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 | A Mother's Secret
Vogue Magazine, September 2001
Martha McPhee
At birth, placed on my belly, Livia turned her face to mine and gripped my eyes with her own - wise, fierce eyes, big and blue. She staked her claim to me, let me know unequivocally that I belonged to her. Those eyes swallowed me whole, terrifying me, as if she knew much more about how this relationship was to work than I did. You're mine, they said, and that made me panic. This was not the emotion I had anticipated, steeped with dread rather than elation. A friend who had recently given birth described the moments after as joyous. The baby lay on her chest for hours while she and her husband sipped champagne. I felt guilty, already a terrible mother, as I handed Livia to my husband and fell asleep.
The depression I experienced began quickly and lasted about ten months. At the time I had no idea that I was depressed. Unwittingly, I smothered my feelings by focusing on my health, believing that I felt bad for purely physical reasons. When my mother and sisters, seeing that I was not myself, suggested I seek mental help, I blocked their words from my consciousness. I repeated the mantra that motherhood was making me happier than I had ever been. I had heard about postpartum depression, but had only a vague notion of what it meant. Most of what I knew was from news reports of good mothers gone bad, similar to the case this past summer where a Texas woman allegedly drowned her five children. The stories were always horrific and extreme. I didn't think for an instant that it was a condition I could be suffering from.
"When you spend time speaking about the most severe cases, as the new media do, you alienate the walking wounded," said Zachary Stowe, M.D., director of pregnancy and postpartum mood disorders at Emory University School of Medicine in Atlanta. "If you make it abnormal to feel bad or have bad thoughts by emphasizing women killing their babies, then no one wants to admit they're ill, because professionals untrained in postpartum depression might overreact, and women inherently fear the loss of their child."
One in ten women suffers from a postpartum major depression, and most of them do not seek help. "It's the most under-diagnosed complication of modern obstetrics," said Diana Dell, M.D., an assistant professor of psychiatry and obstetrics/gynecology at Duke University. "This is because women deny it. It's socially stigmatized."
For 50 percent of women suffering from PPD, depression is occurring for the first time, so they don't recognize the symptoms. They believe they should be able to control their moods and behavior. Those close to them, husbands and family, might not understand either. "They'll say, 'Pull yourself together.' But they don't know what they're dealing with," said Stowe.
Once my depression subsided I spoke with other mothers who had been depressed, to understand what had happened to me. “I kept wondering what the point was since my baby will eventually die anyway,” one woman said. Another refused to let her baby out of her arms for two entire months. She also became consumed by money, wanting to make sure that she had enough to last her baby a lifetime. One friend was convinced that the postman was spying on her and was going to murder her and her baby in the middle of the night. And yet another felt so incompetent as a mother that all she wanted to do was to answer E-mails. “I just wanted to be good at something,” she said. “It was such hard work trying to get that little guy to feed on my breast. We were having no fun together.” Our depressions manifested differently, but in common none of us liked the way we were functioning and all of us were ashamed of how we felt. None of us sought help because we were embarrassed and thought we should be able to fix our moods on our own.
That, I have learned, is not how depression works. It is an illness like diabetes that, in severe cases, needs to be treated by medical doctors. The World Health Organization has declared depression among the top illnesses to address this decade, along with heart disease and cancer.
Yet postpartum depression remains taboo and unspoken until a dramatic story comes along and is blasted across the media. Only then do we learn about the three levels of intensity: the “baby blues” on the light end of the spectrum, experienced by 75 percent of women after delivery and characterized by mood swings and irrational crying: “postpartum major depression,” in the middle and of concern here, with symptoms including fatigue, insomnia, despondency, guilt, anxiety, bizarre thoughts, inability to cope; and “postpartum psychosis,” the worst manifestation of the illness, so rare it afflicts just one in 1,000 women. It strikes suddenly and soon after delivery, is defined by delusions and hallucinations, and can lead to infanticide.
