Thank you for taking this month, day by day, with me to learn about and support Maternal Mental Health.  

Some final thoughts and reminders.  In my opinion, maternal mental health would be better termed maternal emotional health.  Of course mental and emotional are closely linked and rarely separable but, all too often we fall into the trap of believing that one’s thoughts are in control of our feelings.  With women suffering during pregnancy or during postpartum/motherhood, their emotions are the engine of the roller coaster they are on, their emotions are doing the steering, their emotions are overpowering their thoughts.  The thoughts are only the brakes.  They may be able to logically reason that their feelings are not rational in the situation but their “brakes” can only slow things down so much for so long.  Much of the work I do with women who are suffering PMADs or who are simply struggling in life, is done in part by addressing the emotional crisis they are feeling at the moment…addressing their symptoms, problem solving together and giving them tools for managing their emotions in the moment…and in part by addressing their overall life circumstances that may be contributing more broadly to their depression, anxiety or unhappiness.  

Remember….a mom is a mom whether it’s her first baby or her eighth.  PMADs can strike at any time.  A mother having positive and healthy mental health will set the stage for her children’s upbringing and mental health to also be positive.  If you see a mom struggling, reach out to her (literally or figuratively).  Even if you don’t know what to say, a gesture, smile, or just being there can be supportive.  We can all do a little more for the moms in our lives! 

Although I won’t be blogging daily after today (it really is taxing to keep up with it!), please look for occasional blog posts, tips, and posting about events coming up or those that I have attended.  🙂 

LGBTQI MOMS

As has been discussed in previous posts throughout this month, PMADs can strike mothers regardless of their sexual orientation and can also strike fathers regardless of their sexual orientation.  It can strike adoptive parents as well as the partner not carrying the baby in a lesbian couple.  However, in sticking to the theme this month of Maternal Mental Health, let us focus on a mother’s mental health within the LGTBQI community.

This can quickly become a complicated topic and I do not profess to know all.  There are somethings that I, as a mental health provider, do know.  I know that individuals who are part of the LGBTQI community are humans…just like those who are heterosexual…and as humans, they have mental and emotional health as part of their make up.  I know that mental and emotional issues can strike any human regardless of their genetics, SES, education, race, ethnicity, religion, or sexual orientation.  I know that mental health as a whole is stigmatized and not enough conversation, support or education takes place around mental health in general.

I also know, from educating myself and from personal experience, that being part of the LGBTQI community comes with stigmas, biases and prejudice of it’s own.  Being challenged daily by a society where some individuals will judge, target, discriminate or shun you because of your sexual orientation or gender identity, can be quite damaging to ones self-esteem, and mental health.  While mental health issues strike all humans, those who are part of the LGBTQI community are 3x as likely to experience a mental health condition (https://www.nami.org/Find-Support/LGBTQ).  Merely living a life in which you are not treated or viewed equally by some can cause a great strain on your mental and emotional health, contribute to feelings of depression or anxiety and increase stress levels.  Being a LGBTQI individual places you at higher risk of getting a PMAD during pregnancy or after the birth of a child.

Prior to ever becoming a mother, many lesbian, bisexual, queer or transgender women will go through the process of coming out to family and friends.  This can result in family rejection or abandonment/distancing by friends.  A support system that many new moms take for granted, may not be as readily available to a member of the LGBTQI community.  And, likewise, for women who may still be living in secret, fearful of disclosing their sexual orientation or gender identity, there becomes the dilemma of how to go about becoming a mother, a single mother essentially, while protecting yourself from the possible judgement and abandonment.   There are many aspects from conception, through pregnancy and deliver and rearing a child that are considerably more complicated for a same sex couple.  Conception can be more expensive as it generally includes IVF or a surrogate.  Delivery poses questions such as, will my partner be considered the baby’s parent if something goes wrong during delivery and I’m unable to make decisions?…or will my partner be put on the birth certificate?  

Now let’s add in societal views of moms in general.  Should they work?  Should they stay home?  Should they breastfeed?  Should they be able to do it all?  These pressures all apply to lesbian, bi, queer and transgender mothers as well.  Plus we have additional societal views and questions…where’s the father?  Doesn’t the baby need a man in his life (especially if you have a son)?  Can same sex parents raise a child well?  It is widely believed that same sex parents are indeed more open-minded and accepting of their own children’s differences.

And the mother’s own worries and anxieties about her baby.  Most mothers struggles with the responsibility of protecting their child while also allowing their child to grow and develop into a capable adult.  How to protect your child or prepare them for all the difficulties in life.  What if you had the added worry that your own lifestyle may actually bring negativity and pain into your child’s life?  What if you had to contest with questions about if the other mothers on the playground would accept you and your child if you walked in holding your same-sex partner’s hand or if they realized you were bisexual, queer or transgender?

