Very confused and nervous

August 30, 2012 8:34 PM

How do I support my friend with postpartum depression without being judgmental, even though I am sometimes concerned about her baby?

This friend and I don't live in the same city anymore, so all of our contact is over email and phone. While she was pregnant, and had her baby, we had been talking less (which I thought was because of all the changes in her life) so I didn't know at first that anything was wrong.

A few months after the baby was born, we had the first long conversation that we had had in a while. I was asking about the baby, and she sounded really hesitant and a bit unhappy in her replies. I kept expressing concern and she slowly revealed more and more things. She said that when she had the baby she felt like something was wrong. She just wanted to give the baby back. She didn't want to hold the baby or breastfeed her. She saw her as ugly and annoying.

I said that I think those feelings are pretty common in a lot of new moms, even if not everyone talks about them. I asked her if she thought about counseling and she said she was seeing a therapist, even though the therapist doesn't specialize in PPD. So, given she was already seeing a therapist and PPD has already been identified as an issue, I thought it was pretty clear what my role was as a friend, to let her know that I supported her and wasn't judging her, and that I cared about her and how she was doing.

But the problem is that lately she has been telling me things that make me worried for her baby. That sometimes she just doesn't want to be around him so she will just leave him outside by himself and go do things by herself in the house. That she avoids holding him, and sometimes she won't hold him until her boyfriend gets home in the evenings and gets upset when she doesn't want to touch him.

Some of these things just make me concerned for the baby. I just feel uneasy. It is easy to be 100% supportive when someone is having PPD thoughts but they are still caring for their baby the same as they normally would. Even if someone with PPD had the most negative thoughts ever towards their baby, I wouldn't judge that. But when the person is actually acting on their PPD thoughts, that makes it a bit scarier for me. It makes me feel like I should express SOME kind of concern. But I am torn because the last thing I want to do is be yet another person who is trying to shame mothers and tell them what do to.

How should I be approaching this as a friend?

posted by Sock of Silliness to human relations (32 answers total)

[Sorry about the weird pronoun use about the baby, I may be a little paranoid but I am trying to keep the gender of the baby unclear for my friend's total privacy]
posted by Sock of Silliness at 8:38 PM on August 30, 2012

"That sometimes she just doesn't want to be around him so she will just leave him outside by himself and go do things by herself in the house."
Are you friends at all with her boyfriend? Can you tell him what's going on? This sounds totally unacceptable. Encourage her to get actual PPD counseling and if all else fails, I would call CPS anonymously. Leaving an infant outside unattended is very negligent.
posted by HMSSM at 8:45 PM on August 30, 2012 [6 favorites]

Are you friends at all with her boyfriend?

Unfortunately I have never even met him and the only way I could get in touch with him would be to ask her for his phone number.
posted by Sock of Silliness at 8:48 PM on August 30, 2012

Encourage her to get into a parent group. Local hospitals often run classes. Having a place to go to get out of the house and hanging out with other moms was a lifesaver for me.
posted by HMSSM at 8:49 PM on August 30, 2012

"Honey, I care about you, and I'm concerned because doing things like that are incredibly dangerous for the baby, and the kind of thing that could find you in serious legal trouble. You need to see a doctor for your own safety as well as the baby's."
posted by Sidhedevil at 8:50 PM on August 30, 2012 [20 favorites]

Are you friends on facebook, can you get his information through her friends list? Use her address to find him at the same location via the internet?

I'd be really worried about the baby, there are times that potentially burning a friendship may be worth protecting someone who can't protect themselves and this sounds like one.

I'd want at least to talk to the boyfriend and even then potentially talk with CPS esp with the comment "just leave him outside by himself and go do things by herself in the house"
posted by bottlebrushtree at 8:53 PM on August 30, 2012 [4 favorites]

Sleep deprivation can be a big contributing factor as well. See how she's doing sleepwise. Hopefully her boyfriend or perhaps another friend or relative can take the baby long enough for her to get minimum 4 uninterrupted hours of sleep. Getting longer chunks of sleep was like a switch for me in helping with my PPD.
posted by HMSSM at 8:53 PM on August 30, 2012 [1 favorite]

Do you guys think it would be intrusive to offer to take some vacation time and visit the area to help? Like if you have had experience with this, would that be taken as an offensive offer? They don't have any family in the area and I would rather quit my job completely and move there to help with the baby rather than call CPS.
posted by Sock of Silliness at 8:57 PM on August 30, 2012

You need to be straightforward. You're not shaming mothers, you're expressing your concern to a friend about the difficulties she feels she is having. Your friend is telling you about her problems, and that wouldn't be happening if she thought they were unimportant. If asking to talk to her boyfriend is something you think would be useful, I would certainly consider it. If visiting for a while is a possibility, if only in order to find out whether she's as bad a mother as she thinks she is, you might do that.

