tackle postpartum depression in its storyline.  I, just like everyone else, was curious to see how it would be treated; however, I had not been watching the series.  Like the anal-retentive reader that I am, I knew I wouldn’t be able to watch except from the beginning, to get a full sense of the story, the setting, the characters.

I started binge-watching this winter during one of the multi-week stretches of snowstorms and flu-like symptoms.  I loved getting to know the Johnsons, seeing their story unfold.  As soon as Rainbow told Dre she was pregnant, though, I waited anxiously for the signs.  They didn’t come until the last episode of season three: Sprinkles.  A headache brought Bow into the doctor’s office and the train of preeclampsia rushed from the station.

As she lay on the operating table waiting for the anesthesia to kick in, Rainbow delivered the opening address of postpartum depression.  She may not have known it at the time, but she outlined many of the contributing factors of postpartum depression.

“This wasn’t supposed to happen like this.”

Unrealistic or unmet expectations

 

“I’m really good at this stuff. I’m a baby maker.”

High standards.  Betrayal or failure of body.

“This is not normal.

Doesn’t meet the ideal.

“I’m really scared.

Fear.  Anxiety.

What if something goes wrong?”

Ruminating.  Irrational fears or worries.

While her blood pressure began to decrease immediately following the baby’s delivery, Rainbow couldn’t hold her baby.  He’s whisked away to NICU while she’s anchored to the operating table.  Go with him, she pleaded with Dre; someone needs to be with our baby.

Dre had his own emotional trauma surrounding the birth.  The doctor intimated that their first priority in cases such as Bow’s is to save the mother, introducing the concept of maternal or fetal mortality.  Trying to anchor his wife in this unexpected development was complicated tenfold by the possibility of losing one or both of his loved ones.  Even when the baby was successfully delivered, he confessed to his father that he’s afraid to love him in the event that something horrible happens to him.

Sprinkles isn’t even the postpartum episode.  But even if I didn’t have the spoilers I did, the writers did a phenomenal job foreshadowing the struggles to come.  As was my own experience with postpartum depression, a perfect storm of conditions converged and they’re laid out in a nuanced and real, respectful manner.

I’d had a long day yesterday and needed to decompress at the end of it.  I knew I was staying up far too late for my level of exhaustion, but needed to unwind.  As I sat there, solitary, sobbing, as the rest of my family slept, I thought, well that didn’t work.  But then, I remembered the date:  May 2, World Maternal Mental Health Day.  How very fitting that I finally happened upon the postpartum part of the Blackish story on this of all days.  This story stirred the very raw emotions of my own experience because it was so eloquently treated – and the story is just beginning.

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IMDb

No More Smoke Screens

Last Wednesday, I had my six week follow-up appointment after the birth of my newest baby girl. The six weeks that had elapsed seemed like an eternity and yet instantaneous – like any spool of time surrounding a major life event does.

In the thick of summer vacation, I marched my older three girls into the office with me. Not ideal, but with the aid of electronic devices and some seats just outside the examination room door, I was able to avoid the embarrassment of an internal exam with the oldest two looking on and retching. I stationed my six year old’s chair full of crayons and coloring books at my head, the infant nestled in my chest.

Upon my arrival, the receptionist handed me the ubiquitous clipboard with the Edinburgh Postnatal Depression Scale. I knew it was coming. I was actually looking forward to it. I took it in hand almost giddily. There were a few reasons for this.

1. I didn’t need it.

Just a few days after the birth of my baby, a visiting nurse came to our house. Since it was a holiday weekend, we weren’t able to get an appointment with our pediatrician to check our breastfed baby’s weight and absence of jaundice so the hospital arranged for the home visit. While I expected the nurse to check the baby, she also looked after me, administering an EPDS. My score fell far below the range of danger for postpartum mood and anxiety disorders. Ever the overachiever, I joked with my husband that was a test I’d happily fail.

2.  But if I did, my answers to these questions would signal to my practitioners what sort of help I needed.

3.  If they gave the questionnaire to me, they gave it to all postpartum patients, which meant that all women had access to help if they were struggling.

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Jennifer Butler Basile

Still, when I handed the clipboard to the nurse in the examination room, and she followed up with questions like, ‘Have you ever thought of harming yourself or the baby?’, she asked them in a hushed voice. She apologized, saying she had to ask everyone.  Her tone insinuated it wasn’t me that was crazy, but it was her job to ask every mother in case one of them was. I knew part of her low volume was to spare my very aware six-year-old the world of suicide and psychosis, but I knew that wasn’t all of it. The apologies were born of shame, stigma; to separate me from those ‘tainted’ women, those we can’t speak of, for fear of ‘catching’ what they have.

