Colic, Sleep Deprivation, Inadequate Support as Risk Factors for PPD

Just a quick post about colic, sleep deprivation, and inadequate support for the new mom as key risk factors for postpartum depression (PPD). There are many topics I want to blog about, but it’s another case of too many ideas, not enough time.  Since these risk factors make up some of the crucial pieces of the puzzle of my PPD experience, and since the Babble post titled “DR. HARVEY KARP ON WHY HE BELIEVES PPD IS MORE COMMON THAN EVER BEFORE” by Wendy Wisner showed up on my Facebook feed today, I decided to do a quick blog post about it. This blog post joins my previous post about Dr. Karp and his 5S technique “Baby Fussy or Colicky? Try the Amazing 5 S’s!“, a technique that helps babies sleep and parents cope with colic.  Colic causes sleep deprivation and feelings of incompetence from not being able to calm your crying baby (due to lack of prior baby care experience and lack of adequate support/guidance provided by someone with experience).  I basically said the same things in my book.

Dr. Karp also believes the following, which are also points that I mention throughout my book:

  1. Sleep deprivation can change brain physiology in the amygdala by causing it to become more hypervigilant and a triggering of the body’s fight or flight mechanism.  This state can cause a new mother to feel anxious and remain in a constant state of alertness, fearful that something bad may happen to her baby.
  2. Self care is as important as caring for the baby…it takes a village….a health mom means a healthy baby
  3. A mother’s getting enough sleep and support = key to reducing the occurrence of postpartum mood disorders

The bottom line is new mothers MUST get adequate support.  But with many parents struggling financially and not being able to afford help (via resources like doulas) and family members experienced with baby care not living close by and/or are too busy to help, it’s no wonder there are so many cases of PPD.  Please see my past posts about the critical role social support plays in minimizing the occurrence of PPD here and here.

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Sleep is So Important, Especially to the New Mom

As soon as I saw the title of the conference slated for June 6th, “Sleep Matters: Effects on Maternal Mental Health & Infant Behavior,” I told myself I had to register for it.  And register for it I did.  The important of sleep–and the lack thereof during the first postpartum weeks–is a topic that is near and dear to my heart.  After all, insomnia was my first symptom that something wasn’t right.  That I was about to embark on a frightening postpartum depression (PPD) journey.

Dr. James Maas, one of the leading sleep experts, the author of Sleep for Success and the consultant to many a professional athlete/athletic team, was the first to speak.  And boy, was he one dynamic speaker…one of the best I’ve ever had the privilege of listening to!  He starts off confirming what we have probably all heard countless times before….that our society is comprised of sleep deprived individuals who don’t get the 8 hours of sleep a night recommended by the sleep experts; that those who sleep less than 6-7 hours a night are more prone to getting sick and have higher blood pressure due to higher cortisol levels.  Remind me to sleep more during the winter when the shorter days and resulting Vitamin D deficiency–not to mention, the greater number of people being sick, period–cause me to get sick on average once every other month.  The one main thing I took away from Dr. Maas presentation–other than the fact that I learned that Sara Hughes, 2002 ice skating gold medalist, attributes her gold medal win to his sleep advice–that as little as 15 LUX of blue light, like light emanating from smart phones, the iPad, e-readers, computers, and television, suppresses melatonin, the hormone that is critical to the regulation of your sleep-wake cycle.

Then there was Leslie Swanson, PhD and Roseanne Armitage, PhD, both from the University of Michigan.  A lot of the great information these subject matter experts covered in their separate presentations I already knew from the books and articles I’d read over the past years.  But what these presentations had in common with Dr. Maas’ presentation–which I wish I could’ve known BEFORE I had my daughter–was the importance of avoiding exposure to blue light within an hour of going to sleep, as blue light suppresses melatonin secretion (a hormone that induces sleep).  Exposure to blue light is best from the time you wake up in the AM and for the time you need to be up.  I had my daughter in December, which meant I had to spend my first postpartum weeks being exposed to the least amount of light of the year, with a 1/3 ratio of daylight (8 hours) to darkness (16 hours).  Yes, indeed, two reasons to hate winter:  cold and short days.  But I’m not sure a knowledge of blue versus red lights and how to use that information to help improve sleep would’ve helped me back when INSOMNIA hit me from left field when I didn’t even know what PPD was to begin with.

What’s a conference on perinatal mood disorders without the esteemed Kathleen Kendall-Tackett, IBCLC, a health psychologist, board-certified lactation consultant, La Leche League Leader?!  I’ve had the privilege of hearing her at practically every Postpartum Support International conference I’ve been to.  Like the previous presenters, Kathleen talked about bright light therapy. She wrote this Bright Light Therapy for Depression article for the Texas Tech University Health Sciences Center, for which she is clinical associate professor of pediatrics.   Among all the data she shared with us was the result of a study that showed that depression tended to occur at 3 months among mothers who had less than 4 hours of uninterrupted sleep.

