Blog: Postpartum Matters

Find Your Comfort Zone

I was one of the lucky ones who determined very early on, without much guilt, that I would be a much better mother to my children if I returned to work, part-time at first.

The part-time option sounded good. I could be home early to spend more time with my baby,  and it felt right, because i was to tired to work a full day, anyway. It was relatively easy for me – I’m not particularly proud to say – to be selfish during those early postpartum months and put my needs right up there next to those of my baby. I have a slight rebellious streak that dates as far back as i can remember. I remember the exultation I felt walking into the high school gymnasium with my boyfriend, clad in jeans, to the formal prom. I remember the work boots I wore with colored socks accompanied by a way-too-short mini skirt, long before it was a fashion statment, simply because I hoped I could get away with it.

Similarly, as I entered the world of motherhood, I recoiled from what was expected of me, whether that pressure came from my family or society as a whole, and soon discovered the comfort in doing things that felt right for me, even if it meant ruffling some feathers. That didn’t mean I wasn’t tempted to surrender when I found myself sucked into the pressure cooker of “opportunities” for young mothers and their babies…

Longing for daytime companionship, I took my 4-month-old baby to a local baby gym class. Hopefully, I won’t offend any readers by saying I am almost positive he did not care whether he was in this brightly decorated room filled with expensive baby-friendly equipment or snug in our living room surrounded by unvacuumed dog hair and a Sesame Street video that had looped in repetition for the fifth time. I sat for a while in the circle of neurotic competitiveness, listening to mothers chatter on about whose baby was doing what and how many activities they had squeezed into their sleep-deprived schedules. Why was I there, I ask myself. Who, exactly expected this of me? That was the first and last class to which I would drag myself.

It was then that I decided that if I were to maintain my sanity, I would pledge to:

  • Not go to baby classes programmed to make my baby smarter, faster, more agile, or speak foreign languages.
  • Not compare myself to others.
  • Not compare my baby to other babies.
  • Do what I needed to do for ME and bring my baby along in the process.
  • Do the best I could.
  • Not be hard on myself if I failed to live up to unrealistic expectations.
  • Ask for help when I needed it.
  • Trust my instincts.

This is what I try to help other mothers do, today. ♥

Adapted from Therapy and the Postpartum Woman (Routledge, 2009) by Karen Kleiman

Before I Was a Perinatal Specialist, I Was Postpartum Mom in Therapy

Before I became a specialist treating perinatal mood and anxiety disorders (PMADs), I was a postpartum therapy client. 6 weeks after our oldest child was born, my husband and I decided to check in with a wonderful and experienced therapist whom we knew both liked. At the start of the session my husband looked lovingly at our daughter and talked about overwhelming adoration and paternal bliss. I sat with my shoulders hunched as our daughter nursed, bracing myself against the intense pain I felt in my breasts. I described constant nursing without a break, constant severe pain throughout each nursing session, and insisted that I would be nursing for a year no matter how much it hurt.  I said I was stressed, sad, and hopeless. With a caring and warm expression our therapist quietly and gently offered “sounds like it’s time for some formula” and shared stories about formula feeding her own children. When we left, my husband suggested we talk with our pediatrician about trying some formula, energized, encouraged, and empowered by our therapist’s suggestion. He was comforted by the experience of another mother and was relieved to have a solution for my apparent problem. I, on the other hand, was gutted. We never visited that therapist again.

I was gutted because deep inside I knew that nipple pain wasn’t my problem. That I was postpartum was my problem. I felt isolated, profoundly exhausted, confused about why having a baby seemed so easy for everyone else. I felt like there were right and wrong ways to do things, and I really didn’t know if I was getting more things right than wrong. I focused so much on breastfeeding, that I decided my nursing relationship must be the barometer for my success as a mother, a woman, a human being. Imperfection did not seem like an option. I was failing. I couldn’t believe I could be feeling such emotional pain at this time in my life. I couldn’t believe the therapist said what she said.

