In the past few years, postpartum depression has had a lot of press. Brooke Shields had it, Marie Osmond had it. Tom Cruise denied it exists. All good for raising awareness. Now we all know it exists, and maybe some of us know the warning signs. But no one talks about this: What if you have post-partum depression and you must continue working?

Three years ago, I was in this position. I haven’t written about it because it was bad. Very bad. I keep waiting for someone to write about what it’s like to have to continue working even with post-partum depression. I guess I will be the one.

Here is what you need to know about postpartum depression if you are the breadwinner of the family:

1. Take maternity leave. Even if you have to make it a little unconventional.
I was a freelance writer, with a husband who did not work, and we were living paycheck to paycheck. I thought there is absolutely no way I could take maternity leave. We’d starve.

But I tried to think of ways to craft an unofficial maternity leave by getting ahead with my writing. I didn’t tell my editors I was doing that, but my plan was to not have to write very much.

2. Plan ahead, for the worst-case scenario.
In our heart of hearts, we know that the best case scenarios don’t actually need planning for. So why make plans assuming best case? Make contingency plans.

I did that a little. Because I’m a freelancer and my husband and son are nearly uninsurable, for prior medical conditions, we usually have crappy, near-nothing insurance. But we raided the last of our savings to buy great health insurance for the baby and me, just in case something happened during delivery.

Other than that, I assumed that things would go smoothly when we got home from the hospital since this was our second child, and I already knew how to care for a baby.

3. Admit that no time off means you’re high-risk for postpartum depression.
The baby came early, and I was not really ahead on columns, and my book wasn’t finished.

So right after the baby arrived, I had to finish my book, which was behind schedule. And, my agent told me that there was no way I could promote the book when I was 40 pounds overweight. After all, there was a chapter about how bad it is for your image to be overweight. So I spent two or three hours at the gym every day.

The baby came everywhere with me—to my book publisher, to my agent, to my newspaper syndicate, to the gym. I breastfed in everyone’s office. I breastfed in the cardio room and the weight room.

I cried all the time, and I felt that I had no idea how to take care of the baby, but I looked okay in all my meetings, so I kept going.

4. Ask for help from people you don’t work with.
Then, one night, the baby was screaming and our three-year-old wouldn’t go to bed and my husband was telling me that I needed to get the three-year-old some milk and I was saying that he should and I’ll get the baby and he rolled his eyes, and then I took a knife out of the dirty dishes and stabbed my head.

I don’t actually remember doing it. I remember my husband saying, “Oh my god. There’s blood everywhere.”

Here’s how crazy I was: I just put the knife back in the sink and went to get the baby.

The next day I went back to my old therapist and told him. While I breastfed the baby.

My therapist said he didn’t think I’d ever hurt the kids, but he had to send me to the emergency room to be checked out. So I went there. With the baby, and my cell phone, and I handled edits for my Boston Globe column from the hospital hallway.

The doctor I saw wanted to admit me to the mental ward. I had a friend call all over looking for a hospital that could take me and the baby into a mental ward together, and not one could. “It’s a huge breaking point in the mental health system,” she said.

The psychologists did not want me to leave, but I was convincing, telling them that we would not be able to support ourselves if I did not work. And I was also convincing telling them that I did not want to risk losing my breast milk permanently by separating from the baby for a week in the mental ward.

The doctor said I could go back home with the baby but I couldn’t be alone with the baby.

5. Postpartum depression is one of those times when you should break the bank.
When I left the hospital, I told myself I would just ignore the doctor’s advice because it would be impossible to not be alone with the baby. My husband had to take our older son all over the city for school and activities. And we could never ever afford round-the-clock care.

But on the way home, I remembered Andrea Yates. I had always felt empathy for her, but now I felt like maybe I could be her. I know it came out of nowhere to her: first she was just sort of depressed, and then she was killing her kids.

Plus, I remembered two times when people had asked me how the baby was and I said, “Sometimes I want to slam his head into the wall.” Both times I got very concerned looks. So stopped saying it, but I knew it was not good.

So I hired someone to stay with the baby and me. Only then did I realize that I was terrified to be alone with the baby. I still cry thinking about how I was probably a danger to my own child. The babysitter was as much for me as for the baby.

