Yalda Kazemi expected the birth of her son to fill her with joy and happiness. Instead she felt emotionally disconnected, empty and lacking motivation.
Her anxiety felt like a rollercoaster, building up, leading up to a drop then suddenly dropping –– making her feel nauseous, like she had knots in her stomach. She felt gross.
Fear set in. Always worrying, she was scared of being alone — and of being alone with her son.
On some days when no one could be with her, she would roam the mall for hours just so that she wasn’t by herself.
She had thoughts of harming her son. Of ending his life.
The depression, anxiety and psychosis she was experiencing reached the point where she ultimately had to be hospitalized for three weeks.
“That’s where it got scary, it’s because it could’ve gotten so much worse. I was just losing a lot of control,” she says.
Kazemi was struggling with postpartum mental illness. Women can develop a wide variety of symptoms related to mood disorder, depression, anxiety and, in severe cases, psychosis.
In a 2018/2019 survey on maternal health, Statistic Canada found 23 per cent of mothers who recently gave birth had feelings consistent with postpartum depression or an anxiety disorder — but that figure could be much higher. Kristin Aanderson, a registered psychologist who specializes in perinatal mental health, says underrepresentation may skew the figures.
Opening up the conversation
Kazemi shares her personal experience with postpartum mental illness in her new book, Unapologetic Truths: The Realities of Postpartum We Don’t Talk About. Kazemi says that once she started educating herself on what she had been through, she wanted to help others.
“When I [had] my experience with all the postpartum ailments, I was kind of like, ‘What’s going on? What’s happening to me?’” she says. “It kind of became my mission to help educate others because I realized how little education there is about it.”
Kazemi, who has a bachelor of science in psychology from the University of Calgary, says though she learned a lot about mental illnesses in her studies, she was not taught about postpartum mental illness. The lack of awareness motivated Kazemi to advocate for postpartum mental health.
“No one ever talked to me about it. No one ever said this could happen to me,” she says.
Dawn Kingston, a nursing professor at the University of Calgary whose research is focused in perinatal mental health, agrees there is lack of knowledge regarding postpartum mental health and, with short appointments and lack of mental health screening prior to birth, mothers are sometimes left to their own devices.
Her research has found that women want mental health screening and for it to become routine in prenatal care but Kingston says practitioners just don’t know how.
“They are not properly trained in perinatal mental health problems,” she says. “Many obstetricians just would not know. They would not ask the questions and they would not know how to link them to mental health systems.”
The transition to parenthood can be a highly stressful situation for mothers and fathers, says Kristin Romanoski, a registered psychologist specializing in perinatal mental health.
“You’re dealing with a lack of resources because you’re putting so much time and energy into taking care of this little baby without much knowledge of what that’s supposed to look like in a right or wrong way,” she says.
It can be beneficial for mothers and families to have the knowledge and understanding about the risks of postpartum mental illness prior to the birth of their child so they can be better prepared.
The non-profit organization Families Matter offers programs, classes and other support to families including perinatal programming. Amanda McMillan, perinatal mental health program supervisor says they found it is just as important for individuals to have support during the postpartum period as an educational understanding prior.
“There’s a spectrum. And so many women think that you have to be at the point of hospitalization to ask for help, and you don’t,” says McMillan.
Kingston and others interviewed by the Calgary Journal say various factors can contribute to why a mother may experience certain feelings both prior to and after the birth of their child.
“We think that this is all hormones and that it starts and stops after you have a baby. It’s one of the biggest myths,” said Kingston.
Though some may discount many of their feelings and emotions during this time, dismissing them as the common “baby blues,” there is a difference. While the symptoms may be similar, the baby blues tend to fade out within the first few weeks after giving birth — postpartum mental illness can last much longer.
“People have to understand there is a fine between what is deemed baby blues versus what’s postpartum and a lot of times I feel like people are too afraid to want to admit to having a mental health diagnosis,” says Kazemi.
Medical journals note that symptoms of postpartum mental illness can start earlier, during pregnancy or anywhere up to a year after giving birth –– something Aanderson, McMillan and Romanoski have all seen.
Another factor some have added into the conversation is the impact of the COVID-19 pandemic.
One study, done by University of Alberta researchers focused on pregnant women and those within one year postpartum, found 29 per cent of survey respondents reported moderate to high levels of anxiety prior to the pandemic versus 72 per cent currently.
“In the pandemic there’s this extra uncertainty about the right way to do things. You’re robbed of a lot of normalcy as well,” says Romanoski.
The cloud of stigma
Those interviewed by the Calgary Journal say the stigma surrounding postpartum mental health can hinder women from getting the support they need.
“We’ve internalized this message of ‘You should be able to do it all alone,’” says Aanderson. “I find it so funny, because we have that phrase, ‘It takes a village to raise a child,’ and then we don’t provide the village.”
The stigma surrounding postpartum mental illness can not be easily summed up, as many different factors contribute to it. Some say in certain cases mothers can impose a stigma on themselves by believing they can’t be a good mother if they are struggling.
Kazemi says she too struggled accepting her diagnosis at the beginning, but realized it was something she didn’t have control over.
“Why should I feel ashamed? Why should I feel any sort of guilt or why should I continue feeling sad about that because I didn’t choose to get sick? The only choice I made is to understand that I was sick and that I needed help.”
Psychologist Romanoski, who works at Moss Postpartum House in Calgary, says that along with biological feelings of not being a good enough mother, cultural and societal expectations also come into play.
“A good mom does it all. A good mom doesn’t feel regret. [It’s] kind of this good-mother myth that exists in our culture and is perpetuated by certain things on social media.”
Additionally, Aanderson and Kingston say that births can be traumatic on a mothers body and mind which can cause a lack of pleasurable emotions for varying amounts of time. Aanderson says it is not not a sign of being a bad parent.
“This isn’t good mom, bad mom, like this is brain science.”
Kingston notes that mental health is not included as part of a woman’s annual checkup and hopes there will be work to elevate emotional health to the level of physical health, adding that the system needs to be addressing issues earlier.
“If we wait to access women postpartum… it’s too little too late.”
Aanderson, Kingston, McMillan, Romanoski and Kazemi, all say it is important to talk with others about feelings you may be having after childbirth. Professional support such as seeing a psychiatrist or family doctor – and other community support for mothers, fathers and families can aid in postpartum recovery.
“Everybody struggles with it differently, but your struggle is your struggle and at any point asking for help is not too soon,” says McMillan “There is no ‘sick enough.’”’
Resources and services for postpartum mental health are available at Postpartum Support International.
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