On 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.
Antidepressants: Yay or Nay?
For 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.
For New Moms: When You’re “Just Not Yourself”
By Meri Levy, MFT
Being a new mother should be a joyous time in your life. But what if you’re not feeling like yourself after having a baby? About 10-15% or of new moms experience postpartum depression, which can begin any time during the first year after childbirth. Depression is a treatable illness that causes feelings of sadness, indifference, and/or anxiety.
Postpartum depression (PPD) is different from the “baby blues.” A majority of new mothers experience the “baby blues,” a period of sadness that isn’t debilitating and passes quickly. Symptoms of the “baby blues” include tearfulness, irritability, restlessness, and anxiety. But when symptoms of sadness, irritability or anxiety continue for more than two weeks or make it difficult to care for your baby, there is more going on and it’s time to reach out for help.
Symptoms of PPD include:
- Fatigue or lethargy
- Feeling sad, hopeless, helpless, or worthless
- Trouble sleeping/sleeping too much
- Loss of appetite/increased appetite
- Difficulty concentrating/confusion
- Crying for no apparent reason
- Lack of interest in the baby
- Fear of harming the baby or oneself
Symptoms can vary in severity, but persistent depression often causes new moms feel isolated, guilty, or ashamed.
You should tell your doctor if you have several of these symptoms for more than two weeks; if you have thoughts of suicide or thoughts of harming your child; depressed feelings are getting worse; or you are having trouble caring for your baby or yourself.
Depression is an illness. It is not a sign of weakness or of being a bad mother. It can be treated successfully, and getting help is the best thing you can do for your baby.
Risk Factors for PPD
Any new mom can develop PPD. Its causes may include hormonal and other physical changes, sleep disturbance, emotional adjustments and chronic stress. However, women are at increased risk of depression if they have a personal or family history of depression, if they are have experienced particularly stressful life events such as significant losses, a high-risk pregnancy or traumatic birth, or if they don’t have adequate support from family and friends.
Other Postpartum Conditions:
Postpartum Anxiety and Obsessive Compulsive Disorder
Many new moms experience anxiety rather than sadness after giving birth. Anxiety, panic attacks, irrational fears or intrusive thoughts, or images can be associated with Postpartum Anxiety or Obsessive Compulsive Disorder. Symptoms of a panic attack can include a racing heartbeat, unusual physical symptoms, a sense of impending doom, the feeling that you are dying, dizziness or nausea.
Posttraumatic Stress Disorder after Childbirth
New mothers can also develop post-traumatic stress disorder (PTSD) following a traumatic childbirth experience. PTSD involves reexperiencing the trauma through flashbacks or nightmares, having difficulty sleeping, and feeling detached or estranged from friends and loved ones.
Postpartum Psychosis
Postpartum psychosis is extremely rare but also very serious. It affects only two out of every 1,000 new moms. The symptoms are severe and may include insomnia, agitation, hallucinations, and extreme paranoia or suspiciousness. Postpartum psychosis is a serious medical emergency and requires immediate attention.
Treatment for Postpartum Disorders is Effective
If you believe you are suffering from a postpartum disorder, the first step is to talk to your doctor or mental health provider.
You should be evaluated by your doctor to rule out a medical cause that can contribute to depression.
Psychotherapy, medication or a combination of the two may be needed to get you back to feeling like yourself. But you must continue treatment even after you begin to feel better, because discontinuing treatment too soon can cause symptoms to recur.
The support of family and friends is also instrumental to your recovery. In addition, joining a support group for postpartum disorders can help overcome feelings of isolation, increase coping skills and provide social support.
Getting help is the most important step you can take for yourself and your baby. Untreated maternal depression is associated with developmental delays in babies, as well as potentially serious emotional consequences for your growing child.
How Partners Can Help
New moms suffering from Pospartum Depression and Anxiety need the support of their partner, as well as friends and family. Help with baby care and household responsibilities, provide an ear to listen or a shoulder to cry on, and be patient and understanding with her struggles. And make sure she gets help.
Partners also need to take care of themselves. Having a new baby is hard for partners too. And if the mother is depressed, you are dealing with two major stressors. Partners can also suffer from Postpartum Depression, a often undiagnosed problem.
How to help a partner suffering from a postpartum disorder:
- Encourage her to talk about how she is feeling. Listen without judging her. Instead of trying to fix the problems, just be there for her to lean on.
- Offer help around the house. Chip in with the housework and childcare responsibilities. Don’t wait for her to ask!
- Make sure she takes time for herself. Rest and relaxation are important. Encourage her to take breaks, hire a babysitter, or schedule some date nights.
- Be patient if she’s not ready for sex. Depression affects sex drive, so it may be a while before she’s in the mood. Offer her physical affection, but don’t push if she’s not ready for sex. She will recover in time!
- Go for walks with her. Getting exercise and sunshine can make a big dent in depression, but it’s hard to get motivated when you’re depressed. Help her by making walks a daily ritual for the two of you.
Take a test to see if you have Prenatal or Postpartum Depression
Reading Your Baby’s Cues
People 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.
Read More…
Feeling Clueless? Reading Your Baby’s Cues
By Meri Levy, MFT
People 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.
Co-Parenting With a Partner
The First Year Can Be Rough, by Meri Levy, MFT
If you’re like me, I really thought that, despite my decision to breastfeed, my husband was so gung ho about being a Dad that we would share the parenting responsibilities pretty equally once our first child was born. I was in for a rude awakening. Breastfeeding meant that much of the time I was literally attached to my new baby, and when I was not, I had an easier time calming him than my husband did. And even when I didn’t, I couldn’t stand to have my husband trying to comfort our fussy baby without stepping in and trying to help. Whether due to biology or psychology, I was so attached to my new baby that I couldn’t tear myself away long enough to really get a break. As a result, I became more comfortable in the baby care role, and he became less.
There are many reasons why fathers often take a backseat in the early days with a new baby. Whether because of a hormonally-afflicted “helicopter” Mom, an inexperienced Dad, a baby who is more easily calmed by the mother, or gender-related attitudes about who does what, newborn care often falls disproportionately to the mother. And since Mom is generally recovering from childbirth, likely adjusting to breastfeeding, undoubtedly sleep deprived, and in the throes of huge hormonal changes, this disproportionate share can become a BIG PROBLEM. You know that saying that “if Mom isn’t happy, nobody is happy?” I think the truth of that statement is widely underestimated.
So, we’ve got a Mom who can’t let go to allow her partner to care for the baby, a Dad who is either mildly incompetent or feels he is (or is being treated like he is), a baby who’s getting used to being cared for by Mom, and a Mom who is at the end of her rope and feels like she just can’t get a break (and is not sure she would take one if she could). Not a recipe for a happy family.
Negotiating who does what, recognizing the barriers to fairly allocating parenting and household responsibility and actually making and carrying out a plan to address those barriers and create a cooperative, supportive and fair allocation of workload is one of the major tasks of the first year of parenthood. Working out a plan for who does what, figuring out how to set goals for change if change is needed, and implementing those changes, can make a world of difference.
I once read a study (and I don’t have a citation, but I like to believe that it is true) that claimed that of all the factors that might predict the well-being of children as they grow up (e.g. praise, affection, discipline, structure, etc.), the one variable that is most predictive of a child’s future well-being is the degree to which his or her parents have a cooperative relationship around parenting. So, if that is true, it matters less who does what (or if it is done correctly), and it matters more that parents are supportive of each other as parents and partners.