You're right to be concerned about your friend, and she probably wants to hear that concern from you.
posted by howfar at 8:59 PM on August 30, 2012 [1 favorite]

As a total longshot, has she mentioned her therapist's name? I know that the therapist couldn't (and shouldn't) share any details of her care with you, but you could report to the therapist your concerns. Hearing that she is leaving the baby unattended outdoors is terribly worrisome. I don't think it's something you can ignore, even if that means your only recourse it to report to CPS.
posted by SweetTeaAndABiscuit at 9:01 PM on August 30, 2012

Visiting would be fantastic, you can assess the situation much better, and start a friendship with the boyfriend. While you're there in person you can help your friend find the help she needs. You are an amazing friend and I would have loved to have you when my little guy was born.

Don't ask her when is ok either. Just tell her "I booked my ticket, I am coming on this date, I want to see the new baby and visit my friend."
posted by katypickle at 9:01 PM on August 30, 2012 [12 favorites]

Nobody usually likes to be intrusive but this person is begging for your help, one way or another. I agree with katypickle - if you have the wherewithal, GO! You'll feel better than if you didn't.

You sound like a great friend and a great person :)
posted by ftm at 9:11 PM on August 30, 2012 [5 favorites]

You need to advocate for the baby. The baby is your 1st priority, not her. Tell her you'd like to talk to her partner, (he's not a boyfriend if they live together and share a child) to put your mind at rest.

This is classic post natal depression, by the way.
posted by taff at 9:40 PM on August 30, 2012 [2 favorites]

If you can't get there, and she won't listen to any advice or concern, get the name of her GP and pediatrician. Call and tell the doctor. They could call her in for routine appointment and check up on things. You could pretend that a friend is moving to the area and needs a doctor's name.
posted by barnone at 9:41 PM on August 30, 2012 [1 favorite]

As a therapist, leaving a child outside would prompt me to make a CPS report. Even if she's doing everything right, trying to get treatment, that is a real safety concern. I think it is important to try to contact the therapist if you can, and CPS if you can't. If you are not sure, you can call hotlines and ask a hypothetical, asking "this is what may be going on, if that were the case, would a report be appropriate?" They will tell you and then you can decide whether or not to pass on the info. This is not a betrayal of your friend. This is taking care of a child who cannot advocate for itself. Even if they have to remove the child, it doesn't mean it has to be permanent. I have made CPS calls. It sucks. But it was the right thing to do. And bonus, the parents got the help they needed, and the kids stayed in the home.

Not to scare you, but postpartum depression is a big deal. Unfortunately, I've met women who, experiencing PPD with psychosis, have killed their children. While this is an extremely low probability event, it is important to consider. And think of your friend: when she recovers, how is she going to feel about the situations she put her child in while depressed? This is not about blaming, this is about the reality of the dangerousness of the situation. She can't help it right now, which means others have to step in and take care for her.

PPD is extremely hard to deal with. And I think it is socially verboten to talk about the even normal sort of discomfort that may come with new motherhood. I'm not sure if you are familiar with Heather Armstrong, but she talks a lot about her experience with PPD on her blog (www.dooce.com) and how hard it is to feel emotionally disconnected from your child.

I think you can validate her experience without condoning her behavior. I might say "man, I know you're really struggling right now. I can tell from your voice how hard you are trying to get better, and do the right thing. I worry about you and your child. Is there something I can do to help you take care of yourself, and your child, to make sure you both stay safe?"