The ways and manners in which being part of the LGBTQI community can impact a mother’s mental health are vast and diverse.  There is more our society as a whole can and needs to do to close the gaps in services and support, to create more equality not only tangibly but in our own hearts and minds.  There can be immense support in the LGBTQI community despite it not necessarily being perfectly tailored to maternal mental health.  At NAMI’s national website you can find mental health support groups and at NAMI’s page for LGBTQI individuals:  https://www.nami.org/Find-Support/LGBTQ  you can find resources to help locate an LGBTQI-inclusive provider.   What is most important is to keep looking, not only for professional support or treatment, but for community support, and non-traditional places of support until you find what works for you.  There is always more we can each do as individuals.  Being the mom who is accepting and welcoming at the playground, mommy meetup or support group can really help change how this environment is experienced by a newcomer who is already battling societal negativity and/or internal negativity such as someone from the LGBTQI community does.

Military moms

Are you a military mom on this Memorial Day?  A mom of someone in the military?  A wife of someone in the military?  Was your mom in the military?   Are you a mom and part of our armed services?

Having a connection to the military, particularly if you are a mom/wife/partner of someone serving, someone lost in battle or are serving yourself, can add another level of complexity to your mental health.  Let’s focus on moms who serve and moms who are home, parenting alone while their partner is deployed or training.  Both are equally hard in their own ways.

Imagine having a partner, but functioning as a single mother for periods of the time. Sometimes long periods of time.  From conception, through pregnancy, delivery and raising your baby, everything is done a little differently.  It can be quite anxiety provoking to attempt to conceive on a schedule you have no control over.  Imagine spending your pregnancy without your partner, experiencing the ups and downs alone.  Imagine packing a laptop in your hospital bag and extra batteries to make sure your partner can witness your baby’s birth.  Imagine traversing parenthood part of the time on your own and part of the time with a partner.  Each step is unique and not necessarily subject to the typical pregnancy or postpartum advice.  

An abstract of a research study “Associations of Post Partum Depression with Spousal Military Deployment and Isolation.” created by Jeffrey H. Millegan, M.D. NMCSD Mental Health; Daniel Robrecht, M.D.; Lynn Leventis, M.D.; Crescitelli Jo, R.N.; and Robert McLay, M.D., Ph.D., notes that the risk of postpartum depression to military wives is 2.31 times greater.  

Often the stigma is greater and women whose partners are in the military are more accustomed to doing things on their own, being strong and not having the support that other women may have available.  Often military families move around and the moms are faced with rebuilding their social and support systems while trying to settle into a new home and potentially help their children settle into new schools.  And with all the moving, it is almost impossible to be near family or get regular family support or assistance.  

Military moms on bases have to contend with increased anxiety and stress related to noise and disturbances disrupting the all too valuable nap time or bedtime for their babies.  Military wives can experience almost constant anxiety about when they will next get to talk to their partner during deployment.  When will they get to share about the newest development of the pregnancy or baby’s development.  When will they share good or bad news?

There are endless ways that having a partner in the military can effect the mental health of a mom during pregnancy and that all important postpartum time.  

And what about the moms who serve themselves?  Again, complications from the onset.  This time, you are the one away, unable to see your partner on a regular schedule in order to attempt conception.  Though now you also have to consider how pregnancy will impact your role in the military.  Women make up about 15% of the military.  There are limits to what you can and are allowed to do when pregnant.  And there are expectations after the baby is born.  Many women struggle with returning to work outside the home after baby is born.  Many take 6-12 weeks maternity leave before having to return to work.  But imagine if returning to work possibly meant being sent out of the country for months at a time.  Leave your children or leave your career completely.  This is the dilemma for many military servicewomen.

And if you are not faced with deployment or the decision of career vs. children, you will undoubtedly be challenged in many other ways.  Breastfeeding, pumping, witnessing first milestones for your child.  These are challenges for many working mothers.  But there are unique factors if you serve.  There are unique expectations and restrictions on your schedule and your ability to stop and pump or leave work early.  Time off is closely monitored and requires extensive approval.  The regular stresses of being a mom are amplified by the unique structure of your job.  

Experiencing a PMAD can be shocking to one’s system.  It can make you question your abilities as a mom and in your workplace.  It can cause you to have difficulty thinking and functioning.  It is hard enough to manage these symptoms when you are not in a high stress environment.  Being away from baby can be anxiety provoking enough when you know you’ll see her that evening.  Managing this anxiety for months at a time can be strickening.  How does one establish an identity as mom and bond with their baby when they are in a completely different country?  How does a mom manage her emotions in an environment prided on strength and courage?

On this Memorial Day, let’s remember that many service men and women have been lost over the years.  And let’s remember their partners and children, their parents and siblings.  Let’s remember that those men and women would not be serving us without great sacrifice of their own and their families. 