 Almost 8 years later I am a therapist specializing in PMADs. Here are a few things I’ve learned from sitting on both sides of the couch:

  1. A lesson for you and a lesson for me: good therapists say the wrong thing and can still be good therapists. Speak up if you are triggered or if your feelings are hurt. Your therapist will learn from you and that will benefit you and others. Be braver than I was and use your voice.
  2. If you are a few days or a couple weeks postpartum and you feel a little sad, weepy, or teary, you might have the baby blues. Baby blues lasts for a few hours or maybe a few days and feels better with self care- rest, eat well, enjoy Netflix, and surround yourself with good company. If you are more than a few weeks postpartum and you are still feeling “blue” you may need a little more help overcoming your symptoms. At this point, see suggestion number 3.
  3. Remain hopeful and do not give up. There are an incredible number of resources for pregnant and postpartum women around the world. Specialists, groups, and online communities are eager to help you. Don’t stop asking for help until you find it. Your person is out there.
  4. MOST important, there is no such thing as not sick enough for support. All mothers, happy, sad, anxious, blissful, depressed, all mothers, are entitled to support. Becoming a mother is a monumental change and no matter how you spin it, it’s hard. No matter how well or how bad you feel, reach out if you want to talk or grow your support network.

Bonus tip: I learned that if you show everyone who will look your bleeding and cracked nipples eventually a pediatric nurse might recommend antifungal medication and all purpose nipple ointment…. Which just might miraculously clear up that nasty 6 week old case of unusually presenting thrush that was causing So. Much. Pain.

Hilary Waller, LPC

 

Tokens of Affection Relationship Workout

For couples who believe in their relationship, aspire to keep it strong, and wonder how awesome it will be to read this together in 20 years… Each of you should fill it out separately and share as a gift for a special occassion that is meaningful to you. Then, put somewhere for safe keeping.


Date_____________

The first time I knew I loved you was__________________________________________________

One of my favorite things to do with you is _____________________________________________

One thing I don’t tell you enough is ___________________________________________________

Sometimes, when I find myself needing you the most, I ___________________________________

One of the things I need most from you is ______________________________________________

After twenty years together, I’ve learned that you ________________________________________

When I’m sad or scared, I ___________________________________________________________

I love it most when you _____________________________________________________________

What makes me laugh the hardest when we’re together is __________________________________

If I were to be completely honest, sometimes I wish _______________________________________

Loving you has always felt easy, but one of the hard parts is _________________________________

One of the things I like best about you is ________________________________________________

One of the things I think we should do more often is _______________________________________

When we’re together, I wonder if you know ______________________________________________

My life with you is __________________________________________________________________

I love to hear other people tell me that you ______________________________________________

Since we’ve been together, I’ve gotten better at __________________________________________

I love the way you _________________________________________________________________

I need you most when I _____________________________________________________________

One of my favorite memories of us is___________________________________________________

One of the dreams I dreamt that has come true is_________________________________________

One of the dreams I dream that I hope will still come true is_________________________________

I wonder if you really know how much __________________________________________________

Twenty years from now, I hope ________________________________________________________

I am so proud of how we_____________________________________________________________

Empowerment in the Face of Despair

 “I know what I’m ‘supposed to do’ to feel better. Everyone keeps telling me the same thing. I should exercise. I should sleep more. I should eat well.   I should take the medicine. I know, I know, I KNOW. But something inside my head keeps telling me to push through this. I can get better. I don’t want to take the medicine while I’m breastfeeding. I can’t possibly keep feeling this bad, so I’ll just wait. But then I start feeling desperate, like I’ll never feel better again….This isn’t working. Nothing I’m doing is helping. It doesn’t matter if I exercise or not, everything is dark and heavy around me. Inside and out. Nothing looks the same. I wish someone would just tell me what to do. Or do it for me. My head keeps spinning with all the reasons I shouldn’t take the medicine. I know I’m getting in my own way, like my therapist keeps telling me. I know that. But I can’t help it.”

Women with postpartum depression know only too well how the symptoms of depression interfere with help-seeking and solution-oriented behaviors. Therapists, doctors, partners, friends and family members can tell them over and over and over again, how they should be taking care of themselves, but many women find themselves swirling around the vortex of distorted thoughts and misperceptions. Anxiety driven ambivalence becomes a fierce enemy, what if…? Why can’t I just…? How do I…? Maybe I could just…

Postpartum depression and anxiety do not discriminate. Symptoms impede the functioning of devoted stay-at-home moms and Harvard-educated attorneys. Intrusive thoughts can puncture the most perfect plan. When this occurs, rational thought seems to evaporate. Any previous accomplishment or personal triumph takes a back seat to the all-consuming and interminable anxiety.  Soon, that is all that is felt.  Women describe this by proclaiming “this isn’t me” or “I just don’t feel like myself” or “I’m usually so easy-going, I don’t know who I am now.”

