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MICHELE NORRIS, host: Today in our series "Beginnings," we look at a problem that often goes unrecognized or ignored after women give birth. Surveys show that one in seven new mothers in the U.S. goes through a prolonged period of overwhelming depression or anxiety. It's not just a phenomenon of Western societies. Postpartum depression occurs in the developing world, too.

Joanne Silberner reports on how two women - one in the U.S., and one in Uganda - dealt with their depression, and how the stigma can keep women from seeking proper treatment.

JOANNE SILBERNER: Heidi Koss is in her kitchen just outside Seattle, making banana bread.

(SOUNDBITE OF COOKING UTENSILS)

SILBERNER: Her 10-year-old daughter, Bronwen, is working on a crafts project. Sixteen-year-old Elora is watching TV. It's getting on 6 p.m.

HEIDI KOSS: So Elora, what are you feeling like for dinner? We've got leftover duck.

SILBERNER: After Elora was born, Koss got hit hard by postpartum depression.

KOSS: I would say about two weeks into it, I started feeling the blues at first. And then I started crying a lot every day, feeling more and more depressed, having a harder time getting out of bed.

SILBERNER: Koss was intensely anxious about her baby. She worried obsessively that she might hurt her. She had terrible nightmares. One time, her husband had to stop her from jumping out a third-floor window. Things were no better when Bronwen was born.

KOSS: With my second daughter, when my symptoms kicked in, I felt nothing towards my baby. It was as if one day, I woke up and I didn't care about her. I would look at her, and I felt no feelings of bonding or attachment. I didn't care.

SILBERNER: This is the tragedy of postpartum depression. It isn't the way things are supposed to be. Women may have persistent sleep disturbances, a lack of interest in the world, dramatic changes in weight and extreme anxiety. Symptoms vary in severity. Koss' were severe.

KOSS: I would envision hurting her when she was crying inconsolably, and there was pretty much nothing I could do if I tried everything to soothe her. I would visualize smothering her with a pillow. I would visualize smacking her head against the wall until she was unconscious and couldn't make a noise - horrible thoughts that I was terrified by, and horribly ashamed of.

SILBERNER: It was clear to Koss that this was not what people call the baby blues. Those come on a few days after birth and are gone by day 10. Postpartum depression is different. It appears within a month of birth and remains for months before lifting. No one knows exactly what causes it. Researchers suspect some combination of hormones, stress and genetics.

Psychiatrist Katherine Wisner, of the University of Pittsburgh, says it damages not only the mother but the baby, too.

Dr. KATHERINE WISNER: The mother's much less able to pick up the baby's cues, respond to the baby, comfort the baby because she's having a lot of difficulty comforting herself.

SILBERNER: Several studies have shown that children of mothers who had postpartum depression are more prone to behavior problems and are less successful in school, especially if the mothers go for a long time without treatment. Wisner says it's not unusual for postpartum depression to go unrecognized and untreated because the pressures on women to be normal can be great.

WISNER: This beautiful baby is in the arms of a smiling mother who's just delighted - that's what we as a society want to see. So to walk into your obstetrician's office and break down crying, or say you don't feel the way that society expects you to, is a real burden.

SILBERNER: These societal pressures are not just a factor in the U.S. Postpartum depression happens everywhere, even though some Westerners dismiss depression as a luxury of rich societies.

DOROTHY MWESIGA: (Foreign language spoken)

SILBERNER: Here in a rural village in Uganda, down a bumpy, red-clay road miles from the highway, 30-year-old Dorothy Mwesiga had postpartum depression after the birth of each of her three babies.

MWESIGA: (Through Translator) But every time I give birth, I get it. And this is the third time I'm getting it.

SILBERNER: She would get overwhelmed with anxiety - not wanting to let anyone touch her baby, not wanting to sleep because someone might take her baby. She had the same diagnosis as Heidi Koss in Seattle, but because of the stigma a label like depression carries in Mwesiga's small village, it's called something else: the worries. Her health officer, Emmanuel Musumba, explains.

EMMANUEL MUSUMBA: In Africa, depression is - it's not easy to explain to someone that you have a disease called depression, as it is in America. I told her we are treating the worries, and trying to reassure her that all will be well when she takes this medication.

SILBERNER: He says if he told her she had depression, she might be shunned by people in her community, the same people who helped her take care of her babies when she was sick.

MWESIGA: (Through Translator) Now, I say that I love my baby, and I look after her - after the baby. But when I get sick, I don't want other people to touch my baby. I think they're going to take away my baby.

SILBERNER: She credits her community, her religious faith, and the counseling and antidepressants from the health officer for getting her through. Katherine Wisner says postpartum depression can be treated successfully about half the time with medication or counseling. It's getting the diagnosis in the first place that's the problem. Women are sometimes too embarrassed to admit they're depressed, and the health-care system isn't always set up to recognize it.

WISNER: And there are some physicians who tell me that they don't see postpartum depression in their practices. And my guess is, that's right. They don't see it.

SILBERNER: That's because they're not looking, she says, and they feel out of their league treating it. And getting reimbursed for it is complicated. Koss says that when she complained to her obstetrician after her first daughter was born, he said there wasn't much he could do for her.

KOSS: I am angry that my OB didn't know better information to give me, that I couldn't have received early intervention, that I suffered that long, that my daughter was exposed for so long to a mom that wasn't well.

SILBERNER: Her older daughter is being treated for depression. For Heidi Koss, who now has a loving relationship with both daughters, the whole experience has left lasting wounds.

KOSS: I was very sad. I think I'm still sad. I still feel guilty that as a mom, I didn't feel love for my baby.

SILBERNER: The grief, the pain and the guilt broke up her marriage, she says. But one good thing came of it all: Koss' anger sent her back to school. She's now got a master's degree in family therapy. And she's counseling women with postpartum depression, so they'll have an easier time of it than she did. For NPR News, I'm Joanne Silberner.

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