After having her fourth baby a few months ago, Sunriver mom Michele Cardwell felt down. A veteran mom, she figured this time around would be easier, but she found she lacked energy and struggled to see beyond the moment. Worse, she felt she couldn’t enjoy her kids.

“I was just blah with my emotions,” she said.

Cardwell also felt isolated. Up late at night alone with the baby, she felt as if no one understood her.

It didn’t help that Cardwell had spent the last weeks of her pregnancy on bed rest. Then a few weeks after the baby was born, she became ill with kidney stones, then a kidney infection then a blood infection. “I was sick the entire month of April,” said Cardwell. Only within the past few weeks has she been able to acknowledge, to herself and to her husband, that she has been struggling with postpartum depression.

Cardwell knows because she also experienced it with her first child, Justus, now 7. That time she “felt inadequate and worried all the time.” The only thing that helped her was time. “I never asked for help.” What helped pull her out this time was recognizing her feelings for what they were and knowing “I won’t always be feeling this way.”

Like many moms who experience postpartum depression, Cardwell was reluctant to talk about it. “I was always embarrassed to bring it up. I always worried about people’s response.”

But postpartum depression is one of the most common side effects of childbirth. According to Postpartum Support International, a nonprofit based in Portland, about 25 percent of moms in Oregon experience perinatal depression and anxiety. This is the term used to describe lasting feelings of sadness, anxiety or stress felt by pregnant women and new moms.

Postpartum depression is a public health concern because it can affect how moms bond and attach to their babies. But the good news is the condition is temporary and treatable, and, since late last year, Central Oregon has resources to help.

What is it?

Almost every new mom experiences stress coupled with emotional highs and lows. “It’s completely normal to have mood swings,” said Wendy Davis, executive director of PSI. “That’s normal, hormonal changes.” Women cry, their appetites can vary greatly (wanting to eat everything; wanting to eat nothing). Some women feel everything is uncomfortable and their sleeping is off, says Davis.

But a sign that what women are experiencing is beyond typical — and therefore they may need more support — is if these feelings last for longer than two weeks or if the feelings are interfering with day-to-day functions. Still not sure? Davis suggests the individual get some rest. Afterward, if she feels worse or the same, it’s time to start thinking something else is going on. Davis says another common symptom is for women to feel “flat,” or emotionally numb.

And while it is often called postpartum depression, the condition does not always include depression. It can include symptoms like anger and anxiety. The condition can also begin in pregnancy and can last for up to two years after childbirth. Postpartum depression and anxiety can also affect men; PSI estimates 1 in 10 men experience it. A more extreme condition, called postpartum psychosis — although it is much more rare, from 1 to 2 new moms in 1,000 getting it — can affect women. In this condition, women may hallucinate and it may sometimes result in them harming themselves or their babies. These are the cases — for example, Andrea Yates, the Texas woman who drowned her five children in 2001 — that often receive media attention. But Davis would like public awareness to shift away from the horror stories and focus instead on the more likely cases.

Davis believes public awareness around postpartum depression has improved in recent years, but contends that most women “don’t recognize symptoms when they have it.” She also finds many women are reluctant to seek help. The PSI slogan is: “You are not alone, you are not to blame and, with help, you will be well.”

Davis became involved with issues surrounding postpartum depression after experiencing the condition herself. She was a therapist who specialized in treating anxiety and depression. And yet, in all her studies, she had never learned about postpartum depression. After having a baby 18 years ago, Davis found herself crying all the time. She had no appetite and felt ashamed, embarrassed and confused. Perhaps worst of all, she didn’t think she loved her baby. She was sure that this lack of love was causing her depression. Her logic was: Of course she was depressed; she didn’t love her baby. Once she realized the flaw in her logic, everything shifted. Her depression was affecting her ability to feel love.

As she recovered, Davis learned how important it was to reach out and to take care of herself. Ever since, she has been dedicated to helping other women.

Davis explains that the logic of a person who is depressed or anxious is bent: “Instead of thinking you are anxious, you think something terrible is going to happen. Instead of thinking you’re depressed, you think you are a failure.”

Central Oregon

For years, there were no resources for local women experiencing postpartum depression. “If a parent needed support in Central Oregon, they either had to go outside of the area of just take the chance that their (primary care) provider knew something about it,” said Davis. Now, she says, the local community has developed a “really organized and sustainable network of support.”

