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.

My Blog’s 5th Birthaversary and Info on PSI Zumbathon Fundraiser

Some people call it a Blogoversary.  Some people call it a Blog Birthday.  The French say “Joyeaux Anniversaire” for Happy Birthday.   I don’t really care much what it’s called.  I just know that both Blogoversary and Blog Birthday hold the same meaning, and my blog has been around for 5 years!  Woohoo!!!  Actually, five years and one day, since the momentous occasion was yesterday.  But I was too tired to blog last night…..anyway, I’ll just compromise and call it a Birthaversary.  🙂

In these past 5 years, I’ve seen an increasing number of personal experiences with postpartum depression (PPD) posted on blogs, on Huffington Post, on online parenting magazines, etc.  Seeing these articles gives me hope that we are reaching more and more people about maternal mental health issues.

At the same time, however, there are still stories in the news of how we–despite being in 2014–are still failing our mothers all over the world.  Sometimes, I think that it’s willful ignorance that keeps people in the dark.  And like the UK  case I wrote about recently, misguided priorities and inadequate training are still leading to mothers falling through the cracks.

I want to implore all PPD survivors, PPD advocates and medical/mental health professionals to make a more concerted effort to:

ISL_020714

Work together
Remember that a healthy baby means a healthy mother
Really focus on the mother’s well-being
Break down silos
Encourage collaborative care
Support mothers and discourage mom-petitions
Embrace the fact that there is no one right way to mother
Ensure there is increased public awareness and research initiatives to improve early detection and treatment
Encourage a culture of sharing and banish stigma

Before I end this post, I would like to share information about an upcoming Postpartum Support International (PSI) zumbathon fundraiser being held in memory of Cynthia Wachtenheim, a mother whose life was tragically cut short last March.  All proceeds from the event will go to maternal mental health public awareness and support.  I am proud to be a member of PSI since 2006.  It is an organization that is very much at the forefront of all of the positive efforts above.

One Step Forward, Two Steps Back – Maternal Matters

*** This post may be triggering if you are suffering from postpartum depression (PPD) and are sensitive to negative news events ***

I felt like blogging tonight.  Partly to keep my mind preoccupied so I won’t be nerve wracked all night, worrying about a presentation I have to give at work tomorrow.  Some of you know that I absolutely HATE public speaking of any sort.  HATE.  😦

As my regular readers may have noticed, I don’t rant much any longer….I’ve mentioned before that my years of book writing and blogging have been EXTREMELY cathartic.  I mentioned in my last post that I will continue to share what I feel to be newsworthy developments in research and media that demonstrate a continued forward momentum in the mission to de-stigmatize postpartum mood disorders and provide mothers with the care that is so desperately needed and is yet so lacking, still.  I will also continue to share interesting tidbits I run across from my daily reading material that comes up in my Facebook news feed or elsewhere.

Tonight’s post shows how –despite valiant efforts in advocacy, public awareness and mother support on the part of many, some of whom I personally know–for every one step forward that’s made, there are forces out  there that are ever so ready to drag us two huge steps back.  I would like to highlight two examples of barriers to progress that were mentioned in news articles in the past couple of weeks.

FIRST ARTICLE
This week’s announcement of the closing of the Shuswap Family Resource Centre’s Mother’s Journey Prenatal and Postnatal Support Group in British Columbia, Canada, is an example of how, despite the known benefits of having a postpartum support group, establishing and maintaining such groups within communities that don’t observe social support customs and rituals when it comes to expectant and postpartum mothers has been an ongoing challenge, mostly due to lack of funding.  The postpartum support group offered mothers education (including self awareness and coping mechanisms) and support on 25-week open-ended cycles, meaning that mothers were able to freely join or leave at any point.  Despite the realization of the importance of such a postpartum support group by healthcare practitioners and the community, and the simple fact that there were so many PPD cases and not enough trained individuals to provide the needed care, this center is closing its doors for good.  Even while it was open, because there was no other support group like this anywhere in the area, PPD moms generally had to wait several weeks just to see someone.  If a couple of days felt like an eternity for me when I was in the depths of my PPD, having a mother wait several weeks is simply unacceptable.  Postpartum support groups should be opening, not closing, their doors to mothers!

We need more postpartum centers that focus on the needs of mothers and ensuring there is adequate support in the first one to three months after childbirth. Early intervention and women-centered health initiatives and programs and support services need to be the standard of care rather than the exception!

SECOND ARTICLE
The title of the article is “10 reasons why breastfeeding is out of fashion,” written by Beverly Turner in the The Telegraph.  I don’t get why women in media–or actually in this case a journalist who reminds me a lot of the other political developments that pop up in my Facebook news feed everyday that make me wonder how we could be in the 21st century and still be faced with so many anti-women initiatives (but I won’t go into there because I KNOW how right wing versus left wing thinking can terminate friendships at the snap of a finger, and this blog is not a political, feminist, or pro-choice versus pro-life blog) –want to be a barrier to progress for women?  What she wrote made me sit there and re-read certain parts of her article, all the while scratching my head and going “Huh?  I don’t get it.  This makes no sense whatsoever.  And she’s supposed to be a journalist?  This article is so poorly written!  How could she criticize other women when she doesn’t have a clue about their experiences?”

Now, as for her so-called ten points:

1.   “Lack of post-natal care to help women establish feeding pattern.”
Sure, we need an overall increase in the availability of postnatal and breastfeeding support for new moms in the first 3 months.

2.   “Lack of high-profile role models breastfeeding.  This is why I implore the Duchess of Cambridge to get out her royal orbs when she has her first next month.”
I actually think there are a good number of celebrities that have announced that they are breastfeeding, or breastfed, their babies.  Granted, there could be more, but we have more now talking about breastfeeding than ever before. Honestly, though, did she have to refer to the Duchess’ boobs as “royal orbs”….?!   Does she sound like a man, or is it just me?  From this point on, the article goes downhill very quickly…..never mind very quickly, try at warp speed.

3.    “Noisy loons creating ‘Brestapo’ caricatures to appease their own consciences.  These women are oddly vocal contingents, who bring their own neuroses to public forums shouting that women ‘shouldn’t be pressured…rather than helped (doh!). They are the same crowd who shout ‘women who have caesareans haven’t failed’! rather than, ‘what the hell is wrong with a system that is failing so many women’? It’s oddly misogynistic.”
WTF?  Hypocritical much? I don’t need to go into this in detail because the fabulous, er, Fearless Formula Feeder has already blogged about this in a brilliant letter addressed to this, er, so-called journalist.

Reasons 4-6 and 8-10 may make sense being included on this list but the points she makes for each are weakly written.  Not even worth mentioning, really.

4.    “Reluctance to give time to our babies.”
WTF WTF WTF?  This screams mommy war completely.  How does she know what each mother’s experience is like?   Get this woman a huge dose of empathy, STAT!  I wish people like her who’ve never known firsthand what it’s like to experience PPD or other postpartum mood disorder and/or serious breastfeeding challenges would just keep their flapping and condescending lips shut.

There is a correlation between success in breastfeeding and PPD occurrence, which is why I think it’s important that as many of us that have been there–suffering from PPD and/or experiencing breastfeeding difficulties, and having very little support for either–speak up and have our voices heard.  Because without our voices, we will forever be taking steps backward.  We want progress!  Mothers should support each other, not bash each other!

LET’S KEEP OUR FOCUS ON THE FOLLOWING:

  • End the mommy wars!
  • More breastfeeding support can increase breastfeeding success.
  • We need more postpartum support groups, not close their doors!
  • If you can’t say something nice, don’t say anything at all!
  • Continue steps forward, no backward steps allowed!

Guest Post over at Mama’s Comfort Camp: Happy First Birthday!

MCCBadg_member
My friend Yael Saar is a mama on a mission to remove guilt and shame from parenting in order to make room for joy and love. She is the Founder and Keeper of the Mama’s Comfort Camp, a Facebook community that functions as a safe haven and refueling station for hundreds of moms from around the world. This community is free and open to moms of kids of any age, and we share our laughter, tears, and triumphs, all the while normalizing motherhood struggles and bridging the gap between expectations and reality in a uniquely nurturing environment.
I’m so happy to be one of the Campers, and I would love for you to join us.
Please check out my guest post written to celebrate the first birthday of the wonderful community that Yael and her Den Mothers have created.

Online Support Groups for Moms

Today is the birthday of a dear friend of mine named Yael Saar.  I promised I would write a blog post on her birthday, and I am just barely making it before midnight!

