Baby Steps
Reasons for hope in the struggle against postpartum depression
by Jennifer Kelley


One afternoon two weeks after Lynnewood resident Holly Jenkin* gave birth to her second child, she walked upstairs through the home she shared with her recently expanded family. She intended to never come down again.


When her husband entered their bedroom to check on his wife about 20 minutes later, he found her lying on the bed on the edge of consciousness, with an empty bottle of sleeping pills at her side. One ambulance ride and a stomach pump in the ER later, Jenkin was placed in the psych ward of a Philadelphia hospital, having been turned away from her ZIP-code-assigned local facility due to a lack of in-patient beds.


“It was so awful being involuntarily committed in that place,” she recalls, her voice cracking at the painful memory. “It was also an eye-opener, like something out of ‘One Flew Over the Cuckoo’s Nest.’ That next morning, when I woke up there, that’s when I knew I’d hit rock bottom.”


Jenkin’s journey to the darkest part of her life had been a rough slide down a slippery slope. After the birth of her daughter in 2006, she got pregnant within the year. Tragically, she miscarried six months into the pregnancy following a bout with Lyme meningitis, which forced her to deliver her offspring stillborn—a shattering experience for Jenkin. In 2008, still struggling with the loss, she was once again with child; this time, she carried to term and gave birth to a healthy baby boy.


“But I had bottled up all my emotions [from the miscarriage], never really dealing with it my senses of guilt and failure,” she says. “When I had my son, I just burst.”


Compounding the stress, her husband was laid off from his job just prior to the birth, instantly straining the couple financially. “That day,” Jenkin adds, referring to her suicide attempt, “I just wanted to go to sleep and never wake up to all the sadness and stress. At the time, I just couldn’t bear it.”


The condition Jenkin had been bearing, according to doctors, is known as postpartum depression (PPD), one of the most common side effects of pregnancy, and a serious health problem occurring in approximately 15 percent, or approximately one out of every eight, of new mothers. The seemingly sudden brain abnormality is most likely triggered by radical changes in a woman’s hormone levels after giving birth, but there is no conclusive evidence of the disorder’s definitive cause. Its known risk factors include a history of mental illness, marital or financial problems, isolation and the aftermath of a miscarriage, among others. 


Traditionally mistaken for “baby blues,” which are common after delivery and often last several weeks before dissipating, PPD can pose significant and potentially long-term consequences for the entire family. It can strike at any time within the first year of a pregnancy, and the depression- and anxiety-related symptoms often don’t go away on their own, experts say.


PPD is characterized by frequent crying, mood swings, irritability, extreme fatigue, an inability to concentrate, sleep problems, loss of sexual interest, anxiety, appetite changes, negative or frightening thoughts, and feelings of inadequacy, hopelessness and despair. In addition, thoughts of suicide and feelings of anger, shame and guilt are often present. Historically, however, this socially indiscriminant mental illness has been stigmatized, and essentially unaddressed in the medical community.


Increased awareness of the affliction has been a double-edged sword, experts suggest.


“On the one hand, it has enlightened some healthcare practitioners to be alert to the signs and symptoms of PPD, thus improving detection and treatment outcomes,” says Karen Kleiman, founder and director of the Rosemont-based Postpartum Stress (PPS) Center, and noted author of several books on PPD. (Her latest, “Dropping the Baby and Other Scary Thoughts,” is due to be published at the end of this year.) “Unfortunately, sensationalism of PPD and the anxiety it causes persists, leading to widespread misperceptions.”


Seeking Support

Kleiman cites the common misunderstanding that mothers with PPD want to hurt their babies as an example of its lingering infamy even in today’s age of widespread information. “Because of these misrepresentations, uninformed [insurance] providers overreact,” she explains, “and mothers are still afraid to tell people how they are feeling.”


Kleiman established her clinic in 1988 to offer comprehensive clinical intervention to any woman suffering from the range of PPD mood disorders—from mild to psychotic—as well as complete diagnostic assessments.


“Postpartum women come to the [PPS Center] with adjustment issues, such as being overwhelmed by the demands of parenting, having difficulty prioritizing, self-esteem issues, severe stress and despair,” she says. “We also see a fair amount of fathers who are seeking support for their own depression after childbirth.”


Most of the region’s larger healthcare systems simply don’t have the capacity to effectively address PPD, analysts contend, where treatment is frequently reduced to prescription antidepressants—and, sometimes, a preemptive call to social services.


That’s what happened to Kim Bryce*, a Middletown resident who is still stricken by her perinatal cesarean-section experience at a major medical facility in Chester County. Her pregnancy at age 34 was unexpectedly debilitating for the soon-to-be first-time mom, marred by near-constant, toilet-clinging sickness. Her body’s ongoing trauma led to the need for a highly invasive emergency C-section that resulted in 140 stitches and “got hit by a Mack truck” pain, following delivery of her 9-pound son.


“When the doctor held him up over the curtain [separating her from the surgery taking place below her belly], all I could think was, ‘There is no friggin’ way that big, gangly thing just came out of me,” she says. After the initial revulsion, “I just felt ... nothing,” Bryce adds. “I didn’t even want to hold him. Here I had waited my whole life for a baby and, after all I had gone through, I had one. But suddenly I just wanted them to get him away from me.”


Bryce’s last departing visit before discharge was from the state’s division of Children and Youth Services, which investigates allegations of child abuse. Bryce’s husband—to her complete mortification, she says—was advised that someone should be in the house with his wife and the baby “at all times,” or there would be a home-monitoring visit and, possibly, actions taken to secure her son’s safety.


Outraged, humiliated and still recovering from the traumatic surgery, Bryce felt her PPD symptoms intensify once she left the hospital. But a personal referral from a home nurse connected Bryce with a nurse clinician, whom she began to meet with weekly for counseling. The counseling sessions, combined with a prescription “mood elevator,” effectively mitigated her anxiety and fatigue. The embrace of supportive family and friends also helped her begin to feel better.


This was helped by her 5-month-old son rapidly developing “from this needy blob to a smiling, curious, wonderful little person,” she says, laughing. “I just began to love him so much—at last.”


Despite its potential severity, PPD is extremely treatable, according to Kleiman; support groups can also go a long way toward diminishing the isolation and social stigma that depressed mothers often feel. The turning point in a woman’s recovery, she says, often depends both on the woman herself and the help she is getting: “When an experienced clinician tells a woman that she will be OK, she begins to believe it.”


Help on the Way

In contrast with nearby New Jersey, which stands as one of few states to pass legislation mandating PPD screening, follow-up outreach and enhanced treatment options, Pennsylvania has no laws for routine screening or dedicated funding sources for such resources.


More than ever before, however, area hospitals have begun to take notice of this too-often suppressed medical issue, according to Kleiman, and are taking “baby steps” to address PPD among their patients. In addition, Congress recently made an historic federal move, advocates say, by including the Melanie Blocker Stokes Mothers Act in the Healthcare Reform Bill. The act opens the door to funding provisions for PPD support services, allocating funds for more education, diagnostic tools, awareness campaigns and treatment options by 2014.


But first and foremost, according to Kleiman, women need to trust their instincts.


“If they think something is wrong, it probably is,” she says. “It usually means they’re not feeling like themselves and should reach out to a healthcare provider they trust so they can get the support and treatment that they need.


“Suffering in silence will prolong the distress, and it can lead to a harder-to-treat, prolonged illness,” she continues. “Relief and recovery from PPD often starts with a simple phone call.” 

* Names changed to protect privacy.


Jennifer Kelley is a freelance writer.