What I also wish I had known BEFORE I had my daughter is that:

  1. sleep and depression are intimately connected,
  2. sleep deprivation is a risk factor for PPD, and
  3. getting 4-5 hours of uninterrupted sleep is critical especially to the new mother at high risk (in my case I was high risk due to the events leading up to the 6th week postpartum, especially when it comes to my childbirth complications, my being starved for 7 days, and inability to get uninterrupted sleep even from day one at the hospital because the staff was constantly waking me up through the night).

It’s reasonable to believe that sleep deprivation in a society of super-achieving mothers–mothers who feel they should be able to do it all (take care of baby, cook, keep up the house and round-the-clock breastfeeding) with very little to no help and inadequate amounts of sleep–has caused PPD to crop up in 1 out of 8 new moms!  This also applies to moms with no family nearby to help with the baby, as I previously wrote about in my post on the historical perspective on social support.

I can tell you from my experience that, and I’m confident many other moms feel the same, before my daughter was able to sleep through the night, when she was waking every 2-3 hours or in highly irregular intervals (she was not a great sleeper in the beginning until we determined she had to sleep upright for the first month or so, so we kept her in her car seat, and she had to sleep tightly swaddled–both of these things we had to learn through trial and error as I had mentioned in prior posts), my apprehension that at any minute, I would have to be checking on the baby and/or feeding her prevented me from feeling truly at ease and able to fall asleep as easily as my husband did each and every night for the first few weeks.  Had there been guilt-free care (i.e., no need to worry about my husband getting enough sleep because he had to work the next day) and an assurance that there was someone there to do the night time feedings each and every night until she could sleep through the night, I could’ve very well have prevented my PPD onset entirely.  That would only have been possible, however, if we had known enough to hire a doula ahead of time to spend the evenings with us for the first couple of months.

Speaking of apprehension, I had mentioned in my book how fatigue, depression and stress are highly interrelated in that sleep deprivation can trigger the stress response, which results in the production of stress hormone (i.e., cortisol).  Cortisol, in turn, causes a decrease in the level of the neurotransmitter serotonin.  A decrease in serotonin usually leads to insomnia.

I’d like to wrap up this post with a little yelp of excitement in that Kathleen Kendall-Tackett bought a copy of my book!  This woman has written more than 300 articles, authored/edited 22 books, was a founding editor for two scholarly journals, and served on the editorial boards of five others.  First Jeanne Watson-Driscoll, and now Kathleen Kendall-Tackett.  I wonder who’s next?

MY ONE AND ONLY

When I spotted the July 19, 2010 edition of TIME magazine sitting on the coffee table at my in-laws’ house this past Saturday, I was instantly drawn to the cover and the title of the feature article “The Only Child: Debunking the Myths.”    The intro lines of the article really grabbed my attention, with the typical setting that for some reason seems to be a common setting that kicks off many articles, both printed and on the web.  The setting is a supermarket.  Sometimes the exchange is between two women standing on line.  Sometimes it’s between the cashier and a customer.  In this case it was the latter….a mom, minding her own business, with her adorable, pink-cheeked baby seated in a grocery cart and the cashier.   Usually, questions asked at the supermarket pertaining to babies usually have something to do with the age of the baby, and if there are no other children present, whether that is the first baby.  Well, in this article, the cashier starts off the conversation with the latter.  If the answer to that question is “Yes” as it was in this case, then sometimes, the conversation steers toward comments suggesting that she ought to work on the next baby real soon, so that this one isn’t lonely and has a little brother or sister to play with, and to avoid the “single child syndrome” — the belief that single children end up spoiled rotten because their parents lavish all their attention on the one child, lacking social skills and selfish because they don’t have any siblings with whom to interact (and therefore no “sibling rivalry” experiences) and with whom to share their toys.

In all honesty, I didn’t finish the article because I already got what I needed from it, which is inspiration to write a post and share my experience with others who care to listen.   Then, I was inspired even more to make this post a priority when, on Sunday, I saw a tweet from @ArmsOpenGrace where she was saying that she was at a BBQ and couldn’t help but to compare herself with everyone else who all had 2+children, and she’d just had her first child not that long ago.   I tweeted to her: “I can’t help but wonder what it’d be like to have 2 instead of 1. I don’t even compare myself with others anymore. No point.”  So I proceeded to tell her that the TIME article inspired me to write my next post.  And here we are.

For strangers to be prying for this kind of information is a bit much, I have to say.  And it’s all based on this societal pressure to have more than one child, all thanks to Granville Stanley Hall about 120 years ago.   But I’ve learned to come right out with the truth just to cut the exchange short.   That really stops the conversation from getting further than it really has to.

I can’t tell you how many times I’ve had to experience the following exchange, similar to the one in the TIME article, from the time my daughter was an infant til now (and she is now 5-1/2).

Acquaintance/Colleague/Stranger  (A/C/S):  “What a beautiful little girl!  How old is she?”

Me:  [I would tell them my daughter’s age at the time]

A/C/S:  “Do you have any more children?”