Yael is an amazingly kind, supportive, gracious, and caring individual that I have had the fortune of meeting first online and then recently at the Blogher12 conference in New York City.  She is the author of  the blog PPD to Joy and the founder/leader of a Facebook support groups for moms called Mama’s Comfort Camp, a closed forum consisting of over 300 moms from around the world who provide one another with encouragement, support, reminders to be kind to ourselves and a non-judgmental ear to listen and share the ups and downs of our parenting experiences.   It’s a place where moms can vent and seek advice on a situation with which they are experiencing difficulty (i.e., in-law challenges, childcare challenges).  There have been all sorts of posts, spanning the whole range of emotions from humor, elation and excitement to sadness, anger, concern, and anxiety.  Members have been encouraged to share pictures, stories and blog posts to help them get to know each other better. Yael calls the group a “refueling station: a safe haven of self care and self kindness for moms.” Hence, the name of the group.

Until I joined this group, I had no idea just how much company I have in terms of the feelings of being overwhelmed, fatigued, uncertain and anxious.  Yes, indeed, there are other moms out there with similar experiences as me.  I just needed to know where to look for them!  I didn’t join Facebook until 2009, and my daughter was over 4 years old already by that time and I no longer felt the need new mom support any longer at that point.  It’s great to see it’s not all just about mommy wars and moms competing with moms.  There are many supportive women out there.  Ideally, you should already have some in your life that are prepared to assist BEFORE you embark on your journey to motherhood.

I learned AFTER my postpartum depression (PPD) experience that:

  1. there are PPD blogs to provide support and help you feel less alone in your experience,
  2. social support is critical in the first weeks after childbirth and there are doulas and baby nurses for those who don’t have loved ones available to help in the first weeks postpartum, and
  3. there are PPD support groups (like Lauren Hale’s Facebook PPDChat Support group and #PPDChat on Twitter at 1:30 pm EST and 8:30 pm EST on Mondays), infant feeding support groups (like Fearless Formula Feeder and Bottle Babies), and mom support groups (like Mama’s Comfort Camp).

Oh, how I wish I knew about all this BEFORE my own motherhood journey began.  I could’ve used all these resources to help feel less alone, anxious, and miserable in thinking I was the ONLY mother who felt the way I did.   While everyone else around me gave the appearance that motherhood was a piece of cake, I felt like an utter failure right from the get-go.  As part of my commitment to spread awareness about PPD, I want to also spread awareness of these online support groups that are available as wonderful resources for new moms.

The Importance of Mothering the New Mother

Chinese call it Zou Yue.
Mexicans call it la cuarentena.
Greeks call it sarántisma.
Indians (Hindi) call it Jaappa.

Regardless of what it’s called or how long it is observed–be it 30 or 40 days–the goal is the same.  Taking care of the mother, so she can take care of her baby and get adequate sleep to recover from childbirth.

Many other countries in Asia, the Middle East, South America, and Africa observe a traditional mothering the new mother period.  40 seems to be a magical number, a number that has survived through the centuries and therefore has special significance….no doubt it has something to do with the fact that 40 days is the average length of time for a new mother’s body to recover from childbirth and return to a pre-pregnant state.  That is also why your OB/GYN will say to you once you’ve given birth that he will see you in 6 weeks.

The May 11th NY Times Well section included an article How to Mother a Mother by Tara Parker-Pope.  In it she talks about Claudia Kolker’s new book, The Immigrant Advantage: What We Can Learn From Newcomers to America About Health, Happiness and Hope and how practices such as la cuarantena can help Americans (if they are willing to learn from immigrants) to achieve–just as the title says–health, happiness and hope.

Cuarentena sounds like how the word sounds in English for quarantine, or a period of isolation for illness.  The term refers to the first 40 days after childbirth in which the female family members and friends of the new mother surround her and provide her and her baby with care, so that the new mother’s only focus is on getting rest and bonding with/feeding her baby. They also help around the house and prepare meals.  Certain rituals are observed that are similar to those observed by the Chinese Zou Yue, such as the preparation of certain foods, like chicken soup, to help keep her body/system warm, as chicken is viewed as a warm food.  Foods that are considered cold, like cucumbers, are avoided.  She is to be protected from feeling overwhelmed; hence, visitors are kept away (or kept at a very minimum) during this time (this is probably how the term la cuarantena was derived).  She is told to avoid bathing for fear of catching cold.  All these rituals have the mother’s well-being in mind.  I am rather surprised to see such similarities between the Mexican and Chinese customs….after all, the countries are nowhere near each other!  In terms of breastfeeding, female family members are on hand to teach her how to do it. In these other cultures, there is no expectation that the new mother know how to breastfeed instinctively and easily.  There is a reason behind the phrase It takes a village.

Since I blogged previously about the importance of social support and how through the years we seem to have lost perspective on things when it comes to the community coming together to help a new mother who has just had a baby, I won’t repeat myself here.  What I will say is–because we can’t emphasize it enough nowadays–that getting adequate social support–comprised of both emotional support (e.g., shoulder to cry on, listening non-judgmentally) and practical support (e.g., help with breastfeeding, cleaning, errands, laundry, taking care of the baby for a few hours so mom can take a nap or shower) IS CRITICAL FOR NEW MOMS.  Having enough support during the first 4-6 weeks–until your body recovers from childbirth and your hormone levels return to their pre-pregnancy state–can help keep anxiety levels down, help you get the rest you need from all the changes your body has gone through with childbirth, and minimize risk for postpartum depression.

Don’t be afraid to ask for help or accept help from your significant other, family members and/or friends.  Before baby’s arrival, you should try to line up 4-6 weeks’ worth of live-in help from a family member (mother, mother-in-law, sister) or at minimum help with night-time feedings those first few weeks is critical in allowing you to get adequate rest.  If you don’t have any family members nearby and/or willing or able to help, you may want to consider hiring a postpartum doula, if finances allow.  The presence of a doula that is experienced in infant care can help keep anxiety levels and concerns about infant care to a minimum, and provide comfort in knowing that both you and your baby are in good hands.  Click here to learn more about postpartum doulas and how to find one near you.

I devote a chapter in my book to the importance of social support, what social support entails, how to go about ensuring you get adequate support in your first postpartum weeks, postpartum rituals in various countries, and postpartum support services in this country (including support groups like Santa Barbara Postpartum Education for Parents, as well as doulas)–and unfortunate lack thereof and the trend of having postpartum doulas fill the void in support for new mothers.  I have Sally Placksin’s book Mothering the New Mother to thank for educating and inspiring me to write about social support in my own book and every chance I can get.

I started writing this blog post on Monday (late at night after my daughter went to bed), lost gas quickly and stopped.  I started it up again on Tuesday (late at night, again after my daughter went to bed) and lost gas quickly (the result of a combination of a long, stressful day and aging).  On Wednesday, I had a lovely time catching up with a good friend over dinner so I didn’t get a chance to write at all.  Just today, I happened to stumble across a website/blog named Mother Love Postpartum Doula Services that just recently linked up to me by way of its blogroll.  Thank you, Liz, for linking to my blog!    She happens to touch on the postpartum rituals I touch on in this post.  What fortuitous timing, as I just needed to finalize the post…and voila, I’m hitting the Publish button….now!

This Mother’s Day – Let’s Focus on What Really Matters

THIS MOTHER’S DAY – LET’S FOCUS ON WHAT REALLY MATTERS

What’s all this recent fuss?
This fuss with yet another ploy
By media to add fuel to the fire
Of moms who breast-feed versus bottle-feed
Of moms who attachment parent, the seemingly new trend,
And of moms like me who are like, what is attachment parenting (or AP) anyway?

Why the lingo?
Why the mompetition?
Why not community?
Why not support for each other?
Why don’t we honor mothers the way other cultures do?

Well, let me tell you why.
Our society is one in which the primary goal is success,
And who’s best at this or that.
Who’s best at motherhood.
Who’s best at their career.
Who breast-feeds the longest.
Who returns to their pre-baby body the quickest.

Our culture is more bent on pitting mother against mother
Than finding ways for them to support each other.
Through the years, our culture has lost its way.
Just think….
Why is good childcare hard to find?
Why is info on PPD so hard to find?
Why are support services for new moms so hard to find?
What are medical professionals who know how to recognize
And treat PPD correctly so hard to find?

Who gives a rat’s tush….
If someone breast-feeds for a few days versus three years?
If someone bottle-feeds because they choose to do so?
If someone bottle feeds because they and/or their baby had to have a….
Life-saving procedure
Or was sick
And had difficulty breastfeeding
And had very little support?
If someone does “AP” or doesn’t even know what the heck that term means
Does it really matter?
And why someone have to even come up with it in the first place?

