Like so many middle-class couples these days, Lou and Casey planned their first child. They worried a little bit when it took them longer than expected to get pregnant, but when it finally happened they were ecstatic. The months of pregnancy went by uneventfully for the most part, with doctors’ visits, encouraging friends, and doting relatives marveling at Lou’s growing belly and the inevitable deluge of baby showers when her due date drew near. No one expected Lou to collapse in a puddle once she got home with the baby, but collapse she did. And no one was more surprised than Lou—unless it was Casey. Lou said that she felt like she was down at the bottom of a well trying to look up but not seeing any light. Casey was horrified to see how little interest she showed in the baby. Even Lou’s mother was alarmed and took turns with her sisters staying over so Lou and Casey could get a full night’s sleep Lou looked like something the cat drug in—she had deep circles under eyes that were red from crying. She was so horrified at her own reaction to the baby that she thought everyone would be better off without her. She wanted to run away, but she had nowhere to run. She wanted to die, but her faith prevented her from taking any action to end her own life. Every time the baby cried Lou cringed and recoiled, then, noticing her own reaction, she wept. “I’m a terrible mother,” she moaned. “My baby deserves better.” Avoiding holding or talking to her infant seemed like an act of self-sacrifice and honorable giving. “Its better that someone else holds her—I’m no good at this,” she would say. Later, when she felt better, Lou described this time of her life as “living in a cartoon.” She felt as if she was observing life, not participating in it. Try as she might, she couldn’t bridge the gap on her own. Everything seemed to be playing out in slow motion, strangely disconnected from feeling. Like Lou, not everyone falls in love with their baby at first sight; but just about everyone I meet expected to. Parenting skills do not necessarily rise up out of the soul complete with a deep conviction of competence—many first-time parents will necessarily find themselves at the bottom of a learning curve. Most new parents have some idea that sleep deprivation comes with the territory, but knowing about something is often quite different from experiencing it. Coping with the fatigue of sleeplessness is not for the faint hearted. Lou was a labor and delivery nurse. She had coached many women through labor and watched wistfully as they left the hospital with bundles in arms. She was a confident professional and quite competent at her job. But she didn’t know the first thing about mothering—she was going to have to let the baby teach her that part. And she hated feeling stupid. So when she wasn’t filled with joyous motherly feelings she judged herself harshly, attributing her lack of competence and disappointing lack of positive emotions to a deep, immutable, core defect in herself.
Alex and Sydney are a typical middle-class American couple. When baby Skylar was born, Sydney adjusted pretty well. She started exercising right away, and the weight she had gained during pregnancy came off fairly quickly. Skylar was an active baby, and Sydney loved being a mom. Six weeks of maternity leave went by in a flash, and Syd was back at work, juggling executive meetings and day care. But Alex wondered where his wife had disappeared to. He missed their long walks and the way they would talk about everything. Whenever he tried to be romantic, Syd seemed far away. The truth of the matter was she always had an ear out for the baby. She lived poised to jump at the slightest whimper.
Alex started staying at work later. When he came home he was either online or reaching for a beer. He had gained a lot of weight during her pregnancy. Their friends had joked that theirs was such an egalitarian marriage that they were expecting twins—Syndey carried one and Alex the other. Missing Syd and feeling left out, Alex also started working out more. Alex often thought that if sweat were tears everyone would be able to see how deeply he hurt. Not that he didn’t love Skylar—of course he did. But he missed Sydney so much that he thought his heart would break. Still, it wasn’t until he realized that he was drinking just so he could get to sleep at night that he decided he’d better get some professional help. Alex was clinically depressed. Even though he had not given birth, his depression occurred after the birth of their daughter and in response to the many changes to his life that Skylar’s birth ushered in. Alex had postpartum depression. But like many men, his depression showed more as an empty restlessness than an active sadness.
One of life’s hidden expectations is the hope that relationship satisfaction will stay the same or increase with the addition of a baby. But the best-kept secret of marriage is that marital satisfaction declines over time. And the best-kept secret of parenthood is that marital satisfaction declines, often rather dramatically, after a baby is born (MacDermid, Huston, and McHale 1990; Doss et al. 2009; Kluwer and Johnson 2007), These findings have been replicated innumerable times; the knowledge is unquestioned among those who study or treat families. More than twenty studies in different locales within the U.S.. and overseas have supported the conclusion that marital satisfaction typically declines immediately following the birth of a first child (Schulz, Cowan, and Cowan 2006; Doss et al. 2009)( Half of all divorces happen in the first seven years of marriage; one third happen in the first five years (Shapiro, Gottman, and Carrere 2000). For many of these divorces, the watershed event leading to the unraveling begins with (usually the wife’s) declining marital satisfaction after the birth of the first baby (2000). The first baby brings a decrease in positive, affectionate interactions between husband and wife (or between partners in gay and lesbian families), an increase in conflict, and first a steep decline in the wife’s satisfaction with and commitment to the marriage, then, sometime later, the husband’s declining satisfaction (2000). Of course, couples who were unhappy to begin with are typically the hardest hit (Belsky 1985; Figueiredo et al. 2008) But happy couples are not immune.
