By Sarah Hall
Editor
The story of Cynthia Wachenheim haunts Christine Kowaleski.
“She was in her mid-40s, an attorney,” said Kowaleski, a psychiatric nurse at Crouse Health. “She couldn’t wait to have a baby.”
Wachenheim, 44, was a New York State Supreme Court attorney in Manhattan when she gave birth to her son, Keston Bacharach, in 2012. Over the next several months, Wachenheim, while on extended maternity leave, became increasingly convinced that there was something wrong with her son.
“Baby bumped his head,” Kowaleski recalled. “She takes baby to the pediatrician. Pediatrician goes, ‘Well, I don’t really think it’s seizures, but …’ and all she heard was seizures. She started cycling, this rapid cycle downwards. Tried different meds, didn’t like them. Ultimately, long story short, kid hit his head again. She thought the kid was brain damaged.”
According to reports from the New York Times, the baby’s “injuries” were no more than everyday bumps — bouncing his forehead off the floor while lying on his stomach or falling from a sitting position. But Wachenheim believed that he had sustained multiple concussions and possible brain damage. And not only was it her fault, but no one believed her.
On the afternoon of March 13, 2013, Cynthia Wachenheim wrote out a 13-page note detailing her perceived failures as a mother.
“I am so unbearably sorry, which I know does nothing to undo the evil I have done,” the note read. “I wanted to be a mother so badly and I hoped to be a wonderful one, and instead I have become the worst of the worst.”
Then she strapped Keston to her chest and jumped out the eighth-floor window of her Harlem apartment. According to the note, “if I had unknowingly caused brain damage to my beautiful, precious baby, I didn’t want to live.” And she couldn’t bear knowing her son would live a life of suffering. She died on impact. Miraculously, Keston survived with just a scratch — and he developed normally with no delays or problems.
‘They think they’re alone and they’re not’
What would cause a mother to commit such a terrible act? Wachenheim likely had postpartum psychosis, an extreme and rare peripartum mood disorder that occurs in approximately .1 to .2 percent of births. Far more common are peripartum depression and peripartum anxiety, as well as a temporary postpartum hormonal shift termed “the baby blues” — about 85 percent of moms go through some kind of mood adjustment during or after pregnancy.
“A lot of people are struggling, and they think they are alone and they’re not,” said Kathleen Miller-Murphy, Crouse’s manager for community education.
To help those moms, Crouse Health’s Spirit of Women program offers a support group every Friday at CNY Healing Arts in Syracuse. The free group, led by Kowaleski, is one of several efforts Crouse has undertaken to better support moms with perinatal anxiety and depression, Miller-Murphy said — something that had previously been lacking in the community.
“We went out [three years ago] and talked to the OB providers and said, ‘What kind of things do you need for your patients?’” she said. “Resoundingly, they identified support for the moms that have postpartum anxiety and depression.”
The Spirit of Women program, which promotes women’s health and wellness — “because women tend to not take care of themselves first, if they even make it on to the list,” Miller-Murphy noted — worked to make that support a reality, bringing together childbirth educators, Crouse’s community engagement team and perinatal mood specialists like Kowaleski to provide a resource so that when moms were identified as having a problem, there was somewhere for them to go.
“What was happening was physicians were not asking always about that, because if they had a positive screen they did not have resources to send them to,” Miller-Murphy said.
The group was formed to provide an outlet for new moms with severe cases of anxiety and depression, according to Nicole Miller, Crouse’s Integrative Medicine Specialist. Miller helps create the programming for moms. But that’s not all that’s available to moms in need.
“What happens is, a mom is struggling, and we don’t care where they are from. We don’t care what hospital they delivered at,” Miller said. “If they need support they can give us a call.”
Miller said anyone who reaches out is first assessed to determine what kind of supports are already in place. Then she and Kowaleski work to fill in any gaps, whether it is a need for social support like the Friday group at CNY Healing Arts, talk therapy from a counselor who specializes in perinatal mood disorders or pharmaceutical support from their physician.
“We fill in those gaps,” Miller said.
Mom-friendly methods
However, those outside resources have to be complemented with support at home.
“Actually validating mom is very important,” Kowaleski said. “If the partner and the extended family can validate her and say, ‘It’s okay, you’re going to get better, 85 percent of women go through this, let’s see where we can get you some help,’ that is probably the best thing that they can do.”
She also encouraged new moms to get as much sleep as possible — no easy feat with a new baby.
“They’re not sleeping because now they say, ‘I’m home. I should be the one that gets up with the baby,’” Kowaleski said. “How do we torture people in the military? We keep them from sleeping. They become psychotic. They become psychotic from not sleeping.”
Kowaleski said Crouse has shifted in the last few years to a “mom-friendly” model on the maternity floor, allowing mothers more time to sleep in hopes of improving their mental and physical health.
She also pointed out that struggles with breastfeeding may spur a battle with PPD or postpartum anxiety. If that’s the case, she said, babies do just fine on formula.
“I was a NICU NP for 25 years, so the value of breastmilk is — I understand it, but it never is more important than a mother’s mental health. Ever,” she said.
In fact, a mother’s depression or anxiety can even be detrimental to baby.
“It’s the baby’s first adverse childhood event,” Kowaleski said. “That puts that baby at risk for [missing] mdevelopmental milestones, risky behaviors and even early death. We’re setting this baby up, and it’s just because the mom is trying to do it all herself. If I said to a mom, ‘You have to go on meds to make yourself feel better,’ they’ll say ‘No, no, no, no.’ If I say, if you don’t this baby is going to suffer in the long run, ‘Okay, I’ll take it.’”