I kept working. I kept seeing a therapist. And we went into huge debt in order to pay for the babysitter.

In hindsight, I wonder, What could I have done differently?

My career could not have handled a three-month maternity leave. But I should have hired the nanny at the first sign of trouble, even though it caused a lot of debt. I was so scared of spending money. I cut corners on things that I thought I could handle but couldn’t. And the biggest thing, in hindsight, that I thought I could handle, was being a working mom with no support system. No one can do that and stay sane.

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  1. Christy Ramon
    Christy Ramon says:

    Thank you for being honest. Women of my generation – I’m 26 – owe you the immeasurable value of foresight. Maybe you lost out on some cash, you’re giving this big, free lump sum of wisdom to so many.

  2. David Rees
    David Rees says:

    Penelope, people may call you a lot of different things, but they can never call you a coward.

    We have all had our dark moments and I admire the strength it takes to be so open about your humanity.

  3. Matt Bingham
    Matt Bingham says:

    “And, my agent told me that there was no way I could promote the book when I was 40 pounds overweight.” This is why I would never make it in the public eye. To me, I like you for what you write, how you think and how you present your ideas. Sorry – that comment really bothered me. At any rate, thanks for the honest post. Your brute truth tactic is humbling and chilling all at the same time. Thanks for sharing!

  4. Rosie Ramazani
    Rosie Ramazani says:

    You had to take the baby everywhere with you? And then you had to hire someone so that you could avoid being alone with the baby? It sounds like your husband was not taking on enough of the child rearing himself. It is possible to take an infant along while driving another child to school.

  5. Tamara Paton
    Tamara Paton says:

    I’m 7 months pregnant and Canadian. Why do those 2 ideas go together? Because Canadian mothers get 12 months of maternity leave.

    Thanks to my employer’s benefits policy, I’ll get 100% of my salary for 6 weeks, 75% of my salary for another 11 weeks, and then government support thereafter. And my employer isn’t an outlier – this is standard corporate practice. Most government employees get 100% of their salary for the entire 12 months.

    I have to wonder if PPD incidence is lower north of the border. Given how common it is here to breastfeed for 6-12 months, I would imagine that the difference is significant.

  6. Latoya Peterson
    Latoya Peterson says:

    Hi Penelope –

    I have no children and do not plan on having any for quite sometime now. But I did want to tell you that I think this is one of the most important things you have ever written and I think it will help a lot of women.

    I know I will keep this post in the back of my mind and remember to send it to women I know who may need a little help.

  7. Jessica W.
    Jessica W. says:

    Penelope, Jay sent me a link to your post today. (not that you’re not on my NetVibes page, but he knows I don’t check that everyday)

    As someone who dealt with very mild PPD, I can’t express how much I applaud your honesty! This is what our society needs…to talk about it and acknowledge it….to be aware that it is invading homes across America. As women, I find it imperative that we support one another in a way that hasn’t really been taught to my generation, IMO.

  8. Ken
    Ken says:

    Stabbing yourself in the head and not really remembering why you did it, or that you actually did it, sounds more like post-partum psychosis than depression.

    It’s very rare, but very dangerous. I can see why the doctors wanted to keep you longer for observation.

    I’m happy to hear that you pulled through and are doing better.

    Our son, our only child, just turned one about a month ago. My wife stays at home and often I’d come home from work and find her in tears. She felt very uncomfortable and sad and alone and scared and angry.

    Being new parents, we just thought she had a touch of the baby blues.

    It wasn’t until nine months after the baby with the same symptoms that we realized she was probably dealing with post-partum depression, so we did what everyone should do in such a case:

    We moved to Wisconsin.

    Hi Penelope down south. Hope you’re enjoying the big snowstorms normally reserved for those of us way up nort’.

    We’re near the border of Michigan’s upper peninsula.

    I’m new to your blog since Yahoo let you go (what a mess they have to deal with now), but have enjoyed it immensely so far.

    I’m glad I stumbled upon it.

  9. Sydney Lagier
    Sydney Lagier says:

    Wow, thanks for sharing that. I have a friend who was suffering similarly after her first baby. She had no idea what was happening to her. A neighbor came over one day and said, just from looking at her “call your doctor now, you are having postpartum depression and you need help”.