As thoughts and feelings alternate between despair and rapid-fire obsessiveness, women with PPD begin to lose focus, along with the ability to successfully advocate for themselves.

If your baby were sick right now, would you know what to do to get him help? The answer is usually yes.

If your husband needed to get to the emergency room right now, while you’re feeling this bad, would you know what to do? The answer is usually yes.

But women have difficulty fighting for themselves when they are entrenched in this battle of their lives. Their energy, motivation, inspiration and zest for life has been eclipsed by the cruel paralysis imposed upon them.  They also have difficulty responding appropriately to the loving guidance from those around them. They simply cannot see through the shame, the guilt, the incredible disbelief that they feel so ineffective in their own life. And so they sit, rocking back and forth between their opposing thoughts.

Therefore…

If symptoms are bad enough, if hopelessness sets in, functioning is severely impaired, and clarity has vanished – others must make some decisions for her. When it reaches the point when her wellbeing is at stake, we become less concerned about hurting her feelings or saying things to protect her. At this point of personal crisis, we no longer defer to her sadness or her longing to do this “her way.”  If doing it her way means postponing treatment or prolonging suffering, it is not okay.  This is when it becomes necessary to intervene on her behalf, tell her exactly what she needs to do next and how we will help her do that.

This commanding posture is not always a comfortable one for therapists who are working hard to empower their clients. But remember: Our objective is to lead her to symptom relief, before any other work can be done.  One of the ways we do this is by demonstrating a sense of expertise, confidence and composure. After all, it is our composure, our self-control, our trust in the process, that will convey our expectations of a positive outcome. And that, indeed, is empowering for her.

And so, we say:

1.      You will not always feel this way.

2.      You must take care of yourself and you need to follow through, whether you feel like it or not.

3.      If medication is part of your treatment plan, you need to take the medication – whether you are breastfeeding or not. Discuss any concerns you have with your doctor and then decide whether you will continue breastfeeding or whether you will wean. Either way, take your medicine if it has been prescribed for you.

4.      Do not let the noise in your head sway you from doing what you need to do. It may feel like you have no energy but you do. It may feel as if you have no power left, but you do. It may feel like no one knows how bad you feel, but some do.

5.      Pick a person you trust and listen to them. Do not question the veracity of their words. Let yourself believe that this person can help guide you through the darkness and then, stop fighting against them. 

6.      You need to keep moving forward through this, even if you don’t feel like it. Get up when you don’t feel like getting out of bed. Go outside even if the sunshine is too bright for your weary eyes. Eat even though you may not be hungry. Rest even when you are not tired. Try to turn off the chatter in your brain. Distract yourself. Count backwards from 300. Take a walk. Call a friend. Avoid caffeine. Avoid alcohol. Avoid people and things that make you feel bad. Come to therapy. Talk to your partner.

7.      Your depression is not your friend. It is an illness that confuses you and distorts your thinking. Do not forget this. Challenge the illness, not those who are there to help you.  Take your pills, no matter how you feel about having to take them. Remember that your fight is against the illness, not against yourself or those who support you.

8.      Believe that you will feel better again.

 

pic source: aleksander1/123rf.com
copyright 2012 Karen Kleiman, MSW, LCSW  postpartumstress.com

Healthcare Providers and Your Perinatal Population: Your patients are at risk.

Resources for Healthcare Providers Treating Intrusive Thoughts

 

1. Book for new mothers and their treating healthcare providers

Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood

2. Information on scary thoughts and our #speakthesecret campaign

What if I’m having scary thoughts?

3. Article by Jon Abramowitz, MD, expert on perinatal OCD

Beyond the Blues: Postpartum OCD

4. See “Clinical Tools For Your Practice” for assessments

5. Sample of selected research by top PPD researchers

*Disclaimer: Many of the articles listed below with Obsessive-Compulsive in the title also mention or review the nature of intrusive thoughts that are subclinical and not related to an OCD diagnosis. Red notations are ours to highlight relevance for specific providers. Some are available online as pdfs. If you are unable to find them, you can try finding access to an academic database through your local university library.

Risk of Obsessive-Compulsive Disorder in Pregnant and Postpartum Women: A meta-analysis.
Russell, E.J. Fawcell, J.M. Mazmanian, D.
(2013) Journal of Clinical Psychiatry 74(4): 377-385.