Haven’t parents been parenting for thousands of years?
Babies have turned out just fine,
And in some ways, even better than they are today!
Were there electronic gadgets and fancy terms for childcare decades ago?
My peers and I grew up without all that
And I would like to think we turned out just fine!

If we want our babies to grow up fine
We feed, hold, kiss, hug, and interact (read/sing/play) with them.
We do the best we can given our personal situation.
Doesn’t matter how expensive our toys are
Or how fancy the name of the trend du jour is,
Or whether we end up bottle-feeding for whatever the reason may be.
Bonding will happen.
Babies will thrive.

Don’t give in to our society’s myopic ploy.
A ploy with a focus on situations that encourage moms to compete with each other.
A society with mothers feeling alone,
Mothers feeling stressed out,
And mothers feeling like they’re not mom enough.
A society that provides very little in the way of
New mom support services,
Comprehensive maternal health (mental/medical) care services,
And awareness campaigns to bust the stigma surrounding perinatal mental health!
And you wonder why the number of moms with PPD are one in eight!
We are bringing it upon ourselves!

What can we do to change things, you ask?
Let’s end the mompetition.
Let’s have moms be supportive of each other.
Let’s create support services to help new mothers and their families.
Let’s have a society that honors its mothers
Not just on Mother’s Day but always!

For all the moms out there, remember self care.
Without it, you cannot care for your babies.
They need you.
As long as you’re doing what YOU feel is right for you and your baby…
And given YOUR situation…
Then filter out all the media tactics and mompetitive attitudes…
Take a deep breath and repeat after me:
“I AM MOM ENOUGH, AND I WON’T FORGET IT.”

For all those who have a mom (or two) you care about
And will be celebrating Mother’s Day with her today,
Please remember (especially if this is a new mom) that the greatest gift
You can give her is emotional and practical support.
Don’t provide advice unless she asks you for it.
Do provide a shoulder to cry on if she’s having a rough day.
Do provide help so she can get the rest she needs
And/or time to do something just for herself,
And last but not least,
Remind her that SHE IS MOM ENOUGH AND SHE SHOULD NOT FORGET IT.

Happy Mother’s Day to all the moms out there!

A wish from one mother to another!

xx

Please Support MotherWoman’s Moms are Worth a Million Mission

Here we are, in the month of May already.  Spring….and Mother’s Day both come to mind.  I know, some of you out there think Hallmark when you hear “Mother’s Day.”  But I have to say it should be way more than that…

Tonight’s post is about….you guessed it…MOTHERS.  Not hard to guess, considering my blog is devoted to maternal mental health.  🙂  Mothers have the toughest, yet most rewarding job…. a job that in this society often gets taken for granted…and is an unpaid one at that.  After all, isn’t being a mother an instinctive, no-brainer kind of thing? <shaking head vigorously>

My post from last night mentioned motherhood myths and societal attitudes that don’t help, but rather make motherhood all the more challenging.  The end result is that the new mother often finds herself isolated both in terms of perception and in reality when it comes to having adequate social support.  The motherhood myths, societal attitudes, and social support are things I actually tackle in depth in my book….and I might add, with great relish.  Because I really LOVE to combat false notions that are detrimental to mothers!

Today’s post is about MotherWoman’s latest mission….and what better time to announce as Mother’s Day approaches!  I can’t agree more with the following, which lies at the very heart of that mission:

When you support a mother, you uplift her family.
When you uplift a family, you strengthen their community.
When you strengthen a community, you change the world.

The theme is the same as what I’ve said before and I’ll be happy to say again:

A healthy and happy mother means a healthy and happy family.

Isn’t that the truth?  Yeah, you know it!!!

MotherWoman’s latest mission, which I think is absolutely critical, is to raise $10,000 for scholarships by July 2nd to enable 25 community leaders and professionals working for nonprofits to take a 3-day MotherWoman Support Group Facilitator Training to learn how to provide peer-led support to moms.  This year, the training is taking place in Massachusetts, New Jersey (in June…I plan to be there), Washington, and Guatemala.  There have been requests for training in other locations, which is a wonderfully encouraging thing to hear, because we so desperately need more support groups for mothers out there!!!!  Coincidentally, I was just saying this in my post last night!

Please take a few minutes to watch this video and hear about the impact this project has had on four mothers and how they are now giving back to other mothers by leading MotherWoman Support Groups in their communities.

 

Please consider helping to support the project by donating and/or spreading the word about this mission to others on Facebook, Twitter, your blog, via email, or even in person!

Click here to donate and see some of the neat perks to donating.  Any amount would be appreciated! 

Also, if you are interested in applying for a scholarship yourself, contact Liz@motherwoman.org.

Parenting…..It Takes A Village

Here’s my second quick blog post for today.  This one was inspired by a good article titled “My Parenting Village” that I stumbled across that was posted last June by Ann Douglas on The Life Channel Network.  Ann writes about her experience as a mother for the first time and how she found that the secret to parenting success is accepting help and advice from other parents/friends/neighbors.  She participated in parenting support groups, used daycare services, looked to her neighbor for help/advice, and formed friendships with other new parents. 

I love the following:

After all, it’s not enough to care for the child: the village needs to care for the parents as well, by creating a place where support can be offered and information can be shared. It’s such a simple idea: investing in parents and children. And the dividends are incredible: brighter futures, happier families, stronger and more stable communities.

The article doesn’t touch on what happens when the stress of being a first-time mother, as well as inadequate social support, can be a major factor in postpartum depression (PPD). I devote a whole chapter in my book on the topic of social support–including what it entails and the history of it in this country (including the whole “village” approach of older generations) versus other countries–and many other relevant details including biopsychosocial risk factors of PPD, and advice–all of which I wish I had known about BEFORE I had my baby.  Having that knowledge might have prevented me from succumbing to PPD.  Consider buying a copy (soft cover, e-book and hard cover versions available for purchase via Amazon, Barnes & Noble, and other online retailers).  Thank you!  🙂

Group Approach to Prenatal Care…Start of A New Trend, Hopefully

I realize its been 2-1/2 weeks since my last post. …yikes!  Time flies…as we know all too well!  I’ve been caught up with a lot of things going on at work, home, editing my manuscript, celebrating Chinese New Year, etc.  Yes, Chinese New Year….the Year of the Rabbit.  For all those who observe, may it be a year of good fortune, happiness, and above all, good health!    The Chinese New Year festivities period began on February 3rd and lasts 15 days, until February 17th.  新年快樂! 恭禧發財!

I have been out of the loop for the past couple of weeks and only stumbled across a tweet from Amber Koter-Puline regarding a Delawareonline.com article titled “Building A Sisterhood Among Moms-To-Be” that caught my attention.  Why did it catch my attention?  Well, specifically, the word “Sisterhood” caught my attention.   This is, I feel, so lacking in this society.  A society that used to be more about social support of new moms and their families during pregnancy and postpartum and is now based on a model of competitiveness, do-it-yourself, and the ever prevalent supermom myth.  And let’s not forget the 2-minute visits with the OB/GYN too.   The model upon which society and women’s healthcare are now based is, quite frankly, pitiful.

So, take a few minutes to read through that article and see if you agree with me that we need to have more of this type of approach in not just prenatal care, but postnatal care as well!   The article tells us about the Christiana Care’s Smyrna Health & Wellness Center and its group approach to prenatal care and how its patients feel.   It’s important for a woman who’s pregnant, especially for the first time, to feel empowered, confident and prepared, rather than apprehensive and feeling like she’s all alone in that apprehension.  To be able to participate in a group setting where advice and thoughts/feelings/concerns of other pregnant women are shared is extremely valuable and reflects the way it used to be when society was more social support-oriented.

They refer to their approach as Centering Pregnancy, which focuses on not just medical care but education and support…again, what you would’ve found back in the days of social support in days gone by (and in other cultures today).   This program, which is optional to patients of the Center, is limited to about a dozen women at a time and is comprised of 10 visits altogether.  These women would begin at around 4 months into their pregnancies.    Each appointment in the program takes about 1.5 to 2 hours.  In addition to the one-on-one time with the healthcare provider going over test results and other concerns, patients spend the majority of their time in the program with other pregnant mothers, listening to and sharing experiences with each other.  Healthcare providers also provide presentations to the group of women on topics related to pregnancy and wellness, including breastfeeding, nutrition, and postpartum depression (PPD).  Yes, even PPD!   

The benefits to such a program are many, including the fact that healthcare providers don’t need to repeatedly go over pregnancy and wellness topics individually with each patient because the information is provided all at once to the group of women in the program.  It’s important to note that there has been a reduction in the number of pre-term births for mothers enrolled in the program….I’m sure due to the lower anxiety levels in these mothers, as there is a correlation between high anxiety levels and pre-term births.   Additionally, many of the women become friends with each other during the program and stay in touch–even arranging playdates for their babies– after the program ends for them.   What I’d be interested in finding out is if there has been a reduction in the number of mothers with PPD as well…..though,  I have to say that I wouldn’t be a least bit surprised, since there is a correlation between high anxiety levels and PPD.

