Baby Blues

By:Julia Silverman

On her very lowest days, at midnight, Shannon Foxley used to make a plan. She could put the dog in the yard, she’d think to herself, and put the baby in his car seat in the middle of the living room floor. He’d be buckled in so he’d be safe, with a few toys to keep him happy, just until her husband came home. And then she could leave, close the door, walk away and finally be blessedly alone.

Two fears kept her from ever actually doing it, she says now. She worried that something would happen to her son Forrest, now nearly two, and also was afraid that she wouldn’t want to go back home again
It took Foxley months to realize it, but like one in every eight women, Foxley had postpartum depression, fueled by the stress of sleep deprivation and the demands of a baby who never would take a bottle.

“I had tried so hard to have a kid,” says Foxley, who got pregnant after three and a half years of trying, and then only after she and her husband had started the process of adopting their other son from Guatemala. “And then I finally had a kid and I didn’t want one. The hardest thing was not being able to share it with people. There’s so much societal pressure to just love your kids.”

For years, postpartum depression (PPD) and its close sister, prenatal depression, have been in the shadows, far less talked about in the public arena than other major health problems.

Now, though, as in a handful of other ahead-of-the-curve states, Oregon is working on a package of legislation to address maternal mental health, to give healthcare providers better training in how to recognize and treat it, and to create a network of support services.

It’s a crucial effort: Although the depression and anxiety eventually lifts for most women, it can have long-lasting effects on their babies. Their first few months of life are critical for brain development, but a mother who has disappeared into the fog of depression might not be able to give her infant the stimulation needed to build key life skills later on. Studies have shown that babies with mothers who had untreated PPD have lower school readiness levels and are more prone to behavioral difficulties later in life, including susceptibility to drug and alcohol abuse.

Doctors may think they’re doing enough just by asking postpartum women how they’re feeling, says Wendy Davis, the program director of the Oregon chapter of Postpartum Support International and the founder of Baby Blues Connection, a Portland-based nonprofit that helps mothers who are struggling with depression and anxiety both before and after birth. But it’s so simple for doctors to just hear an overwhelmed “fine” in answer to that question and leave it at that, Davis says.

Instead, doctors could be trained to say something like, “It’s been six weeks since the birth of your baby. This is the time when many mothers start to feel frustrated and helpless. How do you feel emotionally?” An open-ended question like this can open the floodgates.

Foxley, who returns to her job as a guidance counselor for the Gresham-Barlow school system this fall after two years at home, said that even with her clinical background, it took her weeks to realize and accept what was happening to her. She put up a good front, and when she told people how Forrest never slept more than two or three hours at a time, or how they’d bought every bottle on the market and he’d refused them all, she got lots of rueful laughs, and “Welcome to parenthood!” She told herself that things would get better, that she was just being a baby.

Still, she knew something was wrong, she remembers, the day that it was too much for her to walk to her car and get out the stroller to go to lunch with friends after going to a breastfeeding support group. Instead, she got in the car and started driving, not certain where she was headed.

“No matter what I did that day, I felt like crying,” she says. That was especially true when she’d finally manage to get the baby down for his nap, and their dog started barking after just half an hour. Her baby would start howling. Her husband wanted to know why she couldn’t just think to put the dog outside before naptime, she says, and when she tried to explain that that seemed like one task too many to handle, he looked at her like she was crazy.

“And I went into the den and lay down on the floor, and cried for an hour and a half,” she says.

Two days later, she went to her ob-gyn for a prescheduled appointment; before she’d even said four words, she remembers, the doctor was writing her a prescription for Zoloft, an antidepressant commonly used to treat PPD.

So far in Oregon, statewide progress to help women like Foxley, particularly those in rural areas without such ready access to care, has been slow but steady. A bill passed by the legislature this past February designated May as Maternal Mental Health Awareness month. An advisory group is now meeting to hammer out meatier legislation to propose when lawmakers reconvene in January .

The problem, as always, will be finding money to pay for training for doctors and nurses and other services, especially in a time when schools are laying off teachers and seniors are losing state-provided care.

But Davis, who is also a member of the group working on the legislation and the director of the Oregon chapter of Postpartum Support International, said there is a core team of advocates determined to increase services, and that there should be some federal matching dollars that Oregon can use, thanks to the healthcare reform law approved by Congress this year.

Rep. Carolyn Tomei, D-Milwaukie, who chairs the Oregon Women’s Health and Wellness Alliance, has made maternal mental health a personal priority, Davis added, giving the issue a high-profile champion in Salem.

For now, there’s a patchwork of nonprofit resources available throughout Oregon for help with maternal depression, including Baby Blues Connection in Portland, the “Well Mama” support group in Eugene, both Spanish and English support groups in Salem and a postpartum depression group hosted by St. Charles Medical Center in Bend. But Davis said that if proposed legislation is approved, help would be far more available.

Working group members are reviewing programs from several other states, including Illinois, Iowa, Ohio and Massachusetts, looking for the best possible models to emulate. In Illinois, for example, babies of mothers who are diagnosed with postpartum depression immediately qualify for early-intervention help from the state; the state also allows doctors to bill Medicaid for screening women for the disorder, both before and after pregnancy. In Iowa, women can get Web-based prescriptions to help cope with the effects of depression; in Ohio, state workers will make home visits to women who ask for them. Massachusetts has an especially strong public awareness campaign, both to alert women to the disorder and to the help that’s available.

For Foxley, being able to talk about her condition made every difference. “You’re not crazy,” she says. “What you’re feeling is a lot more normal than people want you to think it is. Share with people; you will find someone who understands.”

Julia Silverman is a Portland writer and mother of twin toddlers, Eleanor and Benedict.

Baby Blues Connection: http://www.babybluesconnection.org/
866-616-3752