But I was like them. I had what they had. I was just six years out.

Six years earlier, I would’ve been scared off by whispers like that. I wouldn’t have answered truthfully, if I’d thought it would smear me with that shame. Not because I didn’t need help. Not because I wasn’t having irrational thoughts. Not because I knew how to fix it myself. Because I felt that saying yes would be submitting to defeat.

I’m not trying to pin the shortcomings of postpartum care on this one nurse. If anything, this one nurse’s demeanor only shows just how difficult it is to discuss these matters. But the only reason I didn’t face these struggles this time is because someone asked the tough questions. Because a friend, a mother who had gone through the same struggles insisted I get help. And because once I healed, I knew how to prepare and preempt the struggles this time.

So wave the clipboard proudly. Answer the questions honestly. Ask for help loudly.

Mental health screenings should elucidate symptoms, not throw up smoke screens.

When does a perinatal mood disorder start?

Please read on to pinpoint when you or a woman close to you will begin to see signs of a perinatal mood and/or anxiety disorder.

  • When two lines appear on the pregnancy test
  • When pregnancy is unexpected
  • When pregnancy is finally achieved
  • When pregnancy is not achieved
  • When the mother loses the baby
  • When the mother chooses not to have the baby
  • When the adoption falls through
  • When the drastic changes in lifestyle that having a baby will induce begin to occur:
    • nausea
    • extreme exhaustion
    • no more wine with dinner or beer after a rough day
    • limited mobility
  • When the hormones at flux in the pregnant body affect thought processes
    • heightened anxiety at the amazing responsibility of growing and then caring for a baby
    • fear of the unknown or varied outcomes of gestation, labor, delivery, and aftercare
    • ambivalence over the new self the mother must create or become
    • mourning the loss of the former self
  • When medication regimens must be altered due to unknown effects of routine prescriptions on the fetus
  • When mother worries and feels guilty about continuing medication and its effects on fetus
  • When mother suffers a loss during pregnancy
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    postpartumpathways.com

    • death of a loved one
    • separation from partner
  • When the mother has no partner or support person
  • When a drastic transition occurs during pregnancy
    • moving homes and/or locations
    • away from support network
    • loss of own or partner’s employment
  • When labor and/or delivery does not go as planned or expected
  • Traumatic labor and/or delivery
    • physical trauma
    • emotional or psychological trauma
  • Complicated recovery from labor and/or delivery
    • infection
    • injury
  • When adoption is complete
  • Unexpected medical condition in infant
  • Loss of infant
  • Difficulty feeding infant
    • breastfeeding
    • colic
    • reflux
    • allergies
    • tongue tied
  • Extreme fatigue recovering from labor and caring for newborn around the clock
  • No routine
  • No schedule
  • No down time – constantly being needed, touched, suckled
  • Disappointment at real life not matching imagined version of motherhood
  • Hormones further thrown into flux after baby-growing part of process complete
  • Stress
  • Too much interference and advice from others
  • Not enough support and help from others
  • Isolation
  • Weaning child from breast (days, weeks, years after birth)
  • Being sole caregiver for a fragile, totally dependent being

After reading this list, it should be an incredibly simple and precise process to pinpoint exactly when you or a woman close to you will exhibit signs of a perinatal mood disorder. Diagnosing and treating it should be even simpler. And recovery? Piece of cake.


Hopefully it is quite obvious that the way I’ve chosen to frame this list is tongue in cheek. The individual items on the list are anything but. They are varied; some mutually exclusive and many overlapping – to show that there is no one road map for predicting, preventing, diagnosing, or treating perinatal mood disorders. Perinatal mood disorders come in many different forms with many different time lines. The one surefire tool to helping yourself or a woman close to you who is suffering is awareness. Awareness of the myriad possible causes and many symptoms that can present. And then reaching out.

To her. To your physician. Midwife. OB. GYN. Pediatrician. Counselor. Therapist. Psychologist. Psychiatrist. Friend. Mother. Partner. Neighbor.

With an illness this insidious, multi-faceted, and far-reaching, silence is not an option. The lives of our mothers, babies, and families depend upon it.

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