If you are in the military or a military mom, and need support, please go to:  http://www.postpartum.net/get-help/psi-support-for-military-families/

PMADs- The facts…

Time after time, I encounter both new and seasoned moms in my office saying “no one told me…if I had known…”.  And it’s true!  It’s quite likely that no one did tell them. Not during an annual visit, not during one of the many appointments you have during pregnancy, not during a birth/delivery/baby care class.  It’s very common for women to get through a year or more of pre-conception and pregnancy appointments without ever hearing about depression, anxiety, OCD, PTSD or paychosis during pregnancy or postpartum. It’s often not until after the baby is born that providers hearing from women who are confused by how poorly they feel.

Although many providers focus on the first year postpartum when talking about maternal mental health, the effects of how a mother experiences the first year with her baby can last a lifetime.  A mother can carry with her all the self-doubts and negative feelings that developed during that early postpartum time.  It can effect how she relates to her children as they move through adolescence and how she relates to her partner over time.  And it is with this lasting impact in mind that I offer the following information so that women can be better informed.  Education about what a mom is feeling and the facts around PMADs is part of the work I do and can be very helpful to women suffering with these diagnosis.

The following information is commonly accepted and widely known in the Perinatal Mental Health community.  More information or details can be found at Postpartum Support International’s site http://www.postpartum.net

The facts…

• Upwards of 15-20% of women experience a PMAD during pregnancy or the first year after a baby is born.  
• Postpartum Depression is the number one complication of childbirth.  
• Untreated, postpartum depression can lead the mother to suicide.
• Postpartum Anxiety can be experienced as general symptoms of anxiety or can be more a more specific anxiety disorder such as Postpartum OCD (3-5% of new moms) or Postpartum Panic Disorder.  
• About 9% of women will develop Postpartum Posttraumatic Stress Disorder (PTSD).  Though it has been found that up to half of women experience childbirth as traumatic, all may not develop PTSD as a result.  
• Postpatum Psychosis affects 1-2 in 1,000 women.  It has symptoms including hallucinations, delusional thinking and paranoid thoughts, and usually sets in in the first 2 weeks.  It can result in suicide (5%) or infanticide (4%).  
• Bipolar Disorder can also have onset during the postpartum period and should be considered and monitored for if a mother has had episodes of mania before.  
• Women who have experienced PPD after a birth have a 75% increased likelihood to experience PPD after a subsequent birth.  

Who is at risk to get a PMAD?

• Pregnant women
• Women who are within one year postpartum (though if untreated, or treated late, symptoms can extend beyond first year)
• Mothers who have had a PMAD before
• Fathers
• Lesbian partners (the mom not carrying the baby)
• Parents who give their baby up for adoption
• Adoptive parents
• Someone who has suffered a fetal or infant loss

Factors that increase your risk for a PMAD:

• low income/socioeconomic disadvantage
• single mother
• military mother or in the military 
• LGBTQ population
• family history of anxiety or depression
• having your own previous episodes of depression or anxiety
• history of previous trauma
• parents of multiples

Arming yourself with information can help you prepare or help lessen your risk. The best news about PMADs are that they are temporary and treatable.  You will get better! 

Where to find support…

We all need support. But, alot changes after you have a baby. And some of your regular outlets or friends may not be as available. Or, your schedule has changed and you’ve lost touch with old activities. Or, you’ve been a mom for so long (or not so long) that you’ve forgotten who else you are and how to make friends.

So, where do you find the support that you need and deserve?

1- Just as their names say, specific support groups either for moms (mostly newer moms attend these) or for more general mental health needs such as depression or anxiety can be the  perfect place to find people who can commiserate and identify with where you are at in life.  For mom support check postpartumhelp.net and for general mh support check NAMI.org

2- Other moms…moms in your family, friend moms, moms of your kids friends. Being a mom is taxing and lonely sometimes. You may be surprised how unalone you really are if you reach out to other moms you know.  If you aren’t ready to disclose how you are feeling, just start with a general lunch or coffee invite and see how much it can help to just be around another mom.

3- Gym classes- these can be intimidating but also empowering. To be in a room with other women. Working hard and being encouraged. Particularly yoga which lends itself to kindness, welcoming, everyone honoring individual abilities.  Or small group personal training. This can get expensive unless you find a reasonably priced gym where classes are included.  Also, some gyms have organized activities such as basketball or other rec team sports. Awaken your former athlete. And remember, YMCAs and some other gyms offer childcare.

4- Take a class. An art class, a music class, or audit a college course (usually free).  Refresh a former talent or learn something new. Go in person (not online) for a break from parenting and a chance to be around people with a shared interest.

5- Religious centers. Whether you attend regularly or have not attended recently. Finding the right religious center for you can create an immense support system.  Keep looking until you find the right one for you.  Check out volunteer opportunities, women’s groups or coffee gatherings. And don’t forget to see if childcare is offered during service or other meetings so you can fully engage and know your child is cared for nearby.