    She called her (male) doctor. His prescription: “tonight when your husband gets home from work, you hand him the baby and pour yourself a nice glass of chardonnay and go take a bubble bath.”

    Can you believe–this from the medical profession!

    • emily
      emily says:

      We, as a culture, are kind of ill in certain ways but we isolate the illness to individuals so we all don’t have to take on what we need to take on to change. That might sound hippy dippy, but we could all help each other a lot more than we do. Women’s post post-partum depression is a big deal social problem in the US – does anyone have cross-cultural statistics?

      This is an old comment and an even older post, but I’m just now reading and was wondering what it was that you wanted the doctor to say? I understand that it’s terrible for the medical profession to deny that there are real problems but sometimes I wonder if it’s actually not best for them to let the real problem be healed – in this case, the dad wasn’t taking on his share of the responsibility at home. I’d actually agree with the doctors’ bubble bath cure – IF he recommended this solution not only for that night but for 100 nights after.

      Call that feminist and unrealistic, but i think that it’s much more of an issue if the medical profession actually denies that the woman needs anything at all. It’s much more common, and dangerous, i think – if the depression is seen as something without any real world relationships – something in someone’s head that’s isolated. It comes up a lot with mental illness when people somehow thing they can catch it from other people and so I often think that illness is the wrong word to use all together.

  10. holly
    holly says:

    I have always appreciated your honesty in saying things most people don’t like or want to hear. Now, appreciation has turned to admiration. Your experience gets to benefit others now. What a gift.

  11. Natasha Reilly www.creativenachos.com
    Natasha Reilly www.creativenachos.com says:

    Penelope,
    Thank you for your raw, heartfelt, heart breaking honesty. It was incredible to see what you went through…I can’t even imagine. I have a 10-month-old and work part-time but I have help in the mornings everyday. Until I had my baby, I had no idea how important it is to have support. It’s important as you move through pregnancy and SO important after. Mom’s need the support of one another and loved ones.

    My heart aches for all that you went through. You are an inspiration and it is my hope that from here on in you always reach out for support. Whether we have children or not, we NEED support and lots of encouragement and love in this lifetime.
    Thank you for the gift of your truth. I think this post should be everywhere!

  12. Jennifer
    Jennifer says:

    Depression of all kinds is still highly misunderstood. First no one believed it was real. Then it became over-diagnosed and over-medicated. This has taken us right back to where we started. The people who genuinely suffer from depression are marginalized by the scores of people that have been diagnosed. The people who need the actual help and support are not getting it because everyone is on anti-depressants so therefore think they understand.
    Thank you for being open about your struggle.

  13. C
    C says:

    I realize this advice may seem trite, but it worked for me. When I had post partum blues I took lots of vitamins. I took a B vitamin that had at least 25 mgs of all the B vitamins. It worked. I continued taking a multivitamin at least 3 times a day since then. It can make a difference in the way you feel.

  14. Evan
    Evan says:

    Never commented on an article in my life, but felt compelled because of your courage.
    Thank you for bravely sharing this.

  15. Mary
    Mary says:

    I certainly remember you during those days and how you struggled to hold it together since everyone in your family was depending on you. Even though you were going crazy, you still seemed strong. Your will and determination to get help and get through it was impressive.

    Work was actually a haven for me during the tail end of my PPD.

    My own PPD happened after my first child was born in August 2001. I suspected within weeks that I had PPD for a number of reasons, but by this time, it was after 9/11 and everyone was depressed. I would think, “what right do I have to be depressed when so many people around me have lost loved ones?” My midwife told me I didn’t have PPD. I also wound up in the emergency room of some hospital and was told the most they could do was either take away my baby (so nice they told me that!) or sign me up for therapy–but there was a waiting list of 2 months. Great–I’ll be happy to live for 2 months trying to not hurt myself or my baby. I told the doctor, “why can’t you help me?” and she said, “I am helping you. I’m going to put your name down on the waiting list.”

