November is Prematurity Awareness Month – Join in blogging efforts to raise awareness on November 17, 2010

Premature birth is the #1 killer of newborns during the first month of life.  Each year 20 million babies–half of a million of them in the US– are born premature.  A baby that is born too early is not fully developed and thus cannot even suck and/or breathe on his/her own.   It’s simply heartbreaking.  

For those that survive the first year, all too many end up facing serious health challenges and lifelong disabilities.  What is alarming is the fact that the rate of premature birth is increasing (i.e., it has increased > 30% since 1981).  In half the cases, the cause of premature birth is not known, which is why we need to unite in our effort to raise awareness, raise funding and promote research efforts to prevent premature births! 

Here are a couple of things you can do to help promote awareness of this crisis:

1.      November is Prematurity Awareness Month®.  If you are a blogger, please grab a badge and post it on your blog for the month, as well as join other bloggers on November 17th to raise awareness of this crisis.   You can join in this event at Bloggers Unite and at the March of Dimes site.

2.  Ask your U.S. Senators to support the PREEMIE Act (S. 3906), a bill designed to increase research and education on preterm birth, by sending a letter to your Senators and tell them to act quickly on this March of Dimes priority.  To see details of the bill, click here.

3.  Sign up for advocacy alerts, which is a great way to stay informed on legislative developments.

Some of you who have been following my blog for some time and read my blog post last year on the same topic, the following is a reiteration, which I’m including again because I think it’s highly relevant……

What’s premature birth got to do with perinatal mood disorders, you ask?  Well, for starters, approximately 1 out of 10 women experience antepartum (antenatal, prenatal) depression (or depression during pregnancy), though unfortunately many cases go undiagnosed.  Research has shown that preterm births are twice as likely to occur for women suffering from prenatal depression (or depression during pregnancy). To complicate matters, antidepressants to treat prenatal depression have also been shown to contribute to premature births.  And let’s not forget that there is a high risk for postpartum depression (PPD) in women who give birth to premature babies, not only for those with prenatal depression—since depression during pregnancy in most cases will follow into postpartum—but also because the amount of anxiety, stress and exhaustion caused by having a baby in the NICU for an extended period of time can lead to PPD. 

In Deborah Sichel’s and Jeanne Watson Driscoll’s “Women’s Moods: What Every Woman Must Know About Hormones, the Brain, and Emotional Health” (pg 178),  “Anxiety, whether mild or severe, can…..harm the fetus.”  Per Sichel and Driscoll, high levels of anxiety can cause premature births, stillbirths, low birth weight babies, and other complications due to the reduced blood flow, and therefore flow of oxygen and nutrition, to the fetus that results from the constriction of arteries in the uterus when the mother experiences high levels of anxiety.  You need to be aware, if you don’t already know, that the fetus is connected to you via the placenta.  The fetus is basically a part of you.  Just as all the nutrition you get from your food passes between you and the fetus through the placenta, medicine that you take will pass through to the fetus.  Similarly, stress hormones in a woman’s bloodstream from chronic anxiety will flow through the placenta.  In severe cases, stress hormones can cause blood vessels in the placenta to contract so much that it can pull away from the uterine wall, causing hemorrhaging and premature labor.

BOTTOM LINE:  Depression during pregnancy can lead to premature labor and delivery, not to mention low birth weight babies.  Since antepartum depression and antidepressants can cause premature births, more research is URGENTLY needed for the early detection and treatment of prenatal depression, as well as to find ways to treat prenatal depression without harming the developing baby.

Text4baby – Maternal and Infant Wellness Info Via Free Text Messages!

I wanted to share this exciting news with you!  If you haven’t heard about the Text4baby initiative let me tell you a little bit about it.  This is a brand new, totally free and first health education program in the U.S. of its kind to use one of the most widely-used technologies in America–the cell phone– to deliver timely information on maternal and infant health to women through pregnancy and through the first year postpartum.

Signing up for the service is easy.  All you have to do is text “BABY”(or “BEBE” in Spanish) to 511411.  Those who sign up for the service will receive three text messages weekly on their cell phone.  The timing and duration of the text messages will be based on the woman’s due date.  Topics covered by the messages include—but are not limited to—birth defect prevention, nutrition and  importance of sleep for the expectant/new mom, depression (during pregnancy and postpartum) and the Postpartum Support International (PSI) toll-free number to call if an expectant or new mom (up to 1st year postpartum) feels sad anxious or hopeless, a reminder to schedule appointments with the pediatrician for checkups and immunizations, and breastfeeding (including a toll-free number to call for support in their community).

Yes, that’s right.  PSI is an outreach partner of text4baby, which means that texts related to mom’s mental health will connect women to PSI resources.  This ground-breaking inclusion of mental health messages in this program will help reduce stigma around, minimize risk for, and increase awareness about perinatal mood disorders.

