Postpartum Depression: What You Need to Know

Postpartum Is a Time of Transitions. Your body is going through much as it heals from birth and moves from pregnancy to a lactating and non-pregnant state. Your emotions and psyche are in a state of disequilibrium with hormone fluctuations, sleep deprivation, and increased responsibilities. Your life roles and relationships are changing with the addition of a new member into your family.

The First Two Weeks with Baby

There are some things you can do to get ready for those first few weeks at home with your newborn. It is an exciting and anxious time waiting for your baby to arrive…but I call it the first lesson of parenthood…”we are not in charge”…the baby is.

  • Allow yourself to enjoy those quiet moments with your partner during these last weeks of the pregnancy; they will not be as available after your baby is born. Plan a date or two out for dinner or away for the weekend or a vacation. These times will fill your fuel tanks for the next few years when getting away won’t be so easy. This reconnection will also foster good communication habits that are needed for the transition as a couple into parenthood.
  • Think about and arrange for help in those first few weeks. Plan that you will be taking care of yourself and your baby.  Others will be needed to support this, by doing everything else (cleaning, cooking, shopping, laundry, etc.). Often family members are as excited as you are to be there and meet the baby, but remember to help them realize (before the baby is born) their job is to support you. If you feel they will not be able to do this or will add to your stress with their own needs, gently but firmly tell them “no” and have them come later when the baby is older and you can handle this element of their relationship with you and the family. It is very important for you to realize that this time is a delicate and vulnerable time when you are getting to know yourself as a mother, your partner as a parent and the baby as a son or daughter. Be gentle with yourself and firm with your family about your needs. This will allow for the psychological space needed to transition.
  • Pick a doctor for the baby that you trust and makes you feel comfortable. This health care provider will be an essential element of support as you discover who your baby is and what they need. This person should be someone with whom you can ask any question and disclose all your fears and concerns and still feel they are respectful and listening. In your prenatal interview be sure to ask about their parenting philosophy; you will want someone who sits in your ballpark and is in line with your basic parenting approach. If they are not in line, then you will discredit their parenting suggestions and lose out on their vast knowledge from working with families and children for so many years.
  • Remember to take care of yourself. Plan to sleep when the baby sleeps, eat well, drink plenty of fluids, decrease your activity to allow for healing and lactation. . .hence why you will need help these first two weeks. Stay home and rest these first two weeks.  Outings should be limited to visits with the baby’s doctor or nurse practitioner or for breastfeeding help. Do not plan to travel or entertain guests or move during this time; allow yourself space and time to heal and get to know your baby.
  • Learn how to care for your baby with your partner. This baby is a product of your love for each other; you each have equal responsibility. Letting your partner share in the learning from the beginning is an important piece of the parenting journey.  Many things are learned from trial and error…seeing what works and then repeating it to see if it continues to work. If you are the only one doing the learning it will be harder to let go and watch or let your partner do the same thing to learn. Each of you will have different strengths and abilities; honor this and share the responsibility and the joy of your new child.
  • After the first two weeks gradually increase your activity.  Get out and get some fresh air to open up your world and not hibernate.  But do this gradually, with not more than one errand a day for the next two weeks.  Then after 4 weeks you can return to an exercise routine and normal activity level in your lifestyle.  Pelvic floor exercises and abdominal exercises are safely done at this point and are essential if you want to regain the muscle tone changed by your pregnancy.

Babies are great teachers. But we need to listen to them and be good students, trust your instincts. It takes time to get to know your baby and begin to understand his or her own needs and how to meet them. Raising a child is not about being the perfect parent, but about being the right parent for your child. Trust yourself to be able to do this. 

Sibling Preparation: Helping Big Brother/Sister Adjust As you think about the addition of a new family member, the members already in the family are your first priority. Making this transition as smooth and gentle as possible is the number one goal. It is also a very exciting time and older siblings can share in this excitement. I have always felt the response of the sibling to the new sibling has more to do with their ability to transition and accept new things than it does with their age. Their reaction may have developmental twists (based on their age) but overall it has more to do with their basic personality. With some special considerations, you can help ease the transition.