    I made the decision to go back to work while I was PPD because I had to get away from the baby. I went back when he was 4 months, and by that time I finally found a therapist who could treat me and I had started taking a sleep aid. Thank God, because I’d lay awake at night watching the shadows move on the wall–after 12 weeks of doing that, the shadows started signaling to me. Fortunately, the sleep aid kicked in before I figured out what the shadows were telling me to do. What cured me was some medication, sleep training for the baby, sleep for myself, a fantastic babysitter, and work in an office. The main problem with PPD is you are so exhausted and out of your mind, that it is hard to find the help you need. I felt that there was no therapist for me (and this is NYC, psychotherapist heaven.)

    The best thing you can do, people expecting a baby, is do some research on what treatment is available in your city before the baby is born. Once PPD hits, you have so little reserve to get the help you need.

  16. MariaMH
    MariaMH says:

    Wow – this is honesty! What is clear to me is that our health care system is great in some ways and absolutely horrible in other ways. Recent surveys have shown we are not getting the best care – other countries have far better systems than we do. It’s hard to believe and scary that there are still doctors who don’t believe PPD is a big issue! I try not to play the woman’s card, but it is a “woman’s” problem and frankly, that means a lot of people still think this stuff is “all in our heads.” I would really like to believe that is not true, but it is. I hope more woman speaking out about this helps to turn this opinion around.

  17. kathryn
    kathryn says:

    My, my… what a coincidence. I resume therapy today for my depression and you post anecdotes of just how bad it can get.

    Thanks. I’m still about 3 years away from being able to start my own family but I think this advice will stick in my mind. Given my psychological history, there’s no way that I’ll be able to avoid PPD. (I also understand how easy it is to convince other people–including significant others–that you’re fine when you’re really going batshit insane.)

  18. mair
    mair says:

    What a great post and thank you for your honesty in writing about this. I have been suffering on and off from regular depression for a number of years and have an appointment scheduled with my doctor (this winter has brought it back on hard and fast).

    It takes great courage to write about PPD and what you went through. Thanks for sharing.

  19. Patricia Fraser
    Patricia Fraser says:

    It’s been nearly 29 years since I was a new mother, but I remember how scary it was — and not good “aren’t we having a great adventure” scary, but “can we all get out of this alive” scary.
    Thanks for turning the spotlight on a real problem.

  20. Mrs. Micah
    Mrs. Micah says:

    It’s very brave to share all that. And people like you who tell it like it is make it easier, I think, for others to feel like they’re not completely crazy and alone in this.

    When I’m pregnant, I’m going to try to make plans for this beforehand. Because I know I’m high-risk, since I’ve been fighting with depression for years. And even though I’ve been doing a lot better, I know hormonal balances could get thrown off and make it much worse.

    I’m not quite ready for kids yet anyway, but PPD is another reason that I’m scared to have them.

  21. Ms. Mcgoo
    Ms. Mcgoo says:

    Thank you so much for your honesty. It’s a sad truth that America is hugely behind the rest of the world when it comes to maternity leave. I think your story is an important one.

  22. Andrea C>> Become a consultant blog
    Andrea C>> Become a consultant blog says:

    Thank you for having the courage to be so brutally honest.

    FWIW, living in Canada would not help with the maternity leave situation. Penelope is self-employed and would thus not get mat leave. I am on my second time around with no mat leave. As a result, I was checking emails and back to work very quickly…while my friends had a year off. However, I work from home, so at least I’m with my kids most of the time.

  23. Patricia Robb
    Patricia Robb says:

    I am a single mom and fortunately did not suffer from PPD, but from reading your post, and the comments from others who have, I can only imagine how hard a situation that would have been. Thanks for your post. I hope it will make people more aware and we will pay attention to friends and co-workers who may be suffering.

  24. Sam
    Sam says:

    Where were your parents during all of this? I’m not of the opinion that people are entitled to use their family as surrogate babysitters, but when you need help, they ought to be willing to lend a hand. If they are really rich, as you previously mentioned, then maybe they could help out by offering you some sort of financial cushion, or help with therapy.

  25. french panic
    french panic says:

    Hi. This comment is actually to clarify someone else’s earlier comment (#8, Tamara Paton). Canada is NOT the land of 12 months paid maternity leave; Tamara makes it sound like all Canadian women automatically get 12 months of (mostly) paid maternity leave. This is simply not true. Tamara must have a fantastic job; many Canadian women do not.