Postpartum Obsessive-Compulsive Disorder.
Speisman, Storch, Abramowitz.
Journal of Obstetric, Gynecologic & Neonatal Nursing. 2011 Nov-Dec;40(6):680-90

Obsessive-Compulsive Symptoms in Pregnancy and the Puerperium: A Review of the Literature
Abramowitz JS, Schwartz SA, Moore KM, Luenzmann KR.
Journal of Anxiety Disorders. 2003;17(4):461-78.

New Parenthood as a Risk Factor for the Development of Obsessional Problems
Fairbrother, Abramowitz,
Behaviour Research and Therapy 45 (2007) 2155–2163

Postpartum Obsessive‐Compulsive Disorder
Speisman, Brittany B. et al.
Journal of Obstetric, Gynecologic & Neonatal Nursing , Vol 40, Issue 6, 680 – 690

Obsessive-Compulsive Disorder in the Postpartum Period: Diagnosis, Differential Diagnosis and Management.
Sharma V, Sommerdyk C.,
Womens Health (Lond). 2015 Jul;11(4):543-52

The Impact of Perinatal Depression on the Evolution of Anxiety and Obsessive-Compulsive symptoms.
Miller ES, Hoxha D, Wisner KL, Gossett DR.
Archives of Womens Mental Health. 2015 Jun;18(3):457-61.

Diagnosis and Treatment of Postpartum Obsessions and Compulsions that Involve Infant Harm.
Hudak R, Wisner KL.
American Journal of Psychiatry. 2012 Apr;169(4):360-3.

New mothers’ thoughts of harm related to the newborn.
Fairbrother N, Woody SR.
Archives of Womens Mental Health. 2008 Jul;11(3):221-9.

Obsessions and Compulsions in Postpartum Women Without Obsessive Compulsive Disorder.
Miller ES, Hoxha D, Wisner KL, Gossett DR.
Journal of Womens Health (Larchmt). 2015 Oct;24(10):825-30

Obsessions and Compulsions in Women with Postpartum Depression.
Wisner KL, Peindl KS, Gigliotti T, Hanusa BH.
Journal of Clinical Psychiatry. 1999 Mar;60(3):176-80.

Detection of Postpartum Depressive Symptoms by Screening at Well-Child Visits.
Chaudron LH, Szilagyi PG, Kitzman HJ, Wadkins HI, Conwell Y.
Pediatrics. 2004 Mar;113(3 Pt 1):551-8.

Postpartum Depression: What Pediatricians Need to Know.
Chaudron LH.
Pediatric Review. 2003 May;24(5):154-61.

Detection, Treatment, and Referral of Perinatal Depression and Anxiety by Obstetrical Providers.
Goodman JH, Tyer-Viola L.
Journal of Womens Health (Larchmt). 2010 Mar;19(3):477-90

 

Doctors? Nurses? Frontline Healthcare Providers? ARE YOU LISTENING?

In light of the recent focus on the inexcusable ways some healthcare providers respond to acute distress in postpartum mothers, let us do some teaching here.

Please share and inform your local resources.

**NOTE TO ALL HEALTHCARE PROVIDERS**

Some postpartum women are afraid to tell you how they really feel. They are worried that you are misinformed and may overreact. They are worried you will call the cops. They are worried you will contact Child Protective Services. They are worried you will think they are unfit to be a mother. They are terrified they are going crazy. They are worried you will not know what to do to help them feel better. And still, they come to you for help.

If a postpartum woman finds the courage to speak her symptoms and put words to her pain, please be informed. Read about postpartum anxiety and intrusive thoughts. Learn about obsessional thinking. Do your research on postpartum depression so you will not be alarmed by the high rate of fierce obsessions that accompany it.

If, for any reason, you do not feel you are in a position to offer your patient the appropriate care, it is imperative that you find the words, the gestures, and the compassion to guide her to a safe resource where she will be heard and treated with responsible attention to her vulnerable state. Unless you truly understand the extent to which she is suffering, you have no idea how hard it is for her to tell you how she is feeling and thinking. She is entitled to your best professional/clinical practice.

In light of the recent focus on the inexcusable ways some healthcare providers respond to acute distress in postpartum mothers, let us do some teaching here.

Pay attention, please. There is a great deal at stake.

Please also see our article on Psychology Today addressing this issue.

