| Birmingham -- In the nine months leading up to the arrival of a new baby, it's easy to get caught up in all the excitement. There's a nursery to paint, clothes and furniture to buy, a name to pick out. And when a mom-to-be thinks of what life will be like with her newborn, the images that often come to mind are Johnson and Johnson commercials showing a happy mom, a happy baby -- painting motherhood in this perfect, shining light. As any mother will tell you, while rewarding, learning to live with a new baby is anything but perfect.
"I adore him, but I just couldn't handle one more night of getting up all night."
Naomi Ivker is the mother of two little boys. She says she read all the books but nothing could've prepared her for what she experienced after the birth of her first son. It was hard to get out of bed, she'd cry for virtually any reason and didn't find much joy in anything.
"You know, you think I'm just tired, I mean there's a million rationalizations. I'd be just so upset, you know I had to realize that's not who I usually am. So, it was kind of a relief to figure out what was going on."
What was "going on" was postpartum depression, or PPD. While the "baby blues" may only last a few days to a few weeks, postpartum depression is a much more aggressive disorder, sometimes lasting well into the child's first year of life.
"The older one was about four weeks old and we took a walk up to the lake and I just said, I can't do this. I'm never gonna sleep until I'm 18, he's 18 years old and I don't want him and I think at that point had gypsies come down to take him away I would've given him away."
It's common for mothers dealing with PPD to not feel a connection with their baby. But that disconnect often bleeds over into other aspects of their lives. Psychiatrist Dr. Jackie Feldman...
"Someone with a biologic depression if they could pull themselves out of it, by gosh, they would. They simply don't have the capacity to do that; they can't pull themselves out of bed to generate energy when theres no energy there.
Feldman is the director of the University of Alabama at Birminghams Division of Public Psychiatry and the psychiatrist for UAB's Grace Clinic. In addition to treating women with depression both during and after their pregnancies, the clinic also works to raise awareness of the disorder in the medical community.
"Part of the challenge has been getting out to the doctors and asking them and their offices, sometimes it's the staff that interacts with the patients even more, to just raise their consciousness about what to ask for and what to look for. It's a little scary to work with women who may potentially need some medication."
A big problem with treating the illness, as with any mental illness, is the stigma surrounding it. Between ten to twenty-percent of mothers develop postpartum depression, but only a fraction of those moms seek help. Sometimes because they don't understand what they're going through isn't just the blues.
"You think about having a baby and everything's so wonderful and supposed to be so great and you don't know what's wrong with you."
Dalia Abrams helps counsel moms and moms-to-be with the Oasis Women's Counseling Center. They cover a lot of issues, but a big one is postpartum depression.
"You don't wanna admit it because you're afraid they might, you know, some women are afraid they'll take their baby away if they admit they're depressed. It's very hard to come out and talk about it and a lot of times when women do talk about it people don't treat it so seriously, even doctors will say 'Oh, you're just havin' the blues, you'll get over it'".
Another thing stopping some women from getting help? The fear that if they admit they have a problem theyll be viewed as crazy and dangerous. About 1 in 1000 actually go so far as to hurt their babies -- an example, Andrea Yates. Yates shocked the world when she admitted to drowning her children one-by-one. More recently another Texas mother called police after dismembering her baby girl. In both those cases the term postpartum depression was bandied about by experts and reporters. While the women in question did have the disorder they suffered from a very rare extreme of PPD -- postpartum psychosis. Women with postpartum psychosis often experience hallucinations and delusions; if not treated, the disorder can lead to suicide or infanticide.
Feldman says the fact the term "postpartum depression" is often used to label the severe psychosis makes the more mild forms of PPD, which can be debilitating, seem even worse.
"It really does make it a challenge because people are afraid to identify themselves, or identify a loved one as having it, but the important thing is if you can identify it and get it treated really, we can be very successful in treating depression and getting out of that hole so it doesn't, God forbid, progress onto postpartum psychosis."
In Naomi Ivker's case, she had a support system. Her in-laws work in the medical field and her husband, Josh, is a doctor. He was doing an OB/GYN rotation at the time of their first son's birth. He says his medical background allowed him to figure out what was wrong with his wife, but it didn't make it any easier to talk about.
"Well, it was certainly easier to identify the problem and to bring it up, but, and I can say this from my other experiences in medicine, even once you identify it, you're not going through it, you can draw on the experience of others and what you've been told, but again, you're not going through it."
Naomi Ivker went through it twice, developing it after the births of both sons. She says it was easier to handle the second time around because she, and her family, knew what it was. Although she admits to not even thinking about it before getting pregnant again. Ivker says the hard part, that second time, was figuring out what to tell her older son.
"So I tried to explain, 'well mommy's going to cry for a few weeks and then it'll be over and she's better and she's okay'."
And Ivker was okay. She took antidepressants to get over "the hump" as she calls it and now has her hands full trying to wrangle two active little boys.
But not everyone's quite so lucky. There are a number of women who silently struggle with the illness. Sometimes it's so bad they decide to never have another child. Doctors say erasing the stigma surrounding postpartum depression would go a long way toward making sure women don't have to choose between the illness and a child.
-- Rosemary Pennington, January 31, 2005
Editor's note: This is our second story in a year-long commitment to covering mental health issues in Alabama. You can learn more about our "Making Sense of Mental Health" project and find local mental health resources -- as our commitment continues throughout the year -- inside this website.