Post-Partum Depression and Anxiety
SPM is going to get a little dark and deep here, but this is an important topic. My own experience with Post-Partum anxiety is THE reason I have chosen to enter the field of postpartum care and why I am such an advocate for sleep. There is a decent amount of awareness out there, however I do believe there are some misconceptions about PPD and particularly PPA with regard to symptoms and onset. I am not a doctor (what kind of medical professional would call themselves "Sparkle Pop Mama"?), so I can only share my personal experience and gathered knowledge. There are quite a few ways in which I did not properly set myself up to thrive postnatally. Via hindsight and my doula studies, I've been made aware of how a mother-to-be can better protect herself from going through PPD or PPA or at least be able to spot the signs early enough to get support and intervention before it worsens
The Why and How .
It can be difficult to think about the possibility of feeling anything other than amazingly fulfilled and smitten when we are expecting our first child. We are so celebrated the minute we begin sharing the news with loved ones. They collectively cheer us on through each week of pregnancy. We get literally "showered" with gifts and praise and are treated so gently as if we could break at any moment. It's a beautiful cross-cultural tradition to treat an expectant mother like royalty, however in American culture, the pampering typically ends there. Baby arrives, there is an influx of visitors (mainly there to greet baby and/or to obligatorily check it off of there to-do list), and after a couple of weeks, the visits subside, dad goes back to work and mum is alone. She's alone with this new life she's responsible for keeping alive while running on fumes from lack of sleep and improper nutrition and let's not forget the complete physical and emotional transformation she's simultaneously going through. Kinda makes you excited to have a baby, right? The good news is this vulnerability is only temporary and can be tempered with proper care, preparation and guidance.
When I was pregnant, I was so focused on having the birth experience that I envisioned for myself, that I lost sight of what was going to happen after that birth experience. I read all the birthing books and took all the birthing classes. I made sure I knew CPR in case of an emergency. I stocked my nursery with enough diapers and wipes to last a year. I did have a feeling that I wouldn't be able to leave the house for a while, but I hadn't wrapped my head around what that might be like. I suppose every new mom is caught off guard by expectations vs. reality. I overestimated my own human power and underestimated the sense of isolation I was going to feel. Not only did I neglect to set myself up with enough help, I actually refused the help that was offered because I grew anxiously attached to my baby. Looking back, I recognize the series of events that lead to my anxiousness.
My birth (while it resulted in the kind of birth I ultimately desired) was somewhat traumatic as I almost gave birth to my son in the car on the way to the hospital. It was certainly one of my proudest moments, but also an event that could have gone very wrong. Birth experience trauma can set the tone for the postpartum experience, as can having a feeling of helplessness or disappointment surrounding one's birth experience. Whether the mother felt unsupported by her team, or coerced into decisions against her will or if the labor just didn't go as "planned", she may be faced with feelings of regret or shame.
If a woman has a predisposition for depression and anxiety, be it personal or familial, she may be at higher risk for experiencing PPD or PPA. I've certainly dealt with anxiety for the better part of my life. Interestingly, I was a rather relaxed preggers. Perhaps too relaxed. I didn't fuss about my diet. I had wine and sushi when I felt like it. I hiked mountain peaks in the hot, blazing sun at 32 weeks. Some might even deem these behaviors as irresponsible. I didn't see it that way. I just wasn't quite ready to give up my sense of self. Once that screaming, wrinkly, wet little boy was placed on my chest, all the anxiety came flooding in. "How do I make him stop? It's my job as his mother. I am supposed to be able to soothe this baby because I am the mom. What if I am not good at this? What if I misread his cues? If I fail at this, then I am a complete failure at life." And the downward spiral of thoughts went on and on for quite some time. This person who was not ready to give up her sense of self had completely lost herself to this new role. While there were surely feelings of joy and love beyond measure, there was always this underlying theme of fear.
The "normal" levels of anxiousness and "baby blues" can be heightened by lack of sleep. New moms are running on adrenaline for the first couple weeks, and then it begins to wane and the sleepless nights catch up. Mum runs out of fuel. This happened by about week 4 or 5 for me. I turned to anything extraneous to get through the day: coffee at all hours, mimosas at 10am, and sometimes even a cigarette or two. The loss of sleep was the piece that pushed me over the edge. To this day, I require 8-9 hours. My baby was sleeping in 2-3 hour increments (only while in my bed so he had all night access to milk) until I had to sleep train him for my sanity at 5 mos. That 2-5 month period is a blur of breast feeding, crying, obsessive thoughts and hopelessness.
If you are expecting of thinking about conceiving, I know I am painting a really grim picture for you. I am sharing this experience as I think it is more typical than I was aware of at the time. I felt like everyone else just had a handle on motherhood except for me because these are the stories that most people don't share. Remember, it is just a blip in time and I am also trying to emphasize the point that I did not set myself up for success. Had I properly taken care of myself during the first 4-6 weeks, I may have re-imerged feeling refreshed and energized as opposed to depleted. Those first few months of confusion and anxiety could have been avoided, at least in part, had I taken a few preparatory steps which I will mention, but first I want to discuss some of the less obvious signs of PPD and PPA.
Had I been more aware of what Post Partum anxiety looked like, I may have recognized that I was suffering from it sooner. It wasn't until I regained my sleep and looked back on the previous months that I realized I was battling a disorder. I was aware of Post Partum Depression and it's extreme symptoms. It didn't seem to fit the bill for what I was going through. I wasn't "sad" or "listless". I certainly didn't want to hurt myself or my baby. I heard the news stories about Andrea Yates (warning: her story is very disturbing), and thought that was what Post Partum Depression looked like. As I have learned, her condition was extremely severe and rare.
