Ten days after giving birth, Sarah Witzel had lost all her pregnancy weight, plus five extra pounds.
"I wasn't trying to lose weight," said Witzel, a 26-year-old pharmacist living in Saskatoon. "It just kept coming off and coming off."
That alone should've been a clear sign that the new mom was suffering from postpartum depression, especially when seen alongside her anxiety and lack of sleep.
But at her two-week appointment, her obstetrician dismissed the symptoms as normal — and Witzel was eager to believe her.
"Being a first-time mom, I didn't really know what normal was," she says.
Distinguishing between the natural exhaustion and nervousness that a new mother might feel, and the debilitating amount that can indicate postpartum depression, can be tricky, mental health advocates agree.
But they also say that there seems to be a persistent stigma around the illness that isn't helping and can prevent mothers from even raising worries that they are suffering from postpartum for fear they may be deemed an unfit parent, or worse.
This week, Winnipeg media outlets scrutinized every angle of the illness after the death of Lisa Gibson, 32, and her two young children.
Divers recovered Gibson's body from the Red River over the weekend. She'd disappeared after her two-year-old daughter, Anna, and three-month-old son, Nicholas, died in hospital after being found unresponsive in the Winnipeg family's home.
Family members say Gibson had sought help for postpartum depression.
Despite coverage of such events in recent years, along with media attention on the issue of postpartum depression itself, little has changed, advocate Tascheleia Marangoni says.
"Between my first and third child, and they're 12 years apart, things haven't changed too much in terms of how perinatal mood disorders are addressed in Canada," says Marangoni. "It's pretty unfortunate."
Marangoni started a non-profit corporation, the Postpartum Depression Awareness Project, after suffering a severe bout of the mental illness when her first child was born 16 years ago.
"A lot of people still think it's just baby blues. You're just a little down. Get over it," she says. "That's very old-school thinking."
Studies suggest that as much as 50 to 80 per cent of new mothers experience the innocuously dubbed baby blues. With this, mothers may cry at the drop of a hat or feel overwhelmed and unsure about parenting.
It doesn't usually last beyond six weeks.
Fewer mothers — up to 15 per cent — suffer postpartum depression. They may experience uncontrollable crying, persistently negative thoughts and debilitating anxiety, says Dr. Simone Vigod, a scientist at Women's College Research Institute who studies the topic.
"With postpartum depression, anxious thoughts can involve negative and scary images," said Dr. Vigod. "Women get really, really terrified by those images. They're sure they would never do that to their baby."
Rare is the mother who is overcome by postpartum psychosis, a severe stage that can involve confusion, hallucinations and attempts to harm oneself or the baby. The reported numbers suggest the odds of that happening are in the order of 1 in 600 to 1 in 1,000 mothers.
"People start to lose touch with reality," said Dr. Vigod. "They start to believe 'My child is better off not being alive without me.'"
'Save you from each other'
For Witzel, she remembers the moment three weeks after Claire's birth on Oct. 31, 2011, when it felt like motherhood was becoming too much to handle.
"[Claire] was screaming and I was crying and I didn't know what to do," she said. "I just remember feeling like I just wish we could give her back to the hospital."
At that moment, her husband came into the room.
"He picked her up and took her from the room and said something like, 'I'm going to save you from each other.'"
But suffering from those thoughts, however fleeting, troubled Witzel.
"Some people, they just look at you like a monster" if you tell them, she says. "But when you tell that to another mom who's had postpartum depression … they know exactly what you mean."
It would be more than a month later that Witzel would be diagnosed with postpartum depression — by a public health nurse during a vaccination appointment for her daughter.
Her case is indicative of increased awareness at all levels of the public health-care system of the illness.
"I think that there has been a lot of movement," said Dr. Vigod. "There have been advocacy groups behind this, government behind this and public health groups behind this.
"But I still think that there are a lot of issues around stigma with respect to mental health problems and I worry that that is a barrier."
'Bottom of the heap'
One area where Dr. Vigod says the public health system could improve is ensuring all health-care providers, not just the family doctors, are equipped with the know-how to refer a mother to get therapy or start medication.
Often, new mothers are more likely to visit pediatricians about their child's welfare than other parts of the health-care system.
"They're worried about their kid's health," she said. "They probably overuse pediatric services. So it's actually a good place to target them."
Despite the fact that some stigma remains, Marangoni, who has worked hard to rescue postpartum depression from what she calls the "bottom of the heap" of mental illnesses, says there is a shining light on the horizon for the issue.
More mothers, like Witzel, are sharing their stories, largely driven by a move to openness enabled by social media. That alone helps de-stigmatize the issue.
As for Witzel, she says she's driven by the hope that others learn from her story — and take away a few lessons.
"It's important to know that it will get better and not all stories end tragically," said Witzel. "Claire is almost two and it's such a blessing to have her as my child and to parent without postpartum depression."