We DEFINITELY need more of these prenatal programs across the country IN ADDITION TO postnatal programs like Santa Barbara Postpartum Education and Support (SBPEP).

We Need More PPD Survivors Speaking Up Like This and Trying to Make a Difference

A very, very brief post tonight, as I wanted to share this article by my friend and Program Director of MotherWoman (MA), Liz Friedman who’d recently won for her submission to the TED Women Contest

I’d like to highlight the following excerpt from the article:

It is one of the most incredibly well kept and unfortunately well kept secrets that we have about the postpartum period. We think it is all happy. We think that we will be joyful and supposed to be loving our experience as mothers. It is not the reality. One in eight mothers experiences postpartum depression.

The MotherWoman vision is to have a postpartum support group for every 2,000 mothers across the country. Their goal is to ensure no mother goes without the support they need to get through PPD.  These are truly wonderful goals that are so desperately needed in our society today, due to our lack of a social support model that–with family living farther and farther apart, more and more women with careers and fewer neighbors being available to provide community support — used to be much, much more prevalent in this country.  Not to mention our societal view–or myth, if you will–of the perfect, or super, mother. 

Click here for more about MotherWoman, including its mission, philosophy, and Mother/Postpartum Support Groups.

Please go to my previous post on Social Support and why it makes such a difference for new moms to not only have adequate practical support but emotional support as well in the first  postpartum weeks.

Brava, Liz!  You and MotherWoman are such great inspiration for other PPD survivor mamas!  Thank you for taking your own experience and wanting to make a positive difference for other mothers! 

Evolution of Midwives & Doulas to Fill the Void in Postpartum Support

I am a full believer in the benefit of doulas–both birthing and postpartum doulas.  Had I known about them, I would have considered hiring one or both.  I definitely regret not knowing about postpartum doulas, especially while I was suffering from postpartum depression (PPD)!

Following is why…and this goes hand in hand with one of my older posts, which happens to be about the importance of social support, the increasing gap that doulas happen to be filling in this country.

If there are no relatives or friends nearby that can help during the first few months, and if finances allow, consider doing the following as an investment in your mental health:  1) hiring a cleaning person once a month, 2) hiring a doula that can provide both practical support around the house and with the baby, and 3) ordering out a few nights a week.  Even if you and your husband have always been adverse to ordering out and hiring a cleaning person or someone to come into your home to care for your baby, now’s the time to be open-minded and explore other options you may never have considered before.  While continuous social support during childbirth has been in practice in other countries for centuries, the increase in doulas in this country is occurring due to the decrease in support provided to mothers from their extended families.

Until I started reading up on postpartum depression a few years back, I didn’t even know the difference between a midwife and a doula.

  • A midwife is medically trained to perform vaginal exams and deliver babies in either a patient’s home or in the hospital.  A doula is not medically trained to perform clinical tasks and deliver babies but instead is professionally trained to provide support during labor and after delivery in terms of childcare.
  • The word “doula” comes from the Greek word for the woman who helped the lady of the house during and just after childbirth.  [Mothering the Mother by Klaus, Kennel & Klaus] The word has come to refer to a woman who provides physical, emotional, and informational support to the mother before, during, and just after childbirth.  If you don’t know of any doula services in your area and your pediatrician and friends can’t refer you to one, it would be helpful to check out www.dona.org, the website for Doulas of North America.

Taken straight from DONA International’s Position Paper on the Postpartum Doula’s Role in Maternity Care, 2002:

“In traditional societies women and men grow up around birth, breastfeeding, infants and children.  After giving birth, women are surrounded by caring family members who have a great deal of experience and wisdom to offer.  This kind of help is rarely available to new parents in North America.  The doula’s support is intended to fill the gaps left by our customary postpartum practices, which usually include only medical procedures, occasional checkups and the purchase of baby-related paraphernalia.  The doula’s education, quiet support and guidance are a manifestation of the traditional postpartum support that our society is missing.”

Through the training that doulas receive through DONA International, they become knowledgeable about the physiology of labor, emotional needs of a woman in labor, infant care, breastfeeding and even postpartum mood disorders.  Doulas are trained to enter into the homes of new parents, providing them with any help they require, including the following:

  • Assist the woman and her husband to prepare for and carry out their plans for the birth.
  • Stay by the woman’s side during labor to help provide comfort during labor by way of massage or continuous reassurance, as well as facilitate communication between the woman, her husband and the doctor and hospital staff.
  • Provide guidance with adjusting to parenthood
  • Provide training on the basics of baby care and addressing concerns as they come up, like colic, cradle cap or eczema
  • Take care of any other children in the household
  • Provide guidance with breastfeeding and/or bottle feeding, including latching techniques, quantity of milk or formula intake, feeding schedules, what type of formula to use, what type of bottles and nipples to use, how to pump and store, and what to do when/if the baby has gas, reflux or spits up
  • Provide non-judgmental emotional support/companionship
  • Help with the baby whenever the mom and/or dad need to sleep/rest or even to take a shower
  • Help around the house, including cooking, cleaning, laundry, answering phones, taking messages and fielding visitors
  • Help with errands like shopping for groceries
  • Provide referrals to professional/community resources like doctors, therapists and/or PPD support groups, if necessary

Ultimately, the doula’s role is to help ensure the childbirth experience is as positive, easy and stress-free as possible. Having someone in your household who is experienced with baby care can provide the first-time mother with a much greater sense of security.  Knowing someone is there with you providing nonjudgmental guidance and addressing any concerns that come up can boost your comfort level and lower your anxiety level.  Other benefits of having a doula include:

  • Increased breastfeeding success
  • Content baby and better overall infant health (e.g., less issues with colic)
  • Moms get more sleep, which helps with postpartum recovery and prevention of PPD.
  • Studies have shown that having a postpartum doula can help reduce PPD rates.  The new mom can get more sleep, get help with breastfeeding and feel comforted knowing there’s someone in the house with them that is experienced with childcare (i.e., no need to feel anxious in terms of what to do).

Hey, if you were asked if you’d prefer to read a book or have a human being with experience in baby care show you what to do, address your concerns/questions as they come up, and help you transition into parenthood for the first time, which would you choose?  I would choose the latter, hands down.  In fact, had my husband and I known about doula’s and how they would benefit us, we would have hired one.  In all likelihood, having a doula would’ve helped keep my anxiety levels down and PPD may not have reared its ugly head.

The new parents would learn about PPD early, and the knowledge can reduce feelings of isolation and despair, if PPD were to occur anyway, despite all of the doula’s help. Having a doula that provides reassurance, encouragement and guidance from the very get-go, when a woman is at her most vulnerable, provides the best kind of start to motherhood there is.  It paves the way for a better motherhood experience overall.  The whole family—the mother, the baby, the father and any other children—benefit from having this kind of support.

You would think such services would be valued by society and the healthcare system, but they aren’t.  Insurance companies don’t typically cover the cost of doula services.  Hopefully, one day doula services are accessible to everyone who is in need of those services.  In order for that to happen, some sort of insurance reform needs to occur so that families who wouldn’t ordinarily be able to afford doula care can have access to it if need be.  Society should encourage and support anything that helps ensure families start off on the right foot, such as the work of a doula.

Moms Being Supportive Rather Than Judgmental With Each Other

When I saw Liz Szabo’s tweet about her recent article on USA Today titled “Why do mothers judge one another and their parenting,” I knew I had to write a blog post about my thoughts on just how easy it is for others around the first-time mom to hurt her feelings, especially if she has postpartum depression (PPD).  This applies to the comments they make and the advice they give—some of which can appear to be critical, condescending, competitive and/or judgmental to the new mom.  Subsequent to this post, I stumbled across this article over at Dailymail over in the UK titled: “School gate battle of the competitive mums as two third admit to out do each other.”  Here are excerpts from the article:

Two-thirds admit to boasting about some aspect of their child’s precocious development, from classroom achievements to the more basic skills of walking and talking…..The study of 3,000 mothers revealed the main area of contention is child development, with nearly half admitting they are obsessed with having the first baby to crawl, walk and talk.  Thirty-nine per cent say they can’t help recounting their children’s individual achievements, and a third make a special effort to clean their house if other mothers are expected to visit.  Losing weight after giving birth is another area of rivalry, with 27 per cent of mothers admitting to post-natal crash diets and exercise regimes, while a fifth try to be better dressed than their daily ‘competitors’.  Four in ten admit they are jealous when others appear to be coping with motherhood better than them, with the same number avoiding particularly successful mothersto prevent feelings of inadequacy.