    According to the Human Resources and Social Development Canada (government) website:
    http://www.hrsdc.gc.ca/en/lp/lo/lswe/ls/publications/5.shtml

    “The Code provides for up to 17 weeks of maternity leave. In addition, an employee who assumes actual care of a newborn or newly adopted child is entitled to parental leave of up to 37 weeks. However, the total duration of the maternity and the parental leaves must not exceed 52 weeks.”

    Note that the 17 week max is UNPAID maternity leave – it is up to the employer to decide how much to give, and it varies. Widely.

  26. Wendy
    Wendy says:

    Touching post. You also offer a good reason to get one’s personal finances in order before having a baby. Having a healthy mom is more valuable to your baby than a $1000 crib, etc.

    ***

    I also wonder whether men can suffer from some sort of postpartum depression — from trying to do too much (keep up with — or boost — their job/career, help their wife and child, and deal with any other life stresses).

  27. Wendy
    Wendy says:

    ooops — I hope I didn’t imply that I thought you, penelope, had mis-managed your finances. You obviously had the credit situation that allowed for borrowing to hire help. My comment was because I’ve known people who bought a new car, bought expensive baby furniture, and other items beyond their means and then really struggled when other needs for money came up after baby was born(like for help with baby and household chores when mum needed a longer physical recovery from childbirth than expected), putting stress on the marriage and family.

  28. Wendy
    Wendy says:

    French Panic – I’m in Canada, on Maternity leave, and I get 52 weeks *paid* through the government EI (Employment Insurance) system. 17 weeks for giving birth and another 37 that I’m taking (but my husband could take part of it instead if he wanted to do so).

    The government component is really “partially paid” and is up to 55% of your income up to $40K. It maxes out at about $1500 / month (even if you make more than $40K).

    NOTE: You have to have worked a certain number of hours as an employee in the months leading up to your mat leave. If you’re self-employed and don’t pay into the EI system, you don’t qualify for maternity or parental leave.

    Some employers and unions top up the mat leave pay. Mine does to a small degree.

  29. The Captain
    The Captain says:

    Penelope – I have one 3yr old and another on the way. If I’d known about the trouble you were having I’d have passed on a grizzly old captains hug to you and shared me bottle of rum – but that’s not good for breastfeeding or doable (yet) over the net.

    Yours is my number one blog and this is another great post of yours. Parenting is not easy and you did the right thing getting help – usually the ones that don’t are the ones you read about.

    Good luck with your kids and family mate.
    The Captain

  30. Wendy
    Wendy says:

    Me again (sorry) – to clarify: all Canadian women who work as employees full time are entitled to 52 weeks partially paid maternity and parental leave.

    __That’s 12 months, French Panic.__ (see her inaccurate comment ~ 4 posts up)

    Your employer is also legally required to hold your job for you (or pay severance, the same as if your job became redundant while you were working there). I believe in your absence you could be re-assigned to a different job, but it must be at the same rank and pay (or higher).

    The Mat leave check comes from the government, doesn’t matter who your employer is.

    Some employers are of course more supportive, offering top ups, and some flexibility in re-entering the workforce.

  31. Shefaly
    Shefaly says:

    To me, it seems men know about all this after all.

    At home they pretend they do not, and leave the wife to it all, so they do not have to do much at all.

    But at work, this – along with the paid leave and the guarantee to hold jobs etc – is why women of child-bearing years get asked oblique questions about their husbands’ jobs and their maternal status.

  32. Chris Perkett
    Chris Perkett says:

    As a woman passionate about “having it all” – I went into labor on the way to a business meeting and closed a deal waiting in the OR prep (emergency c-section) – I can relate.

    And, I say THANK YOU for helping others by sharing your experiences. I wish I were as brilliant at making it all sound so eloquent. Bravo, as usual, Penelope.

  33. SF Mama
    SF Mama says:

    Thank you for this painfully honest post, Penelope. I’m a psychotherapist who treats women with PPD, as well as a mom myself. So many moms sit in my office talking about how “all the other moms” look like they have it all, are so perfect, are wearing makeup, have shaved their legs, etc. When really, that well-put together looking mom is dying inside.

    Honesty like yours helps so many women. Thank you!