  • Taking the time to talk about what to expect when the new baby arrives is always beneficial.  Detailing the day-to-day with a new baby – breastfeeding, sleeping, crying, diaper changes - helps the sibling know what to expect.  Reading books and looking at pictures of new babies also opens up the conversation to what new babies can do.  Visit a friend or family member who has just had a baby.  Let him see or touch the baby if possible.
  • Sharing their birth stories and baby stories always helps the older sibling realize how much they have grown and how “big” they are, no matter what the age difference.  Look at pictures from when they were babies.  Make them their own special photo album of their own baby photos to look at whenever they want.  This also allows you a chance to share why they are special to you and unique unto themselves.  Emphasize how “big” they are now and how much they will be able to do.  Showing them how to be helpful can build self esteem.
  • Remember to tell them how special they are and how much they are loved.  The addition of a new sibling always displaces the children already at home a bit.  Anger, jealousy and regression are common emotions even for the most excited and prepared child.  It has been likened to having your partner bring home a new spouse, stating they loved you so much they wanted to have another one and aren’t you happy to share them with this new younger spouse?  Of course it will be hard to share you with a new person whose needs will come first!  Creating support networks to give the child attention in ways they already appreciate (school, friends, grandparents, family) will “love bomb” them after the birth and lessen the shock of the transition. 
  • The other parent often takes on the role of primary parent for this older child. Having this special attention helps ease the reality that Mom is less available. Their reaction is often not towards the new baby (they know it’s not their fault) but more often towards you, who brought the baby into the home!  Keep telling them how much they mean to you and how happy you are they are in your life. Even if they are grumpy, it will help them to know you love them. Try to find time when the baby sleeps to do something one-on-one with them also. You will miss this time as well.
  • I have always thought of the sibling relationship as sacred.  You can try out being the worst with them and the best with them and they will always be there. Through this process you learn to be a better person. Try not to compare your children with each other.  Each one of them is their own unique self and will react and be different from each other.  As hard as it is to imagine sometimes, with each coming from a similar gene pool, they will not be the same.  Stay open to this and appreciate the differences, they are special.

Post Partum Blues/Depression/Anxiety: How to Tell The Difference

Baby Blues are that “let down”, “tears-for-no-reason”, anxious, irritable array of feelings that come and go the first week or two after your baby is born.  Most new Moms experience them to some degree and they resolve spontaneously.

Postpartum Depression occurs in about 10 percent of new Moms and is a more serious situation.  It may occur within days or weeks of your birth or up to one year after the birth. A partner or loved one may see these symptoms before the Mom herself.

Please Seek Help From Your Midwife or Healthcare Provider if Any of These Signs Occur:

  • Fatigue, sleeplessness, exhaustion
  • Feeling sad, hopeless, guilty, inadequate
  • Overly concerned about your baby’s welfare - maybe even afraid to let your partner care for the baby
  • Lack of interest in the baby
  • Crying, confusion, poor concentration, memory loss
  • Loss of appetite or no interest in food

Postpartum Anxiety/Obsessive Compulsive Disorder can occur after the birth of your baby and is when a new Mom becomes extremely anxious. This anxiety feels like extreme fears, rapid breathing and heart rates, shakiness, and feelings of impending doom. Rarely, the anxiety may be felt with intrusive thoughts and repetitive thoughts, and/or avoidant behaviors (fears of harming the baby therefore staying away from the baby to protect him). These thoughts and feelings are very frightening and out of character for this Mom.

These disorders have been linked to rapidly changing or imbalanced hormones, poor support systems, stressful relationship with partner, a history of depression, anxiety, or other emotional problems, and a history of childhood abuse.  Unfortunately, complete knowledge and understanding of these serious disorders is not yet available.  However, symptoms may vary from day to day, from mild to severe, and are treatable with skilled professional help.  

Your midwife or other health care professional can discuss these feelings with you and help you find the support you need during this important transition. Treatment is available and effective, especially with early intervention.