 

Message From Anonymous

This post was written anonymously by a mom in response to our #speakthesecret campaign. We thought her words would resonate with many of you: 

“I want to share my personal story of dealing with postpartum depression. The reason I’m doing this now is because in the last 3 months, 2 mothers from my home town have killed themselves from postpartum depression and I strongly feel that the best way to help each other is to talk about this. We rarely talk about it when going through it and almost never talk about it once it’s over.

I found out I was pregnant on Dec. 31. My husband and I didn’t particularly want children so it was obviously unplanned. But we were both 29 and had good jobs so I said I guess we’re doing this. I tried to talk myself into being excited but I couldn’t. My mom about fell down the stairs when I called her and told her, but I just couldn’t get there. I had 3 baby showers and each one left me feeling worse. I would think ‘What am I supposed to do with all this plastic crap? I don’t have room for it.’ And ‘what do you mean I have to wash these new clothes in special detergent? They’re new. Aren’t they by definition clean?’. And then the guilt set in. Why couldn’t I be grateful? I just couldn’t. My whole pregnancy went like this and it was just one “annoyance” after another. I went into labor early and delivered at 37 weeks which was fine with me. I had a C-section because he was showing distress and ended up going to the NICU. All of which was still totally fine with me. “At least I don’t have a huge vaginal tear and at least I can sleep while the nurses in the NICU take care of him”. Who thinks like that?!?! Me. Someone experiencing a perinatal mood disorder that’s who.

I had a brief reprieve for about 2 weeks following delivery and then reality hit. I wasn’t crying all the time or feeling like I wanted to drive us into a lake or anything but I was nowhere near happy either. I couldn’t figure out how to do things like go to Target and Home Depot in the same day. Daily tasks, that I used to not think twice about, completely overwhelmed me. I couldn’t make a plan or a decision to save my life and I had previously been very much a type A/planner/decision maker. Could NOT get my shit together which then upset me even more and led to more irrational thoughts. I would tell myself it was ALWAYS going to be this hard and I would NEVER get back to normal. I became more and more resentful of everything he needed and then felt more and more guilty for feeling resentful. As time went on, my resentment turned to feelings of incompetence. I’d try to talk myself out of feeling resentful just to then be convinced I couldn’t do it even if I wanted to. It was an out of control spiral that lasted over a year. I never sought treatment and I really don’t know why other than I never identified it as postpartum depression. It started during my pregnancy so how could it be that? I am a nurse and didn’t even know depression DURING pregnancy was a thing! It is most certainly a thing. My husband knew it but didn’t call me out. To this day I don’t know why.

Fast forward 3 years to my 2nd pregnancy. This time it was planned and I didn’t have prenatal depression the 2nd time around. But the postpartum depression hit hard. Same debilitating anxiety like symptoms although I will say I was also sad with this one. Constant feelings of failure and sadness. What little of myself was left felt completely gone. When my 2nd son was 2 months old I left him in his crib during a crying fit and called my mom to come over because I had to get out. I was still on maternity leave and my older son was at daycare so I put him in his crib and left my house. Before she got there. Now granted, she lived 2 miles away and I had talked to her and knew she was able to come over. But still, people, I freaking left him before she got there!!!! Not ok. My husband was PISSED. Didn’t trust me after that and was basically like “listen crazy lady, get your ass to the doctor and get some help because I’m not doing this for a year again”. So I did and it got better.

Take home points:

1) Experiencing a perinatal mood disorder (i.e. Postpartum depression) does NOT make you a bad mom.

2) Getting professional help for a perinatal mood disorder does NOT make you weak.

3) The screening process for perinatal mood disorders is half-assed at best. Don’t wait for your doctor to just “pick up” on it.

4) But…. your family and friends may very well pick up on it. If THEY think there’s a problem, there is.

5) You don’t have to suffer, treatment is very successful.

*The number one cause of death during the postpartum period is suicide.*

Let that sink in.

Think about all the testing and monitoring that happens for complications during pregnancy. Now think about how the follow up for the issue with the highest mortality rate during the postpartum period is almost nonexistent.

Although most people aren’t suicidal, please know you don’t have to feel like this and it’s not your fault. Please know you are not alone, or even in the minority, and there is very successful treatment.”

I ask everyone who has experienced a perinatal mood disorder, or a family member who loves someone who experienced it to comment with your story and share the post. We must talk about it because it’s the guilt and shame that keeps women from getting help. In order to save the lives of these Mommas we must destigmatize this and let them know they are not alone.