A spokesman for market research site http://www.MumPoll.com, which carried out the study, said: ‘Mums put an awful lot of pressure on themselves to be the best at everything.  ‘But it is impossible to have a perfect house, an attentive husband and make the greatest sponge cakes the town has ever seen all the time. And yet, ridiculously, mums everywhere are trying to do just that.  Mums need to remember that as long as the child feels loved and well cared for, they’ve done a fantastic job.’

TOP 20 AREAS OF COMPETITION

1. Being the first to crawl, walk, talk

2. Child’s achievements

3. A clean and tidy house

4. Losing weight after giving birth

5. Being organised

6. Potty training

7. Helpful husband

8. Being the best dressed

9. Having the best baby clothes

10. Throwing fantastic birthday parties

11. Romantic trips away

12. Lack of sleep

13. Earnings

14. Ability to breastfeed

15. Being unflappable when other mothers come to visit

16. Deciding to be a ‘hands on’ stay at home mum

17. Still having a great social life

18. Buying great presents for other people’s kids

19. Owning the best baby toys

20. Still enjoying great sex 

What may or may not explain the behavior of some—but definitely not all—mothers is this quote from Susan Maushart (pg 25) in her book The Mask of Motherhood: How Becoming a Mother Changes Our Lives and Why We Never Talk About It :  “[A] woman’s sense of personal worth as a successful mother is often enhanced by the perceived failures of others.”  Compounding the problem is that, for some reason that has a lot to do with human nature, women seem to feel compelled to brag about their children (and indirectly their mothering capabilities) and play what I call the “one-up game.”  The “one-up game” is where one mother—it may be a friend or merely an acquaintance from, say, a mommy and me class—will try to one-up you with respect to some kind of milestone from smiling to sleeping through the night, rolling over, sitting up, crawling, first words, standing up, walking, or potty training.  If you say your daughter just took her first steps on her own, the other woman will say, “My son did that when he was only 6 months old.”  In my opinion, these mothers do that because deep down they are insecure and by hearing these words spoken out loud and knowing they’ve successfully one-upped someone else they’re able to temporarily boost their self-esteem.  These women seem to believe that there is a correlation between these milestones and their child’s intelligence.  Why can’t mothers be supportive of each other rather than treat each other as rivals?

Moms with PPD tend to be more sensitive, their feelings will hurt more readily, and they will be more prone to feeling unimportant. She will tend to lack self confidence especially with respect to her new mothering responsibilities.  

Here are some ways moms can be more supportive, rather than judgmental, with each other:

  • Try to be as sensitive as possible, as she may mistake your advice for criticism in her first attempts at taking care of the baby.  The first-time mom has the tendency to be sensitive to remarks people make about her mothering capabilities.  The mom with PPD will tend to be even more sensitive than the mom who isn’t depressed.  The first-time mom who also has PPD in most cases lacks self confidence when it comes to taking care of the baby and needs guidance and reassurance that she’s doing a good job.  This reassurance will be especially important if she decides to take medication and feels bad that she will need to stop breastfeeding (remind her that her health is very important to you).  It’s important to keep in mind that words have the power to heal or hurt; the power of words will never be more evident than during the postpartum period. 
  • Only offer advice when it’s asked for.  Unsolicited advice can aggravate the situation for a mother who is already feeling insecure about her mothering capabilities. 
  • Don’t try to force any advice on her in terms of how to care for the baby you may think you’re trying to help her because you happen to have experience while this is her very first crack at being a mom.  However, a PPD mom—especially a first-time mom—will tend to be highly sensitive and low in self confidence with respect to her mothering abilities.  Correcting her or telling her she should do it this way, not that way, will make her feel more unsure of herself. 
  • Last but not least, don’t pass judgment on anyone, and that includes a mother you may or may not know well who seems not to be doing so well in the weeks following childbirth.  Unless you’re that other mother, you do not know what she’s going through.  Unless you’ve had a baby with reflux, colic, eczema, cradle cap and/or food allergies, you should refrain from any criticisms about how the mother of a child with one or more of those health challenges are coping.  I dare not dream for everyone to adapt the attitude of being helpful rather than judgmental.  It’s like longing for world peace.  We dream of that but know in reality it is unlikely to happen.  Whether a mom decides to bottle feed versus breastfeed, co-sleep or not co-sleep, stay home versus return to work and put their child in daycare is her business.  

Women with PPD Need Support, Not Hurtful Comments

I didn’t have plans to post again so soon, but something has come up that I have to write about.  It’s bothering me that much.   For those who have been following me for some time, you know what my peeves are.  Yes, indeedy….remarks made out of ignorance and condescension, and what I refer to as “Meow” behavior (I can say worse things but you get the picture….if not, consider the claws coming out and being mean for no reason other than to make themselves feel more superior by putting someone else down…downright nasty).  Oh, and for guys to attack women with PPD….there are just no words for that other than you should be ashamed.

TO THE MOMS OUT THERE WITH PPD:

If ever you feel like you’re at the end of your rope–and believe me I’ve been there before and it’s a dreadful experience I would not want to wish on anyone–please know that there are resources out there.  You are NOT alone in your experience.  You may feel like you are, but you aren’t!   Here are some support options (other than loved ones, like your spouse, parents, friends):

  • Give Postpartum Support International a call.  This is their toll-free warmline #:  800-944-4773. 
  • Leave me a comment here on this blog, and I will get right back to you.  I am a PPD survivor, and I know what it’s like to have PPD. 
  • Visit the blogs I have listed under my PPD Blogroll.  These are blogs of PPD survivor moms and moms currently going through PPD.

You do need help.  You do need support.  There are still SO many people out there who don’t get it and cannot empathize.  Grant it, it’s hard for someone who’s never been depressed to understand someone who is suffering from depression, but that is no excuse to belittle or hurt someone with their words and actions (or in this case, refusal to be supportive).   Knowing that these people don’t know what the heck they’re saying, you just need to be strong and IGNORE these comments.  Shrug them off.  I know it’s easier said than done, but don’t let anyone’s words get to you.  And be sure to get the help and support you need from people who know better.

I know what it’s like to be feeling so at the end of your rope that you just want to disappear into thin air, run away, or blink like a genie and all will be fine and back to the way it was before your PPD took a hold of your life.  Do not give up, do not let other people’s words (sticks and stones…) convince you into thinking that your children will be better off without you.  They need their mother.  With the right help and some time, YOU WILL BE WELL AGAIN!

TO THOSE WHO CARE ABOUT THE MOM WITH PPD:

Don’t minimize the thoughts and feelings she shares with you.  Doing so will only make her feel ashamed and want to hide her thoughts and feelings, which will only make her feel more isolated, hopeless and desperate than ever.  Don’t trivialize what she is going through or use any expressions that imply that all she has to do is try harder to get well.

MORE IGNORANT COMMENTS ABOUT PPD:

Amazingly enough this is banter I picked up on a site that is supposed to be for mothers and about mothers.  What ever happened to mothers supporting mothers, anyway?  The purpose of blogs, at least for most people I know, is to provide a forum to express (and share) one’s experiences, thoughts and feelings.  That’s the reason why I created mine…other than the fact that there needs to be more PPD survivors blogging to increase awareness about this all-too-often misunderstood and consequently stigmatized condition that all-too-many women find themselves experiencing (1 out of 8 new mothers).  When a mom is in trouble and expresses herself, that takes courage and her reaching out like that usually means she is looking to get reassurance that she is not alone and encouragement that she will get past this.   However, for a mother who shares what she’s going through– only to get criticized–well, this is precisely the reason why women who suffer from postpartum mood disorders keep quiet about how they’re truly feeling and what they’re truly thinking.  With human nature the way it is–always easier to attack than to be empathetic–the stigma of mental health issues will never go away. 

Here are sample comments from people who don’t get it (and should attempt to learn a thing or two about PPD before opening their mouths).  This in addition to—and even worse, I have to say, than–the ignorant comments I posted about last November.

“I get the PPD thing, I really do.  Depression sucks and it hurts.  But you make your own decisions, and you control your actions.”  – Um, yeah…like you really understand PPD?  Right.  You don’t control your decisions and actions if your mood disorder is severe enough. It’s always easy to say what you would do if you were in someone else’s shoes, but it doesn’t work like that.  Those suffering from PPD need help and support, not criticism or to be judged by others who haven’t the foggiest what these women are going through.    You obviously have never suffered from or have any real knowledge of PPD and what it can do to a mother.  Until you do, you haven’t a clue.  People without a clue shouldn’t be claiming they know all about PPD.