Organizers hope this initiative can help decrease the number of premature births, which can be caused by poor nutrition, excessive stress, and smoking.  As I’d mentioned back in November during Prematurity Awareness Month, one in eight babies born in the U.S. is premature (coincidentally, postpartum depression rate is one in eight new mothers), and the rate of premature birth in America (approximately 500,000 a year) is higher than that of most other developed nations).  Premature birth is the #1 killer of newborns during the first month of life, with approximately 28,000 infants dying before their first birthdays.  For those that survive the first year, all too many end up facing serious health challenges and lifelong disabilities.  What is alarming is the fact that the rate of premature birth is increasing (i.e., it has increased 31% since 1981).  In half the cases, the cause of premature birth is not known, which is why we need to unite in our effort to raise awareness, raise funding and promote research efforts to prevent premature births!

With approximately 90% of Americans possessing a cell phone and texting especially prevalent among women of childbearing age and minority populations (who face higher infant mortality rates), organizers believe—and hope—that texting will prove to be an effective means of delivering maternal and infant wellness tips. 

Text4baby is made possible thanks to a unique collaboration of organizations in both the public and private sector, including wireless carriers, as well as federal, state and local agencies, like the White House Office on Science and Technology Policy and the U.S. Department of Health and Human Services.  The text4baby wireless carriers are voluntarily distributing the text messages to recipients at no chargeVisit the text4baby website for a complete list of sponsors and participating wireless carriers.

For more information:

November 17, 2009 – Blogging to Promote Awareness of Premature Births

They say that the reason for nearly half of all the preterm births–which amounts to 10 million babies– that occur each year is unknown.   While thanks to the miracles of modern technology and medicine, many preterm babies are nursed to health, the rate of preterm births is increasing, and all too many that are nursed to health face lifelong challenges.  Per the Bloggers Unite site, the rate has increased 31% since 1981.  Per the March of Dimes website, one in eight babies born in the U.S. is premature (coincidentally, postpartum depression rate is one in eight new mothers), and  the rate of premature birth in America is higher than that of most other developed nations).   I wouldn’t be a bit surprised if there’s a correlation between the increase in preterm births and the increase in fertility issues (refer to past post on infertility and anxiety/depression).

Just as PPD is more common that you realize, depression during pregnancy—or antepartum (or antenatal) depression—is more common than you realize.  Again, due to the lack of public education about this kind of perinatal depression, many women do not seek treatment because they think that feeling tired, having trouble sleeping, and experiencing mood swings, irritability, anxiety and weepiness are normal pregnancy experiences.  The key indicators of PPD—namely, persistent and debilitating sadness and other symptoms that interfere with your ability to function for longer than two weeks—would also apply to antepartum depression and should prompt you to seek help immediately.  

In Perinatal Depression: Hiding in Plain Sight – The Canadian Journal of Psychiatry. August 2007; 52(8), page 483 by Shari I. Lusskin, MD, Tara M. Pundiak, MD, Sally M. Habib, MD:

  • “[The] patient with antenatal depression often worsens postpartum in the setting of sleep deprivation and the stress of caring for the newborn.”  As I’d mentioned in my 11/9 post, since approximately 50% of women with antepartum depression will go on to develop PPD, you will need to decide—in consultation with your doctor—whether to take medication.  Whether to take antidepressant medication or undergo some form of alternative medicine (including therapy) while pregnant is a hard one to make and also depends on the severity of your depression–not to mention, taking into consideration the impact on the developing fetus.  Avoiding treatment altogether will only expose your developing baby to the effects of untreated depression and increase your risk for pregnancy complications and premature birth.  There is risk that untreated depression and anxiety during pregnancy can lead to poor nutrition from loss of appetite, self medication through substance abuse (drinking, smoking or drugs), and/or suicidal thoughts/behaviors.  Preterm births, low birth weight, smaller head circumference, developmental problems, and even infant deaths have been associated with anxiety and depression during pregnancy. 
  • Signs of fetal distress (i.e., alterations in heart rate variability, fetal movement patterns, fetal sleep-wake cycles) have been detected in pregnant women during their 2nd and 3rd trimester obstetrical visits, and studies seem to indicate that 2nd trimester anxiety may have a negative impact on fetal brain development.
  • “The fetuses of highly anxious mothers who had also scored high on depression and anger measures also had growth delays, compared with the fetuses of mothers with less anxiety.  Findings at birth for the same cohort included lower dopamine and serotonin levels, lower vagal tone [which is linked with poor emotion regulation and vulnerability to stress in infancy and childhood].  At age 8 months, infants exposed to antenatal anxiety were found to be highly reactive, to have poorer interactions with their mothers, and to have poorer scores on Bayley Scales of Infant Development [which is a standard series of measurements used to assess motor, language, and cognitive development of infants and toddlers ages 0-3].  At age 24 months, they were also reported by their mothers to have more sleeping, activity, and feeding problems.”

