Category Archives: Postpartum

People-Pleasing Moms: At Risk

Sad new mom holding baby - people-pleasing momsOne of the common themes I come across when working with mothers experiencing depression and anxiety is perfectionism and people-pleasing. Moms get worn out when they are trying to make everyone happy all the time.

There are often good reasons for a tendency to be over-responsible for the feelings of others. Many of us come from families where there was an unspoken expectation that a child must be “good,” because one or both parents were unable to tolerate the challenge of even normal childhood misbehavior. Or sometimes, children develop an unconscious habit of caretaking for others as a way to get their own needs met.

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Letting Go of Parent Guilt

pregnant mom sonThere is no guilt quite like the guilt of a parent. We feel so uniquely responsible for the care of our children. Every lapse in our parenting weighs on us.

Throughout life there are always reasons to feel guilty: the call we forgot to return or the birthday card we forgot to send, or the time we snapped at our partner for no good reason. But when we feel we have failed with our child, this guilt weighs even heavier on our minds.

Guilt is an emotion with a conscience — it helps us try to do our best, and it reminds us of what is important to us. But too much guilt can rob us of enjoyment. And as a parent, there is so much to feel guilty about! If we dote on our child, there’s the house, friends, partner or even job to feel guilty about, and if we try to meet our other obligations, it is easy to feel that you have failed as a parent. It’s a Catch-22!

I wonder sometimes if our parents felt as guilty as we do, or if it is unique to our generation to expect so much from ourselves. And guilt in itself is purposeless. It doesn’t help anyone, but only makes it more difficult to do our best.

When you are feeling guilty, it is important to look at this feeling from some emotional distance, seeing it objectively instead of being its victim. Decide whether your sense of guilt is justified. Sometimes sharing your feelings with a fellow parent can help you sort out what is legitimate and what is perfectionism.

When you feel that you have truly let someone down, it is important to do what you can to make it right. Apologize to the friend you neglected, or the partner or child you yelled at. Try to learn from your guilt to change your priorities and do things differently. Then let the guilt go.

When the guilt is baseless, or unavoidable, like when you feel guilty for a feeling you have, or because you cannot do more than you are capable of, then you need to practice using your “interior parent” to counter those feelings.

If you had a beloved friend who told you she felt terrible because the baby cried while she was on a much-needed outing with her partner, what would you tell her? Probably you would reassure her that she is a wonderful mother, and that she must nurture herself and her relationship in order to be the best mother she can be. You would tell her she has nothing to feel guilty about, and you would also empathize with her pain. This is the role you must also play with yourself.

Listen to your own thoughts, and when they are self-defeating or judgmental, respond to yourself the way you would to a loved one — being a good parent to yourself is part of being a good, loving and joyful parent to your children.

Returning to Work After Parental Leave

By Meri Levy, MFT

Regardless of what you decided about working after the birth of your baby, facing the reality of going back to work or staying at home once the baby is born can be a very stressful time. Many moms, even those who were certain that they wanted to return to work after their maternity leave, have very conflicting feelings about the reality of returning to work. And some moms who always planned on staying home after having children face unexpected emotional challenges in facing the reality of looking toward a future at home full-time with their child.

What is hard to anticipate when considering the decision to work or stay at home before the baby is born is how big a loss either decision represents. For moms returning to work, it is common to feel:

  • An enormous sense of loss associated with leaving your baby in another’s care
  • A concern that her child will be irreparably harmed by the separation from you
  • Anxiety about being away from your baby and having your baby’s care outside of your control
  • An unexpectedly strong desire to quit your job and stay home with your baby
  • Guilt associated with having a desire to return to work or resentment at having to go back to work
  • A feeling that you must rush through your workday to return to your baby as quickly as possible, for fear your baby will forget you, or you will miss important moments.

For moms choosing to stay at home, it is common to feel:

  • An unexpected sense of loss associated with no longer receiving the validation of purpose that is so often gained by outside work and receiving a paycheck
  • A sense of vulnerability associated with being dependent upon their partner’s income
  • Guilt associated with conflicting feelings about leaving the work world
  • Boredom with the tasks of mothering and loneliness, especially in the early months before the baby becomes more interactive and you find activities you enjoy with your baby
  • Loneliness and isolation associated with being at home with a small baby, especially before you connect with other new mothers at home with their babies.