“She is playing victim/martyr whatever you want to call it, and letting PPD be the scapegoat for her actions.” – Um, okay…..since when did you become the expert on other people’s lives that you can say with so much certainty why they’re behaving the way they are?  Until you can say that you are either a PPD survivor or expert on PPD, then keep your mouth shut rather than go bashing someone like that. 

“She is absolutely miserable. Like, I wouldn’t be able to stand to be around her for 10 seconds miserable.  I cannot have an ounce of sympathy for a person who appears to enjoy her own misery.” – Hey, if you were depressed, you would feel miserable too.  You obviously have never been depressed.  Until then, keep your ignorant comments to yourself. 

“She has no accountability to anything. Hopefully she can get some help and realize she is the problem not her children or her husband.”  For crying out loud, who made you judge and jury?  How hard is it to give people the benefit of the doubt?  Innocent until proven guilty?  Pass kindness forward.  Or is asking this too much and is as futile as wishing for world peace?  Sometimes it feels that way to me.  HOW SAD.

“The husband isn’t so much avoiding parenting the kids, but avoiding HER misery.  I think he’s a douche for a reason.   She’s like a perpetual victim.  First it’s oh my infertility, then it’s oh my pregnancy. I don’t blame him for being a jerk if every time he walks in the door she collapses into a heap of everything sucks”.   – This sounds like me, does this make me a perpetual victim too?  Just because I don’t put all my complaints, thoughts, etc. for all the world to see on my blog and I don’t tweet them either, doesn’t mean I don’t feel down about my life every now and then.  Whose life is perfect, anyway?  The way and extent to which someone chooses to let their thoughts be known to others is different from one person to the next.  Only my husband knows how much I suffered through my infertility and nightmarish childbirth experience– and then of course my PPD–and he knew my concerns about my pregnancy.  Until you’ve had a series of health issues, infertility issues, difficult pregnancy, traumatic childbirth experience–or PPD for that matter– keep your criticisms of other people to yourself.  Do you really know without a doubt what another person’s private life and circumstances are like?  Have you installed a camera in their house?  Has there been a reality show about them that I wasn’t aware about?  With one baby (or multiple children) to take care solo, it’s not unreasonable for the mother to ask for help from the husband, even if he has spent a day at work.  After all, she has spent a whole day taking care of her children.  That is, after all, work.

Here is an excerpt from my hopefully soon-to-be-published book…I’m sharing it right now because I want to show you that the PPD mom is NOT alone in feeling like disappearing/running away, guilty feelings, desperation for support, understanding and reassurance from your spouse:

Without actually demonstrating to you what I have been trying so hard to forget, you can never know how scared I was, how each day I was getting progressively worse, and I thought it was possible that I would never survive this experience.  So many days, I spent so much time staring out the window, looking up to the heavens praying for help from God to get me through this, or standing in a room staring into space, sitting in bed and rocking back and forth trying to comfort myself when I was alone in the house with the baby, just wanting to scrunch up into a tight ball and hide in a closet, corner or some small space, or just plain disappearing….anything to get me away from the awful feelings I was experiencing

Usually, I am always complaining about how quickly the days, months and years are flying by.  But during my darkest days, time went by so agonizingly, unbearably slow before my husband came home from work each day.  Minutes felt like hours.  Hours felt like days.  After my husband left for work each day, I was fearful of not being able to make it on my own during the hours I had to be alone with my daughter.  He generally made sure to come home by 4:30.  I can’t remember how many times I had to call my husband for comfort and to see if he could come home early to help out with the baby.  He was the only one I could confide in about my true feelings.  He was my lifeline.  Without him, I don’t think I ever would have made it through the darkest moments of PPD.  Many times, he did come home early.  I felt exhausted and so, so scared of my predicament and being alone with the baby while my husband was at work for 10 hours each day.  At the same time, I felt so guilty about dragging him from work and fearful that he would lose his job.  Thank goodness his boss was understanding of our plight.  We couldn’t afford to have him lose his job, especially when I wasn’t sure whether I could ever return to work.  But even after he came home, there was little he could do to comfort me.  Sometimes I would give him a helpless look beseeching him to help me feel better.  He would put his arms around me.  I would ask these questions, knowing full well he didn’t have the answer:  “What is wrong with me?  Why am I like this?  Am I going to be like this forever?”  I’ve never experienced anything like this and I was so afraid that something was neurologically wrong with me as a result of childbirth.  At the time, I didn’t know this was PPD and I didn’t know what I was going through was experienced by so many mothers.  All I knew was that I felt so helpless and scared that I couldn’t even cry.  I think I only cried a handful of times during those 2 months of PPD. 

SUPPORT OF THE HUSBAND

When a man and woman enter into marriage, they’re entering into a life-long partnership and commitment to each other that is supposed to endure even through bad times.  We’ve come a long way over the past couple of decades.  Fathers today are more involved in childbirth and childcare than were fathers of the previous generation. 

However, not all men have hands-on father role models in their lives, either in their family, among friends or at work—and as such, there’s still a percentage of husbands out there that are sticklers for the age-old belief in and adherence to the segregation of duties—i.e., taking care of babies is what mothers do and hunting/gathering (or nowadays, bringing home the bacon) is what fathers do.  Yes, there are still cases where the husband believes the job of taking care of the baby (and all the housework) is completely the wife’s responsibility. It is sad to read all those stories of women whose husbands don’t help with the baby at all, and even worse don’t support or even try to understand what their wives are going through and selfishly bail out of the responsibility of caring for their babies and wives. 

The only way these men will realize what it’s like is to switch with the women for a couple of weeks, to get a taste for what it’s like at home 24/7 with an infant and no support.  Hey, now that’s a great idea for a TV reality show.  Instead of “Wife Swap,” they should have “Parent Role Swap.”  These men can’t appreciate what it takes to care for a baby, or what it’s like to stay home all day, seven days a week, for months taking care of the baby without any support from their spouses.  These men wonder how the so-called stress from staying at home can compare to the stress he has at work.   These men can’t understand why their wives are feeling blue and having a tough time with taking care of the baby, in addition to the laundry and dishes.  These men believe that, much like their ancient forefathers believed, mothers are supposed to be able to handle all that.  Well, these men need to wake up from their Rip Van Winkle slumbers—or should I say comas—and realize they are now in the 21st century!  They need to realize that there really is a deeper meaning to the words uttered in a marriage ceremony in terms of man and wife being there for each other in sickness and in health.

Recipe for Postpartum Care and Minimizing Risk of 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. 

*  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.

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/relocating, 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.

3 Pieces of Basic Advice for the New Mom

Here are some of the To Do’s I’d highly recommend to help reduce the likelihood that postpartum depression (PPD) will rear its ugly head (gee, I sure wish I had known all this BEFORE I had my baby!):

  • Get a minimum number (i.e., 5) of uninterrupted hours of sleep a night (topic of my next post)
  • Avoid being alone
  • Get out of the house once daily

AVOID BEING ALONE

Do meet up with friends occasionally for coffee or lunch, or have them come over.  Forget about how messy the house is.  It would be in your best interest to talk to someone in person too on a daily basis, and if that’s not for whatever reason feasible, be sure to maintain contact with at least one person on the phone on a daily basis.  If you don’t happen to have any friends who have babies too that you can talk to and share your experiences with, you should try to join a new mother’s group.  This is not a time to lose touch with close friends, even if they don’t have children and you feel as though you’d have nothing to talk about. 

Historically, for the first month or so postpartum, women in the community (extended family, friends, neighbors) used to educate the new mom on what to expect, provide breastfeeding support, address questions and concerns as they come up, and basically help to ease the transition to motherhood. They would take care of everything around the house, allowing the new mother to recover from childbirth, get the rest that she needed and focus on taking care of and bonding with her baby. 

Today, extended family members do not necessarily live close by and with partners off to work all day, the kind of support the new mother needs is often not feasible. With lack of guidance, emotional/practical support and role models, it’s no wonder first-time mothers are anxious and lacking self confidence. Not having had the opportunity to recover and rest up from childbirth, she finds herself alone with the baby during the day, anxious, exhausted and overwhelmed.  

You may wonder, then, what you can do to make a positive difference in the postpartum period?  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 and if finances allow, consider hiring a postpartum doula as an investment in your physical and mental wellbeing.   If you cannot afford a doula, then see if there is a new mom’s group in the vicinity.  Not sure how to find one?  Check out the National Association of Mothers’ Centers for a group near you.  Definitely something all expectant moms should check out!