6- Volunteer opportunities – follow your passion or find an organization that can use skills you have. Get involved. Whether you can serve on a board or only help out in evenings from home, volunteering can give you a new community with a shared interest.

7-  Online- I offer this suggestion with reservations.  Online support sites or chatrooms can be very supportive but can also encourage isolation at home.  Be very careful to choose the right site that is known and trusted, or recommend by someone you trust.  And make sure you limit your involvement to a certain amount of time a day so as not to get too consumed. Face-to-face, real world interaction is important.

Whether you try one of the above suggestions or have another idea, there’s no day like today to seize the opportunity. You need support, you deserve support and there are always new places to find it.  Take care of you!

The storm shall pass but it is nice to have someone with you while it rages.  

Believing you are alone is never more reinforced than when you look around and really are.  

My dear childless self…

Dear childless self,

Enjoy sleeping randomly during the day and night, by choice. Enjoy being spontaneous. Enjoy peeing in privacy. Enjoy eating hot meals. Enjoy getting to give the absolutely adorable baby back to it’s mother. 

Dear childless self,

Be kind to the mothers in your life. Not just your own mother but your grandmothers and aunts, your cousins and friends who have children, the teachers and babysitters who care for children everyday.  See them as women outside of being mothers. Know that they have personalities and flaws, and wonderful things about them. 

Dear childless self,

Not everything is the mom’s fault!  Hold the judgmental glances, the eye rolls and the loud sighs.  Differentiate between an inattentive parent allowing their child to be disruptive or destructive and an exhausted, exasperated mom just trying to get through a grocery shopping trip.  Lend support or kindness rather than reinforcing their already ingrained self-judgment, blame and embarrassment. (These feelings are often caused by internalizing all the judgments she made about moms before she had children.)  Know that mothers are often doing the best they can and trying to be everything to everyone.  There are no exact directions to mothering. 

Dear childless self,

Dream of your future. Your future life…family…children. Dream of all the fun and creative things you will do. Dream of all the trips you will take. Dream of the kind of mom you will be. And then know, there are so many unknowns in motherhood. Expect your dreams to change. Expect to need to be flexible. Expect some disappointments and some wonderful surprises. 

Love,

Me with kids

PS.  To me with kids…give your former self a break (she didn’t know)!  

What are the factors that affect maternal mental health?

Maternal mental health issues can strike whether you are a single mom, married heterosexual mom, married/partnered/unmarried lesbian mom, bisexual mom, ethnic minority, religious or not.  The stress of being a mom and the subsequent mental and emotional struggles do not discriminate.   There are no known causes of maternal mental health issues or PMADs but there are many factors which contribute.  The reason the precipitants to PMADs are considered factors and not causes is because you need to have the right (or wrong) combination of factors for the result to be a mom experiencing a PMAD.  One factor alone may cause stress or symptoms of sadness or anxiety but it is unlikely to result in a full Perinatal Mood or Anxiety Disorder.

These factors generally fit into several categories…

1.  Environmental factors:  Environmental factors can be socioeconomic, housing, or even the state or country in which you reside.  For instance, if you are struggling financially or are at risk of losing your housing, this is likely to cause much anxiety, fear and stress in your life prior to having a child.  Once you factor in the responsibility for another life, these factors are compounded.  Also, if you are a lesbian mother, and reside in a state where same sex marriage is not legal, you are at a disadvantage for some government benefits or programs that might help support you as a mother.

2.  Interpersonal Relationships/Support System:  Relationships and supports in a mother’s life are integral to her ability to traverse life and engage in self-care.  If you are a single mother (either quite literally or due to a partner who is checked-out), it is very difficult to prioritize caring for yourself and sometimes near impossible to make the time to do so.  Having a supportive, engaged partner and other peripheral family and friend supports are imperative for a mother struggling with her mental and emotional health.  Getting a babysitter may seem simple to some people, but what if finances are strapped and you already feel guilty about being away from your baby for work? And imagine being a lesbian mother whose family turned their backs on her when she came out.  Family support is not available for some women.  Or a woman in an abusive relationship who fears asking for help from anyone.  

3.  Personality/Character:    A woman’s innate personality structure can often contribute to her struggles as a mother.  Strong women often struggle most after childbirth.  Being used to handling everything on their own, independently and efficiently, they are now in a position where they are feeling overwhelmed, exhausted and at a loss.  Self-judgment sets in.  Or a woman who normally feels she is burdensome to others.  Someone who generally struggles silently is unlikely to independently change how she handles things after the baby is born.  Instead she struggles in silence, alone.  Or a woman who is an apologizer, always blaming herself.  The guilt that comes from believing you are to blame for how you are feeling can be crushing.  The desperation to change it.  There are so many ways our natural personality and character traits work against us as mothers. 

