Material for Drash - Parshat Tazria - Postpartum depression

This spring I read the book Down Came the Rain by Brooke Shields.  Although I did not suffer from post-partum depression, I could relate to a lot of what she wrote in the book about being a first time mom.  That and the high profile case of a new mother age 45 who jumped to her death 8 stories in March (with her baby, who survived) led me to devote this Shabbat to gathering information about post-partum depression in the context of Parshat Tazria.  Please use the material below and speak about this important topic!!!!

The material below is from the websites cited and from “The Maternity Offering,” Nechama Leibowitz, New Studies in Vayikra, pp. 181-182.

Perinatal Mood and Anxiety Disorders Overview

While many women experience some mild mood changes during or after the birth of a child, 15 to 20% of women experience more significant symptoms of depression or anxiety. Please know that with informed care you can prevent a worsening of these symptoms and can fully recover. There is no reason to continue to suffer.

Women of every culture, age, income level and race can develop perinatal mood and anxiety disorders. Symptoms can appear any time during pregnancy and the first 12 months after childbirth. There are effective and well-researched treatment options to help you recover. Although the term “postpartum depression” is most often used, there are actually several forms of illness that women may experience, including:

Pregnancy (also called antepartum) or Postpartum Depression. A woman with PPD might experience feelings of anger, sadness, irritability, guilt, lack of interest in the baby, changes in eating and sleeping habits, trouble concentrating, thoughts of hopelessness and sometimes even thoughts of harming the baby or herself. Learn more about PPD, including risk factors, symptoms and treatment options.

Pregnancy (also called antepartum) or Postpartum Anxiety. A woman with PPA may experience extreme worries and fears, often over the health and safety of the baby. Some women have panic attacks and might feel shortness of breath, chest pain, dizziness, a feeling of losing control, and numbness and tingling. Learn more about PPA, including risk factors, symptoms and treatment options.

Pregnancy or Postpartum Obsessive-Compulsive Disorder. Women with PPOCD can have repetitive, upsetting and unwanted thoughts or mental images (obsessions), and sometimes they need to do certain things over and over (compulsions) to reduce the anxiety caused by those thoughts. These moms find these thoughts very scary and unusual and are very unlikely to ever act on them. Learn more about PPOCD, including risk factors, symptoms and treatment options.

Postpartum Post-Traumatic Stress Disorder. PPTSD is often caused by a traumatic or frightening childbirth, and symptoms may include flashbacks of the trauma with feelings of anxiety and the need to avoid things related to that event. Learn more about PPTSD, including risk factors, symptoms and treatment options.

Postpartum Psychosis. PPP sufferers sometimes see and hear voices or images that others can’t, called hallucinations. They may believe things that aren’t true and distrust those around them. They may also have periods of confusion and memory loss, and seem manic. This severe condition is dangerous so it is important to seek help immediately. Learn more about PPP, including risk factors, symptoms and treatment options.

A new mother might not recognize depression or anxiety because she is tired, overwhelmed, or simply adjusting to life with a baby.

Depression During Pregnancy; Postpartum

Depression during and after pregnancy occur more often than most people realize.
Approximately 15% of women experience significant depression following childbirth. The percentages are even higher for women who are also dealing with poverty, and can be twice as high for teen parents. Ten percent of women experience depression in pregnancy. In fact, perinatal depression is the most common complication of childbirth.

Symptoms can start anytime during pregnancy or the first year postpartum. They differ for everyone, and might include the following:  Feelings of anger or irritability; Lack of interest in the baby; Appetite and sleep disturbance; Crying and sadness; Feelings of guilt, shame or hopelessness; Loss of interest, joy or pleasure in things you used to enjoy; Possible thoughts of harming the baby or yourself

It is important to know the risk factors for antepartum and postpartum depression. Research shows that all of the things listed below put you at a higher risk for developing these illnesses. If you have any of these factors, you should discuss them with your medical provider so that you can plan ahead for care should you need it.
From www.postpartum.net

From http://www.psychologytoday.com/blog/isnt-what-i-expected/201201/can-we-prevent-postpartum-depression

You can see by this wide-ranging list how easy it is to be at risk for PPD!

Previous personal or family history of postpartum depression, other clinical depression, anxiety or panic disorder, bipolar illness, eating disorders, or obsessive-compulsive disorder. 