Often the happiest couples are, paradoxically, the ones that suffer the greatest declines in marital satisfaction post-baby (Lawrence et al. 2008). Although we have known about and documented this drop for decades, it comes as a great shock and disappointment to many couples. And marital satisfaction will improve, after a time, for some of the heartiest and most skilled couples (usually once the child reaches school age), but some never recover ( 2008; (Doss et al. 2009) In today’s society, most men and women becoming parents for the first time are virtually on their own when it comes to figuring out how to balance and address the needs of their new baby, their romantic partnership, and their commitments to work outside the family (Schulz, Cowan, and Cowan 2006). Relatively few couples—a mere 7 percent of women and 14 percent of men—remain stable or increase their marital satisfaction after the birth of a baby (Shapiro, Gottman, and Carrere 2000; Singley and Hynes 2005; Doss et al. 2009). Having a baby, whether the first or subsequent, is a major life stress. Parenthood changes the identities of individual men and women forever. It also changes their relationship, for better or for worse—forever (Barnett and Hyde 2001; Cowan et al. 1985). Given all these changes, how can we continue to return to the old theories of biological (and hormonal) determinism? If we do, we’ll miss critical opportunities for prevention and intervention. But if we expand our understanding, we will also expand the scope of solutions.
Sara Rosenquist's take on postpartum depression is revelatory and full of hope. Her message is that what we believe shapes our biology as much as the other way around. With this new understanding we can get back in the driver's seat -- we can chose our behavior, make plans and acquire healthy habits of the body and mind. In doing so we can shape our own mental health destiny.
_______________________________________________________________________________ Ethan Watters, Author Crazy Like Us: The Globalization of the American Psyche _______________________________________________________________________________
There are few ambitious, successful and comprehensive guides to postpartum depression for non-experts. Fortunately for us, Dr. Sara E. Rosenquist opens a path for ordinary couples to self-heal. Using direct lucid prose and everyday examples the author identifies and provides ways to relieve the often underappreciated distress of postpartum depression. I admire this book for its brilliant melding of compassionate insight, fascinating research summarizations and presentation of excercises, chapter-by-chapter, to be used to restore a sense of well-being.
_______________________________________________________________________________ Elaine Crovitz, Ph.D. Emeritus Faculty, Duke University Medical School Diplomate in Clinical Psychology American Board of Professional Psychology _______________________________________________________________________________
After the Stork is a detailed and thoughtful guide to challenges that new parents encounter as they make this major life transition. It offers a wealth of different practical strategies that can be used by parents to minimize or mitigate postpartum depression. Because it is so evenhanded and thorough in addressing issues that both mothers and fathers may face, it is a must read for couples expecting or welcoming their first child.
_______________________________________________________________________________ James F. Paulson, Ph.D. Associate Professor Department of Pediatrics Eastern Virginia Medical School _______________________________________________________________________________
As a female ObGyn physician and mother of four, after reading this book - I have insight that may help me be a better mom and wife, but also a better doctor. Dr. Rosenquist's wisdom is appreciated throughout the book. I appreciate her teaching us why depression can set in after having a child, but also value her detailed steps and advise on how to prevent and overcome it. I will recommend this book to all my patients and friends.
_______________________________________________________________________________ Andrea Lukes, M.D., MHsc, FACOG Director, Women's Wellness Clinic Durham, NC Founder and Chair of the ObGyn Alliance _______________________________________________________________________________
Books for professionals are often long on science and short on practicality, while those for non-professionals are often filled with advice not based on scientific facts. In After the Stork Dr. Rosenquist has blended the best of both worlds. Professionals will learn about the daily realities of postpartum depression, and readers with new babies will not only get exceptionally sensible guidance, but will discover the science behind it in a format that is fascinating and easy to grasp. This is a must read for those who care for new parents, and can serve as an invaluable roadmap for those who wish to prevent post partum depression, or overcome it if it has come into their lives.
_______________________________________________________________________________ John C. Linton, PhD, ABPP Professor and Vice Chair Department of Behavioral Medicine and Psychiatry West Virginia University School of Medicine, Charleston _______________________________________________________________________________
In an age when pills are all too often relied upon as the first solution to life’s difficulties, Rosenquist offers a refreshing, evidence-based, psychological approach to the serious problem of postpartum depression.
_______________________________________________________________________________ Irving Kirsch, Ph.D. Professor of Psychology University of Hull, United Kingdom Author of The Emperor's New Drugs: Exploding the Anti-Depressant Myth _______________________________________________________________________________
Dr. Sara Rosenquist has written an incredibly helpful and comprehensive handbook for couples entering into the new world of parenthood. She thoughtfully and honestly describes many of the challenges that couples encounter during pregnancy and postpartum including postpartum depression. We plan to incorporate this workbook into the comprehensive treatment plan that we use at UNC in our Perinatal Psychiatry Program.
_______________________________________________________________________________ Samantha Meltzer-Brody, M.D., M.P.H. Director, UNC Perinatal Psychiatry Program Assistant Professor, Department of Psychiatry University Of North Carolina at Chapel Hill _______________________________________________________________________________