-ANONYMOUS

 

Find Your Holiday Brave

The Postpartum Stress Center
Source: The Postpartum Stress Center

The Holiday crunch is looming. Shopping. Eating. Rushing. Family. Friends. Too much? Not enough?

Excited about it?

Anxious about it?

Dreading it?

Overwhelmed by it?

Ambivalent about it?

If you have a history of depression or are currently depressed, the weeks and days before and during the holidays can descend with crushing anxiety.

It is easy to feel out of control when there are so many events and obligations tugging at you at once. NOW is the time to plan for it. With a little preparation and armed with a script to rely on, you can reduce your anxiety and feel better about experiencing the weeks ahead.

These reminders will help you manage the overwhelm and navigate the days and weeks ahead.

Do NOT forget to:

  • Wear your MAGIC bracelet*. (huh? Yeah, you know who you are.) Re-empower it by repeating exactly how it can help you. You know the drill.
  • Remind yourself you are doing the best you can. (And that’s way good enough right now)
  • Do NOT drink too much. (Limit alcohol & caffeine)
  • Modify your expectations. (Keep things simple)
  • Try to stay in the present moment. (worry = future, ruminating = past)
  • Incorporate one ME moment each day to replenish your spirit. (Really do this)
  • Set boundaries. (This is not being selfish)
  • Avoid conflict. (Or postpone. This is not the time)
  • Allow grief or loss to find a soft place to rest. (It’s okay to be sad)
  • Accept imperfection. (Yours, others)
  • Ride the waves. (Up & down & up again; keep going)
  • Sleep more. (Every chance you get)
  • Say THANK YOU. Say I LOVE YOU. Say I’M SORRY.  (With a full heart)
  • Connect with your partner (Touch, smile, eye contact)​
  • Be grateful for the things we all tend to take for granted…

*Magic bracelet from Therapy and the Postpartum Woman (Kleiman, 2009)

THE ART OF HOLDING IN THERAPY: Foreword

The Art of Holding“Maternal mental illness is a significant complication of pregnancy and the postpartum period. Depression and anxiety are common manifestations, with prevalence rates up to almost 20% during pregnancy and the first 3 months postpartum. As research and public awareness gains momentum, more attention is being placed on medical protocols, interventions and better access to treatment.

For many years now, Karen Kleiman has changed the face of maternal mental health for both clinicians and families. As a speaker reaching many through outlets such as The Oprah Winfrey Show and as an author, through her many books for families and clinicians, Karen is a pioneer in this field providing the mainstream community with an understanding of this devastating illness, validating the women who suffered and helping clinicians gain insight into the experience postpartum depression.

Karen and I first spoke several years ago when I called her out of the blue to brainstorm solutions. I, as an advocate in maternal metal health policy and systems change was combing the landscape to learn why women weren’t being screened, diagnosed and treated routinely by their physicians. I knew that Karen had developed one of the only training programs for clinicians in the U.S. at the time.

After speaking, Karen and I knew that more providers needed to be expertly trained so we could reach more women, augment recovery and improve outcomes. Since then my organization, 2020 Mom along with Postpartum Support International has launched web-based training to easily reach clinicians all over the U.S. and meet a growing demand to learn about this field. Though we have a long way to go, training is now available to more people than ever and Karen’s intensive postgraduate training program at The Postpartum Stress Center continues to produce expert clinicians and is recognized as a best-in-class training.

Recently the United States Preventive Services Task Force, the American College of Obstetrics and Gynecology, and the Council on Patient Safety in Women’s Health Care, joined in this mission and have highlighted the importance of screening and proper treatment of maternal depression. It is now more important than ever that we train providers.

Therapists in this highly specialized field often turn to Karen’s books for guidance when working with the perinatal population. The Art of Holding: An Essential Intervention introduces a novel strategy for treating women with postpartum depression and anxiety. At a time when we are finally paying attention to this widespread crisis in maternal mental health, this book provides a hands-on resource for therapists who are dedicated to making a difference in the lives of women seeking their help.

Clinicians, we need you now more than ever; moms and families are counting on you. Karen Kleiman, thank you for your extraordinary contributions to the field – without your work we would be several steps behind.”