Me:  “No”

A/C/S:  “So, when are you going to have another?”

Me:  “I’m too old.”

A/C/S:   “Nah, you’re not that old.”

Me:  “I’m a lot older than you think.  Did you know I was lucky to have her on my 2nd IVF cycle?”

A/C/S:  “I didn’t know that!  Well, why don’t you give it another try?”

Me:  “I can’t.”

A/C/S:  “Well, you succeeded before….”

Me: “I mean, I really can’t.”

A/C/S: [not wanting to give up]: “But you’re not that old.  Why not?”

Me [just so I can stop this exchange before I start to get nasty]: “Because I’m missing a critical body part.”

A/C/S: [not getting it but curiosity has gotten the better of them]:  “Um, not sure what you mean.”

Me:  “I. Have. No. UTERUS.”

A/C/S: [face falls after a few seconds, realizing finally what I’ve been trying to say]:  “Oh, I see.  I’m sorry.”

A/C/S: [conversation taking a sudden turn]: “Well, you are blessed with this beautiful girl.  You are really lucky to have her.”

Me:  “Yes, I know.  She’s my one and only.”

A/C/S: “You can always adopt, you know.”

Me:  “Yes, I know. But I am happy with just the one.”

And then, depending on who this person is and how comfortable I am with sharing my postpartum depression (PPD) experience with him/her, I may go on to tell him/her about my childbirth complications that resulted in my lengthened hospital stay, followed by PPD that started 6 weeks later.    A couple of people asked me if they thought that it was the realization that I could no longer have children that led to PPD.  I told them it was one factor, but definitely not the only factor.

Would I have wanted another child?  Absolutely!  When I was younger, I dreamed I would have four children…one more than me and my two brothers.   As I got older, I would have settled for three.    That was, after all, more than two…and two at the time just didn’t seem enough.   But then I got married late because it took me a long time to find “the right one” (and he was worth the wait!).  Not long after we got married,  I had to get surgery to remove a dermoid cyst, which my OB/GYN recommended to prevent pregnancy issues.   We got pregnant after months of trying, but only to have it result in an ectopic pregnancy that had to be terminated.  Then, after many more months of trying to conceive, we were encouraged to undergo IVF treatments.   After our 2nd IVF cycle, which thankfully succeeded, and we were well on our way with the pregnancy, I was praying deep down inside that I would be fortunate enough to succeed just one more time.  I was willing to endure one more, just so I could provide one sibling for my child.

When I woke up from my emergency partial hysterectomy, I felt so incredibly sad.   I was sad that I could not have another child.  I was sad I couldn’t provide my daughter a sibling.  I felt unwhole.  I was essentially missing an important piece of me.  A piece of me that would enable me to bear children.  It was so final.   Before, I had all my parts but they just weren’t working quite right.  There was a breakdown somewhere in the complex process that occurs behind the scenes–starting with the sperm swimming and finding a good egg to hook up with all the way through the time that there is a viable pregnancy.  And all I needed was some help (in the form of IVF) to prime up the process and improve my chances for a viable pregnancy that would carry to term.

In the hospital, after hearing the terrible news, I couldn’t help but cry.  But I couldn’t just wallow in my grief.  I now had a baby to take care of.  Since she was my only chance at having a baby, despite my pain and exhaustion, I was determined to do the best I could at breastfeeding her, changing her and holding her.  I was fine until my first PPD symptom, insomnia, appeared during the 6th week.  But in between childbirth and that 6th week, my body and my psyche had to endure so much fatigue and anxiety.  Six weeks of non-stop fatigue and anxiety finally caused my body to shut down.  I’ve endured a lot of challenges and anxiety in the past, but nothing that could compare to such a life-altering experience as childbirth and the weeks of adjustment that go with it.  And I was already starting in the negative, after having gone through what was referred to as a life-threatening procedure in which I hemorraged and lost 4 units of blood, on top of the following chain of events:

  •  traumatic delivery experience that resulted in a partial hysterectomy resulting in loss of ability to have any more children
  • negative experience in the hospital–e.g., constant sleep interruptions in the hospital, constant moving from one room to another and changes in hospital staff, multiple attempts to replace IVs in my arms/hands, food deprivation (I only had about 2 meals the whole week I was there….otherwise what I had were ice cubes for the most part, plus an occasional broth or jello), below-par treatment of certain hospital staff, searing pain (felt like someone was burning me) in my abdomen that came & went for 2 days after the surgery
  • constant sleep interruptions from the noises the baby made throughout the night, plus night feedings
  • baby’s bad case of eczema and cradle cap
  • baby’s one week colic

Sharing My Less Than Perfect Birth Experience

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.

How anyone could think that PPD isn’t real is beyond me

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?

How Hospitals/Docs and Magazines/Books on Pregnancy/Motherhood Can (and Should) Increase Public Awareness on a New Mom’s Need for Sleep

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….

Insomnia versus Sleep Deprivation in new moms (yes, there is a difference between the two)

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 sleepsInsomnia 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 2nd 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).