Surviving the happy crisis


Safeguard your emotional health before baby is born By Sara Nalbach


illustration by Madeleine Avirov  

Claire and Paul Ashley are expecting their third child, and this time they are truly prepared. Sure they have all the basic necessities, and they're pros when it comes to the actual delivery. But after two difficult postpartum depression experiences, they are also equipped to deal with postpartum mood disorders, and they aren't afraid to talk about it.

"It was a black cloud over my head. We were on a trip. It was beautiful weather. I just felt like I was functioning, but barely. And I wasn't really present. I was unable to smile. I remember thinking, ‘Oh my God. I haven't smiled or laughed in a month.' "

After giving birth to her first child, Claire fell into a depression-even though she had never been prone to depression. At five months postpartum, she found the cause-an underactive thyroid. After she began thyroid medication, Claire's problems dissipated, until she delivered her second child 15 months later. Claire was still regulating her thyroid with medication, but struggling emotionally.

At her six-week postpartum checkup, Claire's doctor prescribed an antidepressant, which she took until she found out she was pregnant again. After the first trimester, Claire started on a low dose of antidepressant in preparation for the postpartum months.

"I think [depression] will kick in, but I think now I am at [a] certain stage that I just know what to do," she says. "As a family, we have managed to figure out what works."

Everything is upside down Claire and Paul's story is one of thousands we don't hear. We hear about postpartum psychosis when it causes tragic outcomes like suicide or matricide. Those tragedies scare us, especially since, in general, we don't understand mental health issues, let alone postpartum mood disorders.

Leslie Lowell Stoutenberg, director of the Pregnancy and Postpartum Mood and Anxiety Disorder Program at Alexian Brothers Medical Center in Elk Grove Village, believes "having a baby, as joyful and wonderful as it is, is a crisis because it turns everything upside down, although temporarily: hormonally, emotionally and physically."

So, of course your postpartum mood will fluctuate and change over time. And many women adjust without difficulty. But what if you feel you can't adjust? It's too hard or too scary. What if during the happy crisis you get increasingly weepy, unmotivated or have no interest in your sweet insomniac who nurses constantly? Or what if you feel disoriented and confused or emotionally crazed? Will you know what that means? Will you know what to do about it?

Are you at risk? Expectant and new parents can create a simple plan to better prepare them for the postpartum months, and to help ensure the success of their desire to thrive as parents and a young family.

Although women who have a history of depression are at a higher risk of suffering from a postpartum mood disorder, no one is immune.

If you know how you typically handle stress then you have an idea of your risk for developing a postpartum mood disorder.

Women suffer from postpartum mood disorders for complicated reasons that even the experts do not fully understand. Past and current studies show depression can start during pregnancy, caused by the biological changes during and after pregnancy. In addition, nutritional deficiencies in iron, calcium or omega-3 fish oils are also possible causes of postpartum depression.

Studies also show that women suffer from mood disorders because of social and emotional adjustment difficulties. Stoutenberg says many women who participated in her program have recently moved, left a career, experienced the death of a loved one, have limited social and familial support networks or are experiencing marital strain.

According to Stoutenberg, "A woman will respond to the happy crisis in much the same way she has responded to crises in the past." So there is a good chance a new mother will react the same when she is sleep-deprived, nursing every two hours, living among baby toys and piles of dirty laundry and dishes.

Being self-aware is important, but expectant and new parents also need to know about postpartum mood disorders-not just the extremes-so they have the knowledge to take action if the mother starts to show signs of emotional struggle.

Know what to do Stoutenberg believes that in addition to educating expectant and new parents about postpartum mood disorders, the medical community needs to be able to provide their clients with a phone number they can call and a place they can go if a new mom should show signs of emotional struggle.

Unfortunately, most hospitals and health networks do not yet have a system for screening, diagnosing and treating postpartum mood disorders.

Obstetricians, midwives and general practitioners may know about the various mood disorders, but they don't necessarily have a referral list of doctors and therapists who have years of experience working with postpartum clients or have been trained in postpartum mood disorders.

You can create your own support network and plan of action by first making a list of family and friends nearby who could help you in the postpartum months. Talk with friends and other mothers about how they felt after baby arrived. They might have some information.

Check with your doctor and with local hospitals for new parents and babies programs, postpartum support groups, hotlines and other organizations that service parents and young children. We have a list of some programs on page 46. Also, check the online resources we have compiled at


Sara Nalbach is a writer and the mom of two who lives in LaGrange. She successfully waded through the depths of postpartum depression after the birth of her second child.


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