Originally published in the In Jerusalem, January 13, 2017

I would not have admitted to ANYONE what I was going through. I wore my “great mother” face publicly. I admitted to being tired, a bit overwhelmed, but nothing I did not perceive as “normal with a small baby.” The only times I used the phrase postpartum depression was to my therapists and to Google….if you admit to wanting to harm your baby or yourself, people judge you. When you say you’re overwhelmed, people understand that… They don’t get that you feel like you are drowning and can’t see the way out. They don’t get that you literally feel suffocated and are grasping to hang on.

–Naomi 40, on her experience with PPD

It often takes a tragedy to raise public awareness of many people suffering in silence. The shocking murder suicide of a mother and her children in Jerusalem brought the words postpartum psychosis and postpartum depression to the headlines across the country.

Approximately one in eight women experience PPD, but the public knows little about it. Like other mental illnesses, few want to discuss it.

To break the taboos and open the conversation, I turned to some experts to understand what to look out for and what to do if someone seems to need help.

Ahava Winston, the  director of NITZA, dedicated solely to helping women suffering prenatal and postpartum reactions, explains, “Postpartum psychosis and postpartum depression are only two of the numerous potential reactions related to pregnancy and birth. The most common is Postpartum Blues, which affects 80-90% of women… and usually resolves on its own within the first two weeks….it can however, become PP Adjustment Disorder, which affects one in five women, where a woman functions outwardly, but feels anxiety and self-doubt. With support, PPAD can resolve without professional intervention. However, without emotional and instrumental support, it may deteriorate into the more serious clinical reaction, Postpartum Depression.

PPD is a general term which includes other serious reactions, such as PTSD, OCD, and even Psychosis and Mania. One may “have fears and obsessive thinking, or suffer headaches, stomachaches, dizziness, heart palpitations, feel faint or that she is going crazy. In psychosis, she can be delusional, hear voices. In mania, she may have excessive energy… or express incomplete thoughts.” Abnormal behavior after pregnancy should not be ignored or labeled as attention-seeking.

When is there  a problem? What can we do?

As everyone is different, it is sometimes difficult to know whether symptoms (lack of sleep, frustration, weight loss,) are part being a new mother, or a sign of something beyond the normal upheaval that is having a baby.

Historically, women have always helped one another with childcare. Tribal living meant plenty of hands, support, and women to learn from.  In modern society, a mother may not get the help she needs to heal and adjust to her new reality, especially if she lives far from family.

Many mothers experience bad days — even days when  they can’t recall their own names. This is motherhood in all its glory — not PPD. HOWEVER, a long series of bad days compounded by marital strife, economic insecurity, lack of support, illness, a move, or unresolved loss can lead to deterioration. Women with PPD or anxiety have ongoing symptoms like these most of the time, which make it difficult to function.

In Israel, nurses are tasked with asking questions and assessing women for signs of depression before and after birth. In addition, Tipat Chalav, the well-baby clinics, is supposed to give mothers the Edinburgh Postnatal Depression Scale (EPDS), a series of questions to identify depressive symptoms.

Many women report that they were never asked, while others report that they were evaluated with each child, even receiving follow up care. Some respondents said they answered honestly and others said they wouldn’t trust a stranger with the idea that they weren’t doing well. Some noted the poor timing. “I would find this questionnaire much more effective if it were given at the 6-week postpartum visit with an OBGYN rather than Tipat Chalav. There, you’re so involved with your baby that taking a few minutes to fill out the form is incredibly difficult,” said one mom.

So, how do we ensure that struggling moms get the help they need?  Professor Marsha Kaitz, founder of Em l’Em, Mom2Mom, a national organization that trains experienced mothers to volunteer with new mothers for individual support, says it is very possible to know when someone needs help.

“Ask the question. Listen to the answer.” ‘How do you feel? What’s going on?’ The mom is a person, and she’s just undergone a major life change. We need to check on her. If she isn’t talkative, look around. Does the house seem overly unkempt, beyond normal chaos for a new baby? Does she seem overwhelmed, as though she’s not coping? Does she not want to hold the baby?  Is she behaving in a way atypical to herself?”

Em L’Em volunteers meet with new moms once a week, voice concern if need be, and assist the mother in getting help if she needs. We must do the same for our friends and family. We need to ask questions and provide support.

If you feel someone might be struggling:

Don’t brush off her words or share your own story of baby blues. Do say, “I care about you. How best can I help?”
Don’t tell her that everyone goes through it and she’ll be fine. Do tell her about support groups like Em L’Em and NITZA.
Don’t tell her you think she’s depressed and should get help. Do offer to collaborate and build a strategy with her.

The above advice is for women who acknowledge the need for help.

But, if a woman shows clear signs of depression, seems to have difficulty functioning, doesn’t get out of bed, doesn’t want to touch her baby, or says she cannot cope, listen, discuss your concerns, and suggest professional help.

What should you do if you are struggling?

Pay attention to changes in yourself. Do you no longer enjoy the things you used to? Does the baby’s smile not make you happy? Have you lost interest in your friends? Are you feel anger when people need you?

If so, reach out to friends and family whom you trust, express your concerns and ask for help.  Speak to your family doctor.  Call NITZA or take advantage of the psychological services provided by the national health clinics and Briut Hanefesh Network .

If you don’t feel that your symptoms are severe, but you still need support, you have options.

Many women who spoke up for the sake of this article said that they wished more women would be open about their PPD experiences so that others needn’t suffer alone.

Facebook groups exist where mothers can seek support, share their difficulties, and even cry out for help, even anonymously.

In one group, a mother openly admitted to having suicidal thoughts and immediately was flooded with real life offers for help from babysitting, to meals to taking her to a psychologist. The women check in with her on Facebook as well as in person to make sure she is okay.

In a message to struggling moms, Naomi says,

‘Seek help. Find a therapist to help you. Know that it will not last forever. The clouds will part and you will begin to cope.’

Resources

Israel based English groups:

Russian: 

For Ethiopian Israelis:

For French-speaking mothers in Israel:

Other sources for help include:

    • Well -written and informative, wish the paper could have devoted more time to the subject. I am a nurse -midwife and author of 4 books on childbirth, fertility, baby care and of course postpartum depression. “Delivery from Darkness”, אחרי לידה and מותר לדבר על זה are the first books on the subject of PPAD, PPD and so on written in Israel for the Israeli woman from non-observant to Chreidi.
      I have an amutah, Yadlaem, where we provide support through education and referrals during pregnancy and the postpartum period. If you are going to continue writing or working in this area, I would love to meet you to share our thoughts and information.
      Michal Finkelstein RNCNM yadlaem@gmail.com yad-laem.org.il

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