The last time Emily Chua saw her friend, Allison Goldstein, was at a going-away party just before Goldstein moved from Alabama to Southern California with her husband and 4-month-old baby. Goldstein, whose husband is in the Air Force, seemed sad, but that was understandable as she was about to leave friends and move far away from family, Chua said. No one sensed the depth of Goldstein’s pain, nor how turbulent her feelings had become.
Just two weeks after her move, Goldstein took her own life. She had been quietly hiding her depression and anxiety following the birth of her daughter.
“She didn’t know how to express her feelings,” Chua said. “She hid it so well. By no means was she alone and she was a wonderful mom. But she didn’t know how to say what she was feeling.”
It is the most common complication of childbirth, yet it often goes unrecognized as such. One in seven women will experience perinatal mood and anxiety disorder (PMAD), which is a general term that describes a wide-range of emotional and mental health disorders surrounding pregnancy, including postpartum depression.
PMAD is one of the most easily treatable mental illnesses, and yet only about 30 percent of women who experience symptoms will seek help, said Ann Smith, president of Postpartum Support International, one of the largest worldwide organizations dedicated to promoting awareness, prevention and treatment of mental health issues related to childbearing.
Many women hide their depression, anxiety and mental pain out of misplaced feelings of shame, fear and isolation. Smith wants to change that.
“This should be a subject talked about during pregnancy, just like you would talk about nutrition and vitamins or how often the baby moves,” Smith said. “And we need to understand that it’s an illness, not a weakness. You didn’t bring it on yourself. You aren’t alone, you aren’t to blame, and, with proper help, you will be well.”
PMAD can strike any woman, of any background, ethnicity, culture, age, or education level, which is why anyone who is pregnant needs to understand the symptoms and feel empowered to advocate for themselves and get the help they need, Smith said.
“Every woman should educate themselves about this, but also understand that nobody needs to go through this alone,” Smith said. “Do not be silent. Couples should talk about it. Families should talk about. Dads and partners need to understand that this is something that can happen.”
Understand the symptoms
Many women experience symptoms that aren’t primarily focused on depression, Smith said. They may have anxiety, post-traumatic stress disorder stemming from a traumatic childbirth, or obsessive or compulsive thoughts and feelings. For others, symptoms start during pregnancy, and may continue after birth, or may resolve before the baby is born.
“Many women say; ‘I’m not depressed. I’m incredibly anxious. I can’t breathe. I can’t eat. But I’m not sad,’” Smith said.
Some women find they are battling intrusive thoughts. These are fears that constantly flood a woman’s mind about something horrible happening to the baby, like falling off the changing table or drowning in the bath tub, and oftentimes at the hands of the mother herself, Smith said. These are painful and scary to the mother, though she is unlikely to follow through with them.
“It’s like having a song on your brain. You keep hearing it over and over,” Smith said. “It may happen 50, 60, or 70 times a day.”
Compulsive thoughts are different then suffering from perinatal psychosis, which is when a woman believes she is hearing voices, or seeing hallucinations or images that others can’t see. Anyone suffering from a psychosis is in a medical emergency and needs to seek medical help immediately, Smith said.
The risks of PMAD are real. Some women go on to face a lifetime of chronic depression following untreated postpartum depression. And suicide is the number one cause of maternal death after the first 10 days of giving birth, Smith said.
“Whenever someone has moderate-to-severe perinatal mood disorders, life is very unpleasant. They are probably having a hard time functioning,” Smith said. “But some people, especially those with better social skills, may be able to hide it better.”
There are certain symptoms to watch for, Smith said. Take note if a women seems to be struggling with anxiety, if she makes plans with friends and cancels last minute, or if she is quickly losing weight or gaining weight, crying often, or unable to sleep.
“If you see a friend or a family member struggling or constantly unhappy, you need to sit down with them,” Smith said.
Find a way to connect
Looking back, Chua wished she had been able to help Goldstein open up about what she was going through. At the time, Chua herself was dealing with her own depression and anxiety connected to the pregnancy of her second child, which she hadn’t publicly announced at that time. Chua had also experienced similar bouts during her first pregnancy.
“This is such a hard topic and it’s hard to talk about these feelings,” Chua said. “But the more we talk about it, the more we realize it’s a common thing. We need to retrain society to think about this in a different way.”
Goldstein’s death rocked Chua. Both were military spouses who met while teaching at the same elementary school near Eglin Air Force Base in Florida. They had been through pregnancies together and had supported each other during their husbands’ deployments. They both moved to Alabama around the same time and Chua counted Goldstein as a good friend.
“Allison was the kind of person who was so full of life and energy. She was a very social person and loved having fun,” Chua said. “When she found out she was pregnant, she was over the moon to have a baby.”
After Goldstein’s death, Chua launched a group called Sunflower Meet Ups, named for Goldstein’s favorite flower. The informal “come as you are” support group isn’t focused exclusively on those dealing with PMAD, but it’s a way for any military spouses, of any background, to mingle, connect, and plug into resources if needed. Oftentimes, counselors or representatives from family and mental health support services available on base will stop by to chat with the group, which is held weekly on Maxwell Air Force Base in Montgomery, Alabama.
“Sometimes you just need a place where you can show up wearing leggings and haven’t showered in two days and know the other spouses there will understand that,” Chua said.
Postpartum Support International’s Warmline (English and Spanish): 800-944-4773
National Suicide Prevention Lifeline: 800-273-8255