As I mentioned in my November 9th post, 1 out of 10 women experience antepartum (antenatal, prenatal) depression (or depression during pregnancy), though unfortunately many cases go undiagnosed, and as mentioned over at Postpartum Progress, research has shown that preterm births are twice as likely to occur for women suffering from prenatal depression (or depression during pregnancy).  Given the correlation between antepartum depression and preterm births, there should be an increase in public awareness of antepartum depression and not just of postpartum depression, which you hear so much more about—relatively speaking—than depression during pregnancy.  The following are needed if we hope to reduce the number of preterm births due to antepartum depression:

  • increase in public awareness and destigmatization associated with perinatal mood disorders, so women will recognize when there is a problem and seek treatment without hesitation
  • increase in research for earlier detection of antepartum depression
  • increase in research into safer/improved treatment options for antepartum depression. 
  • increase in public awareness of the effects of stress (and provide the spectrum of the range of stressors) on pregnancy

For more information about antepartum depression, check out this March of Dimes page and the Beyond Postpartum blog.

For more information about efforts to promote awareness of premature births, visit the Bloggers Unite and March of Dimes websites.  Many bloggers share their stories on the Bloggers Unite site.  There’s also the touching story about Charlotte.

Calling All Bloggers! November is Prematurity Awareness Month – Join in blogging efforts to raise awareness on November 17, 2009

Premature birth is the #1 killer of newborns during the first month of life.  Each year 20 million babies–half of a million of them in the US– are born premature.  A baby that is born too early is not fully developed and thus cannot even suck and/or breathe on his/her own.   It’s simply heartbreaking.  

For those that survive the first year, all too many end up facing serious health challenges and lifelong disabilities.  What is alarming is the fact that the rate of premature birth is increasing (i.e., it has increased 31% since 1981).  In half the cases, the cause of premature birth is not known, which is why we need to unite in our effort to raise awareness, raise funding and promote research efforts to prevent premature births!

If you are a blogger, here are a couple of things you can do to help promote awareness of this crisis:

1.      November is Prematurity Awareness Month®.  Please grab a badge and post it on your blog for the month.

2.      On Tuesday, November 17th, please join others to blog about and raise awareness of this crisis.   You can join in this event at Bloggers Unite and at the March of Dimes site.

What’s premature birth got to do with perinatal mood disorders, you ask?  Well, for starters, approximately 1 out of 10 women experience antepartum (antenatal, prenatal) depression (or depression during pregnancy), though unfortunately many cases go undiagnosed.  Research has shown that preterm births are twice as likely to occur for women suffering from prenatal depression (or depression during pregnancy). To complicate matters, antidepressants to treat prenatal depression have also been shown to contribute to premature births.  And let’s not forget that there is a high risk for postpartum depression (PPD) in women who give birth to premature babies, not only for those with prenatal depression—since depression during pregnancy in most cases will follow into postpartum—but also because the amount of anxiety, stress and exhaustion caused by having a baby in the NICU for an extended period of time can lead to PPD. 

In Deborah Sichel’s and Jeanne Watson Driscoll’s “Women’s Moods: What Every Woman Must Know About Hormones, the Brain, and Emotional Health” (pg 178),  “Anxiety, whether mild or severe, can…..harm the fetus.”  Per Sichel and Driscoll, high levels of anxiety can cause premature births, stillbirths, low birth weight babies, and other complications due to the reduced blood flow, and therefore flow of oxygen and nutrition, to the fetus that results from the constriction of arteries in the uterus when the mother experiences high levels of anxiety.  You need to be aware, if you don’t already know, that the fetus is connected to you via the placenta.  The fetus is basically a part of you.  Just as all the nutrition you get from your food passes between you and the fetus through the placenta, medicine that you take will pass through to the fetus.  Similarly, stress hormones in a woman’s bloodstream from chronic anxiety will flow through the placenta.  In severe cases, stress hormones can cause blood vessels in the placenta to contract so much that it can pull away from the uterine wall, causing hemorrhaging and premature labor.

BOTTOM LINE:  Depression during pregnancy can lead to premature labor and delivery, not to mention low birth weight babies.  Since antepartum depression and antidepressants can cause premature births, more research is URGENTLY needed for the early detection and treatment of prenatal depression, as well as to find ways to treat prenatal depression without harming the developing baby.

Forget the Myths, Here are the Realities of Pregnancy, Childbirth and Postpartum Experiences

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 6th 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.