I would imagine there are probably resources out there for parents who are struggling with bonding with their children (and if there aren't there damn well should be!). You might suggest she look into respite services that may be available through community mental health, to let her get the break she needs when she can't engage. Also, support groups might be good, to hear that others are having similar issues, and to see people who are further ahead in the process of recovery might give her some hope and relieve some isolation.
posted by gilsonal at 9:49 PM on August 30, 2012 [20 favorites]

Please go visit, and stay with her to help out. Do this for her baby (to see if the baby really is in danger) and also for her, to help her out during a very difficult and isolating time in life. You are a good person, thank you for caring.
posted by Joh at 10:14 PM on August 30, 2012 [4 favorites]

Maybe you could suggest that she hire a postpartum Doula to help with baby care, if she has the resources to pay for one. See this page: http://www.dona.org/mothers/faqs_postpartum.php#8 or maybe you can chip in for the cost as well,or see if any doulas offer sliding scale in her area.
posted by foxjacket at 10:49 PM on August 30, 2012

Wow, I was prepared to tell you that it's not possible to judge at a remove and how hard it is, but that's some pretty serious stuff there; you are right to be concerned, for everyone.

Three things, based on my experiences:

1) Do you guys think it would be intrusive to offer to take some vacation time and visit the area to help? I think I speak for tired parents everywhere when I say hell no it wouldn't be intrusive it's basically the best thing imaginable, especially if they visitor is not staying nights with you.

2) As a moral, caring person, you need to get in touch with your friend's partner and family. It doesn't matter how, and I find it difficult to believe that he or her family are not on Facebook, you don't know where they work, or you can't look up the phonebook etc.

Because of a sense of pressure and despair, some people with PPD work very hard to disguise it from the closest people in their lives - your friend's husband and family may not know what kind of straits she is in. If you are prepared to leave your job for this, you should be prepared to expend a little detective work to get some contact details for immediate family, it should not be difficult; ask the mods if you need help, they do it all the time for this website and I'm sure would be happy to give you some advice.

3) Reconcile yourself to that CPS may be something that you end up doing. Please do not take it off the table if the options come down to "not enough" - however that presents. This is a very serious, grave situation for both mother and daughter. There are lots of steps you can take before you get to this point, but you need to take those steps asap, and then call or not, asap. Recognise, also, that you may not have the capacity to help; quitting your job and moving there is not a substitute for CPS depending on the situation. You are not a professional, and should not take this burden on yourself.
posted by smoke at 11:03 PM on August 30, 2012 [2 favorites]

Yes, GO!
posted by BlueHorse at 12:28 AM on August 31, 2012

I would be concerned that, while she's seeing a therapist, she's not apparently taking any anti-depressants for her PPD. If she is worried about taking them while breastfeeding, some are okay to take at the same time. Can you discuss that with her as well?
posted by low_horrible_immoral at 1:44 AM on August 31, 2012 [1 favorite]

Please dont commit to anything drastic on the back of random internet advice.

"she has been telling me... she will just leave him outside by himself and go do things by herself in the house."
This may be not be negligent, or true and it certainly isnt the basis for getting outside agencies involved at this point.

However, she needs help. Go see her, get her involved with local parents groups, persuade her to go see her family / get them to go see her.
I would never have believed, beforehand, how hard having a baby can be.
posted by BadMiker at 5:46 AM on August 31, 2012 [1 favorite]

Please urge your friend to call her OB/midwife. They will have a lot of experience dealing with PPD. Zoloft is commonly prescribed for breastfeeding mothers. PPD is related to all sorts of hormonal/chemical changes after pregnancy and I can't imagine that talk therapy is going to do much to help with it.
posted by belladonna at 5:48 AM on August 31, 2012 [2 favorites]

I say go visit, because you can see things first hand.

Maybe she needs to stop breastfeeding. When I had PPD, breastfeeding sometimes felt like yet another chain around my neck, because obviously I was the only who could do it. (It didn't occur to me to pump until several weeks in. PPD sometimes makes you think only in extremes. It's hard to consider solutions and compromises.)

Find out if her boyfriend is helping with child care. If not, or if you think he could be helping more, then have a frank conversation about stepping up to the plate. In my case, my husband would come home from work, and all I wanted was some time by myself, but he had to be taught that he no longer had free time to putz around in the garage. He had to help, or would lose my mind.

Try and get her to ask her therapist for some breastfeeding-safe anti-depressants, as mentioned above. Good god. When my Zoloft started working, I was a new woman.
posted by SuperSquirrel at 6:14 AM on August 31, 2012 [1 favorite]

Lots of new moms are happy to have people help out with the baby. Lots of new moms hate their babies at first- it's like this secret that they never tell you. If you can't go yourself, encouraging her to get her mom/sister/aunt/reputable nanny to come deal with things is a great idea. And mentioning, gently, that you love her but are worried that leaving the baby alone is dangerous etc., is a great idea.
posted by windykites at 6:31 AM on August 31, 2012

I said crazy things on the internet and to people too far away to do anything for me when I had PPD. It felt safer than saying them to someone in person, but a lot of them were only thoughts. And, you know, a lot of dealing with PPD and how bad it can get can really depend on the baby's temperament. I was a victim of a colicky, sleepless baby. Not only was I mess, but I couldn't even take of my baby right --- I mean, a happy baby wouldn't scream for hours on hours on hours on hours on end? Right? This must mean I'm a terrible mother.