These feelings can be very confusing, and new moms often struggle with the decision regardless of what their prior plans were. As a new mom, your entire world has changed, your priorities have shifted, and your now occupies a huge place in your heart. It can be a struggle to align the new role of motherhood with the values you previously held. Many moms change course and decide to stay home despite having planned to return to work, or choose to go back to work full or part-time despite planning to remain at home. Financial considerations play a big role in this decision, as does the developing relationship with your baby, your own clarification of your needs and wants, and your relationship with your partner.

Many mothers seek therapy during this time. Getting help to clarify your feelings about returning to work, exploring alternative work arrangements or more flexible careers, and getting validation for your choices can make this difficult time of transition go smoother. Whether you ultimately decide to stay at home for now or return to work, making decisions from a place of self-compassion, and understanding that there is no one “right” answer can allow you the freedom to honor who you are and who you are becoming.

Postpartum Depression and Perfectionism

canstockphoto10868712I recently had an article published on GoodTherapy.org about how your personality style can put you at risk for Postpartum Depression. Check it out on GoodTherapy.org.

My Journey Through Postpartum Depression and Panic Disorder

Whenever I talk about the symptoms of perinatal mood and anxiety disorders, I always include “unusual physical symptoms.” What does that mean? It means that any new physical symptoms that begin during pregnancy and postpartum can be related to mental health.

My own experience with postpartum depression and anxiety was quite atypical, and that was partly why I suffered for months before receiving the proper diagnosis and treatment.

I had lots of risk factors for postpartum depression: a previous bout of depression, the death of a loved one, a high-risk pregnancy, a traumatic childbirth, an unsupportive marriage, and breastfeeding difficulties. But even though I had suffered from depression before, after the death of my mother, my postpartum symptoms were not recognizable to me.

After my second child was born, my stress level was off the charts. My older son got kicked out of two preschools (he wouldn’t use the potty!) and I was scrambling to find a preschool that would take him. I never made enough milk for the new baby because he was so big and I was so stressed out, and he refused to nurse completely as soon as he started solid foods. I felt guilty about “failing” at breastfeeding and I was also afraid that I would not be able to go back to work after maternity leave because I couldn’t find full-time daycare that would take my challenging and potty-resistant older son.

In the meantime, I had difficulties in my marriage. My husband worked a lot, and when he was there he criticized my parenting style, my cooking, and my housekeeping. Even our challenging preschooler was my fault! I was trying my best to make everyone happy, but I was clearly failing.

During this time, I started to have odd physical symptoms. I started feeling that the room was tilting and that I was off-balance. I had to lie down and felt the room was spinning around me. My doctor thought it was either an inner-ear infection or possibly Multiple Sclerosis, and I was sent for neurological testing. The tests came back normal, although MS couldn’t be ruled out (a bonus for my anxiety, of course!).

My symptoms came and went, and then began to include nausea and vomiting along with the dizziness, a complete lack of appetite, and an inability to sleep. I had a low-grade fever on and off for a couple of months and my white blood-cell count was high. I lost 16 pounds beyond the baby weight, slept about three to four hours a night, and threw up regularly — out the door of the car, in the sink at the pediatrician’s office, etc. I felt that my body was swaying even when I was perfectly still, and my bed felt like it was shaking as I lay in it trying to sleep. My skin felt prickly, my chest burned and my hands tingled. The dizziness made watching TV or reading impossible, and walking or driving became difficult. I felt sure that I was dying.

My doctor considered an inner ear problem, hormones, diabetes, thyroid issues, and even encephalitis, but every test came back normal. I was living on Ensure and Gatorade, because I couldn’t keep any solid food down. The stress of caring for my children became unbearable, so we hired a babysitter and I spent most of every day lying in bed, praying to fall asleep for a couple of hours to get some rest. I was prescribed Ativan, but it just knocked me out for an hour or two and I would wake up feeling even worse than before.

After about four months, I fell apart completely and told my doctor that he had to hospitalize me because I was dying, and at that point I wanted to die if they couldn’t stop the misery I was living in. I was admitted to a psychiatric inpatient unit, but my doctor was still sending me around to specialists, trying to figure out what was physically wrong with me.

I stopped vomiting as soon as I was admitted to the hospital. That was when I realized that whatever was going on with me had to do with stress. I spent 12 days in the hospital, during which time I started taking antidepressants and was prescribed an anti-anxiety medication that allowed me to sleep. For a few days, all I did was sleep. When I was awake I was no longer nauseous, but I was filled with unbearable emotional pain. I was terrified that I would never be able to care for my children without getting sick. I felt like the worst mother in the world.

