Anne Waller, an Ellicott City-based clinical social worker, focuses on counseling women facing postpartum depression and leads a free weekly support group.
(Brian Krista / Patuxent Publishing)

There's a catchy tune called "When Mama Ain't Happy (Ain't Nobody Happy)."

The song is about a man who stays out late drinking and comes home to an angry wife. For such domestic drama, the lyrics and music strike a whimsical chord, but when Mama's unhappiness is due to her own mental strife, an upbeat song or a caring spouse isn't enough to lift her spirits.


Some new mamas are feeling that imbalance -- 1 in 8 according to Postpartum Support International (PSI) -- and suffer from Perinatal Mood and Anxiety Disorders. PMAD are a spectrum of disorders, including anxiety, depression, obsessive compulsive disorder, post-traumatic stress disorder and psychosis, and occur in women within a year of childbirth.

Most new mothers (80 percent, cites PSI) experience "baby blues," a phenomenon explained by the confluence of changing hormones, lack of sleep and the dual excitement and anxiety of caring for a newborn. The result for most women is a teary two- to three-week period, a normal adjustment to life's big event.

For some women, though, perinatal mood symptoms are greater and harder to manage, necessitating help for what is commonly referred to as postpartum depression. Symptoms can include worried thoughts about bonding or being alone with one's baby, or an obsessive-compulsive need to clean or hide common objects, like kitchen knives, to protect the baby, or intrusive thoughts about harming oneself or her infant. Menacing thoughts can overwhelm and debilitate.

Anne Waller, a clinical social worker in Ellicott City, is committed to counseling women and their families about perinatal mood disorders.

"Anxiety is an extreme component for many women," says Waller. "They're extremely anxious and it's intolerable, so they might not be sleeping at all. Usually when people realize something is wrong, it's an acute situation.

"The thoughts women have are their symptoms. Just as if they had the flu, they'd have a fever and a sore throat," says Waller, who leads a free postpartum support group each Monday at MedStar Montgomery Medical Center in Olney. "I tell them, 'This is completely treatable. Your symptoms are your thoughts.' "

She also tries to educate her clients' husbands to understand the symptoms and reassure their wives they are ill, treatable and not to blame.

Wendy Davis, executive director of PSI, agrees. "Every person who becomes depressed or anxious feels it's their fault. That's the nature of a mood disorder. Every symptom is temporary and treatable, no matter how severe."

Davis continues, "In our culture, there is a taboo about talking about our emotions, and for struggling parents, an even greater taboo. It's important for parents to understand this is a common experience, and it's important to talk about their symptoms and to know they didn't do something wrong."

Getting beyond the taboo

There isn't a known cause for PMAD, but there are various biological, social and psychological stress factors that can affect mood. There's no way to indicate one woman's likelihood to experience PMAD over another, but there are risk factors, like a family history of depression, anxiety or schizophrenia.

However, Waller does offer an interesting detail from her experience in counseling postpartum women: "One of the traits that seem to be present, with a handful of exceptions, is perfectionism. They're women used to having everything in their life just so. Many are organized professionals, teachers running a tight ship, health-care providers ready to administer care, or skilled lawyers. Often, they're women you want working for you because they're highly competent and usually five paces ahead of everyone else."

Renee, 51, a caring and decisive nurse in Columbia, experienced PMAD with her middle child two decades ago. Her illness occurred at a time when stress factors brewed. Her infant son experienced the skin condition eczema, and it required what felt like a Herculean effort to comfort and eradicate his rash. Her husband worked long hours cultivating his own business, and the couple kept a discerning eye on their family budget. Renee remembers feeling an impending doom so horrific, she had thoughts to remove herself.

One day, while she was on the phone with her mother, the baby began to cry. "I'm not getting him," she told her mother. "All he does is cry; I can't get him." Alarmed, her mother told her to get the baby, and she would be there soon. Renee replied, "If I don't answer you, I might be hanging off the deck." Her emotions are still raw. "I can't believe I am crying about this 20 years later. It was awful."

