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Being pregnant and middle-aged is like driving an old car with bald tires and worn brakes on a rocky mountain. In the rain. Frankly it will be a miracle if you get to the top. I hardly did.
I was 48 when my daughter was born. Her birth was the culmination of a brutal seven-year odyssey of fertility treatments. After 11 unsuccessful cycles of IVF, one of which ended in miscarriage, I finally got pregnant using a donor egg and carried the baby to term.
My postpartum depression was not difficult to predict. I had eight risk factors: advanced maternal age, use of fertility treatments, pregnancy complications, traumatic childbirth, history of anxiety and depression, lack of sleep, insufficient support, difficulty breastfeeding. My symptoms ticked a lot of boxes.
I wish someone had warned me. Although there have been recent improvements, especially in California, in the way postpartum depression is diagnosed and treated, no doctor told me about it until my daughter was born – nor was my obstetrician-gynecologist. , nor the perinatologist, nor even my psychiatrist.
The first time I held my daughter in my arms, instead of feeling boundless joy and love radiating as I expected, I was overcome with fear and remorse. I felt like I was drowning in the mud, holding it above my head. I was sure we were both going to sink. Once we got home with the baby, I was so overwhelmed with obsessive anxiety that I couldn’t take care of her properly.
During the first few weeks, the situation changed. An irrational fear that the baby would stop breathing and die if I looked away for more than a moment kept me from sleeping. The stress has dried up my milk supply. The baby was not gaining weight and she had blood in her stool. I feared where my growing desperation would lead.
Nationally, about 500,000 American mothers show symptoms of postpartum depression per year, according to a study by the Centers for Disease Control and Prevention. This number is increasing. A recent Blue Cross Blue Shield report said the number of women diagnosed with postpartum depression increased by almost 30% between 2014 and 2018. And a global study released in April showed a sharp increase in the number of pregnant women. and postpartum with significantly elevated symptoms. of mental health distress during the COVID-19 pandemic.
Women over 40 are having their first babies twice as fast as in 1990. Meanwhile, fertility rates for both men and women are plummeting. Women most often delay childbirth because of costs – spending on child care, education and health has grown faster than wages. But the older a woman gets, the more fertility treatments she will need to conceive, and as her age increases, her risk of postpartum depression increases as well.
Accessibility and cost of maternal mental health care are barriers to diagnosis and treatment for many new mothers, as is the stigma of admitting that you have difficulty caring for your child.
I was lucky. I was already under the care of a psychiatrist and my postpartum depression was diagnosed four weeks after I gave birth. I received excellent treatment in an outpatient program at UCLA specializing in maternal mental health. I spent six hours a day, five days a week, in group therapy there, alongside six other clinically depressed mothers. Our babies accompanied us.
My patient colleagues and I came from different ethnic and economic backgrounds, but our symptoms overlapped. We all blamed ourselves for being sick. We felt like we were failing with our babies. But over time, we’ve learned how postpartum depression hides. The truth was, our hormones had failed us, just like the doctors who had not warned us of the symptoms of postpartum depression or diagnosed some of us when these symptoms first appeared.
The cultural landscape has also failed us, presenting us with unrealistic fantasies of motherhood that could be achieved by following the advice of the “Breast is the Best” campaigns, measuring milestones and reading mom blogs. We had adhered to these unreasonable expectations, but were overwhelmed by the very real challenges of parenting while managing our sanity.
In the clinic’s group therapy room, the other mothers and I listened to each other’s stories and reflected each other’s experiences. Feeling compassion for them taught me compassion for myself. Their courage gave me courage. Together, over time, we have healed.
There is good news. Postpartum depression is more openly discussed in the media, and perinatal mental health screening is increasingly common. A 2019 California law requires that postpartum depression screens be offered to all new mothers. And studies continue to be done to find the best types of treatment – in my case, I have found group therapy to be particularly effective.
But there is still a serious lack of specialized treatment, and much of what is available is not accessible to those without financial resources or good insurance. The program I participated in in 2018 was one of 12 of its kind in the United States. There are now 24, but many, many more are needed. After the implementation of the California Testing Act of 2019, the program I attended became so overwhelmed with women calling for enrollment that it had to close its waiting list.
All mothers with postpartum depression deserve quality treatment. The number of programs specializing in postpartum depression needs to be dramatically increased and made accessible and affordable. The stigma associated with postpartum depression must be erased, so that women are not ashamed to seek treatment.
Having waited so long to have a child, if my daughter starts a family of her own, I may not be there to help her. But I can help now, doing my best to make sure she has access to the care she might need when the time comes.
Devorah Herbert is an Emmy-nominated production designer who lives in Los Angeles with her husband and 3-year-old daughter. @devherbert
This story originally appeared in the Los Angeles Times.
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