  34. Lillian
    Lillian says:

    I read this column a lot and enjoy it but this is the first time I have been moved to post.

    I am an Australian and I honestly cannot work out what you guys think you’re doing over there in the US. Here we have legislation that provides for compulsory paid maternity leave of varying amounts, I get 12 weeks of full pay. We also have government family and child support payments for those who need them.

    We also have government funded childcare and laws which protect women from discrimination and protect their rights to flexible working hours upon return from maternity leave. It is almost unheard of down here (and frowned upon) for anyone to go back to work until at least six months after the baby is born.

    I’m shocked you were so unsupported, but I agree with the other posters that your honesty will probably help a lot of people.

  35. Lorraine
    Lorraine says:

    Thank you for your honesty! Having supported my sister through depression for 3 miscarriages it was of no surprise to me that once she finally had her daughter she soon developed PPD. What did surprise me was the lack of support she received. People were very understanding at her depression following miscarriage, but could not understand what she would have to be depressed about after finally succeeding. She had her baby – she should be over the moon and should “pull her socks up and get on with it”. Worryingly that quote came from a woman who had also suffered with PPD and had wanted to throw her child out of the top floor window of their house. This comment could’ve been said because that is what she was told to do by an older generation, but we will never have understanding without talking. I hope your article is a stepping stone towards it.

  36. Kosta Kontos
    Kosta Kontos says:

    At first I thought I didn’t have anything to add to this conversation. Then after a fruitful exchange over at Tiffany Monhollon’s blog, I came back to this post and gave it some thought.

    Then it hit me like a tonne of bricks;

    Pen, not only have you recently blogged about how to be more interesting to other people, but you have just practised what you preached (in this very post), and proven that it works.

    By being open about your struggles, you have burst open a flood-gate of conversation. I bet your bravery will help women in similar circumstances too.

    This young, unmarried male, with little knowledge of postpartum depression (up until now anyway), is impressed.

  37. Curmudgeon
    Curmudgeon says:

    You are at your best when you are starkly honest with yourself, and with your audience. And it is pretty damned good.

  38. Rich
    Rich says:

    Penelope, another fantastic post.

    The idea of PPD is so foreign to men that I think couples need to plan for worst case PPD, and execute the plan whether there is a crisis or not. As a father, I assumed that my wife would switch into ‘Mom’ mode and that everything: the lack of sleep, adult interaction, and physical demands of early motherhood were natural. A bad assumpion.

    Regardless of what previous generations will say, or your images of a perfect parent, PPD is here to stay, it is real and it happens to almost everyone in some form. Parents (especially men) need to accept it, plan for it, and remind themselves constantly that they are doing their children a service by dealing with the reality up front.

    No to sound too sexist, but as a father and husband, and the one without the massive hormone changes, it is our responsibility to care for mommy and see to it that she makes it to the baby’s second birthday without a doctor’s note.

  39. Kristin Ohlson
    Kristin Ohlson says:

    This made me weep. Very brave, very important column. I hope it’s part of a bigger article for a big magazine so that even more people will think about PPD and maybe push to make some changes that will help mothers.

    Good for you.

  40. klein
    klein says:

    But you’re not merely a ‘working mom’. You are the sole EVERYTHING of your own business. Maybe we only get one side of you here, but it sounds like your work is more important to you than ANYTHING else in your world, and that really is backwards.

  41. Jen @ JenuineJen
    Jen @ JenuineJen says:

    What a breathtakingly honest post. I am so sorry that you had to go through such a tough depression while working and supporting your family. Thank you for your honesty.

    If you are pregnant and reading this, make sure you and your spouse (significant other, etc.) are fully aware of the symptoms of post partum depression. That way if you begin to show signs you can get help immediately. Also, be prepared to get help if your spouse or someone close to you suggests it. Sometimes you can be so caught up in the struggle that you do not realize you need help. It is certainly not a sign of weakness to get help.

    Thanks again, Penelope!

  42. Kevin Gossett
    Kevin Gossett says:

    Once again, Penelope, hats off to you. What a wonderful, frightening and insightful post. As an earlier commenter said, this post is “breathtaking in its candor.”

    I’m very glad I read you, and link to you often.

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