But after the clamor of information dies down, what lingers in the mind is the depressed mother drowning her children. Who would want to come forward after hearing about that, especially if a new mother in fact has thoughts of harming her child? Studies show that more than half of depressed women harbor these thoughts – throwing the baby in the oven, cutting the baby up with knives – even though they have no intention of carrying them out. “Nobody discusses them publicly,” explained Laura Miller, M.D., chief of women’s psychiatric health at the University of Illinois, Chicago. “If these thoughts were expressed, people would think she was a horrible mother. But the thoughts are pretty much the norm for women with PPD or who are about to get it.”
If you blur the three grades of postpartum depression, which I did as a new mother, you would believe that, while feeling fatigued or crying irrationally is common, any other type of bizarre behavior would make you susceptible to harming your baby fatally. The reality is, however, that “being tired isn’t always normal,” said Stowe. “Exhaustion can also be a sign of depression. As a culture we’ve spent our entire lives misinforming women. They ‘re supposed to dance and smile through pregnancy, deliver without medicines, breast-feed with no difficulty. Enough credit hasn’t been given to how stressful it can be. If a woman doesn’t feel happy, she feels guilty, which makes her feel even worse. She won’t talk about it, because she feels she’s failed.”
We have many myths about motherhood. There is the notion of the “maternal instinct” – kicking in and guiding us. There is the even stronger belief that the early days of motherhood are wondrous and magical, and that a mother’s love is infinite, fueled by total maternal fulfillment. The expectation is that we will make this transition with ease, so indicated by the two-day average hospital stay for vaginal births.
As if working a factory shift, new mothers are herded in, then herded out, pushed back into their lives with no social support and very few rituals. Never mind that our bodies have just performed an arduous biological feat and are experiencing tremendous hormonal flux. The dominant rituals in our culture are the baby shower and the birth announcement, which do little to bolster the new mother physically or emotionally. Once home we are expected to keep up with our jobs – though, if lucky, we have three months’ maternity leave. We expect ourselves – I certainly did – to remain independent and carry on with our lives as before. But in this almost impossible expectation there is little room for feeling overwhelmed or frustrated or depressed.
For me, pregnancy had been a magical experience. I was in love with my changing shape and had never been less concerned about weight and beauty. I felt strength and vitality, almost a supernatural capability. I was sure that I would not be one of those mothers whose life disappeared with the new child. I intended to incorporate Livia into the fabric of my life instantly.
But it didn’t turn out that way. Though I set to work immediately after coming home from the hospital (only to give up with crashing frustration), I still wanted to be taken care of. My husband had to return to a teaching job in Pennsylvania. My mother was too busy with her business to stay with me. My au pair was too homesick to be of any use. A sister who lives nearby was pregnant and afraid of Livia because she was so colicky. Five days post-partum, and shortly before my husband left, I collapsed running errands and came down with a raging fever. Fearing a kidney infection, my doctor wanted to put me back in the hospital but decided not to so as to avoid interrupting the bonding process. Sitting on the examination table in her clinic, I could hear Livia crying in the waiting room. I wanted to return to the hospital. I looked at my elegant doctor: tall, thin, perfect hair, perfect nails, radiating calm and serenity. I loved her and wanted her to care for me forever, as she had for the past nine months.
Though it turned out I had only a minor infection that soon disappeared, death became an obsession. Instead of thoughts of harming my baby, I concocted scenarios of my own demise. I thought about them late at night, of how sad it would be for Livia. “Something’s wrong with me,” I’d cry to my husband over the phone. I couldn’t think or concentrate. I started to lose lots of weight. The consequences of not working became catastrophic in my mind: I wouldn’t be able to afford my baby. It was as if a motor of panic inside were turned on high.
Then I developed mastitis with an abscess – a huge, hard, angry lump in my right breast. I took this benign ailment of nursing mothers and spun a web so enormous that I had my entire family concerned for my life. (My sisters later said they had discussed who would raise Livia if I died.) I lay on many examination tables in the hopes of finding an answer to something that felt so deeply wrong. One time, Livia lay on my bare tummy and pacified herself by sucking on my flesh while a doctor plunged a long needle into my breast. Livia sucked so hard she bruised me.
