News Article Details

'This truly saved my life' — expectant mother seeks help, averts depression

Providence Journal - 10/21/2017

Oct. 21--COVENTRY, R.I. -- When Kristen Ritchotte ended her overseas relationship with the father of her unborn child, she returned to her native U.S. With no money and no job, she moved in with her parents. Except for doctor's appointments, she essentially stayed in bed for a month, crying constantly.

The young woman had experienced depression before, though never this severe. If not for her baby, she might have resorted to alcohol, an old coping mechanism.

"It wasn't like before," Ritchotte, 34, recalled. "I couldn't drink a bottle of wine and numb myself and make it go away."

Eventually, Ritchotte left her house to attend a meditation class, which she hoped would provide relief. It did not: As she sat in her car afterward, pain cleft her chest and her vision blurred. She thought she was dying.

Somehow, she got home. She telephoned a friend who worked at Butler Hospital.

Something's wrong, Ritchotte said.

You're having a panic attack, the friend said. You need to get help.

Ritchotte drove to Butler's emergency room, where she opened up to an intake psychiatrist. The diagnosis was perinatal depression, a mood disorder during pregnancy that is related to the more commonly known postpartum depression, which occurs after a baby is born. Both conditions can adversely affect the health of the mother -- and the developing and delivered baby.

Ritchotte left the emergency room calmer -- and with an admission to a Butler day program, which allowed her to live at home while receiving care. From there, she transitioned to the Women's Behavioral Health team at Women & Infants Hospital, which partners with Butler in the treatment and research of women's mental health, including mood disorders during and after pregnancy.

"This truly saved my life," Ritchotte said.

It saved her, too, from experiencing postpartum depression when her baby was born six months later. Intervention had kept two more people from potentially dire consequences, at a comparatively minor cost.

The symptoms of postpartum depression include excessive crying, anger, withdrawal, feelings of numbness or disconnection from baby, and shame or guilt about not being a "good mom" -- not meeting the stereotypical images presented in media and everyday conversations of the smiling, capable new mother.

Symptoms can resemble the so-called "baby blues," which affect up to 80 percent of mothers, according to the National Institute of Mental Health. "Babies require a lot of care, so it's normal for mothers to be worried about, or tired from, providing that care," the institute states.

But when symptoms persist for more than a week or two, the cause may be postpartum depression. Untreated, the risk of a mother causing harm to her child or herself rises -- to the possibility of infanticide or suicide in extreme cases.

Risk factors include a previous personal or family history of depression, bipolar disorder or psychosis; poor support from a partner, friends or family; high stress attributable to financial difficulties; a colicky, sick or birth-defective infant; difficulties breastfeeding; and a pregnancy that was unplanned or unwanted. Sleep deprivation and hormonal changes in the body play a role, but discovering the exact biological cause of the disorder remains a goal of research.

About one in nine new mothers in the United States experience postpartum depression, according to the Centers for Disease Control and Prevention (the actual incidence could be higher, since this statistic reflects reported cases but does not include those that do not come to the attention of health-care professionals).

Rhode Island's reported rate is even higher than this national average, according to a CDC study of 27 states, "Trends in Postpartum Depressive Symptoms," published in February. Rhode Island ranked sixth-highest in that study, with a 13.9-percent incidence. Arkansas, at 20.1 percent, ranked highest; Georgia, at 8 percent, was lowest.

The good news?

Rhode Island is at the forefront of identifying and treating postpartum depression. In addition to the programs at Butler and Women & Infants, the state has an unusually high number of therapists, psychiatrists and other clinicians who specialize in postpartum depression. Students and residents at The Warren Alpert Medical School of Brown University rotate through both hospitals, and advanced clinical fellowships are available.

"We have a lot of really top-notch clinicians in the state," said Cynthia L. Battle, a researcher, clinical psychologist and Brown professor who works at Butler and Women & Infants. "It's quite unique, actually, to have so many well-trained clinicians in one area."

Other regions are following Rhode Island's lead. Modeled after and participating in a licensing agreement with the Women & Infants Hospital Day Hospital, the Motherhood Center of New York recently opened in midtown Manhattan. It is the first such center in New York.

"Having a baby can feel wonderful," its website declares, "but it can also feel very overwhelming and hard. At the Motherhood Center, we are here to help every step of the way."

Ritchotte's first symptoms of mental illness occurred when she was in high school, making for what she describes as "some pretty rough teenage years." She did not recognize them as signs of a disorder, nor did her family.

"I didn't have the vocabulary to describe it until I started working with Women & Infants," Ritchotte said. "I just always thought this was my personality. Like, 'maybe everybody goes through this' or 'maybe I have it rougher than other people.' There was always this self-inflicted pressure to just sort of bear it and go on. It was the sort of thing where you push down your feelings, or have a drink, or put on some lipstick and go on with your day."

Ritchotte enrolled at Providence College after high school but left after a few months, then moved with a boyfriend to Florida, where she worked at a car dealership. When she and her boyfriend broke up, she returned to Rhode Island. She worked different jobs and studied at the Community College of Rhode Island before transferring to the University of Rhode Island to study anthropology.