4.  Other life stressors:  It’s quite common to have too much on your plate, whether you work and have children or are a stay-at-home mom.  There are house chores, shopping, other kids, homework, after school activities, playdates…  Now these things alone may have been something you juggled well in the past but add in a new baby and it can all become too much.  It amazes me how many moms will seemingly forget they have a new baby, saying “I could always handle it before, what is wrong with me now?”  The tendency to self-blame and experience this as a change in your abilities rather than a change in your circumstances is quite common and so very incorrect.  

5.  Prior mental health issues:  It goes without saying that if you struggled before, you may struggle again.  Even if you never experienced mental health issues outside of a PMAD, that alone puts you at higher risk.  If you experienced a PMAD with a previous pregnancy/birth, you are 75% more likely to experience one again.  And even though it is not a definite, if you have experienced mental health issues outside of a PMAD in the past, you are at higher risk for a PMAD during pregnancy or after childbirth.  Err on the side of caution and get into treatment early, plan ahead and stay in treatment until you and your providers feel confident you are stable.  

  6.  Your pregnancy and birth experience: Every pregnancy is unique and every delivery is unique.  You are a unique person experiencing them as well.  And how you experience them can greatly impact how you feel as a mother.  Upwards of half of women will experience childbirth as traumatic.  And even those who do not, can be surprised by their inability to feel complete joy after the baby is born.  A good or bad childbirth experience can both contribute to feelings of confusion, sadness or self-judgement after baby is born.  

As you can see, there are many factors that contribute to a mother’s mental  and emotional health.  More than I even listed here.  But, perhaps you can also see the interaction between these factors.  How certain life circumstances might be manageable for one woman but not for another.   You, your child, your family and your circumstances are unique.  I hope this helps you judge yourself and other mothers less, realizing there are many things in life which contribute to a mother struggling.  The important thing is to support her, raise her up, encourage her to get help and talk openly about the struggles she is experiencing.

Birth Stories

When did having a baby become a competition?  How did lengthy labor and horror stories become the go-to birth story structure?  Why do we villanize women who had “easy” labor or delivery?  

Your birth story is your own.  It starts with pregnancy, labor, delivery.  It can end in many ways.  Although there are many varying birth stories, ranging from magical to traumatic, telling your birth story can be a valuable and uplifting experience for many women.  It can be healing if you found childbirth traumatic or difficult.  It can be solidifying if you found childbirth powerful and challenging.  It can reinforce your strength or clarify your understanding of just what exactly happened?!  

If you lost a baby during childbirth, your story is different and it may be difficult to apply much of what I will talk about in this post.  If you lost a baby during childbirth, your story is not just traumatic, it is likely devastating.  I hope you are getting professional and peer support.  I am sorry for your loss.   

Some women, a smaller portion of the population, will report an “easy” pregnancy, labor and/or delivery.  They will report having a glow, a short labor, a painless delivery and instantly falling in love with their baby.  This is wonderful and I encourage women to support one another regardless of their birth experience.  Ask questions of these women rather than shut down their joy with a dismissive comment that implies their experience is less valid because it was not horrible.  

Usually, women report a combination…either a difficult pregnancy but the delivery went well in the end or an easy pregnancy and then their entire birth plan fell apart during labor and delivery.  Often new mothers will dismiss their traumatic experience as a result of their inexperience.  By the time many women have their own birth experience, they have heard so many horror stories, they simply accept their traumatic experience as more of the same.  As typical or expected.  It should not be.  

Almost half of women will report experiencing childbirth as traumatic.  Telling their birth story can be scary and many of them avoid discussing it at all costs.  To them, I say, be patient with yourself.  Be gentle and find the right outlet.  Some women choose to write their story, for themselves or for their child.  Others choose to speak about it with a therapist, in a group (support or therapeutic) or with a friend/family member.  Some hope to never speak of it again.  If you have had a particularly traumatic labor, delivery or postpartum experience, I strongly encourage you to tell your story with the support of a therapist either individually or in a group.

The benefits of telling your birth story (in the right environment and at the right time)…

• Take back the control the trauma has over you.  You tell your story to hear it said outloud.  To accept it’s truth and reality…it’s place in your history and life.  And then to let it be part of your history.  It does not define you as a mother or your relationship with your child.  Acknowledging the pain, hurt, trauma can be the beginning of healing from it.

• Decide what your birth story is.  What will you tell your little one when they ask one day about they day they were born?  Will you tell the anecdotal “I was in labor for 18 hours…it was horrible.”  Or, will YOUR story, tell them more?  YOUR story does not have to include every difficult detail.  YOUR story can tell the general idea that you were in labor a long time and they were born at the hospital or home or where-ever and then focus on the nicer moments…maybe there was a laugh at some point, maybe the experience strengthened your relationship with their other parent or another part of your support team.  Maybe you remember holding them for the first time or watching them sleep all wrapped up in a swaddle.  YOU get to decide what to include.

