Tag Archives: newborn

Postpartum Depression

Risk Factors, Symptoms, and What To Do

Take a Screening Test for PPD

The Baby Blues has become as much an accepted part of being a new mother as engorged breasts and sleep deprivation. But what if the Blues don’t go away? For 10-20% of new mothers, Postpartum Depression (PPD) is an unwanted and difficult part of the first year of motherhood. The causes of PPD are many, and can include hormonal and lifestyle changes, a lack of social support, sleep deprivation, a high-risk pregnancy, a traumatic birth or difficult recovery, or breastfeeding problems. You are also at a higher risk of PPD if you have suffered previously from depression, or have recent losses or trauma in your life. Symptoms of PPD and related disorders can include:

  • Feeling sad, depressed, numb, or crying a lot
  • Restlessness or irritability
  • Unusually strong feelings of anger or resentment
  • Lack of energy
  • Having headaches, chest pains, heart palpitations, numbness, tingling, dizziness or nausea, hyperventilation or other unexplained physical symptoms
  • Difficulty sleeping or excessive tiredness
  • Loss of appetite or conversely, overeating and weight gain
  • Difficulty concentrating, remembering, and making decisions, or confusion
  • Excessive worry about the baby or lack of interest in the baby
  • Feelings of guilt and worthlessness
  • Lack of interest or pleasure in activities
  • Obsessive thoughts or compulsive behaviors
  • Fear of hurting the baby or yourself

Many mothers experience only a few of these symptoms, but if you feel like something is wrong and you’re not quite yourself, that is an important signal. If these symptoms persist for two weeks or more, the mother should promptly get support by talking to her doctor or a mental health professional. PPD is a highly treatable condition, with therapy, medication, or a combination of the two.

If you need medication and you are told that you must give up breastfeeding, make sure you get the advice of a psychiatrist who is knowledgeable about medications for breastfeeding mothers. There are a few antidepressants which are routinely prescribed for breastfeeding mothers with untraceable amounts detectable in the baby’s bloodstream. Moreover, breastfeeding can be beneficial both for the depressed mother, the long-term health of her baby, and bonding, which is even more challenging when a mother is depressed.

Depression not only affects you: it affects your relationships with your partner and your baby. Untreated, depression can lead to bonding difficulties and delayed development or failure to thrive. Getting the help you need to recover quickly is the best thing you can do for your baby and yourself.

Most importantly, tell your support people (your family, friends, partner) how you are feeling. The burden of trying to seem happy and “keeping it all together” can make the depression worse. You need to lean on the people who care about you, get as much help as you need until you’re back to feeling like yourself, and don’t beat yourself up for having PPD. It is NOT YOUR FAULT.

Commitment and Kids

Why the Couple Relationship Is So Important When You Are Parents

baby shoesWhat is it exactly that makes a committed relationship work, after kids come into the picture? It’s maintaining a loving and safe connection that  allows new parents to weather the storms of raising kids with their relationship intact.

If you want to maintain a good marriage, your relationship with your partner has to come first. Most of us have to work to earn a living, and some of us even enjoy our work. And we all have to take good care of our children. But if your partner always comes last, even a good relationship may fail, which will impact both your children and your financial future. A committed partnership takes love, commitment and hard work, and it’s a rare one that can stand many years of neglect.

Most of us want to be the best parents we can. But we don’t always remember that keeping our relationship happy is one of the most important things we can do for our children’s well-being. This means finding a way to spend time together away from the kids, as well as doing things together as a family. It also means keeping your sex life alive and kicking, whatever that takes. And it means working through your relationship difficulties and finding a way to connect and create time for your relationship despite whatever else is going on. It also requires that you accept your partner as a human being and a parent, as imperfect as they may be. Studies show that children fare much better in a family in which the parents’ relationship is solid, even if the parents do an imperfect job.

Communication is crucial. In the short run, it is always easier to bury resentments and avoid conflict. But in the long run, resentments build up and fester – killing intimacy and poisoning your sexual relationship. Learning how to communicate clearly and connect on an emotional level while remaining responsible for your own feelings and reactions can save your relationship.

For example, if your partner spends time caring for the baby and you’re annoyed that you find him sitting in front of the TV watching football, take a minute to think about how you want to respond. Angrily attacking him for not being engaged with the baby will only drive a wedge between you. On the other hand, biting your lip may be even worse, if it will lead to you feeling resentful and unloving toward your mate. If, after letting yourself cool down, you find that you are still resentful about it, one way to start a conversation is by saying something like: “I know you have had a hard day and you enjoy watching football to unwind. And your time with the baby is yours, so I don’t want to tell you how to do it. But I can’t help feeling resentful, after spending the day entertaining and caring for the baby, when I see you watching TV rather than playing with her.”

It may be that this discussion will involve some conflict, and your partner may express anger. But he also might acknowledge that he is at a loss for how to interact with the baby, or that he feels inadequate or inexperienced with parenting a baby. And you might express your concerns about exposing the baby to TV, and your desire for both of you to be good parents, while acknowledging that a football game probably won’t ruin your child for life.