Project Launch is a grant-funded program in Deschutes County Health Services with a goal of improving child wellness. The project is led by Maggi Machala, a registered nurse who has a master’s degree in public health. The program started in 2010 and has $650,000 a year to spend through 2014. One of the aspects Machala wanted to tackle was postpartum depression because maternal depression can “impact brain development” of infants, according to Machala.

“No one was doing screens. There was no place to refer people,” said Machala.

But health officials knew postpartum depression was a big issue locally. Visiting nurses, who visit low-income women at home after the birth of a baby, started screening women using the Eninburgh screening tool in 2009 (see “Eninburgh Postnatal Depression Scale”). According to the screening, about half of the moms tested positive for moderate to severe depression. And while women living in poverty are a higher risk for postpartum depression, they are not the only ones likely to get it. Machala says oftentimes wealthy women who are very put together and appear “so perfect” end up with postpartum depression. “That’s the mom you worry about,” said Machala, because she says they are unlikely to seek help.

“We decided we needed a system,” said Machala. She worked to get obstetricians, pediatricians, nurse practitioners and mental health care providers on board and trained in maternal mental health, and also recruited therapists willing to provide services. The group held several trainings attended by health service professionals and plans more in the future. Project Launch also sponsored several public service announcements on TV about maternal mental health. “It’s a real culture change,” said Machala.

One of the key elements of the system in Central Oregon is a phone line answered by volunteers. Women can call, leave a message and a trained volunteer will call them back. Jennifer Bardwell is the volunteer coordinator for the Deschutes County so-called “warm line” and has a handful of other volunteers. She believes in the importance of early maternal bonding and how this can set a baby up for early learning. “It’s huge as far as society goes.”

In addition to receiving calls from local women, Bardwell also receives referrals from local providers who screen women for postpartum depression. Both Central Oregon Pediatric Associates and Mosaic Medical are using the simple diagnostic tool to screen women and then referring them to the warm line. Bardwell says, since launching the phone line in October, she receives an average of 15 calls a month. She says the calls have increased in the last few months.

Bardwell has a list of therapists and support groups she refers women to. But the biggest gesture she does is to offer support and reassurance. Oftentimes, she says, women don’t need a therapy referral. They need to brainstorm how to take a shower or how to get out of the house. She talks to them about what they have eaten and which people they can talk with to feel less isolated. “Most of the time, they just want someone to say ‘You’re going to be OK.’”

Bardwell enjoys “the feeling of talking to someone who feels really alone … it brightens my day to give them hope.”

Bardwell can also offer personal encouragement — she experienced post-partum depression and anxiety after the birth of her two older children, now age 16 and 13. She had assumed that the birth of her children would be the happiest time of her life. Instead she felt she was living in an “isolated vacuum.” “I just thought it was me.”

She says she was the kind of woman who could never ask for help. Bardwell wanted to appear perfect, with a clean house, meanwhile “inside I was freaking out and exhausted.” She never ended up getting any help — after her first or second child (she says she didn’t experience any issues with her two younger children). “I plowed through it — it went on longer than it should have,” said Bardwell.

Bardwell hopes women can reach out for help without feeling shame or embarrassment. “It’s a very real complication of childbirth. It is not a character flaw,” said Bardwell.

Machala says some women don’t want to reach out, too, because they feel they don’t have time. And they see it as something they would be doing for themselves. She says moms need to think of it differently. “If you do it for no one else, do it for your child. It will help you be a better parent.”

Machala is pleased with how far they have come and the resources available.

“I know we’re making a difference,” said Machala. “We still have a lot of work to do.”

Davis also wants to reassure women that by getting help, they are minimizing the effects on their babies.

For Cardwell, what has helped is reaching outside of herself, even though she is “not necessarily someone who asks for help.” She talks to her husband and her best friend about her feelings. She says her husband, Tony, has been very understanding and proactive, making sure she takes naps and making a lot of meals. Cardwell has had to let go of the idea that she can do everything. “Moms have a feeling they have to be perfect at everything. You can’t do everything and that’s OK.”

Hearing stories of other women going through similar experiences also helps. “It’s nice to be able to say, ‘I’m not alone. I’m not crazy or I’m not a bad mom.’”