• A mother who had PPD 
• History of severe PMS
• Infertility 
• Thyroid problems or family history of thyroid problems. 
• Depression during pregnancy
• Unplanned or unwanted pregnancy
• Complicated pregnancy and/or delivery
• Extreme weight gain during pregnancy and/or difficulty losing weight after pregnancy. 
• Traumatic birth experience 
• Chronic sleep deprivation
• Premature baby
• High-needs or colicky baby 
• Difficulty or perceived difficulty with breastfeeding
• Abrupt discontinuation of breastfeeding
• Social isolation 
• Marital instability
• Unsupportive partner
• Pre-existing and unresolved issues with partner
• Impaired family relationships, especially mother. 
• Lack of or distance from extended family
• Adverse life events, such as difficulty at work, a recent move, a new job or other major change, the death of a loved one, financial problems 
• History of childhood violence or abuse, emotional, physical or sexual 
• History of early major loss, especially parent
• History of drug or alcohol abuse
• Birth control use
• Impaired self-esteem
• Tendency toward perfectionism
• Desire for control

On the Parsha (try to read this for what it says, rather than reactively):

“When a woman has matured a human germ…”  Germ, basically the seed of plants and hence herb-yielding seed (Gen. 1:11), the seed-forming activity of plants for the continuation of their species, when applied to human beings is the usual term for the offspring by which Man continues his generation.  By the use of the expression תזריע here, which occurs only elsewhere in Gen. 1:11 and 12, referring to the activity of plants for the continuation of their species, the mother’s role in producing progeny is looked at in the purely material physical character of its physiological process, and with that one word the whole idea of the טומאה (ritual impurity) spoken of here, is shown.

The highest and noblest occupation, on which the whole future of the human race is built, in which the whole constitution of womanhood finds its purpose and goal, the whole process in the body of a mother for the production of a new human being – is of purely physical nature.  Man originates, grows and exists like a plant and the noblest and most glorious name that the human tongue can utter, the name “Mother,” reminds one at the same time of the purely physical unfree process of human origin.  If anywhere, it is surely here that the fact must be established, that in spite of this, once he is born, Man is a morally free agent.  Above all, the Mother herself, under the fresh impression of her physical, passive and painful submission to the forces of Nature at the most sublime moment of her earthly calling, has to re-establish the principle of her own spiritual station; and only after this impression of lack of freedom of will has completely passed away has she, by an offering, to undertake to allow herself of her own free will, to give herself up to the whole spiritual height of her calling of Woman and Mother which is now restarting with all its momentous and often painful moments; and to allow herself to re-enter the Sanctuary of holy, happy faithfulness to duty.

S.R. Hirsch, quoted in “The Maternity Offering,” Nechama Leibowitz, New Studies in Vayikra, pp. 181-182.

How Other Cultures Prevent Postpartum Depression

What makes the difference?
Stern and Kruckman noted that cultures who had low incidence of postpartum mood disorders all had rituals that provided support and care for new mothers. These cultures, although quite different from each other, all shared five protective social structures:

1. A distinct postpartum period. In these other cultures, the postpartum period is recognized as a time that is distinct from normal life. It is a time when the mother is supposed to recuperate, her activities are limited, and her female relatives take care of her. This type of care was also common in colonial America, when postpartum was referred to as the “lying-in” period. This period also functioned as a time of “apprenticeship,” when more experienced mothers mentored the new mother.
2. Protective measures reflecting the new mother’s vulnerability. During the postpartum period, new mothers are recognized as being especially vulnerable. Ritual bathing, washing of hair, massage, binding of the abdomen, and other types of personal care are prominent in the postpartum rituals of rural Guatemala, Mayan women in the Yucatan, and Latina women both in the United States and Mexico. These rituals also mark the postpartum period as distinct from other times in women’s lives.
3. Social seclusion and mandated rest. Postpartum is a time for the mother to rest, regain strength, and care for the baby. Related to the concept of vulnerability is the widespread practice of social seclusion for new mothers. For example, in the Punjab, women and their babies are secluded from everyone but female relatives and their midwives for five days. Seclusion is said to promote breastfeeding and it limits a woman’s normal activities. In contrast, many American mothers are expected to entertain others—even during their hospital stay. Once they get home, this practice continues as they are often expected to entertain family and friends who come to see the baby.
4. Functional assistance. In order for seclusion and mandated rest to occur, mothers must be relieved of their normal workload. In these cultures, women are provided with someone to take care of older children and perform their household duties. As in the colonial period in the United States, women often return to the homes of their family of origin to ensure that this type of assistance is available.
5. Social recognition of her new role and status. In the cultures Stern and Kruckman studied, there was a great deal of personal attention given to the mother. In China and Nepal, very little attention is paid to the pregnancy; much more attention is focused on the mother after the baby is born. This has been described as “mothering the mother.” For example, the status of the new mother is recognized through social rituals and gifts. In Punjabi culture, there is the “stepping-out ceremony,” which includes ritual bathing and hair washing performed by the midwife, and a ceremonial meal prepared by a Brahmin. When the mother returns to her husband’s family, she returns with many gifts she has been given for herself and the baby. The following is a description of a postpartum ritual performed by the Chagga of Uganda. It differs quite a bit from what mothers in industrialized countries may experience.

From http://babygooroo.com/2012/08/how-other-cultures-prevent-postpartum-depression/