Alisa Hafkin, LCSW

“Depression is the most common health problem women face. As many as one in four will experience it during their lifetime, and about one in seven will experience postpartum depression”; David Bornstein, New York Times, October 20, 2014.

Postpartum depression is gaining more and more attention in today’s media but it still remains an under diagnosed and under treated problem for many women. If left untreated, postpartum depression can become a deeper and more problematic issue not only for the mother but also for her child and other relationships at large. It is important to note that struggling with the stressors of having a new baby is normal but only to a degree that one feels emotionally stable enough to face those challenges. Once depression goes past approximately four weeks or longer, it is extremely important that help is provided as quickly as possible.

The New York Times article goes on to state that there are effective treatments for depression including psychotherapy and cognitive behavior therapy but without proper screening by primary care physicians and ob/gyns, many women endure their depression symptoms alone and caregivers are at a loss as to how to help.

Mr. Bornstein writes about two programs, DAWN and Moving Beyond Depression, that are proving to be successful in identifying and treating women with postpartum depression. Both programs involve screening for depression by ob/gyns and once identified, women are guided to take advantage of care managers, education, therapy and home visits. Another program uses a telephone based model in which women, who have been identified as having a high risk for depression, receive supportive phone calls from mothers who experienced postpartum depression and recovered with appropriate treatment.

Relief from postpartum depression is very possible with proper diagnosis and treatment. It is important for women and men to be educated about the risks of postpartum depression and that a prior history of depression increases the risk of depression after birth. The sooner a woman receives a diagnosis and help, the better the outcome, not only for herself but also for her child and partner.

In September I began a training in infertility counseling with Sharon Covington, MSW and Nancy Hafkin, PhD and together with seven other practitioners in the field, we began the journey to learn more about assisting individuals and couples who are facing challenging reproductive issues. Our second session’s focus of attention was on identifying some of the mental health issues that can arise as a result of getting a diagnosis of infertility and its subsequent treatment.

When clients go through a period of approximately one year of regular, unprotected intercourse without a resulting pregnancy, reproductive assistance is usually the next step in aiding conception. Clients are referred to a reproductive specialist and an in-depth assessment is done to determine the cause of infertility. When clients first find out the reason they have been unable to conceive they may experience a range of emotions including shock, disbelief, anxiety, depression, shame and anger .

Assisted reproductive specialists and their support staff are trained in guiding clients through the medical steps of promoting fertility but when clients confront emotional challenges that can arise during this process, counseling may be a helpful component of treatment. A diagnosis of infertility can affect one’s sense of self; a deep realization of an altered perception of body, mind and soul. It can affect close personal relationships with partners, family and friends and navigating through this phase while undergoing rigorous medical interventions may be aided by talking with a therapist trained in assisted reproductive issues.

The range of emotions experienced by men and women upon receiving an infertility diagnosis is vast and those who have a strong relationship and support network appear to have an increased ability to manage the future challenges of trying to have a baby. Sometimes an infertility diagnosis opens up older issues including relationship problems, family expectations, societal pressures, history of abuse among others. The diagnosis itself is not the only trigger for powerful emotions as the options presented for conception including hormone treatment, donor eggs, donor sperm, IVF, surrogacy, etc. all require a thoughtful approach requiring self awareness, honesty and the ability to collaborate with one’s partner and medical staff while remaining in the community as a family member, worker and friend.

A person who is diagnosed with infertility confronts an unexpected reality; a future self and plan that goes against what had been thought of as a given – I/we will become pregnant and have a baby. Infertility creates a paradigm shift that requires the strength to negotiate a variety of medical interventions and unexpected emotional states.

The recent articles in The New York Times, “Thinking of Way to Harm Her (June 15, 2014) and “After Baby, an Unraveling” (June 16, 2014)  highlight postpartum depression and they have brought much needed attention to this underserved community of struggling parents.

I believe that postpartum depression has for too long been diagnosed primarily as a hormonal issue which often times it is not. It is a composite illness that affects both women and men with many identifiable markers. Postpartum depression is different from baby blues and new parents need to be educated about these differences. Baby blues occurs in women after birth and can last approximately three to four weeks. It is characterized by a fluctuation in mood, including sadness, irritability, anger, etc. This occurs because of a rebalancing of hormones to pre-pregnancy levels. Some of the indicators of postpartum depression include more of the same feelings that occur during the first four weeks but they don’t abate and often times increase.

Identifying who is at risk is of prime importance and depression screenings should be part of the ongoing care for women during and after pregnancy. Women with a history of depression should be closely monitored by their ob/gyn during and after delivery. Women should be encouraged to share their history of depression with their child’s pediatrician so that appropriate care can be provided to the new mother as early as possible in her child’s life.

The recent articles served to raise and support a new level of consciousness about this condition that has far reaching implications beyond the mental and physical health of new parents. As we know, the long term emotional health of a newborn is dependent on the emotional wellbeing of its parents.

This blog is directed to new fathers who are facing the challenges of being a parent and a partner to a new mother who may be dealing with depression. It is not uncommon for women to experience sadness, anxiety, fluctuation of mood and depression after a baby is born. This state is often temporary until hormones return to normal levels. Sometimes however, the emotional distress lingers and both parents are at a loss as to what to do. The usual response is to hope that the depression will pass and if not, to seek help for the mother. I am reaching out to new fathers who are dealing with a partner who is experiencing depression or who may feel depressed themselves.

Depression and sadness is something many new mothers experience shortly after having a baby. There are many reasons for this including fluctuations in hormones and a history of depression. This feeling is not something only new mothers experience, as new fathers are vulnerable to depression as well and often times this is not addressed. Many men feel depressed after the birth of their child and because of an internal imperative to provide and protect, vulnerability is not something men are prone to discuss.

Depression in men after childbirth may occur as a response to a new mother’s depression – not knowing what to do to help their partner who is suffering. Men who face a partner who is depressed sometimes try to cope in ways that may seem counterintuitive such as returning to work sooner than expected and/or working longer hours.  When men see their partner suffering from persistent sadness they may feel a strong sense of powerlessness and fear as anything they try to do to alleviate that sadness does not seem to work. A new baby is “supposed” to make parents feel elated but too often new parents are caught by surprise at their sad reaction to this significant change in their lives. It is extremely important for men to understand that their partner’s depression is not something they can fix and they may need help trying to understand their confusing reactions.

Men also may experience depression as a result of acknowledging the increased level of responsibility that a new baby brings upon his/her arrival. Before a baby is born there is much planning and preparation but no one can actually anticipate what it feels like to be completely responsible for another person’s life until it happens. Men may experience powerful urges to protect their new infant and may be caught by surprise by a desire to have their old lives back out of fear of not being up to doing a good job of parenting.

There has been much press and information of late about the physical and mental health of new mothers and thankfully many women have benefitted from the exposure. Men are also prone to depression and deeply confusing emotions after the birth of a child and they require as much attention as new moms. The birth of a child is not a simple event and it has the potential to bring up feelings that many men struggle to manage on their own. If you are a new father and some of what you have just read resonates with you, please give me a call and together we can sort out these feelings and help you develop ways to cope with the dramatic change in your life.