Over the course of a month I had first, second, third opinions – breast specialists, infectious-disease specialists, diagnosing and reconfirming the fact that I had acute mastitis with an abscess and nothing more. I took to my bed. I gave up on work, became irritable. My insomnia grew worse, thoughts of death more vivid. The lump disappeared on its own, but even so I kept imagining that I felt it there. I was too embarrassed now to call my doctor and complain of anything else. Instead I asked my mother all the time, “Am I healthy?”
Postpartum depression, or what was known as “puerperal fever” in the early days, has been written about since 460 B.C., during the time of Hippocrates, who believed that lochial discharge infected the brain causing delirium and mania. Trotula of Salerno, an eleventh-century Italian gynecologist, speculated that too much moisture in the womb caused the eyes to overflow. In the nineteenth century, Jean-Etienne-Dominique Esquirol and Louis Victor Marce (both French physicians) wrote about the “mental alienation” of pregnant and nursing women – unleashing a bevy of research, for the first time, making the study of PPD more systematic. Now in the medical community there is debate about whether postpartum depression should be differentiated from other forms of depression. Women suffer from depression twice as much as men, and for a large number, the depression strikes during their childbearing years.
The longer a person stays depressed, the more treatment-resistant she becomes and the more likely she is to have recurrent episodes. “Your brain learns that abnormal biochemistry,” Dell explained. And then we all know the effect this has on others – even new babies, who by three months are studying their mothers, taking cues from them. Thus depression can interfere with the bonding process and later with the baby’s emotional development.
Much sociocultural research has been done to look at how rituals in other countries have helped to prevent postpartum depression, many of which are described in an essay edited by Laura Miller in her book Postpartum Mood Disorders (American Psychiatric Press). In China the postpartum custom is called zuo yue zi, or “doing the month”, during which the new mother eats a rich diet and avoids going outside or washing her hair in an attempt to restore her body systems, while someone else tends to the infant. In this way she regains her energy more quickly and feels stronger, more optimistic and powerful. In other cultures, the mother returns to her family of origin to get pampered as if she were a child again. The ultimate effect is to teach the new mother that her concerns, fears, and sensations, while uncomfortable, are normal and will pass. My doorman said to me that in his country, the Dominican Republic, the first 40 days after birth were called the cuarenta – as in “quarantine”, a period in which mother and baby stay at home and are cared for by others. At the time I thought, How oppressive. In retrospect I think, How wise.
“In cultures with rituals firmly ensconced, the rate of PPD is significantly less,” Miller said. “ So even though there are biological factors that contribute to PPD, there are also cultural factors that seem to be protective against it and that we largely lack.” No wonder one woman had told me that her favorite present from friends was a day apiece for the first three weeks.
Shortly after I came home from the hospital a friend brought me a bounty of treats – body lotions and bubble baths and enough food to last a week. She instructed me to indulge and to let others care for me. “Your only responsibility is to take it easy; you’re carrying the species forward,” she said. Put that way, I suppose, there’s no bigger, more important job. I wish I had listened. I know that when I have my next child I will not have illusions of being able to do it on my own, that I will have firmly in place a group of people to help.
It seems to me my desire, and the desire of the other mothers, was to be capable of protecting our babies from all the horrors of the universe. With this new life in the palm of our hands, so much is made vivid about the ugliness of the world. My sister Jenny said to me, “Men go to war; women give birth. It can be a brutal, emotional experience.” The culture is silent about the traumas and adjustments of childbirth, which has brought women close to mortal danger for centuries. “It wasn’t so long ago that mothers and babies regularly died in childbirth,” said Jenny, who has had two emergency C-sections.
There was no defining moment when my depression lifted. It receded slowly like a tide. Livia, too, adjusted to the world, smiling instead of crying. I remember that I started feeling differently about looking into her eyes. She would crawl into my room and watch me in bed. I’d watch her back. As she studied me, she seemed curious about the being that made her – the source of her life. Those eyes lifted me out of bed. I followed her, as she learned to walk, outside, and as she tottered down Broadway, stopping at all that she found fascinating – flowers, dogs, babies, grates, steps – she left a wake of smiling faces behind her. |
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