Although Renee and her family knew she wasn't herself, all were of a mindset that emotional struggle is dealt with on your own. Her husband was attentive but helpless in what to do with her emotions. Her mother supported her by showing up to watch the baby. But her symptoms -- her feelings and thoughts -- were never addressed.


Tired of feeling isolated, she placed her children in a double stroller and began walking. A friend joined her, and they walked, traveling loops around their local mall during cold months. "It took time, a full year, before I felt better."

Burying the shame

Fortunately, women no longer have to suffer on their own, but finding the right help is crucial. When a new mother is overwhelmed, obstetricians and pediatricians are at the forefront to take notice during follow-up care.

Dr. Lesly Berger, of Ellicott City Pediatric Associates, confirms, "It's usually very obvious because a woman's tearful, can't cope, or very sad. Most women who experience some of this recover rather quickly. But others are overwhelmed, and they know it." Berger's course of action is to "refer her to a psychiatrist, back to her OB, depending on the situation. If they've had a history of depression, they need a psychiatrist."

Shame, though common, shouldn't hinder a woman from seeking help. Dr. Michelle Seavey, an obstetrician with Capital Women's Care in Fulton, notes, "I have found a lot of my patients to be embarrassed or feel guilty for having feelings associated with postpartum depression. Society makes you have the idea that everything should be easy, like breastfeeding, and that it should be the most glorious time of your life. So new moms have a hard time admitting that they don't feel this way."

Although Maryland does not require postpartum screening like some other states, postpartum education is offered as part of Howard County General Hospital's childbirth education classes and includes discussion, DVD presentation and written material in a take-home packet.

Hospital spokeswoman Sharon Sopp says Howard County General encourages providers to screen patients, and that social work and case management are made available when depression is suspected or confirmed.

Aggie, 39, of Ellicott City, is a vibrant tri-athlete and mother of four boys between the ages of 2 and 9. An experienced mom with two children, she began to feel anxious, with a chest-tightening sensation, after her third child was 3 months old. "I was scared," she recalls.


One day, she and her sister were setting up a summer picnic for their combined brood, and Aggie says, "I felt scared, and the thought of making peanut-butter and jellies was way too much. I just couldn't do it. I asked my sister if I could just go out to plant the flowers she had for her yard."

Aggie, in tune with her body, participates in Iron Girl competitions and can persist through aches and pains. But this was different. "I knew I looked fine on the outside and this was completely internal." She contacted her obstetrician, who referred her to a psychiatrist and therapist. "I had a team working on it," asserts Aggie. But her symptoms, involuntary and disturbing thoughts, were intrusive and torturous. After 10 months, while at her pediatrician's office, she picked up literature about postpartum depression and recognized herself.

The pamphlet led Aggie to Waller, and she became educated about her illness. She gained a greater understanding of her body's chemical imbalance and the stresses of daily life that exacerbated her symptoms and prolonged her illness. With the help of her new therapy, and the correct medication prescribed by her psychiatrist, her symptoms abated within 12 weeks.

"It was like a perfect storm," says Aggie, "having little kids without a support system. Though both my husband and sister are tremendous, I needed more help. Looking back, you need to be strong enough to say, 'I need help.' "


Licensed clinical social worker Anne Waller recommends calling a doctor or professional therapist if you experience four or more of the following symptoms:

- Crying daily
- Feeling sad most or all of the time
- Can't concentrate
- Loss of enjoyment in previously pleasurable activities
- Can't sleep even when baby is sleeping (or sleeping too much)
- Feel like a failure
- No energy
- Can't enjoy food or crave carbs
- Feel the future is hopeless
- Can't shake depressed feeling
- Irritability, anger, or rage
- Worrying much of the time
- Feeling overwhelmed or anxious
- Guilty feelings
- Feelings of worthlessness

For further information and support:

Postpartum Support International

Healthy New Moms

Postpartum Blog

Anne Waller

Postpartum Support Group
Mondays, 10-11:30 a.m.
MedStar Montgomery Medical Center, Olney
Free, to register call 301-774-8881