GET OUT OF THE HOUSE ONCE DAILY

Do get out of the house once a day for fresh air and sunlight.  All you need to do is, literally, step outside your house or apartment building—whether it’d be on your stoop, porch or deck.  You don’t need to pretty yourself up to do this.  Step outside, look up at the sky, and with your arms in a Y formation, take 10 slow, deep breaths.  If you’ve taken yoga before, now’s the time to use some yoga moves.  If you feel up to it, put a yoga DVD on and try to follow it.   See a recent Postpartum Progress post on the benefits of yoga.

A change of scenery and getting out of the house can help ward off claustrophobia and the sensation that the walls are closing in on you.   It is common for a depressed person to resist going outdoors, feeling too depressed, unmotivated and/or tired to leave the house.  This is especially true in the winter (unless of course you live in a state that has no real winter to speak of, like California and Florida).  Unless it’s just to take the baby for a walk around the block a few times, any other trips can seem like too much trouble for a mom who feels easily overwhelmed and not able to organize her thoughts too well.  Having to figure out what needs to be packed up on a simple errand can be overwhelming. 

This is what happened to me when I stayed in my house (also in the dead of winter, which didn’t help) for the entire duration of my maternity leave….

It’s not just a saying when folks around you say that “fresh air will do you good.”  Whenever my mother-in-law told me to go out a few times a week, and that fresh air will do me good, I just responded with “Uh huh…I will” without ever making an attempt to follow her advice.  I didn’t realized the value of that advice until about 6 weeks after I started to take Paxil and was well on my road to recovery from PPD. 

As each postpartum day went by, I felt more and more withdrawn, and more and more out of touch from the real world.  With no set, daily routine like I was accustomed to (i.e., my daily commute to NYC to work), it was hard to differentiate between one day and the next.  All the days seemed to blend into each other. 

I felt constantly overwhelmed at the thought of future doctor exams, and the seemingless endless varieties of clothes and what seemed at the time to be countless baby paraphernalia I had to worry about getting my daughter, including undershirts that were just the shirt with no bottom to short-sleeve and long-sleeve one-piece undershirts that included buttons in the crotch for ease in changing diapers to footed or footless outfits and sleepers that zip or button down the front to the feet, bottles and nipples, diapers, wipes, and formula and baby food to pick from and stock up on. 

Sometimes when I went outside for a walk around the block, just to get air, on the advice of my mother-in-law, I felt like I wanted to stay out and never go back into the house where I felt like a prisoner, confined and claustrophobic. 

Sometimes when I stepped outside, I’d feel overwhelmed by the lack of walls around me, like I was going to get lost in all that space.  It felt weird on the few occasions I was willing to go out.  I felt unsteady and like I was having an out-of-body experience whenever I went out to the drug store, grocery store, or Babies R Us……or even to visit relatives for Chinese New Year.  I think it was just from staying in the confined space of the house for so long, holed up/boxed-in in my house for 3 straight months, that I wasn’t accustomed to being anywhere else.For several weeks until the Paxil started to work, every time I went grocery shopping or shopping for baby stuff, I’d feel incredibly overwhelmed, unable to think straight, shaky….I almost didn’t make it through the store….I felt disoriented and unsure of what I was doing and panicking from not being sure of what baby stuff I needed.  I couldn’t keep my thoughts straight.  

I wasn’t sure whether I was agoraphobic or claustrophobic.  I just know that I felt like I was losing my mind.

Risk Factors for PPD

As I mentioned in my earlier post, I was going to write about the risk factors for PPD, which are among the many interesting things I learned during the past 4+ years while reading books to learn more about PPD for my own book.  No one is 100% sure what causes postpartum depression (PPD) and why some women get it and some don’t. You need to keep in mind that every individual is unique in terms of life experiences and genetic makeup, and the way in which she reacts to things like fatigue, stress and lack of support is also unique. Although women with some of the risk factors listed below are more apt to get PPD than a woman with no risk factors, PPD can even strike women with no risk factors. As I’ve mentioned before, no woman is completely immune from PPD.

If you were to ask if there’s any way to know for sure whether you are at risk for PPD, the answer is No.  So, how the heck can a woman know her risk for PPD?   It is important to keep in mind that, if you already have the genetic predisposition for depression and/or PPD, you need to prepare for the possibility that you will experience antenatal depression and/or PPD. It seems that a combination of biological, psychological, and social factors increases your risk.  You should also keep in mind that just because you may have some risk of developing PPD, it does not mean you will definitely develop it. And even if you’ve had PPD before doesn’t necessarily mean you will get it again, as every pregnancy is different and you may yourself be different physically, mentally and emotionally.

After childbirth, a woman’s body and the cells that make up the body need to repair themselves, and they usually do that through sleep. If they are unable to repair themselves through continuous lack of a complete sleep cycle (4-5 hrs at a time), the body and its functions will deteriorate. Needless to say, taking care of a newborn is quite an exhausting experience. It takes a lot of energy, both physically and mentally. Energy that a new mother will not have much of immediately after giving birth, which is why getting help is so important. If you’ve just gone through a long and difficult delivery in which you lost a lot of blood in the process, you must let the body recover with proper nutrition and rest. If the body (that includes the brain) cannot get the rest it needs, it will tend to be more susceptible to external stressors—like fear, loneliness and a sense of loss if there was a complication with delivery—that threaten its normal functioning and regulation.

Knowing what PPD is, what the symptoms are, and whether you’re at risk, as well as preparing for the possibility that you will develop it would be to your advantage.  How’s that, you ask?  Well, for one thing, if you were to develop PPD, you will be less likely to panic over what is happening to you, you won’t feel helpless and hopeless, and you will know to seek help immediately.  The best way to prepare for the possibility or reduce the risk of PPD is to have a support network to provide practical and emotional support for you in the first 6-8 weeks postpartum. If everyone were to adopt this postpartum practice, I am confident that the PPD occurrence rate would drop.

BIOLOGICAL RISK FACTORS:

  1. Sleep deprivation from constant sleep interruptions during the night and inability to get a 4-5 hour block of sleep for an extended period of time can trigger PPD for certain women (it did for me).  That’s why it is particularly important, in the first 6-8 weeks—since PPD usually begins 6-8 weeks postpartum (the first signs of my PPD started 46 days after childbirth)—for new mothers to get plenty of help with the baby and household chores, as well as encouragement and guidance from other women who have babies of their own. After the 6-8 weeks of a more vulnerable emotional state have passed and after receiving childcare advice, the new mother will feel stronger physically and emotionally and feel more ready to take on her new motherly responsibilities. This is probably why many societies today still observe a 40-day period during which women in the extended family take over all household chores and care of the mother to enable the new mother to recover from childbirth and focus on taking care of her baby.  Sleep deprivation that begins during pregnancy arises from difficulty finding a comfortable position in which to sleep at night. With a huge belly, movement and sleep positions are much more limited.   Limbs becoming numb, heartburn and difficulty breathing from the womb pressing up into the diaphragm can also make sleeping very difficult. Numb limbs and difficulty breathing were two of my challenges during pregnancy, but fortunately, I was able to sleep through the night. Some women aren’t so fortunate.  RECOMMENDATION: It might be worthwhile to invest in a body pillow, as it helps many women get a better night’s sleep.
  2. Abrupt weaning/discontinuation of breastfeeding.
  3. The return of a woman’s menstrual period for the first time after childbirth.
  4. Difficult pregnancy/pregnancy complications, like preeclampsia, gestational diabetes, ruptured placenta, toxemia, hemorrhage, bed rest for the last few months of pregnancy, or being in pain and/or uncomfortable to the point of distress (like the painful pulling sensation I kept feeling in my diaphragm area, which I’m convinced to this day had something to do with my placenta accreta).

