Postpartum Adjustment: My Plan of Attack

In my last post, I talked a bit about our plan to keep A in preschool/daycare while I'm on maternity leave.

This may seem like a crazy decision for a couple as cash-strapped as we are, but both my husband and I agree that it may save our collective sanity.

When you are pregnant, levels of the female hormone estrogen and progesterone increase greatly. For some of you, this may lead to shiny hair, clear skin and that pregnant "glow" everyone talks about (unfortunately for me, the clear skin is nowhere to be found). But in the days following the birth of your child, your hormones take a bit of a nosedive:

Image Source

That's right - they go back to their pre-pregnancy state in a jiffy, even though you had a good 10 months to adjust to their increased levels. Nature likes to play cruel tricks on us women.


It is thought that these drastic hormonal changes are what cause women to experience the baby blues; and, if you happen to be extra sensitive to all this bodily chaos, you may go on to develop postpartum depression or anxiety.

I knew all of this in theory when I was pregnant with my first child, but unrealistic expectations and lack of experience set me up for some serious postpartum adjustment in the days following A’s birth. So for this pregnancy, we’ve thought a lot about how to avoid some of the issues we (and I say “we” because my partner had to go through this change with me) faced the first time around. I like to call this my postpartum plan of attack or Plan Red. Because truly, I do sometimes feel that I’m going to battle with my emotions:

Zones of Operation
We will be planning for a home birth again. We toyed with idea of going to the hospital this time (just to avoid having A wake up in the night or be disturbed by the birth), but when I brought up the idea, my husband looked at me, aghast, and said “don’t make me go there” in a little boy voice.

So we are staying home, because apparently my husband needs it more than I do.

Allies
It is imperative to have decent help on hand following the birth of a baby, even more so when there are other children that need taking care of.

These have to be helpful people, though. Don’t invite anyone you feel slightly uncomfortable around (as they will be seeing you in your most vulnerable state), and make sure they’re there to cook and clean. Holding the baby is only an option when I am tired and would like a break to take a shower or a snooze. I will be calling in the troops, in the form of my mother, mother-in-law, and sisters-in-law (if they can spare the time). The hope is to have someone staying with us for the entire first month.

I am also hiring a postpartum doula, who will be there as an objective support person. She will support me with breastfeeding, suggest resources/tips I might need, and basically be a good listener (someone that is not scared of listening to me cry or blubber).

Supplies
Yep, I’m taking the plunge, and doing something that even the crunchiest of crunchy finds slightly repulsive. I am going to eat my placenta. I have a doula friend who will be taking my baby's hunka meat, drying it in a dehydrator, grinding it down, and then putting it into capsules for me to consume. I’ve written about this before, but never thought I’d actually do it. I’m desperate enough to see if it makes any difference in my emotions/mood following the birth – I would probably eat fried monkey if someone told me it could help.

Contingency
It’s always best to have a contingency plan in place in case something unexpected comes up. Although we’re hoping that this little baby does not have reflux, we’re open to the idea that it may happen. Which is where preschool comes in – taking care of a child who cries all day (and night) and does not sleep is difficult in the best of times. We want our older daughter to have some sense of structure and routine, just in case we are hit once again with the “reflux blues.”

We’ve also thought about what might happen if I have to transfer to hospital or have a baby who is sick. Again, we’re counting on our “allies” to pitch in and help. The past three years in Ottawa has given me time to meet many wonderful parents, some of whom have become great friends. So although we’re planning for the worst, we’re also hoping for the best – this time, we have reinforcements!

{Ottawa Doula} By Letting Your Child Cry-It-Out, Will You Fix Your Depression?

Image Source

A well-known researcher in Australia (Harriet Hiscock) is responsible for the first large, controlled study of infant sleep interventions (cry-it-out) for mothers with postpartum depression. Although conducted almost 10 years ago, the evidence continues to be used today in Australia (and abroad), with many healthcare workers advocating for sleep interventions to help with maternal depression. One of these popular online networks is Babycenter, which most of you have probably consulted at one time or another.

At first glance, the evidence from this study seems to favour the sleep intervention (as opposed to the "control group," where mothers were given an information sheet on normal sleep patterns, with no advice). The sleep intervention is simply a cry-it-out (CIO) technique - either by leaving the room and waiting longer and longer intervals, or by "camping out" and allowing your child to cry while you sit by the crib or bed.

When reviewing the evidence more closely, we discover several questionable aspects of the study:

• There is no blinding - participants know whether they're receiving the intervention or control, so they're more apt to want to please the researchers, by reporting that CIO worked.
• Depression scores fell in both the intervention and control groups, which suggests that depression will just improve with time, regardless of the intervention (depression scores did fall slightly more in the intervention group, but was not significant. A more signifcant drop was found when they looked only at mothers with more severe depression)
• By 4 months, this improvement in mood was no longer significant for the intervention group. Meaning, all of the mothers in the study (regardless of doing CIO or not) had improved
• Depression scores increased for "persistent sleep problems" - meaning, depression got worse when babies didn't repond to the CIO techniques
• In a follow-up study, 1 in 5 children's sleep problems had returned

So what does all of this mean?

The study does show that CIO techniques seems to improve both baby's sleep patterns and mothers who have more severe depression. What is worrisome is that the evidence is weak for women who are experiencing mild depression (which may just be an extension of the baby blues - I've discussed the difficulty in diagnosing these symptoms in a previous post). So CIO techniques are touted as the "fix" for any woman approaching their doctors with signs and symptoms of depression.

How could CIO fix your depression? Well, we all know that most of us feel more emotional when we lose sleep. Dealing with a child who wakes frequently during the night may become a source of anxiety for women who are already feeling low. So the answer? Let your baby cry, get a good nights rest, and soon you'll be a happy, healthy mama!

Why this line of argument doesn't work for me

If you've let your child CIO, I'm sorry if you're offended by this post. I don't agree with CIO, although I'm not here to judge you. I'm here to support women who may be experiencing signs/symptoms of PPD (postpartum depression), and who've been told to allow their babies to cry so that they may feel better. Here's my issue:

"Normal" infants wake up frequently in the night. This is a fact of life, which extends across all species who breastfeed their offspring. Frequent night waking is NOT a problem.

Depression is multi-faceted, and a "quick fix" is not the answer. The answer is more support for new mothers, more education on gentle baby care, and realistic expectations of what it means to be a new mother

CIO is harmful to parent-child relationships. Please read Annie's post over at PhD in Parenting. This is not just an opinion - it has been proven with high-quality research

CIO works (sometimes) in the short term, but many babies will go back to night waking after any small changes, such as teething, sickness or travel.

CIO can create more depression and anxiety for mothers, as it forces them to ignore their infants' needs and deny their own feelings/desires - mothers are designed to respond to their crying infants.

CIO can lead to mental health issues later in life, as it raises cortisol levels, which remain high long after the CIO has been completed. So if you're depressed, wouldn't it make sense to respond to your baby, in the hopes of warding off the development of your child's own mental health issue?

There are other ways to get more sleep. This goes back to my "more support" point. New moms need to spend their entire first months focusing on resting and recovering from birth. