Research has shown that the first year is critical to a baby’s emotional, psychological and cognitive development.  Studies have also shown that if a mother is depressed for as much as the first six months after childbirth, her baby will likely experience and show signs of motor development delays, emotional difficulties, social problems and depression by their first birthdays.  Your pediatrician typically asks a slew of questions at each check-up to ascertain if your child is reaching his/her developmental milestones and to see if there are any emotional, psychological, cognitive and physical delays or issues to be wary of, like a lack of positive facial expressions and less interest in activities and/or other people.

A great fear I had was that my depression would negatively impact my daughter’s development.  I had read in baby books and magazines that interaction such as talking, laughing and singing are important and positive contributors to a baby’s emotional and psychological development.  So I willed myself to stay as strong as I could in her presence, trying as hard as I could to not show any signs of sadness or worry, and playing with and talking and singing to her as much as I could. 

The amount of information in books, magazines and the Internet simply cannot be compared with what was available to the previous generation.  Floor time, attachment parenting, and infant massage were not terms used in the 1960s and 1970s.  As far as I can remember, there were no mommy and me classes back then either.  With the 1990s came the birth of such terms and a curious focus on, and subsequently societal peer pressure for, ways to enhance children’s social and cognitive development.

I know what it’s like to have no energy at all, to be weak with exhaustion, to feel as if trapped in a thick fog, and how hard it is while depressed to summon up the energy to even smile, let alone play.  But I realized I have a baby who is completely helpless and dependent on me.  I recalled all the years of trying to conceive and the difficulty getting through the IVF cycles only to succeed (thank God) in having a healthy baby.  I wasn’t about to let depression ruin my chances to love and care for her.  Despite the physical exhaustion and lack of sleep that all new parents experience upon returning from the hospital (but my husband and I were already worse off than the average parents from our week of hell in the hospital), I did do the following (before my PPD started 6 weeks postpartum and once my Paxil kicked in) with my daughter: 

1. I kissed her a lot.  As she grew a bit older, starting at, say, 8 months or so, I hugged her a lot as well.   
2. I talked to her a lot….or at least I tried to (I’m not, after all, the most talkative person as my friends and family know).  Per “Postpartum Depression Demystified” by Joyce Venis, RNC and Suzanne McCloskey: “One of the best ways you can interact with your baby and keep her stimulated is to talk to her.  It doesn’t really matter what you say, just as long as you’re making an effort to connect with her.”  In short, simple sentences, referring to her by name as much as possible, I’d tell her what I was feeling or I’d describe to her what I was in the process of doing, from changing diapers to feeding to giving her a bath.  For example:  “Time to change your diap-ee cuz it’s wet and I know it’s uncomfortable.  Okay, you have a new diap-ee and all is better now.”  I didn’t know this until I read Postpartum Depression Demystified—which is based on the U.S. Department of Agriculture, U.S. Department of Education and U.S. Department of Health and Human Services, Healthy Start, Grow Smart, Your Two-Month-Old, Washington, D.C., 2002—that you should refer to yourself as “Mommy” when you’re talking about yourself, like “Mommy’s going to change your diap-ee now.”
3. I sang to her a lot.  Her favorite tunes, even at 1-1/2 yrs, is the alphabet song and Twinkle, Twinkle Little Star—both of which incidentally are the same tune, which I hadn’t realized until I did them one after another each and every day.  Sometimes I made up tunes.  Don’t forget the tried and true Mary Had a Little Lamb, as well as Itsy Bitsy Spider.  I also liked to sing some songs from Sound of Music, since I knew practically every word to every song.  This was to ensure she wouldn’t be tone deaf and will develop an early appreciation for music.  I sang the alphabet song so frequently, she was humming it by the time she was two and singing the whole thing herself by the time she turned three.
4. I read to her a lot.  Again per “Postpartum Depression Demystified” by Joyce Venis, RNC and Suzanne McCloskey: “It’s never too early to start reading to your baby…..[Babies] like the sound of your voice and having you close…..Babies enjoy looking at the pictures and listening to the rhythm of your voice long before they can understand the words.  Reading to your baby encourages the development of a range of important skills, such as talking and understanding language, imagination, concentration, creativity, listening, and problem solving.  Children whose parents read books to them when they are young often learn to speak, read, and write more easily…..Reading to your baby….will…instill in her a love of books that will last a lifetime.”  Even before I read about this, I started a collection of baby board books early on.  My daughter’s first collection of books was a collection of little (3×3) nursery rhyme board books.  Babies cannot tear the pages and can even chew and drool on them.  When you read, try not to read in a dull, flat, two dimensional way—or quite literally (and quite boringly) as mere words on pages. Rather, try to read in what I refer to as 3-D.  In other words, try to bring the story to life and make it interesting.  Vary your intonation, pitch and volume.  Facial expressions are a plus.  I distinctly remember my pediatrician recommending reading nursery rhymes to my daughter.  She explained that babies are drawn to sing-song-y phrases that rhyme.  When your baby becomes a toddler, a great way to boost imagination and interest in the stories you read to them is to pick ones that will allow them to fill in the blanks or tell you what happens next.  A great example is the When You Give A Mouse A Cookie series of stories.  Today, she loves her books.  She asks us to read to her at bedtime every night.
5. I played with her a lot.  Play is an essential part in the development of motor/visual and cognitive skills, learning how to accomplish tasks and learning about cause and effect.  Play is also an important means for bonding with your baby. Getting down on the floor so you can be at the “same level” as her – for example, having tummy time together and looking at each other eye-to-eye – is important in bonding.  Peek-a-boo is the ever reliable way to amuse and make your baby smile.  It’s always fun and rewarding to get your baby to smile. 
6. I danced with her in my arms a lot to music from the television, radio or CDs.  This was to ensure that she grows up with rhythm.   Today, at nearly 5 years of age, she loves to dance and enjoys her dance class in school (just awaiting the time she’s ready for real ballet class).  You can see the joy when she moves to music she likes.  Fortunately, she has my taste in music (not her dad’s taste in death/heavy metal).    More on dance as a means of PPD therapy and bonding with baby over at a recent Postpartum Progress post.  Check it out.
7. I did a little bit of infant massaging but not a whole lot.  I didn’t go as far as applying oil on her skin or anything.  Now that I think about it, I probably should’ve done more.  I was surprised by the amount of literature in childcare class, websites, flyers and brochures on infant massage.  Other than a friend of mine who years ago told me she had heard it was very beneficial to the baby, I’d never heard anyone else talk about it until I became pregnant.  Now I can understand how it benefits both the mother and baby.  For the baby, not only does it help with bonding, it can help reduce a colicky/fussy/irritable baby’s stress level, reduce teething pain, move gas along, and promote relaxation and drowsiness. For the mother, especially a depressed mother, knowing that touch and massage feels good and can provide such benefits to the baby is  a good, rewarding feeling indeed.

Then, when the PPD kicked in at around 6 weeks after our return from the hospital, I was barely able to keep the same level of interaction going.  During that time, I was aware that I had to keep up the interaction but I felt like a robot just going through the motions.  I no longer felt the joy I thought I should feel as a new mother.  I knew I had to keep it up so down the road I wouldn’t look back with any regret that I didn’t do my best.  I didn’t want to ruin my one shot at being a mother. 

It’s bad enough I can’t remember the sound of the baby’s cry during those first few months…everything was a blur to me.  It wasn’t until my head poked through the PPD fog about 4 weeks after I started taking the Paxil that I was able to continue where I had left off in terms of consistent and meaningful interactions with my daughter.

BOTTOM LINE:   A happy mom means a happy baby.  Bonding and interaction is very important to baby’s development.  PPD in the first year can get in the way of proper bonding and interaction, and hence have a negative impact on baby’s emotional, psychological and cognitive development.  It’s important for the mom with PPD to seek help to try to recover as quickly as possible so she can enjoy baby and motherhood.

Just a quickie from me today…..just wanted to share this story I came across today over at Momversation that really touched me.  Please read, share with others, and reach out to this dad who is struggling to care for his wife with severe PPD and his baby, while at the same time fighting to prevent depression from taking hold of him as well.

Was tinkering with my computer webcam capabilities for the first time tonight.  The wonders of modern technology.  Here’s the video I recorded.  I may try to re-record this with better lighting conditions, so I look less haggard.  Yes, that’s the right word.  Haggard.  It was a long day and I am tired (and fighting a nasty bout of allergies-turned-sinus-infection), but lighting makes all the difference in the world.  Hey, it’s the message that counts, right? 

Please share the video link with others!  THANK YOU!

According to a study presented on October 20, 2009 at the American Society for Reproductive Medicine’s 65th Annual Meeting:

“Women who participated in a stress management program prior to or during their second IVF cycle had a 160 percent greater pregnancy rate than women who did not participate in a program.  The study…..revealed a pregnancy rate of 52 percent among women who participated in a stress management program as compared to a 20 percent pregnancy rate for women who were not exposed to the stress management program……Pregnancy rates jumped to 67 percent for women with signs of depression at the start of the study who engaged in the stress management program versus no pregnancies for those that did not.”

Relaxation training, cognitive-behavioral strategies and group support were the specific stress management techniques employed during this study.

In short, what this study shows is that stress management may help increase pregnancy rates (including success rates of IVF procedures) by helping women cope with and minimize anxiety levels.    

BOTTOM LINE….

There is a proven correlation between stress/anxiety levels and lower pregnancy rates.  If you are trying to get pregnant, you need to do what you can to reduce your anxiety levels.  Worrying about whether your IVF cycle(s) will succeed or not will only harm your chances.  I know it’s easier said than done.  I really do.  I’ve been there.  Give yoga a try.  I did…and my IVF cycle at the time succeeded.  Coincidence or not, I may never know.  But I’m sure the yoga helped decrease my anxiety levels, as well as provided physical benefits in terms of the stretching, etc.  I went into that cycle with a much more positive attitude than during the previous cycle (ditching the IVF cycle and doctor I couldn’t stand for a facility I actually enjoyed being a patient at worked wonders as well).  Read my previous blog posts about yoga and seeking therapy with a mental health professional experienced with infertility.

Six weeks of continuous physical exhaustion, anxiety, and brain chemical depletion led to a vicious cycle of exaggerated emotions that became progressively worse with each turn – where normal concerns turned into exaggerated anxiety that led to panic attacks and insomnia.  And it certainly didn’t help when the time came to search for a daycare provider.  It was unimaginable to me that someone I didn’t know would ultimately spend more time with my baby than me.  After all, I didn’t try so hard to have a baby for so long only to have someone else take care of her.  The guilt ate away at me.  But at the same time, a part of me felt relief that I would no longer have to spend most of my days alone with the baby, cooped up in my house (it was 3-1/2 months at that point).  Nevertheless, the remaining 75% of me felt guilty for feeling that way.  The guilt of having to return to work, prospect at having to leave my infant with a stranger, and fear of the unknown from being a first-time mother who never had much exposure to children all contributed to triggering my PPD. 

At the 6-week point, I was exactly halfway through my maternity leave and my return to work was still distant enough not to seem real….or so I thought.  Well, as the traditional thinkers wonder, why don’t you just work it out like the rest of us and stay home and tend to your child if you’re that bent out of shape about going back to work and finding adequate childcare?  Well, first of all, not everyone can afford to live on one salary.  Second, not every woman is happy as a full-time mother.  What the government and companies should do is work together to extend the maternity leave of absence to 6 months, which would catch us up with a number of countries out there. 

I thought I had done a lot of research on daycare providers in the area, but it turns out I hadn’t done ENOUGH research prior to that point.  So in a frenzy, I started calling other daycare providers.  The closest place right in town provided Internet service to enable parents to see their children during the day.  My husband and I hadn’t considered this place before due to some negative things we had heard from multiple parties.  But when we called them to see if they had any openings, they said they were completely booked until September. 

I got more panicked.  I could not bear the thought of leaving my daughter with anyone, not even a live-in nanny working out of our own home.  My husband and I didn’t feel comfortable having a stranger in the house alone with our daughter, and we didn’t trust them with our belongings.  So nannies – both live-in and live-out ones – were not an option.  So that left daycare providers who worked out of their home.  I had obtained a list from my company for in-home daycare providers, and I ended up focusing on two.  One was only a few blocks from our house and the other was on the other side of town.  We made an appointment with the one near our house.  She was gracious enough to meet us on a Sunday morning, at short notice.  A few things she said sent my alarm bells ringing.  She gave us a tour of the house and it seemed drafty to me.  Again, I was fearful that my daughter would catch a cold from being in a drafty home.  I wanted to keep my options open, so I called the other woman.  A few things she said in the course of a few conversations made me think twice about even meeting her.  The fact that she seemed to be having a host of medical problems and was always making doctor appointments made me doubt her ability to take care of my daughter full-time.  Other people on the list either never picked up the phone or never returned my calls. 

As days went by, I felt more and more panicked.  My husband and I had agreed to start my daughter at daycare on February 22^nd, just so we could get used to the routine and idea of leaving her with someone.  I was thinking I’d never be able to find anyone good enough to take care of my daughter.  I started calling my neighbors and others in town.  Someone recommended a woman close by who only takes in one or two children at a time.  When I talked to her, she sounded like the perfect person…..very warm and trustworthy.  However, she regretted not being able to help out, even though I practically begged her to take my daughter in. 

After I exhausted all options I was aware of at the time, it seemed to me that this one daycare center we were considering (that has a national presence and locations throughout the country) was the best place for my daughter.  I ended up calling them with questions everyday of every possible circumstance I could think of.  This was from never having gone through any of this before and I wanted to be sure I knew fully what to expect.  I was totally convinced they thought I was nuts.  I even asked the administrator whether other mothers typically ask a lot of questions and feel nervous about sending their first child to daycare.  She indicated that it was normal for first-time mothers to feel a certain amount of anxiety, but “they aren’t as anxious as you are.”  I dreaded having to call them but felt compelled to ask my questions to feel absolutely 100% comfortable that this was the right thing for me to do.  No matter how many questions I asked and got satisfactory answers for, I was absolutely dreading the idea of having someone else look after my baby. 

The week of February 22^nd came and went.  The last day of February came and went.  Finally, I gave in.  I decided I had to let go…we had no other feasible options.  We went to the facility on March 1^st.  My husband had to leave by 7:30 and the plan was for me to stay for approximately 1-1/2 hrs or however long it took for me to feel comfortable enough to leave. 

I will never ever forget this day…….

There was a rocking chair in the room.  I sat down in it, holding onto my daughter.  There was already a little girl playing in an Exersaucer.  A man came next to drop off his daughter who wasn’t feeling well.  Evidently, she was sick.  She had a cough and temperature associated with teething, so she was crying pretty much the whole time after her dad left.  Immediately, dread was starting to slowly but surely creep all over my body.  Then two more boys were dropped off, one of whom was new and suffered from separation anxiety and had a pacifier that kept falling onto the floor.  The daycare provider kept picking it up off the floor and sticking it back into the boy’s mouth.  My eyes grew bigger out of concern that they were not being as sanitary as they should.  At that point, there were 5 kids in the room including my daughter.  I was counting my daughter but evidently, the daycare center didn’t count her because they told me that I was there holding her so it didn’t count as of yet.  I told them that I had wanted to see them interact with my daughter while I was there.  They told me it didn’t look like I wanted to let my daughter go.  I thought to myself…..”How convenient that they would want to put it that way and put words in my mouth to suit their needs.”  That’s when they asked a new woman at the front desk to come in and be the 2^nd adult supervising the 5 kids.  A 6^th child was brought in….a little girl who had a fever and looked absolutely miserable and was crying non-stop.  I felt like I was going to pass out.  They told me whenever I was ready to leave, to leave my daughter in her crib, which was one of about 12 cribs in a large rectangle formation at the far end of the room (this was a long, large room).  Her crib was in the left corner farthest away from everyone and only one crib away from the back door, which had a cold draft coming through it, which really disturbed me.  The fact that I was supposed to abandon my baby in some corner crib in an institutionalized rectangle of baby cribs where she would probably lie crying for some time before anyone realized she was even there and needed attention made me want to fall to pieces.  But I had to maintain my composure.  I walked out of the room and as soon as I walked through the door, I burst into tears.  They reassured me that my daughter will be OK.  I ended up picking her up at 1:30 and telling them I had decided this place was not for us.  I couldn’t go through with it.  It just didn’t feel right to me.  I’ll never forget what the administrator of the daycare center told me as I was leaving, indicating they’ve had their doubts that I would go through with it, given the number of questions I had asked and my overall anxiety about daycare in general.  She said, while shaking her head:  “You’ll never be able to let someone else take care of your daughter.”   Never backing down from any challenges I come across, I immediately decided I was going to prove her wrong.

I was desperate.  There were only 2 weeks left before I had to go back to work, and we still didn’t have daycare lined up.  What were we going to do?  With my PPD not improving, I was contemplating staying home longer either via long-term disability or unpaid leave of absence.  However, I feared losing my job if I requested additional time away from work to recover from my PPD.  My husband, my doctor and my gut were all telling me that, even though it may feel impossible, going back to work may help me.  My old routine and mental stimulation, both of which I had been without for 3-1/2 months, would do me some good.  I couldn’t see how it would work.  I just couldn’t see a light at the end of this totally dark and scary tunnel I found myself stuck in.  So, my husband and I decided to enroll our daughter with the in-home provider we’d looked at earlier, the one that lived very close to us.  We felt that an in-home setting would work out better than a daycare center with an “institutional” look and feel.  It was working out well for 16 months and would’ve kept our daughter there until Kindergarten if it weren’t for the biting that somehow started to occur (and which we are convinced our daughter picked up from the other kid that was biting). 

In terms of the biting, this is something we had personally NEVER witnessed ourselves and determined was occurring because our daughter figured it was a way to get attention, which she probably didn’t get enough of because of the provider-to-child ratio.  She probably noticed that, whenever she bit another child, she would get picked up and spoken to (and even read to, since there were No Biting books).  She was, after all, only about 18 months old at this point.  Her biting is the reason from our going from the in-home provider to a daycare center (which let us stay there for all of 3 weeks before they kicked us out on our daughter’s 3rd biting episode without even any attempt to discuss with us…this would be the topic of one of my future blog posts because the experience has angered me to no end, and I’m still angry about it, but it is not really relevant to PPD at this point) to another in-home provider (which worked out well for about 6 mos until the woman’s family had to relocate to Texas) to another daycare center (which worked out well until our current daycare center had a spot open up in Sept 2007). 

So, in total, my daughter had 5 childcare providers between March 2005 to September 2007 (Note: My PPD was over by March 2006).  Being that my own family relocated constantly (8 times until my freshman year in high school), I’m determined to live in my current location until our daughter is in college.  The fact that we had to switch from one childcare provider to another made me feel very guilty and helpless because this is the opposite of what I had intended.  I didn’t want my daughter to experience the constant change of environment like I did when I was growing up.    In terms of the daycare center that had kicked us out, I did eventually report them to the governing authority in New Jersey for not following their published policies on biting (they are supposed to meet parents in person to discuss) and for the administrator’s lack of professionalism.

I’m grateful to this day that I was able to gather up the strength and courage to drag myself to work on March 16^th, just as I had originally planned way before I went on my maternity leave.  It was tough, but thank God, I made it through that first day.  After that, it got easier and easier each day.  In the beginning, it was difficult just getting used to taking public transportation again and talking to/seeing people I know.

I went back to work only to find out that people had been taking bets as to whether I would come back to work or not.  That didn’t surprise me.  Nevertheless, it still smarted to know that people would stoop to doing something like that.  You would think that, being that we are now in the 21^st century, there would no longer be this automatic assumption that a woman who just had a baby would not be returning to work.  And people wondered why I wanted to keep my pregnancy quiet until I could no longer conceal it (at 6-7 months, believe it or not).  I suppose the feeling that I was in a “boys’ club” environment, being only one of two women directly reporting to the senior manager in our department, didn’t help matters. 

After I returned to work, days sped up significantly – they were going by too fast, actually, as we were finding that the baby was growing up way too quickly, confirming the truth behind yet another warning given by everyone we knew that had kids.  Slowly, I began to recover my pleasure in everyday life.  People ask me how it was to return to work, commenting how tough it was to leave my baby with someone else and not spend all day with her like I’m “supposed to.”  I tell them that, in actuality, it was the best thing I could’ve done to regain my sanity.  Little did they realize how literal I was being.  They’d naturally respond with an “Oh, yeah?” with eyebrows arched, probably because I am the only mother who has ever dared to admit feeling this way.  So I’d have to go and explain myself as follows:  “Of course, I feel bad about leaving my baby with someone else.  But am I relieved to go back to the life that I had before my daughter arrived?  I’d by lying if I said ‘No.’  I long for the mental stimulation I get from my job.”

When are people going to stop being so judgmental about other people’s decisions/business?

FOR MORE ON THE CHILDCARE TOPIC, PLEASE SEE LAST WEEK’S POST.

The transition to first-time motherhood involves a load of decisions to be made—including whether to go back to work or not, and what kind of childcare arrangements to make if you do decide to go back to work.  This is, of course, on top of the uncertainty and anxiety from not having had prior experience with taking care of a newborn.  All these decisions and changes can be so overwhelming for the new mother who is already so emotionally and physically vulnerable after childbirth. 

For some women with PPD, returning to work aggravates their PPD due to the added stress of trying to achieve work/life balance with an infant to take care of after a day at work.  For many mothers, returning to work can be a cause for added anxiety, guilt and sadness. 

For some women with PPD, returning to work promotes recovery, finding it a welcome relief to be able to return to the structured, stimulating environment of adult interaction and intellectual challenges to which they are accustomed. 

With or without PPD and regardless of financial situation, many new mothers will struggle with deciding whether or not to go back to work.  Though we are in the 21^st century, let’s face it, many people still observe such traditional values as believing that mothers should stay home and raise their children themselves.  The decision is easier to make for some mothers than for others.  Despite what most people will say, which is that the mother belongs at home, you must do what’s right for you.   Only you and your husband know what’s best for your family.  If you feel you should stay home (and can), then stay home.  If you feel you have to go back to work, go back to work.  Don’t succumb to societal or “peer” pressure.  Don’t let other people’s opinions push you in one direction or another.  What is right for someone else is not necessarily right for you and your family.  This is a highly personal decision that requires careful consideration and weighing of options relative to you and your husband’s financial situation and personal preferences.

Different people have different personalities, preferences/beliefs as to what is best for their babies, financial situations, family arrangements, etc. It’s these factors that influence a mother’s decision whether to stay home or return to work.  It’s because these factors are based on individual preferences/beliefs that they should never be compared with that of someone else.  Each person’s preferences/beliefs have to be respected as unique to that person. What’s right for one family may not be right for another family. 

One or more of the following factor into the decision on whether the new mother returns to work or stays at home after her maternity leave is up:

• Some women decide to stay home because their income relative to childcare costs doesn’t justify returning to work.
• Some women firmly believe no one else is capable of taking good enough care of their babies. 
• Some women don’t have to return to work for several years until their children are in elementary school or even older.
• Some women may not need to return to work but do anyway because their career has been so much a part of their lives for so long they can’t imagine not going back to work.  Their careers are too important and too much a part of who they are to leave them for so long, as entry back into the job market after several years can be difficult.  These women are fearful of losing their drive and focus, not to mention all they’ve done to get where they are today.  They’ve worked too hard up until now to just put their careers on hold.  In these instances, some women are fortunate enough to have family nearby that can help take care of the baby during the day, while others hire a live-in or live-out nanny or au pair, or they leave their babies at a daycare center or with an in-home care provider.
• Some women don’t have a choice and must return to work in order to help the husband support the family. 
• Some women have a choice and opt to stay home not only because it is economically more feasible than to pay for childcare costs but also because they prefer to take care of their babies themselves. 
• Some women have a choice and opt to return to work not only because their careers are important to them but also to maintain a certain lifestyle which would not be possible on just the husband’s income. 
• Some women return to work, while their husbands stay at home with the baby. 

From the end of November til mid March, I was stuck inside the house with no routine, no face-to-face adult interaction, and no structure to my days stuck inside the house.  Going back to work proved to be my lifesaver.  But I will tell you this….it was a lifesaver not because I could get away from my baby for pretty much the whole day, 5 days a week.  It was because it got me back into a routine, which is what my mind and body were very accustomed to, since that defined my life for the past 16 years.  I had a set schedule, a routine I followed every day.  Going to work enabled me to exercise my mind and mingle with people, both of which have benefits to the average person. 

You may have every intention to return to work—with no intention or desire to stay at home—but I have to warn you that there is no real way of knowing how you would feel about going back to work until after your baby’s arrival and you’ve had a chance to do some bonding.  There is no way to really predict how you’d feel until the time comes.  True, you need to plan ahead, but don’t assume it’s no big deal to transition from taking care of the baby 24/7 to going back to work and having to leave your baby in someone else’s care. 

For some mothers, leaving their babies in someone else’s care is too much to bear.  It is not uncommon for a woman to plan to go back to work but when it came time to do so, changed her mind, giving up her job to stay home with the baby.  Of course, this can only happen if one salary is enough to support the family and/or there was more benefit in the mother’s staying home and saving on childcare costs versus the woman earning her income, having to find acceptable childcare arrangements, having to cover the cost of childcare, and working out a drop-off and pick-up schedule amenable to both her and her husband. 

Returning to work after maternity leave can prove to be one of the most difficult decisions a woman has to make in her lifetime.  My gut was telling me that I should go back to work because that is something I was meant to do until I retire.  I couldn’t imagine myself staying at home 7 days a week for 5-6 years.  I needed to be mentally stimulated and multi-tasking, as I did all through high school, college and the past 20 years at my company.  If there are other new moms in the workforce, managing to balance family life and their careers, I could do it too.  I’d invested so much hard work in college—not to mention my parents’ hard-earned money paying my way through those 4 expensive years—and the last 20 years of my career to just throw in the towel now.  Realizing this made me feel so guilty, like I wasn’t being a good mother by wanting to go back to work.  This guilt and anxiety of leaving my baby in someone else’s care—particularly if that someone else is not a relative and I wasn’t certain about the quality of care that they would be providing—was very difficult to come to terms with, especially while I was in the deepest days of my PPD.  Then, once I returned to work, I experienced a continuous internal battle over trying not to be worried about the baby all day long, which would prevent me from getting any work done, versus “letting go” and focusing on my work, which would make me feel guilty that I wasn’t thinking about my little one as a mother should.  There was this constant internal battle going on inside me.  That’s why I think it is great that my company allows flextime for employees with particular circumstances like mine.  That way, I can spend more time with the baby after work and before she goes to sleep. 

Having to find childcare arrangements with which you are satisfied adds yet another element of stress to the mother who is dreading the day she will need to leave the care of her baby in someone else’s hands.  I will have to say that quality childcare is tough to find.  My daughter has been with childcare providers since she was 3 months old, when my maternity leave ended and I had to return to work.  From March 2005 to September 2007, we had 5 childcare providers.  Two were private and operated out of their own homes, and three were daycare centers.  One of those daycare centers, which I’ve been dying to blog about since 2006, was an AWFUL experience that I will never forget.  I’m not going to really do that on this blog because it’s not really relevant to my PPD.  Perhaps one day….

It was tough going in the beginning, but once we found the one great daycare center (which we are still using today), it’s been GREAT.  I can’t tell you how stressful finding a great childcare provider was for us.  It was after we found someone we felt confident would take good care of my daughter, I was able to relax somewhat, grow accustomed to the new routine, and feel more comfortable and happy about my decision to return to work.  Before I knew it, I was in my element once more and I felt a tremendous relief.  Returning to work increased my self-esteem, which in turn, boosted my confidence in taking care of my daughter. 

Different childcare arrangements work for different people.  Some prefer the childcare provider who works out of her own home.  Others prefer a daycare center.  Both childcare options provide such benefits as development of socialization skills and learning to adjust to a school environment and being apart from parents at an earlier age.  Upsides to daycare include earlier exposure to other children and adults in a different setting other than your own home, earlier development of social skills, and earlier adjustment to separation so it would be less traumatic later on. 

I wholeheartedly believe we made the right decision to put my daughter in daycare at an early age.  Socialization skills are very important, and it occurs more easily the younger the child is put in an environment where they can adapt and learn from, as well as interact with, peers their own age.  For me, having evenings and weekends with my daughter and working during the day is an achievement of work/life balance with which I am satisfied and over which I have no regrets whatsoever.  I didn’t want my daughter to be shy like I was.  And I’m not saying all this to justify my decision to go back to work and entrust my daughter in the care of others.  It’s the truth.

My next post will be on my experience searching for the right childcare arrangement in the midst of my struggle with PPD.

Follow (and share) this recipe for a happier, healthier, more confident mom with less anxiety in terms of parenting ability:

1. Get adequate social (emotional/practical) support (inc. guidance, reassurance, breastfeeding assistance) – particularly important for the first-time mother – this support network should be lined up prior to childbirth (family, friends, a postpartum doula, baby nurse, housecleaner)
2. Get adequate rest by taking breaks during the day and 4-5 hours of uninterrupted sleep at night (to allow for REM sleep needed in recovery from childbirth)
3. Spend time outside once daily, even if only for 5 minutes
4. Get good nutrition high in protein, plenty of water, Omega-3 fatty acids*

The last ingredient deserves separate mention:  AWARENESS.  Awareness of what postpartum depression (PPD) is (it’s NOT the same thing as the blues, first of all), its symptoms, its causes (biochemical, emotional), risk factors, treatment options (medication, therapy), etc. 

AWARENESS WILL MAKE ALL THE DIFFERENCE IN THE WORLD

Be sure to read up on PPD…..after all, information is empowering.  This will help reduce the risk of isolation and despair if you do in fact succumb to PPD.  Simply by avoiding the topic–like throwing out literature about it during childbirth or childcare prep classes–doesn’t automatically mean you will not get PPD.  Remember, approximately 1 out of 8 mothers–or 15% of all mothers–succumb to PPD.  That statistic should help you realize that this isn’t just talk.  IT’S REALITY. 

Nowadays, whenever I encounter women that are pregnant for the first time and admit to not knowing a thing about babies and try to give them advice from the perspective of someone who’s had PPD, I can swear I could see a flicker of denial cross over their faces.  I can’t quite put my finger on it, but it’s almost like how I felt whenever I saw a reference to PPD while I was still pregnant.  I’d ignore it, thinking “Nah, that would never happen to me.  I would never let it.”

Here’s the issue.  During childbirth/childcare prep classes, the instructor may (or may not) mention the words “postpartum depression” and how some women develop it.  They may (or may not) give you a handout about PPD, but you choose subconsciously to ignore it because you think that it couldn’t possibly happen to you.  It’s only natural for pregnant women to not want to hear about anything that could go wrong during the postpartum period.  They may have enough pregnancy-related concerns as it is, with things like nausea, discomfort, difficulty sleeping, getting everything ready for the baby’s arrival, spotting, cramping, bloating, preeclampsia, bed rest to prevent premature birth, etc.  After all, who wants to think of the possibility of negative feelings when having a baby is supposed to be such a joyous and miraculous occasion?   I have to admit that I fell under the category of denial that PPD would even happen to me.  It’s like, everytime someone tries to tell you about PPD, that invisible shield goes up so you don’t have to listen.  It’s natural to deal with concerns as they arise, rather than worry about something that more than likely would not happen anyway.  But remember, a cross-that-bridge-when-you-get-to-it mentality won’t help you if, once you cross that bridge, PPD hits you like a ton of bricks—suddenly and quite mercilessly. 

Don’t be like me.  I believed I wouldn’t let PPD happen to me.  So, when it did, I didn’t know what was happening to me.  The symptoms caught me totally off-guard.  And believe me, being ignorant and unprepared for it causes unnecessary fear, anxiety, guilt and inability to appreciate the baby to which you just gave birth.  What all new moms-to-be should be advised is, despite how we may not believe PPD would ever happen to you, it doesn’t hurt to be educated about PPD and prepared for the possibility it could happen to you.  Believe me, it pays to be prepared for the possibility no matter how small!

IT PAYS TO BE PREPARED FOR THE POSSIBILITY

Everyone is unique.  Everyone’s needs are unique to the individual.  The more “in tune” you are to your needs, the better off you will be (the quicker you will seek treatment if you know you are not yourself and need help).  You will also be better off planning ahead and becoming knowledgeable about PPD, even if you think it is unlikely you will be unfortunate enough to fall victim to it. 

You may wonder if there’s any way to avoid getting PPD if you are at risk for it, such as following certain preventive measures.  The answer unfortunately is No.  There is no foolproof way to prevent it from occurring.  There are, however, things you can do to reduce your risk and your chances for developing it.   A proactive step in the right direction is reading up on PPD to learn about PPD, its symptoms, its causes, risk factors, treatment options, etc.  Understanding what PPD is and being able to recognize symptoms will empower you to seek treatment earlier and spend less time suffering.  

Buffer yourself from additional stressors that will ultimately tip the scale toward PPD.  What I mean by buffer is to avoid any significant changes in your lifestyle, such as moving, since having a baby is already going to have a huge impact on your life as it is.  Find ways to help yourself get through the first postpartum weeks by getting as much help as possible.  If you haven’t a clue how to care for a baby, there is nothing wrong with leaning on someone who has experience.   That’s, after all, what social support is all about and is what many other countries practice, even today.

Regardless of whether depression runs in your family, it will be worthwhile to prepare for the possibility that you may experience PPD by following the recipe above before you become pregnant or, at the latest, before you have your baby–in addition to lining up a medical and/or mental health practitioner that is a right match for you.  A PPD support group will be a plus.  Those can be hard to find locally.

*  Omega-3 fatty acids are polyunsaturated fats found mostly in certain oily fish like salmon and tuna.   Research has shown they are critical for proper brain development and neurological function in infants.  Research has also shown that, the higher the intake of DHA (docosahexaenoic acid), one of these fatty acids, the lower the incidence of clinical depression.  Studies have also shown that there is a correlation between levels of DHA in breast milk and PPD (i.e., higher levels of DHA usually meant lower incidence of PPD).  Studies have also shown that the fetus derives nutrients including DHA via the placenta, leaving a pregnant woman already low on DHA more susceptible to depression.  Bottom line, there is a correlation between PPD and a low dietary intake of DHA, so expectant and new moms may be able to reduce their chances of having PPD, while at the same time improve their baby’s neurological development, by taking Omega-3 supplements.

I used to think that my daughter’s startle reflex in reaction to sudden movements, sounds or touch during her first few months was the result of the anxiety (though I have to say the level of which was not excessively high or anything) I felt during my pregnancy and the high levels of cortisol that were most likely present in my body, which would’ve been passed through to my daughter.  Her startle reflex was particularly strong, so much so that it would cause her to startle awake constantly from her slumber.  It was during the writing of my book that I read that the startle reflex, also called moro reflex—first discovered and described by, and subsequently named after, the Austrian pediatrician Ernst Moro—actually demonstrates proper motor development in babies up to 5 months.  It’s only after 5 months that the presence of such a reflex may be indicative of a problem. The moro reflex consists of the startle (or twitch), spreading out of the arms (abduction), and unspreading of the arms (adduction).  The baby may also cry as a consequence of the reflex.  It is natural for a parent to feel concerned, just like I was, whenever seeing her baby’s startle reflex.   Talk to your pediatrician if any of the following apply to your baby:  1) any of the 3 components that make up the reflex are missing, 2) there are no startle reflexes at all during the first 4 or 5 months, or 3) the reflexes still occur when she is over 5 months old.

This brings me to the topic of swaddling.  My husband and I learned the hard way,  of course, since no one had advised us on why it is babies are tightly swaddled, that doing so helps them sleep more deeply and for longer stretches, especially for babies with strong startle reflexes.  I just used to think it was done to help the baby feel warm and secure, not to mention womb-like in terms of giving the baby the impression she was in a confined space with movement limitations.  As I’d written previously, for my daughter it wasn’t just the swaddling that helped her to sleep better, it was being kept in a semi-upright position in her car seat.  That was probably due to the  positioning (in my womb) with which she was accustomed.  She couldn’t sleep lying flat. It took us days to put one and two together about the car seat, followed by the swaddling.  For the first month or so, she slept in her car seat in our bedroom.  My parents and in-laws were worried that letting her sleep for long periods of time in a car seat would cause her back to curve.  Our pediatrician told us not to worry about that, so we didn’t.  At least we tried not to.  Fortunately, she was sleeping flat in her crib and unswaddled when the first month was over.  It’s almost like this was my daughter’s 4^th trimester of development that just happened to be, but she was not ready for, outside mom’s belly rather than the dark and protected in utero environment.

As it turns out, and I didn’t learn this until after I started writing my book, swaddling is an age-old practice of wrapping infants snugly to restrict movement of the limbs. It’s amazing that infant swaddling was a practice even as far back as 4000 BC Central Asia! Babies have been swaddled in different countries throughout history but fell out of favour in the seventeenth century when people started to associate such restriction with neglect or unnecessary restriction of movement.  It became popular again as medical studies in the past couple of decades showed that swaddling infants reduces the tendency for them to awaken through reflex motion, which helps infants stay in REM sleep longer.   So, that’s why my daughter was swaddled all the time while in the hospital!  It’s like the hospital thought we’d figure everything out ourselves.  Well, so much for educating the first-time parents!  There was even this particular way of swaddling to ensure a snug fit and the blanket would not come undone. You didn’t simply wrap the baby with a blanket.  So, not only did I have to learn how to diaper properly, I had to learn how to swaddle properly.  Oh, boy – so many things to learn all at once!

So, what’s all this got to do with postpartum depression (PPD)?  Well, remember, the more you know of what to expect, the less surprises–and subsequently anxiety–the new mom will experience.  Had my husband and I known the purpose behind the swaddling, we would not have had to unnecessarily spend a few days not only worrying about our daughter’s strong (and frequent) startle reflex while sleeping but also how to minimize their occurrence.   Childcare classes should throw in a few sentences about the startle reflex and swaddling, so the expectant parents are knowledgeable about all this and won’t have to struggle with so many unknowns all at once.  After all, it’s the unknowns that raise the anxiety levels in the first-time parent.

Just a real quickie from me today….In case you hadn’t seen 2 recent posts over at Postpartum Progress, one of which is on PPD after miscarriage or stillbirth, and the other on the difference between grief and depression after pregnancy loss.   In one post, Katherine Stone links to a mother’s struggle with PPD after miscarriage.  In the post, she links to pregnancy loss/infertility websites that can help those currently struggling with the devastation caused by such experiences.  I’ve added those links to my site (under Pregnancy Loss/Infertility Websites), since as I mentioned in my previous post on my IVF experience, women who have suffered a pregnancy loss(es) and/or infertility are at greater risk for PPD after a successful pregnancy…or even adoption.  I’m highlighting this info for you because I have had to struggle with both, and want anyone going through this to know there are resources and support out there.   And of course, PLEASE feel free to reach out to me anytime you need to!

All mothers fall instantly in love and bond with their babies.  If bonding isn’t automatic and doesn’t happen right away or it’s not intense, then that must mean you’re a bad mother.  Wrong!  This is yet another societal myth that serves to screw with the minds of new mothers. 

Be Realistic, Not Idealistic

Before I proceed any further with this post, I want to be clear that I didn’t know and understand enough about bonding to worry about this much in the weeks following the birth of my daughter.  One of my ongoing themes is to caution people against setting high expectations.  The higher your expectations, the more there is at stake; thus, the greater your worries and stress are, the greater the chances you fill fall short of them, and the greater the chances are that disappointment  will be the outcome.  As through much of life and on the job, you need to learn how to manage expectations.  Actually, you need to maintain a realistic attitude.  It’s not really “Hope for the best, and expect the worst.”  It’s realizing that hardly anything in this world and throughout life works out 100% the way you would like. 

Expectations of having a natural, vaginal birth without pain relief; of immediate bonding with your baby; of immediate success with breastfeeding—if you set such high expectations, when things don’t turn out the way you envisioned, the feelings of disappointment at a time when you are both emotionally and physically vulnerable can lead to postpartum depression (PPD).  Why do we set ourselves up to have such letdowns?  Again, if you go in with certain expectations, you’re at greater risk for disappointment if your experience doesn’t match your expectations.  It’s to your advantage not to have any expectations at all, but instead take things one step at a time.  That way, there will be less chances of setting yourself up for disappointment if your experience doesn’t match that of others around you. 

The Myth That All Mothers Have to Bond Instantly and at First Sight

Something else that society has you believe is that all mothers feel an immediately overwhelming sensation of love and joy—an immediate connection—with the baby at first sight.  Does feeling anything other than that make you a bad mother?   No. Does feeling unmoved, unemotional or disappointed at the baby’s appearance when they first see their newborns signify detachment and lack of maternal behavior and signs of depression?  No.  A woman may have certain expectations of how her baby would look at birth, or of how she would feel looking at her baby for the first time.  She may have certain expectations of how she should feel at birth due to what they hear from other mothers and/or seeing photos of blissfully happy mothers holding their newborns immediately after delivery.  It’s not unusual or bad to feel exhausted and numb after having gone through X hours of intense and painful labor.  I remember feeling disappointed that I didn’t feel ecstatic the way some of my friends—not to mention women on television—felt after they saw their babies for the first time.  She is merely setting herself up for a letdown if she doesn’t feel exactly the way she’d imagined she would feel upon seeing her baby for the first time.  She might even be a little disconcerted about the baby’s scrawny, bloody appearance or head that might be a bit misshapen from being squeezed for the last X hours through her narrow birth canal or maybe a “stork bite” on the face. 

Speaking of stork bites, they are a fairly common occurrence.  In fact, per Medline Plus, they occur in up to one third of all newborns.  A stork bite is a temporary birthmark that a baby is either born with or develops within the first months.  Stork bites are usually pink, since they are due to the stretching (dilation) of certain blood vessels.  Stork bites are usually located on the back of the neck, eyelids, forehead, nose, or upper lip.  My daughter had one on one of her eyelids as well as on the back of her neck—hence the term “stork bite.” 

You prepare and long for the moment, picturing it all in your mind in the months leading up to your baby’s birth, in which you will fall instantly in love with your baby the moment she is placed in your arms.  Don’t let the one mother you know or delivery scene on television convince you into thinking that that is a given occurrence with every childbirth.  Not all mothers fall instantly in love and bond with their babies.  Not instantly falling in love with and bonding with your baby doesn’t mean you are a bad mother. Per “Postpartum Depression Demystified” by Joyce Venis, RNC and Suzanne McCloskey (pg 47) “[It] takes time for that special bond to develop.  You and your baby need to get to know each other a bit in order for those strong feelings of attachment to take root.”  If after a few weeks you still feel detached from your baby, you should review my previous post on the symptoms of PPD to determine whether you are experiencing any other symptoms of PPD.  

Without a doubt, there is greater likelihood for a woman to experience “instant maternal rapture” if her childbirth experience goes well (in her opinion), but Susan Maushart (pg 87) in her book The Mask of Motherhood: How Becoming a Mother Changes Our Lives and Why We Never Talk About It states:  “A woman who has been ravaged by hours or even days of excruciating pain and anxiety, or one who has been so thoroughly anesthetized that (depending on the drug of choice) either her body or her mind is numb, is hardly a likely candidate for ecstasy.”   Maushaurt continues (pg 86) as follows: “[Recent] studies suggest that bonding with one’s newborn is a good deal more complex than achieving a magic postpartum moment.  The fabled surge of maternal feeling which women have learned to expect in the immediate postpartum period is highly variable, even among women who have experienced the most ‘natural’ of natural births….[and] there is no evidence that an immediate bonding experience is a precondition for the growth of maternal feeling over time.”  Since magazines and books seem to focus so much on bonding, it’s no wonder there is such disappointment when what you read is not what you get—when you don’t experience that same “surge of maternal feeling” that other mothers have reported experiencing. 

Let’s take a step back now to ask the question “What is bonding, really?”  Does bonding occur only with breastfeeding?  No! If this were true, then does it mean that everyone who doesn’t breastfeed doesn’t successfully bond with their babies?  No!  Does bonding immediately occur upon first sight of the baby, and as you take him/her into your arms after delivery?  No!  Then what is it?  Bonding is close interaction with your baby which includes holding, infant massage, singing/reading/talking to and playing with him/her.  All these important types of interaction stimulate the baby’s cognitive/emotional/social development. 

I can’t say it any better than Shoshana Bennett in her book “Beyond the Blues: A Guide to Understanding and Treating Prenatal and Postpartum Depression” (pg 53):  “There is no one magic moment of opportunity when bonding must happen….Even if your depression or anxiety has made it difficult for you to care for your baby, it’s never too late.  Bonding is a process of familiarity, closeness, and comfort that continues for years.”  It’s this connection that you have to focus on, not whether or not you breastfeed or were not yourself when you had PPD for several weeks.  Don’t let books, magazines or other moms tell you that your baby will bond better if breastfed.  Keep in mind that there are plenty of children all over the world who drink formula and are perfectly happy and develop close and loving bonds with their mothers.  Bottom line is, if you love your child and show affection to that child, you will bond.   If you are like me and missed a period of bonding opportunity while depressed, once you are out of that PPD fog, let go of what’s already past and make the most of your time with your baby going forward. 

Missing out on the opportunity to bond with—in other words, responding to the baby’s cry through comforting, holding, feeding and communicating—your baby immediately after birth for whatever reason, due to complications from birth for the mother (as with happened to me) and/or baby (jaundice, physical defect), does not mean you will fail to bond properly.  Don’t let the image of bonding at birth become an obsessive thought.  I mean, think about it…what about adopted children?  They don’t stand a chance with bonding with their adoptive parents? 

I’d like to end with this.  PPD that is not treated can prevent attachment and bonding, which can only reinforce feelings of failure—a vicious cycle, of which there are many when it comes to PPD!

Pregnancy is NOT always a smooth, easy and blissful experience

Pregnancy is always a smooth, easy and blissful experience.  Not only that but  you (and your skin) are supposed to “glow.”   Nah, don’t you believe that for one instant!  Grant it, there are those who experience one or more births that most women can only dream of having.  You will occasionally hear about births that progressed so quickly and easily that no pain relief, episiotomies, or stitches even, were needed.  I have a friend who said that labor started so suddenly while still at home that she just gave birth there.  Where all it took were some intense contractions and a few pushes, and it was all over.  Within minutes, baby was contentedly breastfeeding. They couldn’t even wait for help to arrive.  Now, that’s a childbirth experience that can’t be beat! 

In terms of pregnancy and its associated physical challenges—like nausea, vomiting, water retention, difficulty sleeping in the later months—Susan Maushaurt (pg 50) in her book The Mask of Motherhood: How Becoming a Mother Changes Our Lives and Why We Never Talk About It says:  “We fight off our symptoms with a grim determination…..and get on with it, to show the world….that pregnancy is no big deal, really.”  Maushart describes how her nausea, which was triggered by practically every smell and so severe and debilitating, and yet she was “as likely to publicize it as [she] would a bout of bed-wetting.”  Like Maushart, I experienced nausea a lot.  In fact, I was nauseated by every little smell for the entire duration of my pregnancy.  Unlike Maushart, I wasn’t afraid to tell people.  I told people at work, I told my friends, I told my family.  Why would I want to hide this information from others?  It seems that Maushart, along with countless other women, choose to keep quiet due to fear of being judged as not taking it like a woman.  It seems that if we were to dare complain about any aspect of pregnancy and postpartum, we would be branded a failure.  Deep down, we compare ourselves with those women who glow and love every minute of being pregnant.  What we all need to realize is every woman is unique and so every woman’s pregnancy, circumstances and therefore childbirth experiences will be different.  Some experiences will be great, while others won’t be.  That’s just reality.

The reality is that—and you seldom see any of this unless you’re deliberately on the lookout for such information—about 15-20% of pregnancies fail to carry to term, per Ruta Nonacs in her book A Deeper Shade of Blue: A Woman’s Guide to Recognizing and Treating Depression in Her Childbearing Years (pg 84).  Many women suffer from repeated miscarriages.  With each miscarriage, there is grieving and the more a woman grieves and the longer the period of grieving, she becomes increasingly more vulnerable to depression.  Studies show that women with recurrent miscarriages (and/or infertility) experience clinically significant depression. Needless to say, it is very difficult to cope with a loss at any point, whether it’s a loss during the first trimester, later in the pregnancy, at childbirth (stillbirth or death from preterm birth), or up through a few weeks postpartum (neonatal death).  You wouldn’t think that it would be possible to feel an emotional connection within the first few weeks of pregnancy, since there is nothing about an embryo that resembles a baby yet.  For me, even the few weeks during my first pregnancy was more than enough time to become emotionally invested.  When I found out it had to be terminated due to what they referred to as an ectopic pregnancy, I was devastated.  I can’t even imagine carrying a baby to term only to have the baby die.  That has got to be one of the most devastating experiences any woman could ever have to endure.

Each woman is different in terms of their ability to cope with and move beyond a loss.  Some are able to cope and move on relatively quickly.  For others, the experience is so devastating that they may not be fully able (or willing) to let go of the pain and memory of their loss, and fall into depression.  These women should seek professional help to help cope with their loss and move on with their lives.  It really helps to share your feelings with therapists who, unlike friends, family, colleagues and neighbors who—despite good intentions may unintentionally say something that hurts your feelings—make for non-judgmental and supportive listeners.  It isn’t good to keep all your feelings bottled up inside.  Grieving and getting a certain amount of emotional support from others are components of the healing process.  It’s best to deal with grief as it occurs rather than letting those negative feelings accumulate and stay unresolved over time.  At some point, your body and psyche may get to a point that they can no longer hold back depression.

Women who have had previous experience(s) with miscarriage and/or traumatic birth experience—including, but not limited to, having a stillborn baby—will tend to experience high anxiety levels, due to great fear of yet another pregnancy loss, during a subsequent pregnancy.  High anxiety levels make it difficult for a woman to enjoy her pregnancy.  Women who have had to endure IVF cycles and/or repeated pregnancy loss—e.g., miscarriage(s), stillbirth(s)—have experienced much psychological trauma to get to this point and are considered high risk for a perinatal mood disorder.  There is a correlation between feelings of loss and the age of the mother, how long she has been trying to conceive, and whether there were previous pregnancy losses, which in turn lead to feelings of failure and inadequacy, not to mention higher anxiety levels and stress, which can cause a woman whose body and brain are already challenged by hormonal fluctuations to become depressed. 

Let’s not forget that pregnant women can become depressed—this is referred to as antenatal depression.   In fact, approximately 1 out of 10 women experience antenatal depression, though many cases are undiagnosed.  Per Postpartum Depression Demystified“by Joyce Venis, RNC and Suzanne McCloskey (pg 59), untreated cases of depression during pregnancy have a 50% chance of worsening after childbirth.   Depression during pregnancy generally does not go away once the baby is born.

So, in short, while it’s true that mothers who are fortunate enough to have smooth pregnancies each and every time they have a baby more than likely feel that this is a true statement, pregnancy is NOT always a smooth and blissful experience. 

A smooth pregnancy does NOT mean a smooth postpartum period

I had a relatively smooth pregnancy so the thought never occurred to me that I could possibly develop PPD.  Unfortunately, a smooth pregnancy does not always guarantee a smooth postpartum experience.  You could totally love being pregnant and loving every minute of the pregnancy but still end up with PPD.  If you find that a number of the risk factors in my post “Risk Factors for PPD” apply to you, you could still fall prey to PPD despite how well your pregnancy went.

The childbirth experience is subjective and unique to each woman.  What one woman deems as a good childbirth experience may be completely different from another woman.  What is satisfying to one woman may be disappointing for another.  Some women may view a good birth as one in which the baby came out fine, despite the long and painful process.  Some may view a good birth as one that is completely “au natural,” in which no pain relief is administered and the baby is delivered vaginally.  Yet others may view a good birth as one where there is very little pain, or pain that they can deal with, thanks to the invention of the epidural.   Increasing numbers of women are even opting to have caesarians despite the lack of medical necessity and out of preference for being in control and able to decide what day to have the baby and minimize the chance of any complications.  Ultimately, it’s the woman’s perception and satisfaction of her childbirth experience that matters and key to starting off her postpartum experience on a positive note. 

For some, unfortunately, a disappointing childbirth experience increases a woman’s risk factor toward postpartum depression—particularly if there are any complications like an emergency caesarian, pre-term birth and any medical problems of the baby resulting with a stay in the NICU.   Many women long, hope and prepare for a natural childbirth experience.  In other words, no medical intervention of any sort.  A vaginal delivery with no epidural, no forceps, nothing.  Just plain endurance, willpower and heavy-duty breathing exercises.   What they don’t plan for—baby in breach position or other unforeseen medical emergency for the mother and/or baby—are the times an emergency caesarian or other medical intervention may be required.  For these women, not being able to have the birth experience they had hoped for can cause a tremendous sense of loss, disappointment and grief.   It’s situations like this that it’s best to adopt a realistic attitude of hoping for the best but realizing that anything, really, can happen. 

If you read my recent post about my childbirth experience, you’d know that I had to lose my uterus due to a rare complication called placenta accreta (where the placenta grew into my uterine wall) only 3 days after having my baby.  I would say, without a doubt,  that that experience paved the way to my PPD.  I wouldn’t say that that experience alone is what triggered my PPD, since my PPD didn’t start until the 6^th week postpartum.  Needless to say, when you experience a complication like that, which not only takes a lot out of a person physically since it’s a major surgery with 4 units of blood loss—this being only 3 days after childbirth, another big deal physically—on top of the hormonal fluctuations, sleep deprivation, and daily procedures in the hospital, your body is not in prime physical condition, is it?  I was planning to treat all this in a practical and matter-of-fact sort of way and move on.  Put this all behind me.  There was no way for me to even know that in just 6 weeks’ time, I was going to get blindsided with PPD.   Something I could not just snap out of all by myself, without medical intervention. 

The following are just examples of obstetrical complications leading to a traumatic birth experience…. the types of experiences we hope never to have but in reality do happen to some women: 

• Emergency caesarian (especially after having had no pain relief and enduring many hours of labor)
• Baby going into distress during or after delivery
• Inability to see or hold the baby immediately upon birth
• Extremely difficult and long labor
• Baby requiring surgery to correct a serious congenital defect
• Husband not being there with you
• Last-minute change in OB/GYN delivering your baby 

The disappointment of falling short of your birth plans, frustration of this unexpected turn of events, inability to do more for your baby, and/or lack of control can be too overwhelming, too much to bear for a new mom whose hormones are already topsy-turvy and “playing tricks” on her emotions. 

Hear No, Speak No, See No….

Those who’ve been fortunate enough to have smooth and stress-free experiences lack empathy for those who don’t have such experiences.  After all, empathy comes from personal experience.  On the one hand, without going through a difficult pregnancy, childbirth and postpartum experience yourself, there is no way for that person to know what any of that’s like.   On the other hand, women who have had negative experiences with pregnancy and childbirth, such as ectopic pregnancies, miscarriages, and infertility, generally do not talk about these experiences with others for several reasons.  After all, who wants to hear bad news?  Even if you think that someone else would be understanding, chances are you are reluctant to burden someone else with heavy news and/or you don’t feel they can empathize or know what to say to you.  People are generally inclined to stay away from awkward situations.  Because people don’t openly discuss their difficult pregnancy, childbirth and postpartum experiences, the public is only aware of the smooth, easy and blissful pregnancy, childbirth, and postpartum experiences.  It’s natural to feel you’re an imperfect mom when things don’t go smoothly because you only hear good things from other moms.  Or you simply want to hide the fact that your birth experience was not as good as you’d hoped it would be.  Unfortunately, this only supports the notion that all pregnancies are smooth, easy and blissful experiences.  Not to mention, it also makes women like me who have infertility issues, as well as pregnancy, delivery and postpartum complications ask themselves the question “Why me?” and feel worse that they are being deprived of positive experiences every other mother seems to be enjoying.  This only makes them feel more alone in their experience than ever.

Unfortunately, it’s human nature to avoid wanting to hear about problems you have during delivery and/or the postpartum period—as I unfortunately experienced firsthand. People only want to hear what they want to hear, which is that your experience was like any other mother’s experience.  They don’t even want to hear the details of how the labor and delivery went.  They just want to hear these 6 words:  “Mom and baby are doing fine.”  This is what I refer to as the “spare me the details” effect.  Same thing whenever you ask anyone the question “How are you” and you expect the answer to be “Good, thanks.”  People don’t want you to go into details, especially if they’re negative in any way.  I always get this strange look from people whenever I provide a response that’s in any way negative.  It’s almost like, how dare I provide a response that isn’t within the socially acceptable “Good, thanks.”

Empathy seems to be the key that gives people the understanding and realization that others need help and support, that all is not always peachy keen.   You learn from life’s experiences, which motivate people to do certain things.  Why do you think I do what I do?  To help other women, so they can be empowered with knowledge.  Ignorance is NOT bliss when it comes to things like pregnancy, childbirth, and postpartum experiences.  Be in the know.  Also, it’s best going into labor and delivery not having high or certain expectations, since you won’t be setting yourself up for disappointment.  All you should and can do, really, is to hope for the best and be as knowledgeable as you can about the REALITIES of pregnancy, childbirth, and postpartum experiences—including PPD!  After all, PPD is the #1 complication of childbirth.

A real quickie from me today……Check out this recent piece on CNN.com.  It’s a great example of the kind of information that should be more frequently made available to the public about postpartum depression (PPD)….not like those misleading articles in magazines (the most recent one I can think of was in Vanity Fair) that add to the misconceptions about PPD.  It’s chockfull of very important and useful information about PPD, including the following:

1. One mom’s experience with it, plus links to 2 other moms who talk about their experiences on Parenting.com (in my opinion, very well written);
2. why many women are afraid to speak up about/seek treatment for it;
3. the Melanie Blocker Stokes MOTHERS Act and how it, once passed, can help fund related research and education, provide training to medical professionals, and increase treatment options and support services;
4. difference between the blues and PPD;
5. the hormonal/neurochemical/psychological/social factors that can lead a woman at risk to get PPD (and for some the depression begins during pregnancy);
6. how moms with PPD can–and should–get help (and how they should NOT wait or try to tough it out and suffer silently); and
7. last but definitely not least….importance of the new mother taking care of herself and getting the help (emotional, practical) she needs.

Other newspapers, magazines, etc. should follow this wonderful example of accurate reporting that provides helpful links to PPD stories and other resources.  We need more of this kind of reporting to help banish misconceptions, or myths, about motherhood–PPD included!  The public needs to be aware how prevalent PPD really is, it shouldn’t be confused with the blues (which about 80% of new mothers get), and that it should be taken seriously. 

Happy mothers mean happy babies.  Mothers deserve and need rest and support!  

Knowlege is power, folks….and don’t you forget it!

Just a real quickie from me today….I am honored my blog made it to the Nurse Practitioner School’s top 50 postpartum support blogs for consumers and clinicians.  Please check out this great list of resources that can empower expectant parents with information–remember, knowledge is power–and provide helpful resources and support to new parents experiencing a postpartum mood disorder.

At about 4:30 AM on Friday, December 10, 2004, my water broke.  The first thing that came to my mind was “Oh no!  I’m not ready for this!  This can’t be happening already! ”  I woke my husband up and told him what had happened.  I thought maybe, by some chance, this was all just a false alarm.  But we paged the doctor anyway.  When he called back, we informed him that my water had apparently broken.  Much to my dismay, he told us to meet him at the hospital.  I hadn’t even packed the hospital bag yet, which my husband had warned me many times to do.  Somehow, and I don’t remember any of this, we threw a hospital bag together in a big rush and off we went to the hospital.  I experienced mild trepidation about getting the epidural, but I was not obsessed about it.  So when the time came to get it, I just told myself it had to be done to spare me the intense pain from which I wanted to be spared.  The labor and delivery went fine, but immediately after my doctor delivered my baby girl into my arms, he had a look on his face that I’ll never forget……………………………

My placenta would not come out. 

After waiting an hour, the doctor proceeded to try to manually manipulate it out.  Even the epidural couldn’t help with the pain from what he was doing.  So they moved me to the OR where they proceeded to administer painkillers through my IV drip, all the while trying to manipulate the placenta out by hand (yes, a hand all the way up you know what) and then by a long suction device similar to the procedure for a dilatation and curettage (D&C).  I was trying not to scream, but a few times couldn’t help it.  The doctor finally gave up.  He told me he’d schedule an MRI for me the next day, before doing anything further to determine the exact problem.  He explained that one of two things was the problem.  Either my large fibroids (and I had quite a few) were preventing the placenta’s movement out or this was a case of placenta accreta, which is a rare complication where the placenta attaches to the wall of the uterus.  I had a sinking feeling it was the latter and way more serious of the 2 possibilities.

Turns out, they couldn’t squeeze me in on Saturday, so they put me down for Sunday.  In the meantime, I was only allowed to eat ice cubes.  I had to get a blood test at least a couple times a day for the next five days.  Evidently, the technician on duty on Sunday was not the one who usually handles abdominal MRIs.  Basically, he was not familiar with the appropriate protocol, so the entire 45 minutes of my being in the MRI — hooked up to the IV drip and morphine, bleeding from the episiotomy and peeing uncontrollably every time I stood up — was for nothing.  I couldn’t believe I had to go through the same exercise the following day.  The doctor told me that I may have to undergo surgery to get my uterus removed if the MRI proves my doctor’s fears of placenta accreta.  In this situation, the placenta cannot just be cut off, the entire uterus would have to go too.  In preparation for the possibility of surgery, the doctor was not comfortable with my low blood count, so he insisted I receive 2 units of blood.  That sent me into a panic because that would mean I’d get someone else’s blood.  Because I feared I could get AIDS from a blood transfusion, before going into any surgery, I would’ve preferred to store my own blood.  That is what I’d done for my dermoid cyst removal back in 2001.  But this time, I wasn’t prepared.  I refused the blood, which only angered the doctor.  I finally gave in, but only after several crying episodes where not only was I afraid I wouldn’t make it through all this, but that I’d lose my uterus.  A part of me would be gone forever.  I would never be able to have kids again. 

That night, the nurse came in to attach a catheter to my other arm for the blood transfusion.  She wasn’t as good as the nurse who inserted the other catheter.  Because my left arm already had a catheter for the IV drip and antibiotics, they had to find a way to insert one into my right arm.  The clearly visible vein was way over-used by the nurses taking my blood daily.  So the nurse went for my wrist…..and missed.  Then she went for my hand……. and missed.  By that time, I was delirious.  They had to get someone else to try, and luckily, she succeeded in inserting it into a vein that you can barely see at all.   Fortunately, I have no fear of needles or I never would’ve survived all this (and my IVF cycles, for that matter).

Next morning came.  Inside, I was a wreck.  I was starving.  I was still on a diet of ice cubes.  But I maintained my composure the best I could.  This time, the regular MRI technician was on duty.  With difficulty, I slowly got out of my wheelchair and onto the MRI platform.  I was in the MRI for about 90 minutes this time, trying to stay as still and as calm as possible throughout the entire procedure, following the technician’s instructions on when to breathe and when to hold my breath.  Fortunately, I am not a claustrophobic or they probably would’ve had to knock me out just to get me into the MRI.  It was nothing like the CT Scan that was performed on me years ago, which uncovered the fact that I had a dermoid cyst rather than cancer. 

That afternoon, the doctor performed the surgery on me to try again, this time with the aid of general anesthesia, to remove the placenta.  The doctor warned that I could hemorrhage on the table, and if that occurs, I would need additional units of blood and an emergency hysterectomy would need to be performed.  At that point, I was tired of being upset, tired of all the procedures – the MRIs, the catheters, the bleeding, the inadvertent peeing, the daily blood work, the temperature readings, and my lousy diet of ice cubes.  I was numb.  I went into the operation trying not to think about anything but surviving so I can go back home with my husband and daughter.  I was praying I would come out alive.  The anesthesiologist administered the anesthesia and by the time I counted to 3, I passed out.  When I came to, it was 2-3 hours later and I was in the recovery room.  The surgery itself took 2-3 hours.  I was extremely groggy and experiencing throbbing pain in my abdomen.  Not sure if the hysterectomy had occurred or not, the first thing I did was feel for stitches.  And there they were.  They had had to remove my uterus.  I felt so, so sad at that point.  The doctor then appeared and explained what had happened.  I had hemorrhaged and needed 4 units of blood.  At that point, fear of getting someone else’s blood was no longer that big a deal.  What was done, was done.  The fact of the matter was I could no longer have another child. 

Though I can’t say what living in hell is like (and I hope I NEVER do), I don’t know any other way of expressing how I felt during that miserable week.  I lost track of how many rooms I had to stay in….there was the delivery room, a few hours in a recovery room, followed by a room in the maternity ward, then one night that felt like an eternity in what to me was like hell (that’s where I nearly cracked) in the recovery wing of regular surgery patients (where the nurse in charge was — pardon me for saying this, but – a bitch), and I was finally moved to another room in the maternity ward where I stayed the last 3 nights.  For the most part, the nurses in the Maternity section were truly sympathetic and helpful.  These nurses were definitely a step higher than the nurses in the recovery wing with respect to sensitivity to the new mother.  I can recall the first nurse that helped me was like Florence Nightingale….an exemplary nurse.  And the last nurse was truly sympathetic for me and helped me as best she could.  I regret not writing down their names at the time so I could thank them after I went home.  All the nurses in-between, however, were not particularly sympathetic, kind or caring, despite the evidence written all over my face at how miserable I was feeling.  They appeared to be all about just doing their job, callous probably from dealing with patients day in and day out.  No one was particularly pro-active about stopping for even a minute to ask me how I was feeling that day, lend an ear, see if I needed anything.  My stay in the recovery wing was hellish not only because I couldn’t see my baby while I was there but also because it was nearly impossible to get a nurse whenever I needed one.  What was the call button for, if no one ever responded to it?  I had to get my husband to search for one each time I needed something.    Needless to say, but I’m going to say it anyway, it makes all the difference in the world when nurses are warm and caring both during and after delivery, checking on you frequently and anticipating your needs during your stay at the hospital.

Mind you, my diet was restricted to delicious ice cubes for most of my time at the hospital.  I think it was during my last 3 days that I graduated to fluids (e.g., juice, tea, salty beef or chicken broth and jello) and on the last day, I was allowed to eat a couple of delicious hospital meals! All this time, I was trying not to “shoot myself” with morphine.  I was rigged up to the morphine drip and all I had to do was push the button to get some.  If it weren’t for the moments where the gas movements hurt so much it felt like sulfuric acid was burning a hole slowly through my abdominal wall (it was such a searing pain), I never would’ve needed the morphine past the first night.  I hate having to depend on medicine!  Antibiotics, though, are different.  They’re needed to ward off infection.  The nurses gave me a bunch of Percocet to take for pain, but I never touched a single one.  To this day, I’m not even sure if the searing pain that felt like a hole was being burned into my abdomen was caused by gas.  The whole experience made me all the more anxious because I didn’t know what was causing this pain and how long this would go on for. 

To this day I cannot understand why they always had to come in during the middle of the night to take my temperature and sometimes blood.  I’d be sleeping and they’d come and wake me up.  Didn’t they understand how important sleep is to a new mother?  I was never able to get a block of 5 hours of sleep during that dreadful week in the hospital.  At that time, I had no idea the lack of adequate deep sleep and constant interruptions by hospital staff would set me up for PPD.  Hospital staff should be instructed to allow a new mother to get at least 5 hours of sleep at a time.

All this time, I had to keep my chin up the best I could, knowing that I had a newborn to try and breastfeed.  Despite my brave attempts, I wasn’t very successful.  With the help of the lactation consultant that would come by once a day, I was able to successfully get the baby to latch on and suckle for a little bit.  I was surprised that I was so willing to let a stranger come to the room, grab my boob and manage to get my daughter to latch on.  It felt great to be successful those couple of times, but it was to be short lived.  I couldn’t keep this up with all the procedures I had to undergo.  I definitely couldn’t do any breastfeeding the time I was not even in the maternity ward.  By the time we left the hospital, my daughter was already suffering from what they called “nipple confusion.”  I’d already lost precious bonding opportunity with everything I had to go through at the hospital.  Failing at breastfeeding would be a second failure of my one and only childbirth experience.  And I hadn’t even left the hospital at that point.  After leaving the hospital, I gave breastfeeding my best shot for as long as I could manage it, despite my weakness, sleep deprivation and iron deficiency from all the blood I had lost in the surgery.  

I will never forget how, during the seven long, tortuous days at the hospital, my husband was by my side the entire time, sitting/sleeping in a chair next to me. He barely took care of himself during this time, all grimy, unchanged and unshaved.  Though, he did venture to go home to check on the house, not to mention make sure Bunny had enough hay and water, once every other day.  Along the way, some nurses felt so bad for him that they tried to accommodate him the best they could.  When I was stuck in the room from hell in the Recovery Wing, he wasn’t allowed to stay in my room, but the maternity ward was kind enough to find a room for him to stay in. 

It’s interesting how the pain from labor does not keep most women from having more children.  It seems that women have selective memory with regard to their childbirth experiences.  I would say that it’s our desire to have, and love of, children far outweighing the dread one fears of labor pains.  Despite my PPD experience, if I still had my uterus, I’d want to have one more child.  If the placenta accreta hadn’t occurred, I would’ve proceeded with another IVF cycle, regardless of the fact that I’d be at least 42 years old when having the baby.

- – - – - – - -

Now that you have an actual story from someone who survived a not-so-pleasant–to say the least–birth experience (not to mention how tough it was for me to get pregnant), my next blog post will be my gripe on why there seems to be the prevailing notion that pregnancy, childbirth and postpartum are all smooth, easy and blissful experiences.

Postpartum depression (PPD), and depression for that matter, is an imaginary, or make-believe illness, a state of mind that can be changed at will, a means to get attention, an excuse to take medication to escape from reality, a sign of weakness or self indulgence, an excuse to avoid the reality of motherhood.   

Yeah, get a grip on reality–and get educated while you’re at it–for crying out loud.  These statements couldn’t be further away from the truth.  In this day and age, how anyone can believe any of this BS (especially other women) is beyond me.   Why can’t women be supportive of each other instead of being so critical and competitive with each other?!   That includes being supportive of and contributing toward efforts that will help mothers experiencing PPD rather than impeding those efforts (those people, by the way, should be ashamed of themselves).  Why women have to be so feline (note:  my #2 anger trigger is feline behavior, after my #1 anger trigger of behavior & remarks made out of ignorance/racism/condescension) is beyond me!

Skeptics will claim that, since PPD isn’t necessarily detectable via blood work nor a growth or wound or handicap that is visible to the naked eye, that it must not be real.   And please don’t say this is a recent phenomenon or that women have been giving birth thousands of years and we’ve only seen a rise in PPD awareness–and thank goodness for that–in the past decade, so it must be a new invention made up by women in today’s generation because they can’t cut it like the tougher women of previous generations.  Right.    Anyway, this “recent phenomenon” is thanks to the women out there (you go girls!)–plus celebrities who are finally gaining the courage to speak up more about a condition that has been documented as far back as the days of Hippocrates.  Scientists have not been spending years on research on treatments, detection, determination of risk factors, etc. for lack of anything better to do. 

People out there scoff at the idea of PPD and claim to know all about it, when in fact they don’t.  Why?  Because they never suffered it themselves…duh.  They’ll claim that all new mothers experience mood shifts after childbirth.  Hello, you’re thinking of the blues, which happen within the first couple of weeks postpartum and resolve on its own.  They’ll claim that there is no scientific evidence that PPD exists.   They’ll claim that insomnia, a classic symptom of PPD, is merely sleep deprivation and fatigue that all new moms experience.  They’ll also claim that having a panic attack is the same thing as anxiety that comes from difficulties in transitioning to motherhood and being a first-time mom.  Now, had these people actually experienced real PPD, including real insomnia and real panic attacks, they would understand what it’s like to have PPD,  insomnia and panic attacks.   Until then, they should keep their ridiculous claims to themselves.  I’m not going to tell these skeptics to do their reading because no amount of facts will change these peoples’ minds…unless perhaps they experience any of these conditions for themselves.   It’s really a shame, isn’t it, that people insist on maintaining their stubborn beliefs, regardless of how ridiculous they are. 

Many of these skeptics of PPD are also skeptical of depression, in general.  They’ll claim that depression is a matter of mind over matter.  They’ll claim that anyone can snap out of depression on their own accord.  Well, wake up!  The ability to will or wish away depression is a myth.  You can’t overcome it by just putting your mind to it.  PPD is a real illness with a biological cause, just like diabetes and heart disease.  You can’t just “snap out of it” any more than you could if you had an ulcer, diabetes or heart disease.  Until I experienced PPD, I thought depression is just a state of mind.  I used to say things like “I’m depressed” whenever I felt sad.  Now, I’m careful to not use the word “depressed” in the context of sadness.  I believe the majority of folks out there mistakenly think that being depressed is the same thing as being sad, feeling down or feeling blue.   People, particularly OB/GYNs,  need to stop getting these two very distinctly different conditions confused with each other because by doing so, they are preventing women with PPD from getting the help they need right at the beginning.  Not to mention, perpetuate the misconceptions about PPD. 

With PPD, the longer you wait to seek help, the harder it is to recover from.  But why wouldn’t you get the help that you need to get better and enjoy motherhood sooner?  Why suffer longer than you have to?   There are many possible reasons, though high up at the top of the list would be 1) mistakenly thinking that this is just the way it is with being a first-time mother who is trying to cope but just going through a rough patch (because they don’t know any better due to lack of education about PPD and their doctors’ misdiagnosis as blues) and 2) fear from the stigma associated with mental illnesses and what others would think/say and.    All too many women will unnecessarily struggle with toughing it out or self medicating with alcohol or other substances.   

My best piece of advice to you moms out there is to not give a damn what other people think.  Now, if I could take a dose of my own medicine, that would solve one of the biggest habits—or weaknesses, that is—I’ve had so much trouble kicking over the course of my lifetime!  Your priority should be the wellbeing of you and your family.  The best thing you can do for yourself and for your baby—in fact, for your whole family—is to seek help as soon as you experience three of more of the symptoms described in my post “Baby Blues is NOT the Same as PPD!”  Don’t wait until you are crippled by the effects of PPD like I was.    Prolonged and untreated depression can not only negatively affect your marriage and your baby’s cognitive and social development, it can unnecessarily strain your relationship with your partner.  Worse yet, untreated PPD can lead to such feelings of hopelessness that ending your life may seem like the only way out of the pain.  Don’t try to tough it out, thinking what you’re experiencing will pass on its own just as quickly as it developed.  Don’t try to tough it out because others around you are trying to convince you that this is all part of the process of transitioning to motherhood, that every new mom experiences sleep deprivation and anxiety (see previous post on the difference between that and true insomnia, a very common PPD symptom if it is experienced 3 weeks or later after childbirth). 

Though the symptoms and their severity may be unique to every woman, PPD is debilitating to all those who suffer from it.  Depression–and there are thousands in this country today that are afflicted with it– affects people physically, not just mentally.  It is a physical illness that is the result of a chemical imbalance.   Hormonal changes are responsible for perinantal (during pregnancy and postpartum)—and even premenstrual dysphoric disorder (PMDD)—mood disorders and an imbalance in brain chemicals called neurotransmitters.  Serotonin is one such neurotransmitter.  Research shows that serotonin dysregulation is a primary cause of PMDD and PPD.  A sudden and huge drop in estrogen levels immediately after childbirth contributes to a decrease in serotonin availability in the brain.  Since serotonin promotes normal mood, a decrease in serotonin availability in the brain is associated with anxiety/depression.  This is why medications such as selective serotonin reuptake inhibitors (SSRIs), which increase serotonin availability in the brain, have in many cases been effective in the treatment of PPD.   An SSRI was effective for me.

Let me explain something here, lest the words “medications” and “SSRIs” trigger a violent reaction among the anti-pharma faction out there.  I am not advocating medication for everyone.  Different treatments will work for different women.  A woman must be informed enough to be able to make a decision that she feels is right for herself.   Being informed means having ready access to information about PPD, its symptoms, where to go for help, what treatments are available, what medications are usually prescribed and their side effects and risk of being passed to the baby via breastfeeding, etc.   It also means having a doctor that is adequately trained to detect, diagnose and treat perinatal mood disorders.  But many doctors are still not adequately qualified to do any of that, plus lack adequate tools and resources.  This is why awareness about PPD and preventive measures (like lining up adequate social support and getting 5 hours of interrupted sleep as much as possible in the first 6-8 weeks postpartum) are so, so critical to everyone who plans on having a baby. 

I’d like to close with this piece of advice to the skeptics.  Without knowing the full story (or without ever experiencing PPD or any other illness directly) one should NEVER pass judgment on the situation of others.   Women with PPD do not need to be scoffed at, doubted and criticized.  They need support and understanding.  If you were in their shoes, would you want to be on the receiving end of these negative or–shall I say–tasteless behaviors?

Please visit Dr. John Grohol’s post regarding Dr. Doug Bremner’s recent remarks about postpartum depression (PPD).   Warning:  If you don’t have a high tolerance for comments that can get quite heated, to say the least, then ignore the 160+ comments that seem to veer off-topic quite often by people jumping into the discussion, some of whom bring up their own experiences that don’t have a thing to do with PPD at all. 

Here are my own comments I posted in response, to which I want to add after the fact:

Me thinks the only reason why some of the commenters joined is because they have nothing better to do than to try to attack people wanting to support something that can make a positive difference for those women currently suffering from–or will suffer from one day–this silent epidemic known as PPD, all because they have this anti-pharma and/or anti-psychiatry agenda.  Self-serving, if you ask me.

Do people who claim everyone knows about PPD imply that those who don’t are ignorant?  Stupid?  Well, I take offense to that implication!!!  In reality, THEY are the ones that are ignorant for not realizing the existence of such a silent epidemic.  Or maybe they are conveniently staying blind to the fact there is such an epidemic because their focus is to merely try to quash anything that has a hint to do with medication (hence, anti-pharma).

July 14th:

Yes, THANK YOU, Dr. Grohol for your wisdom and ability to see the forest through the trees. We should invite opponents of this bill to think of some other way to speed up the snail’s pace that our country has been moving with respect to public awareness campaigns, as well as education healthcare providers on earlier detection and more accurate diagnoses (and research that will enable this to happen). I had no previously diagnosed mental/mood disorder and yet experienced PPD. Had my OB/GYN screened me for PPD or even bothered to ask me questions to further assess my situation when I told him I had insomnia at 6 weeks postpartum (clear sign we weren’t talking about the blues anymore), instead of merely prescribing me Ambien, I may have been spared the quick decline in my condition and the horrific panic attacks I experienced that left me feeling frightened and completely debilitated. For crying out loud, I couldn’t even take care of the baby my husband and I had tried for so many years to have. I didn’t know what was wrong with me and thought I would never return to my old self again. Hopelessness in the face of depression, if gone untreated, can lead to suicide. It’s frightening to think that was where I might have headed had I not sought help and gotten the medication I needed that brought me to a functioning level within 4 weeks’ time.

Friday, July 31st:

Interesting chain, I have to say. Can’t believe I forgot to check this back out after I submitted a comment up at the very beginning. Anyway, I had to re-join the discussion, though it seems to have veered off the topic at hand. Totally in agreement with skillsnotpills @ 12:17 pm 7/27 (speaking of skillsnotpills, I agree w/your comments @ 5:24 pm 7/16). If you read these comments from the bottom up, you’d never think we were having a discussion about PPD. Especially the deeply philosophical–and circular–points of this guy Matt which fail to reverberate with me, probably due to the fact that he’s not talking about women and PPD at all, or the Mother’s Act for that matter. Michael Elder’s comments are irrelevant in this particular discussion. 

I’d like to acknowledge and applaud Dr. Grohol (esp. comments @ 2:45 pm 7/15, 6:52 am 7/17, 12:42 pm 7/17 and 5:25 pm 7/17), Gina Pera (esp. comments @12:03 pm 7/15 and 2:35 pm 7/15), and Power is Knowledge.

These are by far my fav:
1. Dr. Grohol, thank you for saying the following…I couldn’t agree more!
“I don’t think or see women as “voiceless victims” just because some are trying to empower them with information and more data — data that comes from screening measures. A woman’s choice about what she does with that information and data is just that — her choice. I would never imagine it is my right to come between a doctor and their patient and their right to choose any treatment they want (or no treatment at all). It’s their choice, not yours, not mine. Screening provides women with more data to make an informed decision. Lack of screening keeps women in the dark. Since this bill only provides for voluntary screenings (and doesn’t mandate any sort of treatment whatsoever), I will very much continue to support it.”

“I think we have to realize that our knowledge and ability to understand the complexity of the human body and the mind has a long way to go. I understand that, as do most researchers and clinicians. But what are we to do in the meantime, as our we try and increase our knowledge? Stop trying to help people in emotional pain who want treatment?? Or do the best we can with the tools and treatments we have available? There’s no doubt nor argument that treatment can harm as well as help. The question then becomes, How do we minimize likelihood of harm and increase the likelihood of help? And this is true of any treatment, psychotherapy too.”

2. Gina, thank you for saying this…I couldn’t agree more!
“Overly focusing on mothers and PPD or depression seems a real danger here. The problem isn’t medication or the Internet-based self-medicating-with-opposition crowd’s favorite boogie man, Big Pharma. The problem is poorly trained clinicians who do not know how to screen for a wide variety of mental illness and often treat the wrong thing. We have them to thank, in my opinion, for the medication backlash.”

“Hate to see you defend yourself against such spurious attacks, Katherine. It’s not that the people who make such attacks trouble themselves to read your blog and to perceive your intentions accurately. Such deliberations are beyond them. People who have not one mirror neuron in their brains distrust those who do; it is simply a foreign concept to them. The fact that they see craven motives behind every advocate or volunteer speaks more to what motivates them than what motivates those whom they criticize.”

_ _ _ _ _ _ _ _

I also comment:

“Kimbriel, how the heck do you think an OB/GYN would foster an open, trusting relationship if they don’t necessarily do what they’re supposed to do which is to ensure the new mother is feeling alright after having just given birth without asking a few questions which, if a woman feels uncomfortable answering, she can just pass on? Since when does a doctor jam questions down a patient’s throat? I personally have never experienced it in my lifetime. If my OB/GYN or GP had spent a few minutes asking me questions to try to get to the bottom of what was wrong with me when I had PPD, I would’ve been so lucky. If I had been asked relevant questions–or in other words screened for PPD–as soon as I indicated I had insomnia (rather than just been prescribed Ambien to help me sleep because he thought I had the blues), I could’ve been spared the painful experience that ensued, panic attacks and all.

I have to disagree with many of the anti-Mothers Act opponents in this chain….PPD is absolutely under-diagnosed and under-treated in this society. Every time I talk to a bunch of women, they share with me that they suffered miserably and unnecessarily from PPD without any treatment at all, depriving them of their ability to enjoy motherhood the way that they would’ve liked. Why did they suffer? Because they didn’t know what they had and were afraid to speak up and seek treatment due to the myths out there about motherhood and mental illness. We as a society have a truly long way to go to overcome all that. This country needs to provide education so that every last person is aware of what PPD is. I would’ve loved to have enjoyed my experience in my first few months as a mother, but I didn’t. I was caught unaware and uneducated about PPD and what to look out for.  No one told me anything. Had I known then what I know now, things would’ve been so different, so much better. This is what so many PPD survivors and others interested in the wellbeing of mothers are hoping to finally achieve in this country. Until then, what do all anti-pharma people propose? Be the change that makes a difference for mothers once & for all? That would be great, because it is so desperately needed!

If this bill passes, which I hope it does, it should be up to the individual woman whether she wants to answer questions at 6 weeks postpartum intended to make sure she is okay. If I were asked, I would answer, knowing what I know today.

I agree with many in the chain that the underlying problem and barrier to progress lies in the fact that medical professionals need to be trained to properly detect, diagnose and treat PPD. They also need the right resources/tools to do so.”

Let me start with how I believe OB/GYNs and hospitals–not to mention books and magazines on motherhood and pregnancy– can and should most definitely do more in terms of increasing public awareness of postpartum depression (PPD), which should start with this….the importance of sleep and getting adequate support to help reduce the risk of PPD rearing its ugly head.   OB/GYNs and/or hospitals should put right up at the top of the childbirth education curriculum–short though it usually is (a couple of hours…what a shame!)–the importance for new mothers to get at least 5 hours of uninterrupted sleep as much as possible during the first 6-8 weeks postpartum. 

What should be included in the education: 

1) the fundamentals of adult sleep, including what is considered “normal” sleep

2) sleep cycles

3) what to expect during late pregnancy and postpartum in terms of their impact on sleep

4) strategies for sleep management during late pregnancy and postpartum

5) effects of sleep deprivation

6) facts about newborn/infant sleep

Granted, for the greater majority of mothers out there a) the husband has to work full-time during the week and it is highly unlikely he could work the same hours and do the late-night feedings all week, and b) they lack the financial ability to hire a baby nurse, postpartum doula or nanny to help with late-night feedings.  What that means is, for most mothers out there, it is highly unlikely the mom can get the 5 hour block of sleep at night that she needs.  That shouldn’t, however, deter the OB/GYN from providing the simple fact that a minimum of 5 hours of uninterrupted sleep is imperative to the healthy functioning of an adult (more so for a woman who has just given birth), and depression is one possible consequence for the brand-new mother–hormones all outta whack and all–who fails to obtain that over the course of weeks following childbirth, a time in which she is at her most vulnerable. 

Awareness + Preparation = Keys to a better postpartum experience and reducing the risk of PPD (Note:  You may not be able to prevent PPD if you are at risk, but it certainly doesn’t hurt to be prepared to have a better postpartum experience):

• While you are still pregnant, reach out to friends and family members to provide practical support (like help watching the baby, cooking, laundry, housework, errands) and emotional support (someone who can listen to you, provide advice and be empathetic and nonjudgmental) after the baby arrives.  Believe me, after the baby arrives, you will have neither the time nor the energy to search and coordinate.  If family and friends are not options, consider hiring a baby nurse and/or a doula to help during the first couple of months, if you can afford it.    Having a baby nurse to help with nighttime feedings will enable you to get the sleep you need to take care of the baby the whole rest of the day while your husband is at work, and your husband to get the sleep he needs to go to work each day.  
• Resist temptation to use your baby’s nap time to try to catch up on housework, do laundry, address birth announcements, write thank-you notes, or handle other projects.  I know it’s so much easier said than done. I would suggest you scope out the wording and pick out the birth announcement you want to order (and thank-you cards) before having the baby.  That way, you won’t be stressed out finding the perfect one to send after the baby has already arrived, worry about not getting them out within a month after the baby’s born and hustling to get thank-you cards out within 30 days of receiving a gift.  

What happened to me I wouldn’t want to see happen to you…..

I thought I could handle taking care of the baby, cleaning up, finding announcements, addressing them and mailing them out, etc. since I typically thrive on multi-tasking and I never thought it would be any different after having a baby.  And believe me, the word thrive doesn’t come close to describing how much I try to squeeze in in a day’s time.  Silly me had failed to realize that I had just had a baby, which is a very big deal physically.  And that’s on top of the 7 days of hell I spent at the hospital, not to mention the multiple surgeries, daily blood work, MRIs, loss of 4 units of blood, and constant hunger (see previous post for details of my hellish hospital stay). 

I returned home from the hospital fully expecting to resume my old routine in addition to taking care of the baby.  Every time my mother or mother-in-law suggested I lie down or sit down, put my feet up and relax, I waved them off, saying that I was A-OK and didn’t need to nap.  Now that I’ve actually experienced insomnia and PPD, I know that my mother’s and mother-in-law’s advice was excellent advice.  Relaxing/resting is beneficial, even if you can’t fall asleep.  Problem is, I’m neither a napper nor a rester.  I’ve always considered napping a waste of valuable time that could be spent doing something productive.  For as long as I can remember, at least from the time I was 13 years old, napping was never my thing.  I wasn’t about to nap now. 

Don’t feel guilty for napping instead of doing something productive.  Now is not the time to feel compelled to try to impress others or try to fit the mold of what in your mind is how a perfect mother should be like.  After all, no one is going to expect that your house be spotless with a new baby to take care of.   Don’t worry if your house isn’t spotless and neat for visitors.  I know that’s easier said than done.  My house is messy on a normal day sans baby in the picture, let alone with baby (and exhaustion) in the picture.  It didn’t help that I resisted the idea of hiring a cleaning lady because I was brought up to clean my parents’–and now my own–house, so why pay someone else for the work I can do myself, even if it is for the sake of convenience?   I have issues with privacy and trust in hiring a stranger to come into the house (same reason I couldn’t hire a nanny).   

Don’t be like me, letting yourself get caught up in one hell of a vicious cycle:  If you don’t clean, you are less willing to have visitors, so you will feel more lonely and isolated than ever, which makes your PPD worse….

Here, finally, is my post on sleep (as a follow-up to my post “Some Postpartum Advice for New Moms-Part I”) ….or actually, insomnia.  Just what is insomnia?  Equally frustrating as explaining the difference between the baby blues and postpartum depression (PPD) is explaining the difference between having insomnia and not having the ability (or lack of opportunity/time) to sleep.  Insomnia is when you can’t sleep at night and can’t nap during the day no matter now exhausted you are.  I’m not talking about sleep deprivation, which is what ALL new parents experience in the first 3 months postpartum.  I’m not talking the lack of opportunity or time, either.  To be perfectly clear, a person with insomnia has difficulty falling asleep and/or difficulty staying asleep, even when the baby sleeps.  Insomnia is one of the most common symptoms of PPD. In fact, it has been shown that early severe fatigue predicts depressive symptoms at 1 month postpartum.  For me, insomnia was my very first symptom of PPD and I wholeheartedly believe that the constant sleep interruptions that started during my week-long stay in the hospital charted a course that was headed for PPD. 

You need sleep to stay healthy and to be able to take care of your baby day in and day out.  I had it bad.  You’d think that sleep deprivation would cause exhaustion which would cause me to fall asleep readily and at first opportunity.  That couldn’t be further from the truth in my case.  I couldn’t fall asleep, even when the baby was sleeping.  I couldn’t nap during the day, even with someone taking care of the baby for a few hours.  When I told my doctor I couldn’t sleep at night, he instructed me not to take naps, to which I said “That’s not an issue because I can’t nap either…I can’t sleep at all.” 

I encourage you to try one or more of the following to try to switch gears and condition your body out of this situation.  The key is to have the patience to stick it out for at least a couple of weeks.  I know with PPD it can be really hard to do, but please try your best.  Things don’t happen overnight.  

1. If you can’t fall asleep within 30 minutes, stop trying to sleep.  The more I couldn’t fall asleep, the more I was unable to fall asleep.  This effect is referred to as conditioned insomnia where your mind doesn’t expect you to fall asleep, which in turn, keeps you from falling asleep. Lying there waiting to fall asleep but not succeeding will only eat at you and make you more and more frustrated.  It will do you no good.  The harder you try to sleep, the more anxiety you will experience, and that anxiety will keep you from falling sleep—a vicious cycle.  The key in those situations, it seems, is not to expect to fall asleep.  If you fall asleep, great.  Just relax and try to blank out your mind from any thoughts.  Sounds so easy, but is so hard to do.   So many people warned me that the last thing I should do is toss and turn in bed for more than half an hour at a time.  Instead, I should get out of bed and go into another room to watch TV or listen to some quiet music before trying to fall asleep again (this is to interrupt the conditioned insomnia).  Of course I didn’t heed their advice because I was stubborn.  In my mind, sleeping was the only thing I should be doing in the middle of the night.  Plus, I should be exhausted and able to fall asleep instantly.  But after 2 hours of tossing and turning, I was in a state of anguish beyond words.  Had I known at the time that PPD was behind this all, it never would’ve gotten this bad.   
2. Avoid looking at the time.  Move your clock(s) out of the room, if necessary, as watching time go by will only serve to make you feel even more anxious about not being able to fall asleep.
3. Get a headphone noise canceller or white noise generator to use while getting your 5 hours of uninterrupted sleep.  This is, by the way, just if you have someone like your husband or relative staying with you and helping to care for the baby at night.  My husband had suggested getting me a headphone noise canceller or white noise generator in terms of helping me not to overreact to my daughter’s noises and his snoring (which I could hear even when he was in the den or living room downstairs).  I swear back then I could hear a pin drop, I was so attentive to every little sound that was made in the house!
4. Have your husband or whoever might be staying with you to give you a back/shoulder massage right before bed.  Ordinarily, a back/shoulder massage right before bed feels so good and is so relaxing, I would fall asleep immediately.  Needless to say, my husband’s massages when I was already sick with PPD didn’t help me one smidgeon. 
5. Establish a bedtime ritual:  Much like trying to condition your baby to associate a bath, reading a book and/or humming a lullaby with going to bed, you should try to recondition your mind to associate drinking warm milk (if you’re not lactose intolerant) and eating something high in complex carbs that can promote drowsiness like bread, taking a hot soothing bubble bath or listening to relaxation music (the kind that would be played during a massage) with going to bed.  I never realized that the reason why so many people suggest warm milk to help you sleep is because it contains tryptophan, which increases serotonin, promoting sleep.
6. Avoid exercising within 2 hours of going to bed.  My doctor suggested exercise anytime during the day except for within 2 hours of your bedtime may burn off excess energy/reduce jitteriness and promote sleep.  I tried but couldn’t keep this up. 
7. Avoid napping during the day.  My doctor suggested that I avoid napping during the day, as it may charge me up to the point and increase the likelihood that my body will feel less tired at the end of the day.
8. Do a wind-down routine.  My mother suggested I do a wind-down routine, similar as I would do for my daughter, every night before going to bed.  I should avoid exerting myself or watching stimulating television shows or read books that require too much thinking.  She gave me some information about Chinese relaxation techniques that have been used for centuries.  I tried that, but that night, I ended up having my first anxiety attack from failing to fall asleep after 3 hours of doing that relaxation exercise.  She also suggested I try breathing exercises and visualize positive things when I’m in bed, so as to facilitate sleep.  But try as I might, it was to no avail.  The harder I tried, the more I expected to be able to sleep, and the more agitated/panicked I felt that I would never fall asleep without medication for the rest of my life.  A friend told me that counting backwards in three’s helps her sleep.  I tried that too, but with no success.  It actually drove me crazier.
9. Reserve your bedroom for sleeping only.  There’s a reason behind the saying “Mothers know best.”  But nearly half the time, I dismiss my mother’s advice as “old wives’ tales.”  Well, when my mother advised me to reserve the bedroom for sleeping only and not do anything like read, watch TV or write in bed, I waved off her advice saying “Uh huh whatever you say, mom.”  Then, I read in “Postpartum Depression Demystified“ by Joyce Venis, RNC and Suzanne McCloskey (pg 41) that you should “Make your room your sleep sanctuary.  In other words, don’t watch TV, read, or play with your baby there.  Your bedroom should be only for sleep.” So, mom really does know best, after all.
10. Stay away from caffeine.  For me, caffeine wasn’t a factor, since I was totally caffeine free all of my pregnancy and continued to be caffeine free postpartum.
11. If within a week all the above suggestions fail–provided you don’t experience tremendous anxiety from not being able to fall asleep–then it’s time to see your doctor.  Don’t wait or you could you find yourself going down the same road I traveled—in other words, experiencing high anxiety and panic attacks from not being able to fall asleep.  Don’t wait.  You could go from bad to worse very quickly, and I wouldn’t want you to experience what I experienced (or worse).  Do see a doctor for an evaluation to help determine what is causing your insomnia.  Be honest about all your symptoms when talking to your doctor.  No question is a stupid question when you are a patient.  Doctors are paid to provide medical care, which includes consultation about your diagnosis and treatment.  Leaving out key details will only impede your recovery.  Also, do not let your doctor try to convince you that this is temporary and is experienced by all new mothers.  If you find that your doctor doesn’t know the difference between the blues and PPD, it’s time to find another doctor.  If you don’t know where to find a doctor that can help, reach out to your state PSI coordinator.

 Additional Suggestions

 Here are some of the things we did to help my daughter sleep through the night, which may be helpful to you: 

1. If you are breastfeeding without any difficulties, you may want to consider having the baby sleep in your room in a co-sleeper so you can pull the baby into bed with you for nighttime feedings without ever having to get up. 
2. If you aren’t breastfeeding, it would help to prepare bottles of pumped milk or formula in advance and have your husband take turns with you in terms of nighttime feedings.
3. By 3 months if you haven’t done so already, have the baby sleep in her crib in her own room so you will not constantly be disrupted, especially if the baby tends to make a lot of noise while sleeping.  My daughter started sleeping in her own room at 6 weeks because her noises kept us from sleeping during the night, which I know contributed toward my insomnia and PPD.  I had every intention of keeping her in our room through the 2^nd month.  Avoid setting this expectation, as it will only let you down harder if you are unable to follow through.  The fewer expectations you have and the more open-minded/flexible you are, the better off you will be.
4. Keep a clear distinction between night and day as bed time and awake time, respectively.  Keep the room completely dark and quiet at night and bright during the day, with constant noise and hustle and bustle of activity (even when the baby naps during the day).  Doing this consistently can contribute toward your baby’s sleeping through the night earlier.  Every baby is different, I realize.  Fortunately, our daughter was sleeping through the night within 2 months.
5. Establish a bedtime ritual for your baby, like reading a book or humming a lullaby so she associates bedtime with them.  My daughter used to hum and then drift off to sleep.  So she clearly associated humming with sleeping.  In fact, at four years old, I can still tell when she’s tired because she would all of a sudden start humming/singing to herself.
6. At 3 months, you may want to start trying to avoid immediately going to your baby when she cries during the night or as you put them to bed.  It’s tough to not immediately go to your baby when they cry.  A minute can feel like an eternity when you hear your baby crying.  At first, you may want to give it 5 minutes before going to her.  If you can’t last 5 minutes, try 3 minutes at first and work your way to 5 minutes.  And then over time, stretch the interval to 10-15 minutes before going into her room, calming her down and letting her cry another 10-15 minutes.  To calm her, you can try humming a lullaby or talking to her, avoiding picking her up, and then walking out of the room.  Repeat this until she falls asleep on her own.  Pick her up and comfort her (or feed her if necessary) only when all else fails.  Keep this up…it will work.

 We found that for 1-2 weeks at a time while she was teething, and even after she learned how to go back to sleep, she would wake up every night at around 2:30 AM crying.  She needed our comfort during that time to fall back asleep.  So we’d pick her up, hold her while sitting in the rocking chair, and sometimes hum her back to sleep.  After about 5-10 minutes, we’d put her back in her crib whether she was asleep or not.  At first, we feared she had regressed.  But it was only temporary.  You may find this will happen to your baby while they are sick, teething or have an ear infection.  A baby who is teething and/or has a fever and/or is not feeling well should be comforted immediately.

 By 4 months, in order to teach her to fall asleep in her crib while she is still awake, begin putting your baby to bed at night while she is still awake.  If your baby will only fall asleep if you rock, nurse and/or hum a lullaby, she will come to depend on being rocked, nursed and hummed to in order to fall asleep, so that when she wakes up in the middle of the night, she won’t know how to fall back asleep without your intervention.  

Stay tuned for my next post that continues on this topic, specifically in relation to awareness of the importance of sleep and setting up a support network before you have your baby as being the key to prevention of insomnia (and PPD).

Just a real quickie from me today.  If you haven’t already done so, please visit Postpartum Progress for the open letter to Time about postpartum depression in response to Time’s article written by Catherine Elton.   Read it and you’ll see why the article ignited me and others to submit letters to the editor complaining how it was misleading and how many facts were left out in support of the Melanie Blocker Stokes MOTHERS Act.

I know I said my next post was going to be about the importance of sleep for postpartum moms, but there are times that I cannot wait to get my thoughts–not to mention anger–out of my system (and onto this blog…after all, that’s what my blog’s for…to vent and share my thoughts with others).  What’s got me riled up this time?  I’ll let you guess (but then again, my title is a give-away, isn’t it?).   As many of my friends (and blog followers know), my #1 anger trigger is when people say things out of ignorance/stupidity/condescension/racism.   What falls under this category of anger triggers is when the media wastes its ability to reach out to mass audiences with the truth, and instead focuses on one thing, which is to generate sales and attract attention while distorting the truth and adding to the misconceptions (or myths) that exist about motherhood and postpartum depression (PPD).  

Check out  the Time article I am ranting about.  It’s about the Melanie Blocker Stokes MOTHERS Act.  And here is my letter that I sent to the editor on Friday in response.  I am sharing this with you because, quite frankly, I doubt anyone at Time would pay any attention to it.  Why would they?  After all, they chose not to include my interview in the article because I don’t say things that shock and disturb.  I’m only telling the truth from a PPD survivor’s perspective, who has taken on blogging and writing a book to join the growing numbers of women who are gaining the courage to share their experiences with others.

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Frankly, I am shocked and dismayed at this article, which shows a completely one-sided view with respect to the Melanie Blocker Stokes MOTHERS Act.  Catherine Elton only named an opponent but no advocates, despite the fact that she interviewed me and a couple of other PPD survivors who are active on the PPD blogging scene.  By failing to mention advocates, you are giving—whether intended or not—the appearance of a lack of support for this bill, particularly of women who happened to survive a perinatal mood disorder, happen to have their eyes wide open, and can see clearly how this bill would bring us from out of the Dark Ages and into the 21^st century in terms of public awareness and once and for all ending the myths that keep women suffering unnecessarily in silence.  

Passage of this legislation would benefit thousands of mothers in this country each year through an increase in public awareness campaigns, education, support services, and research to ensure early detection and treatment of perinatal mood disorders.   Those with a strictly anti-pharma agenda fail to see what this bill is truly about.  They are letting their hatred of medications cloud their ability to see the benefits and, even worse, imagine things that don’t even exist in the language of the bill—i.e., forced screening and drugging of expectant mothers. 

I am shocked that you would consider this fair and accurate reporting. This is but another example of another opportunity to educate the public about PPD completely wasted with attention-getting headlines and a biased focus that serve to prevent progress that’s so desperately needed with respect to public awareness of PPD.  If you think this article is helping mothers out there, you are dreadfully mistaken. 

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By writing an article about this bill, Time should have done so with all sides equally represented.  There ARE MANY supporters of this bill that are PPD survivors and friends and family members that saw what these women had to suffer through, and totally support this legislation.  Such a one-sided view, as this article was written in, only shows there might be some kind of bias on the part of the editor and/or author.  Makes you kind of think there is a hidden agenda….

It’s a shame that words of hate and anger on the part of the bill opponents–so much louder and attention-getting because they are so much more frightening (not in a good way, mind you)–can easily distort the truth.  In the long run, all this does is work against the very people this bill is trying to help…MOTHERS.