Joy Burkhard, MBA
Founder and Director
2020 Mom
Chair, The National Coalition for Maternal Mental Health

 

The Incubator: A Premature Paradox

I wonder, now, why I have such conflicting thoughts about this place. A place I knew as my own sacred space before I was ready for the world or before the world was ready for me.

Warm, radiant, transparent plastic encloses the precious gap between me and life outside the box.  It is, by design, both protective and isolating.   A womb-like shelter to promote healing while simultaneously separating a fragile newborn from the nurturing limbs of life.  I imagine this is one of life’s earliest, if not most acute, experiences of ambivalence.  Has this newborn been prematurely seized from her mother’s secure haven only to be shuffled to a temporary incandescent chamber?  Or, has this infant been rescued from an insufficient breeding ground to be nurtured and shielded from harm’s way until she can move forward as expected? Was it merely an interim therapeutic residence or was it, in fact, a sanctuary?

I try now, with the wisdom of adult retrospection, to see if from both sides. How scary, it must be, to be whisked out-of-womb with seven vital weeks of development remaining.  Wait!  I’m not ready. (Though my mother insists it were she who was not ready and I who was so hasty and impatient– so true to my nature – with my arrival).  I’m tiny, I’m crying, I’m red with the tension of copious blood vessels bursting with disappointment.  I’m cold and alone, even confused, perhaps.  I suspect when babies of any species are separated from their mothers, there is a flood of panic. Where are you taking me?  Why?  In those days, mothers were knocked out, as they euphemistically referred to it, anesthetized to oblivion, so even if my mother were able to hold me, she wasn’t aware of it, which takes all the pleasure away from me.

Scooped out of this unfriendly transition, I’m then ever-so-gently wrapped in a very pink and very tiny blanket that was, I am certain, not a fair substitute for my mother’s loving arms and hungry heart. She missed me, I know for a fact now.

I’m sure I knew that then, too.

But let’s face it. This was over 60 years ago. What if, the medical community of that time was right?  What if, that instrument that embraced my feeble self was, indeed, the optimal environment within which I could thrive? What if, without that intervention, however detached it may seem or be, preemies would die?  Without which, I would have died?  What if, as frightened as I might have been, I knew I was safe and free from the assault of unkind forces that were way beyond my control? What if, nothing could hurt me as long as I was secure within the confines of this clear plastic home?

Or, what if, I spent the rest of my life trying to free myself from this box so I could step into the world while trying my best to stay within its protective walls at the same time?  What if this primal ambivalence persisted and shadowed every step I took?  What if, I were to spend much of my adult life trying desperately to grow up despite a profound desire to stay put or go back, perhaps, to put closure on that which was left undone. A raw, unfinished innocence. Organic anxiety.

Premature intrauterine development. Eager, I dare say anxious, and at such an unripe age, to embark upon the challenges that lay ahead. I suspect I had little choice in the matter and consequence of prematurity, though primal therapists (who may believe that any early trauma could cause repressed pain and subsequent neurosis) would claim I knew exactly what was happening, on some level.

So many risks. Low birthweight. Thermal shock. Cyanosis. My mother recalls the day her  nurse reported that overnight I had experienced a cyanotic attack. Apparently I turned an alarming shade of blue, and then, everything was fine.

“Wow. That’s scary. Were you worried?” I asked, as I gasped for a deeper breath, doing my best to resemble that same shade of blue.

“No.  I wasn’t worried at all.”  My mother claimed, with a smile I could actually feel through our long-distance phone connection.  “By the time she told me about it, it was over, and I knew you were fine.”

“But I stopped breathing. Weren’t you afraid that could happen again?”

“Truly, no, I wasn’t. I knew everything was fine.  Really.”

And it was. To be sure. So why did my chest feel so tight and my breath feel so shallow while we recreated this 60 year old story?

Respiratory distress syndrome.

I think I had that then.

Or is it now?

Sometimes, I wonder what the difference is.

 

Scary Thoughts: #speakthesecret

 

The Secrets Women Keep

 

This thread is amazing. Needs to be turned into a list and handed out to expecting moms by every ob/gyn. They tell women everything under the sun about what to expect for 9 months; why not this?!