• Process the experience with your partner or family who were there.  Share what you remember and hear what they experienced.  You will learn details you had not noticed and be able to come together through a shared experience.  Decide that the good memories, no matter how small, are the important ones.

• Let go of self-blame.  Childbirth is uncharted territory for first time moms and even second or third time mothers can run into the unexpected.  Women come out thinking they could have had more control, or handled things differently or really had that ideal, dream birth they had written out in their birth plan.  The sooner you talk about your birth experience and hear from others who were there, the sooner you can let go of that self-blame.  You can understand how many people and factors were in play and you can appreciate that in reality, you were mostly along for the ride.                                                                                                                                               It takes a great deal of advanced planning to actually have control over your birth experience.  It usually means having your baby at home, or outside a hospital environment.  If you are at a hospital, having a birth doula or other outspoken and experienced individual at your side and having all the stars align in terms of timing, low risk to you and baby and a good hospital staff all help.  In the end, there are many factors out of your control, particularly if you are new to this (talking to you first time moms!).

• Learn for next time.  Often women experiencing Perinatal Mood or Anxiety Disorders (PMADs) or those who found childbirth to be traumatic, can not wrap their minds around the idea of “going through this again.”  And to that, I say, “and maybe you won’t.  Maybe you will never choose to have children again.  Maybe you will have one beautiful baby.  Maybe you will adopt.  But…maybe you will change your mind.”  Time has a way of changing our minds.  Talking can do that too.             Telling your birth story can be a wonderful way to learn (for next time).  Learn what you liked and didn’t like.  Learn what you really have control over and what you don’t.  Learn how systems work.  Learn what you would do differently the next time and learn what you would keep exactly the same.  Each birth experience being different does not mean one will be better or worse.  It just means they will be different.  And, if you do not feel good about the last experience, different can be an appealing idea.  

There is no blue ribbon for having the worst birth story.  Sometimes the purpose of telling a harrowing tale is the attempt to alleviate a self-judging voice that wants desperately a way to explain and justify why things did not go just so…why she was not completely in control…why it seemed so terrible.  Women who have good experiences want to share how wonderful it was and want to talk about how other women can have good birth experiences too.  It is important to recognize that regardless of if you have a vaginal birth or C-Section, regardless if your labor was short or long, regardless if your delivery was painful or pain free, childbirth is not easy.  A woman’s body goes through quite a lot during childbirth, physically, mentally, emotionally.  As soon as we start realizing that carrying and birthing a human (no matter how it is done) is momentous in and of itself, the sooner we can focus on a mother’s strength.  We can process the negatives and raise up the positives of the experience.  I hope telling your birth story will be powerful for you if/when and however you choose to tell it.  

SO MUCH INFORMATION!!!

Whether you are a parent or not, you’ve probably heard the old adage Kids don’t come with a manual.  While this is very true, there are still hundreds of books, apps and websites out there just waiting to tell you how to parent, cure your child’s illness and read every baby cue ever studied.  (Mind you, I write this with acute awareness that you are reading it via my website or Twitter.)  It can all be a little overwhelming.  

So, what is a mom to do?  Your baby can’t talk (or your older child won’t) and you are left feeling exasperated, exhausted and frustrated.  Essentially you are judging your own inability to figure it out as a reflection of your value as a mother.  After spending time guessing and running through the usual (diaper, hungry, tired, hot, cold…), who has time to read or research?!  And if you do read, does it help? Or just make you feel more confused and worse?  

Some simple tips:

• Read only if you have the time and believe it will be helpful.  Don’t read books simply because someone gave it to you as a gift or because your best friend swears by it.  Look for books that are well organized and have a Table of Contents and Index.  Look up just what you are having an issue with and read only about that topic at the time.  If you find a book that seems to speak to you (through it’s organization, advice and clarity) then use that as a go to resource.  And please remember (this is very important) there are many baby books but not all books are about YOUR baby.  

• Your pediatrician and other doctors/nurses are your best resource(s) for any illness related questions.  Many first time moms worry they will be considered “high maintenance” or “over-reactive” if they call their pediatrician’s office.  In fact, many pediatricians prefer you call them rather than blindly try to figure out what is going on with your child.  And, many pediatrician offices have a nurse who spends much of her day answering questions for parents so you are not interrupting the doctor’s day.  And this means you don’t have to actually take your child to the office every time something seems off.  I know it seems easy to pull up WebMD or another “medical” website/app but in the end, it’s best for your child’s doctor to be managing their health from the beginning of any new illness.

• Everything I said above about books is also applicable to websites and apps.  The amount of information available in our digital driven society can be quite overwhelming.  If you are inclined to research or use site/apps as resources, please check that they are evidence/fact based and utilize more than one for a variety of information, advice and directions.