I would take the "leaving the baby outside" comment with a grain of salt at the moment. I've known other parents whose babies had colic or screaming fits as newborns that they had to step away for both themselves and the baby. I knew one mother who would go out into the yard for a few minutes. I know other parents who lived on a cul-de-sac and would walk around the cul-de-sac a few times to get a break from the screaming.

I am not saying this is what is going on with your friend, but if she happens to have PPD AND a difficult baby, there may be a couple of things that sound horrific that aren't really that terrible. Like, maybe what she means by outside is on her porch in a pack'n'play while she does dishes looking out the window in full-view. Her actions may not be as bad as she is making it sound. She doesn't hate the baby. She hates herself. And probably more than anyone she knows her failings and those are magnified times a million.

I am by no way minimizing that you should be concerned, but she is not remotely herself. And she may be an unreliable narrator --- I said all kinds of truly exaggerated things when I had PPD. I would say I hated to the hold baby, but I held him all the time. I'd say I wouldn't hold him for a long time, but really I meant I had to put him down for 10 minutes because I couldn't handle the screaming any more. But that 10 minutes in my mind magnified into a week's worth of never holding the baby.

And yes, absolutely you should go visit her. As soon as you can! And when you are there, call the person who was her birth attendant and ask for resources in her area. When you visit her, do all the things. Do the laundry. Make the food. Stock her up on lots of food for when you leave. Be with her. Having a clean space did wonders for my PPD. Take the baby while she naps ---- sleep deprivation was another huge part of my PPD. On the days/nights where I could get even just four hours uninterrupted I felt like a new woman. Fawn over the baby, and please, tell her she is doing a good job and you know she is a good mother. And then remind her that no mother can or should do it alone and that you will help her not do it alone by getting her the help she needs.
posted by zizzle at 6:32 AM on August 31, 2012 [15 favorites]

My best friend had terrible PPD. I regret that I didn't understand the extent of it, and that I didn't go to help out at the time.

If you can go, go. It will be good for everyone.
posted by Ruthless Bunny at 7:26 AM on August 31, 2012 [1 favorite]

I have a good friend who suffered from terrible PPD. She did eventually get help and get through it, but what started her on the right path was another friend who showed up at her house every day, all day. For weeks. She (the friend) did the dishes, cooked, made the baby's bottles (breastfeeding was failing, which didn't help anything any), took care of the baby, made sure Mom had a chance to hold the baby while he wasn't screaming, did the laundry, took the baby back while he was screaming, held Mom while she cried, and was generally just there. I know it was quite a drive for her, probably an hour each way in traffic, but she did it all day every day, and she may have saved two lives.

Go. I agree, there are plenty of ways the "I leave the baby outside all day" statement can be completely fine; I used to leave my difficult baby in her stroller on the front porch, asleep, with the door open while I sat inside, literally ten feet away, and read a book. But your friend is not OK, and she needs someone to take her seriously. To this day, I don't know if I had PPD or just severe sleep deprivation, but I ended up in the ER for a psych eval when my child was 14 months old, and I felt like I had been screaming for help for months and everyone just figured I was OK. Go.
posted by KathrynT at 8:22 AM on August 31, 2012 [2 favorites]

1. Definitely go! I disagree with the advice of not staying the night. Nights can be the WORST time with a small baby - that lack of sleep, on a sustained basis, can drive people quite insane. If you can go for a week, do that: stay three days with them there, taking up at least some of the night slack - baby cries, you get up with the bottle; if she's breast feeding, you bring baby to her in bed and then take baby away and do the diaper change, do whatever needs doing. Then after you've given them three nights of sleep and learned the baby's rhythms, encourage them to go away together for the rest of your stay. If she's breast feeding and dislikes it, feel free to encourage her to stop. It is fine to stop. Formula is fine. Breast feeding can be a terrible millstone and mother's sanity comes first.

During your stay, keep your eyes open, and open lines of communication with the boyfriend.