After such a discussion, you might find that you don’t feel angry anymore. You may understand where your partner is coming from and recognize that the baby will survive some football-watching with Dad. Or, the discussing may spark the idea of giving Dad more time with the baby to improve his confidence. But either way, your feelings of resentment will be less if you work through the issues and understand each others’ feelings.

This is not to say that there are never times when it pays to let something go rather than discussing it with your partner. But the important question to ask yourself is: “will I truly be able to let this go?” If the answer is no, then you have to talk about it, preferably when you are both feeling calm, so you can move past the feelings of resentment and reconnect with your partner.

Remember that there is no intimate relationship that can remain loving without dealing with some conflict. Expressing feelings in a sensitive way is how you grow closer and resolve difficult situations. If you find that these discussions are unproductive, get the help of a qualified couples’ counselor sooner rather than later, so there is enough good will between the two of you to work on making the relationship better.

Often, the issues that keep coming up between you two mask fears and anxieties about the safety and security of your relationship. Reestablishing that bond can make all the difference in resolving the little conflicts that arise and maintaining a strong, healthy bond with your mate.

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.

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

How Doulas Can Help With Postpartum Depression

family with babyOn Wednesday, I was invited to speak to a group of local doulas, the Mt. Diablo Doula Community, about prevention of Perinatal Mood and Anxiety Disorders (PMADs), as well as how to recognize the disorders and how to help their clients. I hope the presentation might be helpful for doulas who are wanting more information about these disorders and what role they can play in keeping moms healthy and happy. You can access the Presentation Here. Attachments to the presentation are the Edinburgh Postnatal Depression Scale and an associated Suicide Screening Interview.

Feeling Clueless? Reading Your Baby’s Cues

By Meri Levy, MFT

father babyPeople have a physiological reaction to the sound of a baby crying. Our hearts pound, our blood pressure rises, and we start to sweat. This reaction causes most of us to try to stop the crying, regardless of how tired, irritable, or hungry we might be ourselves. And that’s a good thing. It’s how our babies learn to trust that their needs will be met and that the world is a safe place.

But sometimes (often!) new parents wonder what the baby is trying to say? What does the baby need? We run around randomly, trying different remedies: jiggling the baby, rocking the baby, changing her diaper, offering a breast or the bottle, or a pacifier. And sometimes the baby still cries. We desperately want to eliminate the cause of the crying, and we become frustrated, angry or guilty when we fail.

I faced this situation with my first child, Benjamin. I never knew what he wanted. He seemed to be constantly fussing, and I was never very good at calming him (and I did not feel calm myself). My second child, Elijah, always wanted to eat, so it was easier to consistently meet his needs. But I had not really improved my ability to read a baby’s signals.

With my third child, Emma, I hoped and prayed she would never (or rarely) cry, so I wouldn’t feel quite so inadequate again. But in the meantime, I picked up a copy of Secrets of the Baby Whisperer by Tracy Hogg. I had heard her on a talk show, and she claimed she get babies to sleep through the night, on their own, without letting them cry. This was a secret I wanted in on.

What I got from the book was very different from what I expected. The book is not for everyone. The author is not an advocate of “attachment parenting,” for example. But regardless of your parenting philosophy, The Baby Whisperer has a lot of good information about caring for your baby in a respectful way. She focuses on honoring your baby’s individuality, understanding how babies communicate, and learning how to meet their individual needs.

The book prompted me to stop when Emma began to cry, and to really listen and observe her, rather than jumping in and trying to “rescue” her without knowing what she was asking for. When I figured out what she was saying to me, I was in a much better position to meet her needs.

Here are some of the body language cues discussed in the book that I have found helpful:

Tiredness:

    • Yawning;
    • Moving head from side to side;
    • Flailing, uncoordinated arms, clawing at face;
    • Strong, uncoordinated kicking;
    • Bloodshot eyes.

Overstimulation/overtiredness, same as above, plus:

    • Turns away from objects and faces;
    • “Seven-mile stare.”

Hunger:

    • Turning head to one side and craning neck back with an open mouth;
    • Bringing hands to mouth, trying to suck them;
    • Pursing lips;
    • Curling tongue at sides.

Coldness:

    • Quivering bottom lip;
    • Extremities turning bluish;
    • Mottled skin;
    • Goose pimples;

Pain/gas:

  • Silent screaming, then gasp and audible wail
  • Grimacing, often scrunched up face
  • Arms shaking, slight tremor
  • Rigid torso
  • Legs pulled up to chest

What I discovered, from observing Emma more closely and choosing how to respond to her body language and cries, is that frequently what I used to interpret as hunger or gas was in fact tiredness or overstimulation. What happens if you feed a tired baby who isn’t hungry is that frequently she may get gas and be overtired and more difficult to put to sleep.

The goal is not to stop all crying. Babies cry to express themselves, and even a “perfect” parent, if such a thing existed, couldn’t prevent all crying. Nor should you, necessarily; your baby may benefit from having a chance occasionally to self-soothe, which is an important skill as your baby grows older. For subsequent children, this skill is learned by necessity because parents can’t always respond immediately. But by learning to read your baby’s cues, you can avoid some frustration for yourself and have the confidence to know you are doing the best you can for your baby.