PSYCHOLOGICAL RISK FACTORS:

  • Depression/anxiety during this pregnancy (antenatal depression/anxiety):  Just like me, when you see the word “anxiety” listed as a risk factor, some questions will pop up in your mind. First and foremost, you will wonder what anxiety has to do with PPD, or for that matter, depression. I asked my doctor to explain the difference between anxiety and depression, and he had trouble explaining it to me. But what helps put it into perspective is Venis & McCloskey’s “Postpartum Depression Demystified: An Essential Guide for Understanding and Overcoming the Most Common Complication after Childbirth”  (pg 59) following statement: “Even if you’ve never experienced a full-blown bout of depression or acute anxiety but have a tendency to get down or anxious during stressful or uncertain times, you may be more susceptible to depression when you’re expecting [and/or postpartum].”  Being prone to anxiety when you are at your most vulnerable will increase your chances of developing PPD.
  • Personal history of depression, perinatal (antenatal, postpartum) anxiety/depression, premenstrual dysphoric disorder (PMDD), substance abuse, obsessive compulsive disorder (OCD), bipolar disorder, eating disorders (anorexia, bulimia, binging, purging), tendency to worry excessively, and/or tendency to experience mood changes while taking birth control pills or fertility medications.
  • Family history of anxiety, depression, PMDD, substance abuse, OCD and/or bipolar disorder. One of the first questions my doctor asked me was whether I have a family history for anxiety or depression. If doctors are going to ask a question like that, it would be helpful if they helped define what constitutes a history of depression, like asking the question: “Have you ever felt depressed or down, most of the day, nearly every day, for more than 2 weeks at a time?” In several of the PPD stories I read (like Sylvia Lasalandra’s A Daughter’s Touch: A Journey of a Mother Trying to Come to Terms with Postpartum Depression), the woman’s mother also had PPD but failed to mention it until her daughter’s illness was well under way and already fairly serious. What a difference it would make if all PPD survivors were to share their experience with their daughters so they will know their risk for PPD before heading into pregnancy and prepare for it in advance!
  • Unresolved issues/grief:  Loss or separation from parent(s) at early age from death or divorce, dysfunctional relationship with mother, growing up with an alcoholic parent(s), and/or history of abuse (physical/sexual/emotional). Having a baby could stir up painful memories of what is was like to live in a dysfunctional household, causing extreme anxiety and distress, which may ultimately lead to PPD.
  • Difficult/traumatic/disappointing birth experience–e.g., obstetrical complications leading to a traumatic birth experience, emergency caesarian (especially after having had no pain relief and enduring many hours of labor), premature birth, 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, last-minute change in OB/GYN delivering your baby. The type of delivery you have (c-section or vaginal), whether you have an epidural or not, your overall satisfaction with the care you received during delivery (including quality of staff and hospital services), and whether you experience any complications during delivery – all of these may increase your risk for PPD. 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, grief and/or utter lack of control in birth experience. RECOMMENDATION: This is why it’s best to adopt a realistic attitude of hoping for the best but expecting the worst. It’s best going into labor and delivery not knowing what to expect (like me), since you won’t be setting yourself up for disappointment if you went into it with certain expectations.
  • Feeling less attractive from weight gain, not being able to fit in your pre-pregnancy clothes, and/or not having time to maintain your appearance.
  • Abrupt weaning can impact a woman’s maternal sense of competence.
  • Negative life events related to childbearing–e.g., history of and unresolved grief associated with pregnancy loss (previous stillbirth, abortion, miscarriage); multiple failed IVF cycles. There is a lot at stake emotionally with the baby that is conceived after years of trying, possibly with the help of IVF and after failed attempts/cycles and perhaps even miscarriages.  See previous post on this for more info.
  • Low self esteem; pessimism; tendency to worry; tendency for perfection/control and to have everything “just so”/high standards/expectations of self (including need for structure and consistency in day-to-day life); controlling personality (fear of losing conrol).  Studies have shown that pessimistic women (those who tend to interpret events negatively) are more likely to become depressed after negative events. There is a correlation between a woman’s self esteem and how confident she feels at mothering and how high her expectations are for herself based on perfectionist tendencies and being misguided by literature supportive of the myths of motherhood (disappointment in gap between reality and expectations). Caring for a newborn is a huge responsibility that challenges even the healthiest woman’s self-esteem and sense of identity, so entering this situation with self-esteem and identity issues can make the postpartum period a very difficult time. Being a first-time mother, you learn the ropes as you go. Practice makes perfect. But for those mothers with perfectionistic or control freak tendencies, they find it particularly hard to adapt to the fact that much of their motherhood experience is one in which mistakes will be made and it isn’t possible to have control of your life when you have an infant to take care of. Those who set high expectations and have specific thoughts of how their childbirth and motherhood experiences should be are setting themselves up for disappointment when their expectations are not met.
  • Any feelings of loss:  It is only natural for such a major life transition as having a baby to result in changes to the way you live your life, which causes you to experience a range of thoughts and feelings. RECOMMENDATION:  Rather than feeling bad about these thoughts and feelings, acknowledge, accept and most importantly, share them with a nonjudgmental listener.  
    • Loss of baby inside you – Some women may even grieve over, or have difficulty adjusting to, the transition of happily carrying a baby for nine months to no longer carrying a baby.
    • Loss of one’s old self (e.g., pre-pregnancy body, lifestyle, social life, routine).
    • Loss of control/predictability – Particularly challenging to first-time parents is the adjustment to the lack of control and unpredictability of having to care for a newborn baby. Your daily routines will no longer be predictable, revolving around your baby’s feeding, sleeping and diaper changing schedules.
    • Loss of structure/stimulation – There are those whose lives are all about routine and the comfort such routine brings to the person’s life. Going from such a structured life to one in which each day is totally different from one day to the next (due to the unpredictable nature of having an infant that depends completely on you for everything), many days of which are lacking adult conversation and interaction, can only contribute toward a loss of touch with reality.
    • Loss of freedom/spontaneity/mobility – Realization that there are three of you now, and you’ve lost your freedom to go wherever you want whenever you want (vacations, movies, shopping, road trip, or even just errands), without having to pack up everything you need for the baby or look for a babysitter. Realization that for many years to come your world will revolve around the baby. Realization that you are now fully responsible for another human life for the rest of your life (at least up he/she becomes an adult) who will be completely helpless up to the first year and completely dependent on you for several years more. Gone are the days that you could do whatever you wanted to do whenever you wanted. Gone are the days you could sleep in and do basically nothing except watch television on the weekends.

SOCIAL RISK FACTORS:

  1. Poor support system–i.e., not having enough support (emotional and practical help from husband, mother, mother-in-law, other relatives, friends, neighbors, doula, nanny, midwife, housekeeper). Isolation, or the feeling of being alone, is not necessarily about not having any, or insufficient, company. It’s a perception that you are alone in your feelings and experiences.
  2. Major life stressors–e.g., death/serious illness of loved one, marital problems (divorce, separation), financial difficulties, unemployment, relocation, mourning loss of your old (pre-baby) self and lifestyle. Any kind of change—even a change in lifestyle due to baby’s presence or change in husband/wife relationship—can cause stress, particularly if you have difficulty coping with changes to begin with. And having a baby is one of the most significant life changes you’ll experience in a lifetime.  RECOMMENDATION: Since adapting to new surroundings is only adding another element of stress and something else to feel insecure about, you should avoid moving during pregnancy or in the first year postpartum.
  3. Childcare stress, such as health issue for baby–e.g., preterm birth, difficult infant temperament, hyperviligance, high anxiety levels, feelings of helplessness from a baby that cries a lot or cries inconsolably (i.e., a colicky baby). These can cause a mother to question herself and eat away at her self-esteem as a parent.
  4. Being a first-time mother:  Lack of prior experience in taking care of a baby and setting high expectations based on motherhood myths play a role in setting the stage for PPD.  First-time mothers are particularly at risk for higher levels of anxiety from the uncertainty that comes with never having experienced pregnancy, labor and delivery before. It certainly makes sense, in direct correlation to the fact that all too many mothers are led to believe that the transition to motherhood is a snap—the anxiety levels of a new mother are often sky high when they realize that, lo and behold, they now have 24/7 responsibility for a completely helpless newborn without so much as any hands on training of any sort. I can personally identify with the following trend: with women being more career-oriented and having children later, and with families being smaller nowadays, women generally have little experience caring for other peoples’ babies and being around women who are having babies. Lack of experience with babies doesn’t help a mother feel warm and fuzzy about her mothering capabilities.
  5. Myths of motherhood:  Certain women go into pregnancy with the intent to carry out their dream of motherhood down to the last detail they’d envisioned, with breastfeeding at the top of the priority list. Not being able to successfully breastfeed can be a devastating blow to the mother who had envisioned doing so for the first few months, and not being able to live out that dream is, needless to say, a huge disappointment and a crushing blow to her self-esteem.
  6. Being a single mother:  It’s tough enough when you’re married having to take care of a newborn let alone a single mom who is on her own with no spouse to help with childcare, financial support, and housework, etc. Unless you have a very good support network of family, friends, neighbors, community programs, etc. the stress of having a baby to care for in addition to a job (or even multiple jobs), housework, etc. can easily put you at risk for PPD.
  7. Low socioeconomic status.
  8. Unwanted or unplanned pregnancy: Those who did not plan or expect to have their babies at this point in their lives are at even greater risk, whether it’s the married woman who has children and wasn’t prepared to have another, the married woman who wasn’t ready to start a family yet, the single woman who isn’t prepared to support a child on her own, or the teenager who is but a child herself and the least emotionally prepared to have a baby out of all these examples.