• Parental Advice:  This can be most overwhelming.  Often it is unsolicited, and given in person or via a text/email conversation.  It is difficult to say “I’m going to think about it (or research) it more before trying what you suggest.”  What you can say, however, is “oh, I hadn’t considered that, let me talk to (partner) about that idea.”  Or, simply “Hhhmmm, I hadn’t thought of that, thanks for sharing how you handle…”  These responses give you the ability to keep things very open ended and not commit to use their parenting style or approach.

• Something that I often encourage parents (particularly new parents) to do is to make a list of their “trusted resources”.  Identify 3-4 other moms (or dads if they are the primary caretakers) who you trust in general.  Try to pick a variety of people…maybe one family member (a sister or cousin with kids), pick someone who has a child your child’s age, and pick someone who has children older than your child, if you have a friend/family member who is a nurse you could include this person in your list as well.  Anytime you have a question, big or small, draft an email (or text/DM) and send it to each of the 3-4 people separately (just copy and paste the same message).  Wait for replies.  This will either give you several ideas/options to try or will give you a general consensus for how to handle the situation.  Either way, you get concise, focused information, addressing exactly what your question is and you can thank them all in writing and then weigh the options in the privacy of your own home.

Now go look through all the baby books you have and throw half of them out!  🙂 

Sundays…

Once a time of relaxation and leisure…enjoying the sun, or snuggled up warm when there’s snow…Sundays are now a source of anxiety and panic for many mothers.  Even those who are not diagnosed with or suffering from specific PMADs often experience an increased sense of stress, anxiety and edginess on Sunday.

And no wonder…Sundays are no longer days to lay in bed together and waste away the day, or go on long drives or watch back-to-back movies.  For new moms, Sunday feels like every other day now…full of work.  She gets up with the baby…feedings, diapers, entertainment, chores…

And the preparation for the week.  If your baby/child is in daycare/school then you have to make sure clothes are clean, lunches made, bags packed…

If your home with your child, weekends may be the only time you and your partner have together to take care of joint decisions, larger projects or bills.  All with a child or more in tow.

Sundays bring a sense of urgency and tension.  We lose our ability to enjoy each others company.

Moms often are unable to stay present in their day.  This happens often but Sundays are the worst culprits.  Mothers who are struggling are either thinking about having to return to work the next day themselves or thinking about their partner going off to work and leaving them with the baby again.   Feelings of anxiety, sadness, depression and frustration can set in even when none of the precipitating factors have even happened yet.  Sunday feels like it’s over when it’s just barely began.

Anxiety has a way of taking over your mind.  It finds it’s way into your thoughts and causes them to become negative, catastrophic and repetitive.  It causes sadness, loneliness and difficulty enjoying the present.  So, how do moms get their heads out of Monday and back into Sunday?  How do you take Sunday back and make it part of your weekend again?

1- Start by making a reusable master checklist of things that have to happen every Sunday.  This might include “make lunches, pack school bags, lay out clothes for tomorrow, pack the trunk, give kids baths, wash clothes for the week” or any other things unique to your family’s routine.  Now look at the list and see if there is anything you can move to another day, even just one thing.  And talk about the list with your partner and kids if they are old enough to understand.  When both partners have an understanding of what needs to happen in a given day, it is more likely to get done and the work be shared.  You could even decide who will do each thing on the list to take some things off your plate (it doesn’t have to be 50/50 if one person works on weekends or has other obligations).  And if there are things that can get done early in the day (like laying out clothes or packing a bag), do it first thing to get it out of the way.   Having a clear plan for getting done the “musts” will already start to alleviate some stress and panic.

2- Next, decide that every Sunday will have something nice for you in it.  Some weeks it might be big and others just a small something that you will enjoy doing.  This gives you something to look forward to, and reminds you that Sunday is a whole day with time to fit in good things for yourself too.

3- And, finally, the hardest part, which will take the most practice.  Be mindful of your present.  Remind yourself often that “it’s only Sunday…I have the whole day to enjoy.”  If you find your mind wandering to the dread of Monday and the week ahead…

• Take three deep breaths (this sounds cliche and something you have been told to do since you were young but please do it anyway).  Deep breaths where you feel your diaphragm and lungs fill completely and count to 4 as you inhale and 4 as you exhale, can do wonders for your stress.  Getting oxygen into your bloodstream, slowing your breath and relaxing your shoulders when you breath will all lessen your anxiety, stress and tension.
• Think about your present.  It’s only Sunday.  You have plenty of time (no matter what time it is) to do nice things and get things done.  You have this day to enjoy your partner, your baby, your world.  Focus your mind on what is important to you that day.  Review in your mind what you would rather be doing then thinking about the next day.  And go do those things!
• Look at your partner and your child(ren).  Think about enjoying time with them rather then thinking about the next day.  Watch them, listen to them, stay as focused as you can on what is happening right around you.  And if your mind wanders and you feel stressed…start back with the deep breaths.  Being present is a practice…there’s no way to do it perfectly or always.  Allow yourself to practice it for the benefits and not critique how well you are doing.

