postpartum depression

By Laura Dorwart

I have taken the postpartum depression inventory a total of five times: one time honestly, the other four times lying to varying degrees. (I had good intentions, I promise).

Louis-Victor Marce is often described as the first clinician to write openly about postpartum depression and other mental health conditions. His 1858 “Treatise on Insanity in Pregnant, Postpartum, and Lactating Women” has been widely cited as the “first” depiction of pregnancy-related mood disorders and anxiety before his monograph went largely untouched for 100 years (except, sometimes, to justify the involuntary confinement of recently pregnant women), prior to the reopening of a dialogue about postpartum depression in the 1950s when the field of psychiatry took hold in the United States. His wasn’t, of course, the actual first documented mention of postpartum mental health issues—a female physician, Trotula of Salerno, wrote in the 11^th century that if the womb was too moist, the brain could become filled with water and cause women to cry involuntarily and excessively, perhaps referring to conditions leading to an excess of amniotic fluid—but it was the first extensive one in Western, conventionally documented, male-dominated medical history.

He seems like he was kind of a dick, but that appears to have been a requirement for early psychiatrists and psychoanalysts, especially 19^th– and early 20^th-century ones (many far worse than the most obvious Sigmund “Literally Everyone Wants to Fuck Me So Badly It Makes Them Neurotic” Freud). Besides, the fact that his writings about fairly inarguable realities—“hey, so, women undergo huge hormonal shifts during and after pregnancy and also quite possibly the most physically painful and exhausting experience possible right before their entire lives change permanently and maybe that can be traumatic?”—were used as excuses to get all Yellow Wallpaper on a host of middle-class women and to institutionalize lower-class ones can’t be blamed solely on him, really.

Regardless, Marce started the clinical dialogue that eventually led to the development of the Edinburgh Postnatal Depression Scale, now used as the primary diagnostic tool in determining whether a woman has or is at risk of developing postpartum depression.

The test, which alternately starts with one of two fairly sinister statements (either “as you are pregnant or have recently had a baby, we would like to know how you are feeling” or “postpartum depression is the most common complication of childbearing”), requires you to respond as to whether a series of ten statements apply to you in the past seven days (always bolded) with one of five answers. The answers seem awkward and vague if you analyze them too carefully—“not as much as usual,” “about as much as before,” and such—but the test has been proven to be clinically significant for years. Women considered “at risk” of developing postpartum depression are given the screening regularly throughout pregnancy and usually twice postpartum, once after delivery and again after four weeks, when the risk of developing postpartum depression or psychosis lowers significantly. I am “at risk.”

I have been able to laugh and see the funny side of things.

The day I went into labor, my husband Jason and I were in Whole Foods desperately buying castor oil; one of the midwives at UC San Diego had suggested it to induce labor naturally. She had a voice like a meditation track and disarmingly perfect cheekbones, so I was lulled into a false sense of trust before I saw the warning label on the castor oil—“not to be consumed.” A beleaguered Whole Foods employee told us frankly, “No, it’s safe to eat, you’ll just have the runs really bad.” “Sure you want to do this?” Jason frowned at the bottle. I wasn’t, but I was big as a house. Jason is a quadriplegic; his service dog had started to have to help both of us pick up our underwear because nobody in our household could bend over properly. I was ready.

Luckily, we didn’t need it. We went home and I promptly started contractions that sped up to every four minutes. Jason read children’s books aloud to me, part of his job description as my personal anxiety coach. My water broke, a pop and a hiss, right around midnight, while he was reading to me about Rosalie the fairy helping Jack Frost get a makeover that seemed at the time to be gesturing at gender-affirming surgery. He wanted long hair and he needed fairies to give it to him, but they wouldn’t, presumably because of fairy codes that I think represented health insurance issues.

Jason stuffed towels under me in the front seat and a heavy overnight pad into my underwear. I started shaking and I didn’t stop for the next 30 hours.

In triage, they announced I’d need an IV. I was GBS-positive, which meant I could pass infection-causing bacteria along to my baby (a girl, presumably eight pounds according to the latest ultrasounds) if I didn’t get several doses of antibiotics. The first nurse was impossibly blonde-pretty, like a contestant on The Bachelor. I didn’t trust her; she lacked grit. I like my nurses slightly mean. She jammed around inside my veins for a while while making soft little “hmm” sounds for a while, usually right around my contractions. I tried to have polite contractions, smiling shakily at her whenever she made one of those high-pitched “hmms.” I have heard those before. that meant “I am never, ever getting this IV into you and I will have to call someone else.”

She did. And that one had to call another. “Your veins are tiny,” they said, one after another, always scoldingly as if I’d made them myself. When my arms failed, they tried one of my hands. “Is this what junkies go through?” I joked weakly (and problematically) through a contraction. No one laughed.