She was participating in a study-abroad program in 2010 in the Dominican Republic when a magnitude-7 earthquake struck adjacent Haiti. Ritchotte felt the shock, and later volunteered for the relief effort. Work with suffering children emotionally overwhelmed her.

"All of the things I had repressed came out. I just lost my mind when I got home. I was barely able to get out of bed. I would wake up screaming because I thought it was the earthquake."

URI provided counseling, and Ritchotte was diagnosed with post-traumatic stress disorder. She began to see a therapist.

But during one session, according to Ritchotte, the therapist said they should begin to discuss her childhood. The memories of her teenage years were too painful then.

"That's when I shut down," Ritchotte said. "I just stopped going."

Search Google for images of "baby magazines" or "pregnancy magazines" and you will find virtually nothing but depictions of beauty and joy.

"Show off your bump!" one headline proclaims.

"You can do it!" declares another.

"Happier than ever!" reads a third.

For some women, that is the case. For the nearly 10 percent or greater -- 13.9 percent in Rhode Island -- for whom it is anything but, the message can be devastating. Similar images on Facebook and other social media amplify the shame and guilt women can experience. And they can bottle that up, keeping their fears secret as best they can.

"They feel defective," said Margaret Howard, director of Women & Infants' Center for Women's Behavioral Health and Day Hospital, and a Brown professor of psychiatry and human behavior. "There's this cultural embodiment of the myth of motherhood as this most glorious, joyful time in a woman's life."

Said Battle: "It's one of the reasons why there can be reluctance to open up and admit that, 'Yes, I'm pregnant and struggling and maybe my feelings are even mixed about the pregnancy.' And that can be a really hard thing for women to say: that they're pregnant and yet they are depressed or anxious or not so sure about the new baby in terms of feeling connected."

Ritchotte graduated from URI and was accepted at Tulane University, where she earned a master's degree in anthropology and began working toward a doctoral degree. She was not addressing her mental health -- but she was achieving, as she had since childhood.

"I was sort of raised with the expectation that I would go to Harvard and take on the world," Ritchotte said.

She left Tulane after meeting a man and moving with him overseas. She did not expect to become pregnant, or for the relationship to end.

As her pregnancy progressed, Ritchotte's care through Women & Infants included talk therapy and medication -- which, depending on dose and formulary, can be safe for the unborn child. She enrolled in Butler Hospital's Healthy Expectations Prenatal Wellness Program study, which is assessing whether exercise during pregnancy can mitigate or prevent postpartum depression. Early evidence suggests it can. Related research into the effects of yoga and improved sleep patterns suggests those are beneficial, too.

Ritchotte found a job at Roger Williams Park Zoo, where she is now Play Partner Program specialist, a valued employee whose personal story is known to colleagues and executives. She is one of the few employees entrusted with the care of Reba, a red-tailed hawk who came to the zoo from Tennessee, where she had been rehabilitated after losing half a wing to a gunshot.

"The organization makes a commitment to support all our employees professionally and personally," Shareen Knowlton, director of education, told The Journal. "It is very important that the zoo family be there for each other through both good and bad."

At 8:06 p.m. on Aug. 24, 2016, Lorelei Clara Ritchotte was born at Women & Infants.

Rory, as she would be familiarly called, was normal and healthy. Her mother, who continues with talk therapy and medication, was elated.

One morning not long ago, the sounds of a happy baby filled the Ritchotte residence, a spacious home in a quiet Coventry neighborhood. Kristen grew up here and lives here again with her daughter and parents, Diane and David Ritchotte. David is at work.

Rory is eating her breakfast.

She starts toward her mouth with a blueberry, but Kristen intercepts her.

"That has a hair on it," she says, taking it away. "With a house full of girls, there's hair everywhere."

Diane nods in agreement.

Rory laughs.

"Are you silly?" Diane says.

Rory turns up her nose at a berry that apparently is not quite to her liking

"You should eat it," Kristen says.

This time, Rory does. And smiles.

"Thank you," Kristen says. "Food costs money. Mommy works for a nonprofit!"

Soon, Kristen will leave for the zoo, leaving her child in the care of her mother. She may not have money, but what she does have is priceless.

Why Kristen shared her story

It is not easy to publicly share a painful journey, even one that ends in a good place. Kristen Ritchotte did so from a sense of altruism.

"At the beginning of my pregnancy, I couldn't have felt more alone," she told me toward the end of the extensive interviewing of her and others that went into these articles. "I was afraid that giving voice to my depression would make me seem ignorant of my relative privilege or that I didn't love my daughter. I needed community. I needed support. Thankfully, I was surrounded by people who made me feel unashamed to seek the help and support I so desperately needed.

"I'm sharing my story because I want to empower others to discuss their mental health without reservation. Everything my daughter and I have is the result of a community coming together to prevent tragedy. We are immensely grateful to the many people who have helped us on our way and are committed to paying it forward."

FOR HELP: Women & Infants and Butler both belong to the Care New England Behavioral Health Services system, which operates a 24/7 call center: (844) 401-0111. Information on Butler's programs can be found at http://www.butler.org/programs/ Women & Infants' Day Hospital is at http://womenandinfants.org/dayhospital

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(c)2017 The Providence Journal (Providence, R.I.)

Visit The Providence Journal (Providence, R.I.) at www.projo.com

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