It’s taken me a little over five years to write this article—five years digesting what happened to me and finding the tools to talk about a battle that pitted my rational, pediatrician’s sensibilities against the flights of fear and paralysis any woman can face when blindsided by postpartum anxiety.
I gave birth to my second son, AJ, in 2010 and immediately found myself paralyzed by anxiety. I lay awake at night consumed with worry – worry that if I fell asleep, he might wake up and then I wouldn’t be able to function the next day and my milk supply would get thrown off. Worry that I would never be able to leave him with a sitter, because he would need me while I was gone and I’d have to pump and everything would be thrown out of whack. I thought that if my nanny had to give my son a drop of formula he was doomed, and I was a failure.
Intellectually, as a pediatrician, I knew my baby was fine, but, as a mother, I couldn’t stop worrying—all the time, about everything, including the fear that other people were judging me. Why wasn’t I happy? I must be a terrible mom. What was wrong with me? I kept these fears deep inside, hiding miserable, dark isolation behind smiles over brunch menus. Motherhood was suffocating me, but I was too scared to tell anyone. I judged myself in ways I would have never done to any friend, family member or, heaven forbid, patient.
Then, just as I was about to return to work, I had a panic attack and knew I needed help.
As far back as the early physicians Hippocrates and Galen there are descriptions of “melancholia” in women following childbirth. In fact, during the late 1800s and early 1900s, women who suffered from postpartum mental illness were classified as having “hysteria,” from the Greek word hysteron meaning womb (thought to be the origin of the illness). The diagnosis was so prevalent and so detrimental to women that the time period became known as “the golden age of hysteria.” The go-to treatment back then was institutionalizing women against their will.
In the mid-19th century, French physician, Dr. Louis Victor Marce, decided to actually study postpartum depression. Based on his research, he concluded that depression after childbirth had a unique set of characteristics that he was convinced were biologic in nature. But his work did little to make a dent in the stigma associated with mood disorders around pregnancy. Women were still locked in asylums and many kept silent out of fear. In 1986, the American physician James Hamilton lent his voice to the idea that postpartum mental health disorders were biologically driven, but mainstream medicine remained unmoved.
Recognition of perinatal mood and anxiety disorders and research into them has been hampered by the assumption that the bond between mother and child is the most naturally occurring relationship, that it necessarily develops without a hitch or need for intervention across all species.
That assumption—of a biologically automatic, harmonious path through pregnancy and childbirth, one that leads, in the collective imagination, to inevitable, motherly bliss—has given birth to a taboo that keeps maternal mental health shrouded in darkness. Women are supposed to love being moms right out of the gate. If they don’t, the first assumption is not that they have a mental health disorder that can benefit from treatment, but that they are somehow flawed as people and as mothers.
Only recently has science begun to approach a more nuanced understanding of the range, mechanics of, and effective treatments for perinatal mood disorders such as postpartum depression and anxiety and still an older physician colleague who told me I shouldn’t tell anyone—particularly my patients—that I once suffered from postpartum anxiety. He suggested that patients and colleagues alike might see this as a sign of weakness and worry about my competence. It’s inconceivable to me as a woman, and a doctor, that we can be so culturally insensitive to a medical issue that can deeply impact women’s lives and the healthy development of their families.
I didn’t listen to that colleague, thankfully. In fact, I am passionately open about this topic with patients, colleagues, friends, and family. Other women do not need to suffer like I did, which is why I screen new moms for perinatal mood and anxiety disorders at the two-week, 5-week and 6-month well baby check-ups. I also ask them how they are doing when they seem to be struggling, and I listen to what they say. I let them know that what they are feeling may get better with time, but that they don’t have to wait and see. There are effective treatment options and the sooner they take advantage of them, the faster they can begin to enjoy life with their new baby.
At my practice, Premier Pediatrics in Brooklyn and Manhattan, we also developed a program called The First Month in which we provide lactation consultation, nutrition guidance, and mental health support to ensure the overall wellness of the entire family in the first month after a baby is born. We partner with local therapists to offer our patients therapeutic interventions at low cost. For new moms who are suffering, the realization that they are not crazy and that their feelings are common and treatable lifts an enormous weight off their shoulders. And then we get them help.
Increasingly, pediatricians are mothers themselves. They too were pregnant. They might have also struggled with breastfeeding and sleep training. Like me, they may have experienced postpartum anxiety. The changing face of pediatrics, provides a unique opportunity for a doctor who regularly interacts with new mothers to key into struggle, offer reassurance and screening and help a new mom be the best she can be for herself and her child. An opportunity they—and all of their colleagues—should not pass up.
I recovered from my anxiety and panic through a combination of medication and weekly therapy, and then I fell in love with my son in a way I couldn’t in the first four months of his life. But I shudder to think what could’ve happened to me, and my baby, and what could happen to any mom who isn’t screened or given the help she needs in time.