All told, I was not getting an IV put in for nearly four hours; near the end, during one particularly painful (and still unsuccessful) poke, I finally let out a scream that brought all the midwives on call in to look at me pityingly. When the three nurses finally left, muttering about calling anesthesiology, Jason (who had been squeezing my non-abused hand the whole time) decided to entertain me with an ironic sexist joke about how if the anesthesiologist was male, he could finally get something done around here. I laughed wryly and told him I hated him.

The anesthesiologist showed up four hours into my labor. He was, indeed, male. “You have great veins,” he said, sliding the needle in with aplomb, the slight slice tingly-pleasant like acupuncture. Jason and I looked at each other and grinned sideways. A punchline.

I have felt sad or miserable.

“This is Laura Dorwart, 28. She is six days postpartum and had a vaginal full term delivery of her first baby. She has a medical history of depression and chronic PTSD,” the nurse read, monotone, to her replacement, as my parents watched. My mother’s eyes flew open and her lips pursed in disapproval, I thought—or maybe it was all in my head. The nurse didn’t notice. I laid back in my gown and closed my eyes, feigning exhaustion.

Three days after our daughter was born, with Jason asleep on the table, I tried to make myself hate her, or to become so obsessed with her that she could transform into an object of sadism, masochism, something. I hadn’t felt any guilt when others picked her up or any resentment when she was handed back to me. I didn’t feel like a worthless mother. I looked into her eyes and snuggled her baby-skin. I weighed the burden of her. It was baby-sized. Not the weight of the world.

I began to realize on the fourth day postpartum that I was perhaps hoping for a crisis. Catastrophes wipe things away, don’t they? They start things new, they erase what was. They break and then you’re forced to rebuild.

Plus, I figured with my prior reactions to the mundane, a real catastrophe could do me some good. Some guy breaking up with me when I was 17 caused me to seriously consider dropping out of school. I seriously considered leaving town rather than going into work late once. I had five lemon vodka shots and threw up in a cab after a frat party in college and slept on the tile floor of my dorm room in despair. I still obsess over my breakup five years ago from a girl I knew for a total of eight months; in my mind, it’s sometimes reached Tristan and Isolde levels of tragedy.

Then there are the real crises: The day after I was raped by my then-girlfriend, I went in to work on time and copy edited a fifty-page curriculum booklet. I went to lunch and a meeting. I had chicken wings. I did not cry.

The night that my best friend died, I played a game on the computer that required me to digitally bob for apples. I felt like a sociopath for experiencing satisfaction at hearing the crisp sound bytes of capturing the pixelated apples one by one. Crisis, I remembered, does nothing for me.

Still, I tried to create one. I stared at my baby and attempted to muster some kind of resentment, some kind of foreboding warning sign of synapses misfiring in my brain and causing me to detach. No dice; sometimes I felt an overwhelming love, sometimes the lighter affection I feel for all babies, and on the negative end, nothing but mild annoyance in my most sleep deprived states.

I had wondered, alternatively, if I would feel grief and loss. Some women describe feeling empty after their babies are born, their wombs like voids aching for the return of togetherness, their tiny soulmates now skin-separate. Not me. I felt intact. I was intact. Heavy as I always ways, just thirty pounds lighter. Filled to the brim with the same longing as before, no different. It’s been four weeks. There was no crisis, no catastrophe. I did not break.

I can’t say I’m not disappointed.

The thought of harming myself has occurred to me.

Never check yes on this one.

Never let them see you sweat.

I have been so unhappy that I have had trouble sleeping.

I checked my medical records after all was said and done. For me, nothing I didn’t already know: For Ruth, her medical conditions: a CPAM—congenital pulmonary airway malformation—that we’d known about since the beginning. A benign cyst hiding in her lung. Meconium. And: “Child of depressed mother.” Born of a sad woman: A preexisting condition. A diagnosis in and of itself.

It stuns me, hits me hard in the chest, a clenched fist like a heart attack—just a slower squeeze. I show Jason, and he doesn’t get it, not really. “What are they afraid of?” he asks, though he knows. Postpartum depression makes everybody angry, even Tom Cruise, who took up quality potential Scientology-pushing time to rant about Brooke Shields’ baby blues.

Some people baptize their babies. I’m an atheist on my best days (on my worst, I assume God is a menace), but it turns out, even nonbelievers want to cleanse their offspring of original sin: Our new pediatrician asks us to forward our hospital medical records, and I opt out. She’s going to be nothing like me, no stains on her record, no sorrow-as-birthright. She’s going to be free.

Laura Dorwart is a Ph.D. candidate at UCSD with an MFA in creative nonfiction from Antioch University. Her work has appeared in Catapult, McSweeney’s, The New York Times, VICE, BuzzFeed Reader, Lady/Liberty/Lit, The Eunoia Review, Blanket Sea Magazine, and others. 

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