2. Help research mothers' or parents' groups in the area. In my area there's a wonderful community, it has a nominal cost to join, and it's a HUGE help to new parents - everything from organized playgroups so there's always some social thing to look forward to, to recommendations for local doctors, babysitters, etc. Maybe there's something like that in her area. If there's a cost to join, that's a good indicator that it's a better group and will be more helpful than a free thing every flake can weigh in on. Pay it for her.

3. Someone upthread talked about the baby being your only priority right now. God, please don't take this attitude. One of the things that can be awful for first time moms is how her own identity can be so taken over by this little creature - she's not even the most important person inside her own SKIN for ten months, and then when the baby comes, it takes over everything, and you have to subordinate every one of your own interests to its interests for the foreseeable future. So don't do this. Be your friend's friend. Talk to her about stuff you used to talk to her about. Let her have a conversation that isn't about diapers and how tired she is. Obviously if, once you've gotten the lay of the land, you think she's endangering the baby, then you'll need to take some action, like calling her parents. But PLEASE don't ride in there like a prosecuting sheriff.
posted by fingersandtoes at 8:23 AM on August 31, 2012 [5 favorites]

Since breastfeeding mothers get more and better quality sleep, and can recover from PPD faster and easier, if she is having trouble with breastfeeding rather than encouraging her to give it up, help her find an IBCLE http://www.iblce.org certified LC, (not just someone who says they're an LC.) so they can fix the problems and be successful.

If she doesn't want to breastfeed that's fine, but if she wants to but is just having trouble and is miserable about BF because she's having trouble, it will be better for her in the long run to fix the problem so she can have the benefits of BF. It's okay to stop but if she wants to and needs help, the right help will actually help her PPD.
posted by jesirose at 10:28 AM on August 31, 2012

PPD is serious and very real, what your friend should be getting is proper medical help. Drugs, counselling and a proper doctor. Your suggestion of going to visit is absolutely marvellous, please do go and help her, that is the action of a true friend.

zizzle and fingersandtoes have given excellent advice here. If you go and help with the work, and reassure her, and point her in the direction of support, and help her get some sleep, you will be doing wonders. And help her self confidence so that she doesn't feel she's utterly failing. She very probably is taking excellent care of the child while feeling as though she's dying inside.

Let me second the notion that leaving the child outside isn't some dreadful form of child abuse - it was recommended practice not long ago to leave the kid outside in it's pram for hours 'in the fresh air'.

"Since breastfeeding mothers get more and better quality sleep," not wanting to be rude here but sorry, that made me laugh out loud.
posted by glasseyes at 1:27 PM on August 31, 2012 [6 favorites]

"Since breastfeeding mothers get more and better quality sleep," not wanting to be rude here but sorry, that made me laugh out loud.

I don't know why you should laugh. I was a single mother with no help available and the combination of breastfeeding and co-sleeping was the ONLY possibility for getting any decent sleep. Getting up several times a night and walking around and heating up a bottle cannot possibly be conducive to restful sleep.

Agree with Jesirose about encouraging breastfeeding success for this overwhelmed new mother. In addition to health benefits, breastfeeding can aid in maternal-infant bonding, especially if supportive friends and family can help point out things to aid the bonding process. "Oh, see how his little face is relaxing in bliss as you feed him?" Of course, this can be helpful even if bottle-feeding. Going to visit and help with whatever, and just being there, is a wonderful idea. And after you leave, your friend should be urged to call daily and talk about the little things she notices about her baby. Keep the sense of wonder alive by sharing it with you, etc. -- this can help keep the PPD demons at bay.
posted by RRgal at 8:44 AM on September 1, 2012 [1 favorite]

For a non-parent to "encourage breastfeeding success" to a new mother, without having been asked to do so, is extremely presumptuous and rude, and OP should NOT DO IT.

By all means if the friend is committed to breastfeeding, then OP can help her by bringing baby to her in the night. But the finger-wagging about breastfeeding and the pressure to do it can be absolutely horrible for some mothers, and I'd hate for OP to get the idea that it's something to pontificate about. The friend has already mentioned that she dislikes it!

"Since breastfeeding mothers get more and better quality sleep," is hilarious because it is true as compared to mom having to get up herself, alone, and deal with bottles. Sure. But you can get really fantastic sleep - however much you need! - when SOMEONE ELSE DOES THE BOTTLES. That is the point, and that's what OP ought to be aiming for.
posted by fingersandtoes at 4:41 PM on September 1, 2012 [4 favorites]