After I was released from the hospital I did a full-day partial hospitalization program for a month, which gave me time for the antidepressant to start working and allowed me to take care of myself for a change. I learned in group therapy about the ways in which I had prioritized my responsibility for others way above self-care, in unhealthy and unhelpful ways, and I began to heal. With the help of medication, therapy, and later couples counseling, I recovered. I still had anxiety at times, but I also had joy and passion for life. I became a lactation educator, started a small business helping other new moms, and led new parent support groups for several years. Eight years later I went back to school to become a Marriage and Family Therapist.

I still have to be vigilant about managing stress and maintaining good self-care. I tell myself that this is the “gift” of being prone to depression and anxiety: I don’t have the luxury of tolerating a great deal of stress like some people seem to do, or living life in a way that generally makes me unhappy. I am obligated to do work that I love, to have a healthy relationship with my husband, and to prioritize joy, peace and comfort as well as caring for my family. I know that I always have to be mindful to avoid a recurrence of depression, but I also know that I am strong and resilient and will do whatever I have to do to be healthy and take good care of myself and my children.

My mental health issues began when my second child was seven months old, and yet no one ever considered a postpartum condition. My symptoms were fully consistent with panic disorder and depression, and yet my doctor and my therapist (yes, a trained therapist!) never considered these diagnoses. My hope is that in the future, mothers and their caregivers become better educated to recognize perinatal mood and anxiety disorders so that they can be treated early and mothers can return to enjoying their lives again.

  • If you need immediate help, please call the National Suicide Hotline at 1-800-273-TALK (8255)
  • If you are looking for pregnancy or postpartum support and local resources, please call or email Postpartum Support International:

Call PSI Warmline (English & Spanish) 1-800-944-4PPD (4773)
Email support@postpartum.net

Antidepressants: Yay or Nay?

canstockphoto19841317For individuals who have struggled with depression, the decision of whether to try, or later to stay on antidepressant medication is often a difficult one. Some people swear they will never try an antidepressant, until or unless their depression becomes so debilitating that there seems to be no other option. For others, the promise of relief is so attractive that they jump into the decision to take antidepressants, but then they struggle with the question of whether the medication is a lifelong sentence.

To Take Antidepressants or Not to Take Antidepressants

There are no easy answers to this question (as is true for most important ones!). Studies show that individuals suffering from moderate to severe depression have better odds of recovery with a combination of therapy and antidepressants. However, for some people, changes in diet, additional exercise, and better strategies for coping with stress can work just as well. For debilitating depression, medication can often help to lift a person up enough to be able to meaningfully participate in therapy. But depression generally happens for a reason, and often changes in thinking patterns, relationships or career are necessary for a person to have more happiness and fulfillment in their life. Medication alone may not make these changes happen. Does relying on antidepressants to make life more bearable reduce the motivation to make needed life changes that will improve the quality of one’s life? The answer to that question may be different for every individual, and is something that can be explored in therapy.

Side Effects

Some individuals find great relief on antidepressants, and don’t have any bothersome side effects. But others experience weight gain, sexual side effects or other unwanted secondary effects from these drugs. Sometimes, switching medication can resolve these issues, but in some cases the antidepressants that work for the individual are the same ones that cause other problems. That is a common reason why some people consider going off medication and try to manage their depression in other ways.

Never Go Off Antidepressants Without Consulting Your Doctor

A reminder here is important; never go off antidepressant medication suddenly, or without the supervision of the prescribing doctor. Some of these drugs require an extended period of weaning to avoid serious withdrawal symptoms. And an important factor to consider is the possibility that if you wean off your antidepressant medication, the same medication may not work for you as well in the future. That is one factor that you need to weigh with your health provider when making this decision.

Issues Raised by Weaning Off Antidepressants

Individuals that decide in consultation with their doctor to wean off antidepressants face a whole other set of challenges. The fear of a relapse of depression can be the most difficult part. Coping with the symptoms of withdrawal can be challenging, and often brings up these fears. Also, people who go off antidepressant medication may find themselves more vulnerable to feelings of sadness, irritation, anger and stress than they are used to. Learning coping strategies for these emotions is very important. A really bad day can create a lot of anxiety that the depression may be returning, even if the emotions involved are normal and healthy. Therapy can be an helpful place for reality-testing in terms of what is healthy and what is a signal that depression may be returning.

The thoughts and feelings around the decision to go on or off of antidepressant medication can be confusing. Therapy and consultation with your medical provider to sort through the questions and concerns raised by antidepressants is a good place to start.