I think it’s wonderful you’re making this list for new moms. It would have been reassuring for me to know I was “normal”

“Scary Thoughts” is an expression used to encompass any and all categories of upsetting thinking that can interfere with the well-being of a new mother. Scary thoughts refer to negative, repetitive, unwanted and/or intrusive thoughts or images that can bombard you at any time (Kleiman & Wenzel, 2010). Scary thoughts are anxiety-driven, they are extremely COMMON, and most new mothers admit that have, at some time, imagined or worried about harm coming to their babies. The shame of having these thoughts can prevent women from speaking about them. In response to women telling us they feel isolated and ashamed of their thoughts, we asked women to share their scary thoughts in an attempt to help them express these distressing ruminations, so they can get relief and also help other mothers understand how universal this phenomenon is.

The objective of our PPSC project #speakthesecret is to obliterate the stigma attached to scary thoughts which are so common in new motherhood. 

Our page is an ongoing list of the thoughts that brave women have chosen to share in the hopes of helping women know they are not alone and that having scary thoughts is common during pregnancy and the postpartum period. We will add thoughts as they are submitted.

DISCLAIMER: This list is anonymous. You can contact us at any time if you want to modify or delete your submission. If you are worried about the way you feel, let a healthcare provider you trust know if you are worried about the way you feel.

♥ THANK YOU ♥

to all the brave women who continue to disclose their scary thoughts.

Together, we will educate many and help reduce the anxiety and stigma. #speakthesecret

 

Click here to SUBMIT Your Scary Thought and help reduce the stigma

“I Had No Idea I Was Overdoing it”

Experts and postpartum women themselves have long been aware of the interrelationship between postpartum distress and some individual predispositions. We cannot make any claims of direct causality, nor do we have research to back it up. What we have is tons of anecdotal evidence that postpartum women are doing too much.

Women who describe themselves as “Type A” or “perfectionistic” seem to be particularly at risk for postpartum depression and anxiety. Responding to the overwhelming responsibility of caring for a newborn can catapult vulnerable women into hyperdrive, kicking off a compulsive response to conceal how they really feel or think. Efforts begin to focus on making sure they look good and appear to have everything in order.

The effort it takes to present this pretense that all is good, if they are severely stressed or in need of immediate support, can be grueling and unsustainable. And yet, the fear of making a mistake or doing something wrong, keeps women locked into a no-win scenario while constantly bombarded by the uncertainties and unpredictability of new motherhood.

But here’s the real problem. Most of these women are, by nature, doers, high-achievers, accomplished women who have limited insight into how their successful attributes also put them at risk. This proclivity toward busyness and goal-oriented behavior keeps them focused and distracted. They simply do not always see it or feel it, when they are overdoing it. In addition, they often go unnoticed by friends and family as being in trouble or needing support.

Therefore, women who are pregnant or postpartum and have self-identified as perfectionistic by nature need to place close attention to how they are feeling and how they are doing. Literally. Sometimes, I will listen to a client describe her day and be slightly surprised by her lack of awareness that she is wildly overbooked and obviously exhausted. Often, the mention of this is met with disbelief or denial. We understand that these situations are complicated by imposing variables and intricate dynamics, but the bottom line is this:

Postpartum women are doing too much. And it is making them sick.

While we could launch into a discourse on the impact of our oppressive postpartum culture, let’s just focus on what moms can do today to help themselves.

  1. If you think you might be overdoing it, you probably are.
  2. Pay attention to your tendency to overdo, overthink, overworry, overreact, overwork. Then, do less. Give yourself permission to let go, to stop working so hard, to accept help from others.
  3. Making mistakes are a normal part of motherhood. Accepting this early on will protect you and create resilience.
  4. Think of overdoing like dehydration. You’ve heard that by the time you are thirsty, you are already slightly dehydrated and the key is to drink enough water throughout the day before your body responds with feelings of thirst. Likewise, if you are overdoing it, by the time you feel exhausted or depleted, it will be much more challenging to feel better. Intervene before you are overtired. Stop doing so much. Stop believing that your worth as a mother is defined by how hard you work and how good things look.

Take care of yourself while you take care of your baby.

 

photo: Dmitriy Melnikov

The Six Points

When you are in an anxiety-producing moment, it can be tempting to continue to focus on scary thoughts and exaggerated worries.
Accepting that anxiety is a part of your life right now and that there are things you can do to help yourself through the challenges will help you gain a sense of mastery over the anxiety.
The Six Points is a tool that was developed to help manage symptoms of anxiety by Manuel Zane in 1984.
Copy these points down or print it out so you can keep them handy as reminders.  The more you practice them when you anticipate anxiety or actually feel anxious, the more you will see how they work to ease your discomfort.

 

 

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