When his second son was born, Jared knew something just wasn't right. Although the New Jersey father's baby boy had been born healthy, and his wife gave birth without any major physical complications, the family was suffering.
Jared (not his real name), 33, noticed red flags immediately. His wife had significant anxiety about breastfeeding. She had trouble sleeping. When it came time for Jared to go back to work, his wife was extremely concerned about being alone with the new baby. A few weeks later, she started sending him frustrated texts and voicemails full of anger and resentment.
"I could sense there was a storm brewing," Jared remembers. "No matter how hard I tried to help – whether it was because my patience level was not where it should have been or the fact that I'm not an expert in raising babies or giving medical advice – I just felt that whatever I said went over her head."
Luckily, Jared's wife eventually made an appointment to talk to a psychologist and get the help she needed. For those first few weeks, however, both she and Jared felt completely helpless.
Their experience is not uncommon. According to current research, 10 to 20 percent of all pregnant women experience some form of depression. And according to one estimate only 17 percent of women who meet the criteria for PPD will actually get care.
Experts say the keys to overcoming PPD are to identify it early and be proactive about seeking treatment together. Here are some tips for what to do if you think your spouse has PPD.
What to look for
Postpartum depression is a broad term, and many experts prefer the term 'perinatal' to 'postpartum' because it covers the whole time period around a baby's birth. Perinatal mood and anxiety disorders (PMADs) can manifest themselves in different ways. It's common for women to be exhausted and especially emotional in the few weeks immediately following the birth of a child. (This condition is known as the baby blues.) After a few weeks, however, continued sadness, exhaustion, or anxiety could be a sign of something more serious.
Other symptoms of PPD include loss of appetite, excessive weight loss, insomnia, panic attacks, and difficulty concentrating. Postpartum Progress, a nonprofit that educates and supports women with PMADs recently published a checklist of PPD symptoms.
Karen Kleiman, founder and director of the Postpartum Stress Center in Rosemont, Pennsylvania, and author of The Postpartum Husband, adds that while monitoring telltale signs is important, spouses also need to trust their instincts about their partner's behavior a few weeks after childbirth.
"If you think something is wrong, something is wrong," notes Kleiman. "There's a fine line between not feeling good and it being ok, and not feeling good and it not being ok."
What to say
When you bring up the subject with your spouse, it's critical to use a gentle, supportive tone and avoid sounding judgmental. Because stigma and shame keep so many women from getting help, partners can have a tremendous impact by starting from a place of acceptance.
"It has to be in the context of caring," says Samantha Meltzer-Brody, director of the perinatal psychiatry program at the University of North Carolina Center for Women's Mood Disorders in Chapel Hill, NC. "Less, 'You seem crazy' and more, 'I've been noticing you seem really anxious and overwhelmed. I want to do whatever I can to help you feel better."
Word choice is another big issue during this conversation. As Meltzer-Brody mentions, any hint of the word crazy is a mistake. Even telling a spouse she 'is not herself' could be hard to hear when it's likely she is having a hard time acknowledging that this time of her life does not feel the way everyone expects it to.
"[Talking about] how ‘I'm feeling’ is always going to be less offensive than [talking about] what ‘you're doing’," says Meltzer-Brody. So, begin statements with 'I' and avoid statements that begin with 'you.'
Kleiman adds that the right setting is also critical for having the initial conversation. She advises against bringing up this sensitive issue when the children are screaming or when anyone in the family is anxious or upset. This doesn't necessarily mean waiting days to discuss concerns, but it can mean waiting a few hours to allow a particularly heated incident to pass.
And once you've broached the subject, it's important to know where you can direct your spouse for more support. Mara Acel-Green, LSW, a therapist in the Boston area, notes that each state offers different resources for women experiencing PPD. She also says because many families struggle with PPD well after the child's birth, it may be counterproductive to suggest that a woman go back to her ob-gyn for treatment. Instead, she notes, it may be better to start with a woman's primary care doctor.
Another option is the "warm line" operated by Postpartum Support International. This service provides over-the-phone advice and a list of perinatal clinicians by state.
"Sometimes it's good to come to the conversation with a list of options," says Acel-Green. She adds that even simply offering to watch the children while the mom gets help can relieve some of the stress a new mother might feel about focusing on herself after the birth of a child.
Other ways to help
Self-reflection is another way for partners to help spouses overcome postpartum mood and anxiety disorders. It's perfectly normal for partners to have their own emotions about their wives experiencing PPD, and Meltzer-Brody says that it's possible partners might find themselves getting so angry or upset they have trouble being supportive. In these cases, she notes, it can be really beneficial for men to seek psychological help as well.
"It's often extremely upsetting to dads to see their [partner] struggling. The uncertainty puts the family into crisis," she notes. "Sometimes men need just as much help."
Most family psychologists can help fathers manage difficult feelings. Often programs that treat moms have good options for spouses as well. There are also some great Internet resources, including PostpartumDads.org, and often experts affiliated with women's PPD treatment programs can refer husbands to clinicians who have experience helping men.
The bottom line: Do something. According to Acel-Green, even though PPD impacts mothers most directly (and most significantly), it's important that fathers and partners seek help as well.
"Perinatal mood and anxiety disorders affect everybody in a family," she says. "The more time you spend understanding the feelings associated with them, the better everyone will be."