I also remember reading The Yellow Wallpaper in college and thinking that the poor woman narrating was just so overlooked and misunderstood by the people closest to her. How could they all let it get so bad? When you are in it, there are very few people who can begin to grasp what you're feeling internally unless you are telling them.
The website Postpartumprogress.com offers "6 Surprising Symptoms of PPD and Anxiety":
Anger: In all the years that I’ve spoken to mothers about postpartum depression, they are always most surprised by rage and irritability as symptoms of postpartum depression. Yet, so many of you experience this. It may be that everything makes you angry. Or your baby, or partner, or older children are irritating you at a level that you have never felt before. You might want to throw things, or yell at everyone. Some of you tell me you know that you shouldn’t be so mad all the time, but you can’t help it, and you’re worried about how rough you are being with the people you love.
Brain Fog: For many of us, our brains just don’t work as well when we have postpartum depression and anxiety. We have a hard time remembering things, thinking of the right words—or any words for that matter. We can’t multitask as well as we used to. During my bout with postpartum OCD, I used to drive through stop signs, finding myself out in the middle of an intersection before I realized I hadn’t stopped. If your mind is cloudy and you feel like you’ve lost at least 20 IQ points since you had your baby, you’re not alone.
Scary Thoughts: Most people think they’re in full control of their thoughts. I know I had no idea whatsoever that your mind could think a thought you didn’t want it to. Then I got introduced to intrusive thoughts, which are scary thoughts that enter your mind that you don’t want that are very upsetting but continue to plague you. Often they start with the phrase “what if,” as in what if I did this terrible thing or what if that awful thing happened? It’s like walking around having mini-nightmares all the time. Intrusive thoughts are a sign of postpartum anxiety and OCD, and NO, they do not mean you’ve turned into some horrible monster.
Numbness: If you think women with postpartum depression are full of strong emotions, sad, and crying all the time, and instead you feel nothing whatsoever, you may be surprised. Some of you tell me that you feel only emptiness. You are just going through the motions, doing the things you know you are supposed to do but not really feeling it inside. If you are disconnected from things you used to care about and it feels as if you are hovering over your life looking down on it but no longer part of it, it’s worth talking to your doctor. This is not what new motherhood is supposed to feel like.
Insomnia: Sleep when the baby sleeps, they say. But what if you can’t? It’s pretty shocking for a new mom who has never been more exhausted in her life to be unable to sleep. You keep thinking that eventually you’ll just crash, but you don’t. Or you fall asleep fine but then you wake up and can’t go back to sleep. All new moms are tired, but not being able to sleep when you have the opportunity to can be a sign of postpartum depression or anxiety.
Physical symptoms: Most women expect postpartum depression to impact their mind only—how they are feeling. But for some of you, PPD manifests as physical symptoms. I hear from new moms who are suffering with headaches, back aches, upset stomachs, nausea, or even panic attacks that make them feel as though they are having a heart attack. If you are suddenly plagued by aches and pains that don’t appear to be caused by the flu or food poisoning or any other illness, they may be symptoms of postpartum depression.
Note that these symptoms can be experienced immediately after the birth of your child or even 2 years after. Additionally, you don't have to be the biological mother to experience PPD or PPA. I spoke with a woman the other day who went through postpartum after becoming a mother to her adopted children. She felt the motherhood role was thrust upon her by her husband who wanted children more than she did and she dealt with feelings of guilt, betrayal and resentment. Could a softer landing have eased the blow?
The Support (Preventative and After Onset)
Set yourself up for success! Try to do the following for the first 4-6 weeks after giving birth. It may even become part of your permanent routine for self-care:
-Make yourself aware of what PPD and PPA is so you can gauge your feelings accordingly.
-Read the books about transitioning motherhood. I've read a few great ones now that I will post under Resources.
-Hire a Post Partum Doula (Oh hey! That's me!) to help you with the transition. If that's too much of an expense, set up system with family and friends in advance.
-Use Meal-Train, freeze meals in advance or make meal lists for visitors (warm, nourishing foods are essential).
-Put a note on the door for visitors that lists a household task that each one can do to help you out.
-Know your limits. Set boundaries with visitors ahead of time with regard to how many you can handle per day and for how long.
-SLEEP when baby sleeps. Try to nap when you can. If you allow visitors a chore or two, it makes napping easier.
-If you're open to sleep training, have a plan in place for when your baby is the proper age and weight. Read the books on helping your baby's sleep schedule. My sleep training bible is listed in Resources as well.
-Make time for yourself. My "me time" is physical activity. Whatever makes you feel whole and like you are only tending to your own needs, do that for an hour at least 3 times per week.
-Create a space for yourself in your home that reads as a sanctuary for you and your baby. A place for bonding, feeding, sleeping and resting that is yours and no one else's.
-Talk to someone if you are feeling alone and isolated, especially another mom. Chances are she's been there too if she's not there now.
If you feel that you may be suffering from PPD or PPA, please get in touch with your OB or midwife right away. There are support groups and therapists who specialize in women's health. Talk, talk, talk about it. Bring your experience to light. I just attended a Women's Circle called "Mother to Maiden" in which mothers of children of all ages shared their birth and postpartum experiences with expectant mothers who in turn shared their fears about what is ahead of them. Even with my postpartum anxiety 7 years behind me, it felt cathartic to talk about a period in time that was so poignant and impactful for me. There were women in the room who had suffered in a similar way those first few blurry months. Had we found one another earlier, perhaps we could have held each other's hands through it. We held each other's hands that day and I felt supported and acknowledged. We mothers are all just trying to do our best, but we can't do it all by ourselves. We need to lean on others as we wade through the glorious and sometimes dark and murky waters of motherhood.