It's more than baby blues: postpartum depression

When postpartum depression makes the news, it’s usually because either a celebrity is involved or because some woman hurt her baby. Despite its common occurrence-1 out of 8 women will experience it-it is still not openly talked about. Maureen O’Hara in this month’s Mothering magazine talks about depression, including PPD and how it’s still stigmatized in our society. It’s even more pronounced in a society where we’re expected to raise our children isolated from the extended family support systems that humans have lived in since before we walked upright.

According to Ruta Nonacs, MD, on emedicine.com, most women will experience minor mood disturbances in the postpartum period. 10-15% of women will have the more serious postpartum depression. Postpartum psychosis, the most severe form, is seen in only 1-2 women out of 1000 births. Risk factors or PPD include prenatal depression or anxiety, childcare stress, marital or family issues, low social support, history of previous depression, low socioeconomic status, unwanted pregnancy, history of genetic mental illness and substance abuse (Wikipedia). Even with increased awareness, PPD often goes unnoticed and untreated. In addition to the toll this takes on mom, it can affect relationships with other family members and can inhibit the normal development of mother-child attachment. Research suggests that untreated PPD can have long term affects on baby’s development and behavior (Nonacs).

It’s no surprise that women go through significant changes immediately following birth. Hormone levels of progesterone and estrogen that rose gradually throughout the pregnancy now drop off sharply. So how can you differentiate between “Baby Blues” and depression? It can be common for women to have mood swings, irritability and tearfulness after the baby is born. These usually peak on the 4th -5th day following birth and are resolved within a few weeks. Most importantly, they do not interfere with the woman’s ability to care for herself or her baby.
Postpartum depression usually sneaks up over the first three months, although it can have a rapid onset. PPD is persistent and debilitating. Symptoms of PPD include: depressed mood, tearfulness, inability to find pleasure in events that were formerly pleasurable, insomnia, fatigue, appetite disturbance, suicidal thoughts, and recurrent thoughts of death. Women with PPD may have incessant fears about their babies’ health or, conversely, be ambivalent towards or have thoughts of harming their babies. I think this last one often causes women to hide or ignore their symptoms. When I had my first daughter I was a poor, single mom with a history of depression. Her father did not help with her care and I was afraid to go to take my problems to my family for fear of looking like a failure. Several weeks after she was born I started having images of accidentally putting her in the oven or the freezer and forgetting her there. I couldn’t get it out of my mind and I really thought I was going crazy.
My silver lining was my support network. At the time I had several friends who were pregnant and gave birth around the same time as me. We babysat for each other, laughed and cried with each other. We had someone who never tired of hearing every minute detail of the newborn experience. Another thing that helped was breastfeeding. Nursing releases prolactin, a hormone that stimulates the mammary glands to produce milk. Prolactin has also been shown to increase feelings of satisfaction. In a study done by Maureen Groer, at the University of Tennessee School of Nursing, women who breastfed were more likely to report less stress and negative moods in the postpartum period than formula feeding mothers. She reports that breastfeeding seems to be protective of women’s moods in the postpartum period.
Some women may need more help. There are traditional and non-traditional therapies for PPD. There’s no shame in taking antidepressants to get you over a tough spot. If you are breastfeeding and think you need to go on antidepressants, talk with your doctor about the best medicine and when to take it. kellymom.com is a great resource on breastfeeding and has information on BF and antidepressants, alternative therapies and PPD. In April, 2006, Governor Corzine signed a bill requiring health care professionals to screen new mothers and provide information on PPD> The NJ Department of Health and Senior Services has a web page on PPD, http://www.state.nj.us/health/fhs/ppd/index.shtml or call the 24 hour hotline(in NJ)1-800-328-3838. If you think you may have PPD, or if you think someone you love might have it, get the help you need, it’s the best thing you can do for yourself and your baby.

Family Leave: The Law and Your Rights

On February 5, 1993, Bill Clinton signed the Federal Family and Medical Leave Act, fulfilling one of his campaign promises. The law guarantees employees 12 weeks a year of unpaid leave for giving birth to or adopting a child, caring for a sick child, parent or spouse, or being unable to work due to health reasons. New Jersey had already passed a similar law in 1990, granting you 12 weeks of unpaid leave every 24 months. Knowing what you’re entitled to can be confusing. I took family leave in 2005 and even my human resource department was unsure of certain things. Make no mistake, HR is looking out for the company’s best interest, not yours.

According to the federal law, family leave is unpaid leave provided for birth, placement of child for adoption or foster care, to provide care for the employee's own parent (including individuals who exercise parental responsibility under state law), child, or spouse with serious health condition, or employee's own serious health condition. The NJ law is similar, except that is does not provide leave for your own medical conditions. Each law has limits on who is eligible. For a good run down on the differences between the federal and the NJ laws, go to http://www.dol.gov/esa/programs/whd/state/fmla/nj.htm or you can get further information by contacting the nearest office of the Wage and Hour Division, listed in most telephone directories under U.S. Government, Department of Labor, Employment Standards Administration, or by dialing 1-866-487-9243. The Office of the Attorney General, Division of Civil Rights also has a website with info: http://www.state.nj.us/lps/dcr/law.html#FLA

When you’re thinking about taking family leave, you need to give your employer at least 30 days notice. Where I work, you must use up all of your paid leave concurrently with the unpaid leave. That means, if I have 3 weeks sick time accrued, my family leave starts with my first day off giving me 3 weeks paid and 9 weeks unpaid. This is at the discretion of your employer and is not specified in the law. Sit down with your HR person and get everything in writing. A friend of mine took family leave due to an illness and was not told that she could take it intermittently. For instance, if you are getting treatment for cancer, you could take the federal family leave for a few days following every chemo or radiation treatment, which sometimes require months of treatment. She took all her leave at once and thereafter had to drag herself to work no matter how sick she felt.

In NJ women are also paid temporary disability before and after the birth of a child. In normal circumstances, this is for 4 weeks before your due date and 6 weeks after vaginal birth, longer if you had a C-section or other birth complications, another disability or are unable to perform your job. Again, check with your employer. They may let you take your disability first and then dip into your paid sick time or they may make you use up your sick time first, leaving you with less weeks to collect disability. Find out how much your disability is going to be. In NJ, the weekly benefit amount is calculated on the basis of your average weekly wage. If eligible, you will be paid two-thirds of your average weekly wage up to the maximum amount payable, which is $502 for disabilities beginning on or after January 1, 2007. Also, see if your job has supplemental disability insurance you can sign up for. With supplemental insurance, you can usually collect up to 60% of your regular pay. Don’t plan on getting 100% of what you normally earn and you can’t double dip, meaning you can’t take paid sick leave and disability at the same time.

While you’re out, your employer must retain your benefits as they were while you were working. If you pay for a portion of your benefits, you might still have to pay that portion but you do not have to apply for COBRA. When you return they must give you the same or a commensurate position. There are exceptions, check with the above site or phone number for more info. And again, have a talk with your company’s HR department and get everything in writing.

Unfortunately, many parents cannot take advantage of the Family Leave Act because they cannot afford to take unpaid time off. NJ Citizen Action Campaign (http://www.njcitizenaction.org/pfl.html) is working on a bill in the NJ legislature that would allow for employee funded family leave insurance. Granted, it’s not as good as Denmark, where mothers get 18 weeks off at full pay after the birth of a child. Maybe someday we’ll live in a country where the needs of families are given a higher priority. In the meantime, know your rights.

**This article was written for people living in NJ. For information on your state, try here.