Sundays are as much a day as any other.  Treat them as such.  Another 24 hours to enjoy your life.  Take the opportunity.  

Maternal instinct…

What is it?  Is it a myth?  A societal notion that suited it’s purpose? Or a real characteristic that some women have?  Why do some women seem born with it and others not an ounce in their being?

If broken down maternal instinct, by definition (compliments of Merriam Webster) means…

maternal:  of, relating to, belonging to, or characteristic of a mother

instinct:   a natural or inherent aptitude, impulse, or capacity

So together it would mean a natural or inherent aptitude, impulse, or capacity for characteristics of a mother.  

Some believe that maternal instinct is what makes a woman want to be a  mom.  She is a nurturer by nature and has always gravitated towards being a caretaker.  Others believe maternal instinct refers to the bond a mother forms with her child once he/she is born. That maternal instinct kicks in when a mother sees her child and feels compelled to protect and nurture him/her.

These beliefs can cultivate a feeling of failure for moms.  What if they never believed they had maternal instinct and now they are going to have a baby?  What if they didn’t feel that instant bond and draw to their baby? What if some days they don’t want to nurture but want a break?  What if they always felt maternal and now, after having a baby, they are questioning their abilities and natural instincts?  Like many labels or terms used throughout life, maternal instincts can have a deeper impact on a struggling mother.  The implication is that good mothers simply know how to be mothers and if you don’t, you are not a good mother.  This is so wrong.

And how then do we explain the love that many fathers feel for their children?  The desire and drive to protect and nurture is blind to gender or sexual orientation.  Maternal instinct sometimes seems more like a societal term that was used to reinforce the notion of women as the caretakers and explain why men went to work rather than staying home for the most part.

There is no doubt that studies and research show that women, even if left alone in a jungle, can birth a baby and instinctively know how to care for it.  There is no doubt that there are women out there who, from the time they are very young, dream of being a mom. But there is also evidence that women who never dreamed of being mothers, still take quite well to the job, enjoy it and raise wonderful families.

So I ask that you trust your instincts as a mother but do not feel bound by this notion.  Do not judge yourself based on the expectation that you should just know how to be a mother.  Do not let your measure of being a good mother be based on your instinctual ability to know all the answers.   Be patient with your child and yourself.  Learn together and when you do have an instinct about your child.  Trust yourself.

Dentists and doctors and check-ups…OH, MY! 

Mental health is not only about your brain or your emotions.  It is about whole body health.  Most women pay extra attention to their physical health during pregnancy; but, it is quite frequent that new moms forget about their own physical health in lieu of caring for their little one.  It is even more common for moms suffering from PMADs to neglect themselves.  Whether you have been in perfect health your whole life or not.  Whether you had an easy, complication-free pregnancy and delivery or not. Whether you feel like something is wrong or not, regular, routine healthcare is important to your ability to be the best mom you can be.  Although there are many ways to take care of yourself and many specialists you can see, here are some of the basics to take care of asap.  Whether you see Naturopathic/Homeopathic providers, Western Medicine/mainstream providers or both, it never hurts to let them know what you are dealing with emotionally so they can support and advise you within their specialties.

Many women’t vision changes during pregnancy or afterward.  It is very important to get your vision checked in the 6 months – 1 year after baby is born.  Even if you are someone who never wore glasses or contacts before.  Without realizing it, your vision could be affecting your mood, frustration levels and could be causing headaches or tired eyes separate from the fatigue you are experiencing.  More reliable information here: http://www.webmd.com/eye-health/pregnancy-and-vision

As well as vision, make sure you are getting regular (twice a year if your insurance allows it) dental check-ups and cleanings.  It has been widely found that those suffering from anxiety and depressive disorders often suffer from dental issues as well.  It is difficult to make and keep appointments when you are suffering from PMADs but it is very important that you enlist your support system to help you do so.  Dental issues can greatly affect your mood, cause increased depression or anxiety, and make an already difficult day even more uncomfortable with physical pain.  Even if you are not feeling dental pain, you could have problems starting and preventative care is best in addressing this before it happens.

And finally, the dreaded Annual Physical Exam.  These are almost always covered by current insurance plans so take full advantage.  This is a chance to make sure you are not losing too much weight due to depression, that your lab tests are all WNL.  Often when a mom is experiencing a PMAD, she does not eat properly or get enough outside time in the sun.  This can lead her to be deficient in Vitamin D3, iron or other nutrients that are important to stabilizing and lifting your mood.   Also, during a physical exam, your PCP can run a Thyroid test.  If this is not routinely done, ask for it.  Thyroid issues can impact your mood quite a bit.  It is important to get this tested if you are experiencing symptoms of depression or anxiety.

Ask your partner, family or friends to help you schedule and keep appointments if necessary.  Whatever it takes….healthy mom = healthy baby.