She pointed out that some sadness and weepiness for a couple of weeks after birth — known as the “baby blues” — is normal.
“The cord is cut, within five days, the mother is back to pre-pregnancy hormones,” Kowaleski said. “It’s the biggest, most rapid hormone shift she’ll have in her life… That’s responsible for the crying for no reason. That we don’t worry about. It’s self-correcting.”
But if the mother continues to feel depressed in the following weeks, it’s time to seek help. (To learn more about the difference between baby blues, postpartum depression and postpartum psychosis, see below.)
Expanding the reach
In addition to the support groups at Crouse, there are a number of resources available to moms in need.
“We give them a bunch of numbers to call,” Kowaleski said. “Postpartum Support International has an online blog. They have a warm line [see below for information]. Come to our group. Come to one of these, express yourself. Whatever you can do to get yourself in a group.”
Miller-Murphy said Crouse is now working to expand the program into other areas.
“Our next steps are to look at taking it out throughout the region and helping other hospitals within our region set up simliar programs so they’ll find the resources in their community,” she said. “We get folks from Binghamton, Watertown, get people from all over so there’s definitely a need.”
If you’re worried about opening up to people who might not understand where you’re coming from, don’t be—Kowaleski and Miller-Murphy said they’ve both been there.
“I had postpartum depression with my second,” Kowaleski said. “It was not a pleasant experience and SSRIs weren’t around then. Mothers feel a tremendous amount of guilt. I’m continually trying to make it up to him — he’s 37.”
“For many of us who have worked on the program, put it together, a lot of us have all been through postpartum depression, whether we realized it at the time or not,” Miller-Murphy said. “It’s easy when women have these issues to isolate and to want to isolate. They have built a wonderful network, and that support is crucial. It’s just really about building a community around what you’re going through and surrounding yourself with people who are doing the same thing.”
Kowaleski said that network has helped many women survive one of the toughest times of their lives and find the joy in their babies again.
“People that come to our program get better. They just do,” Kowaleski said. “I guess I can say we figured it out.”
Postpartum depression: When to seek help
Baby blues
Most women will experience mood swings, weepiness and crying spells for about 10 to 14 days after childbirth. According to Christine Kowaleski, psychiatric nurse at Crouse and regional coordinator for Postpartum Support International, it’s caused by a massive and rapid hormonal shift.
““It’s the biggest, most rapid hormone shift she’ll have in her life,” she said. “That’s responsible for the crying for no reason. That we don’t worry about. It’s self-correcting.”
Postpartum depression and anxiety disorders
When that sadness and crying persists beyond a couple of weeks, the mother may be experiencing postpartum depression. About 15 percent of women experience significant depression following childbirth. Ten percent of women experience depression in pregnancy. In fact, perinatal depression is the most common complication of childbirth. Symptoms can begin any time in the baby’s first year and include:
- 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
Some mothers also experience postpartum anxiety — this is seen in about 6 percent of pregnant women and 10 percent of postpartum women. Symptoms include:
- Constant worry
- Feeling that something bad is going to happen
- Racing thoughts
- Disturbances of sleep and appetite
- Inability to sit still
- Physical symptoms like dizziness, hot flashes, and nausea
Mothers should also watch out for more severe versions of PPA, including Postpartum Panic Disorder, which includes the above symptoms as well as panic attacks, as well as Postpartum Obsessive Compulsive Disorder, which affects about 3 to 5 percent of new mothers, as well as some fathers. Symptoms include:
- Obsessions, also called intrusive thoughts, which are persistent, repetitive thoughts or mental images related to the baby. These thoughts are very upsetting and not something the woman has ever experienced before.
- Compulsions, where the mom may do certain things over and over again to reduce her fears and obsessions. This may include things like needing to clean constantly, check things many times, count or reorder things.
- A sense of horror about the obsessions
- Fear of being left alone with the infant
- Hypervigilance in protecting the infant
Moms with postpartum OCD know that their thoughts are bizarre and are very unlikely to ever act on them.
Postpartum psychosis
PPP is the most severe postpartum mental health complication, but it’s also the rarest.
“We don’t see much of that. It’s less than one percent,” Kowaleski said. “When we see it, it’s a medical emergency. It’s the artery that’s cut open with no tourniquet.”
While the onset of PPP is usually sudden — within the first month of birth — it can take months to manifest. PPP requires immediate treatment; while most women who experience the illness never harm themselves or anyone else, research has suggested that there is approximately a 5 percent suicide rate and a 4 percent infanticide rate associated with PPP.
Symptoms include:
- Delusions or strange beliefs (these are not always violent)
- Hallucinations (seeing or hearing things that aren’t there)
- Feeling very irritated
- Hyperactivity
- Decreased need for or inability to sleep
- Paranoia and suspiciousness
- Rapid mood swings
- Difficulty communicating at times
The information in this piece is provided by Postpartum Support International. Postpartum Support International offers links to local resources, online support groups, statistics about peripartum mood disorders and more; visit postpartum.net. They also have a toll-free warmline (a warmline is not staffed 24/7 and not equipped for crisis situations, but calls are always returned): 1-800-944-4773 (dial 1 for Spanish and 2 for English); a text warmline: (503) 894-9453; and a crisis textline: text HOME to 741741 from anywhere in the U.S. about any type of crisis.
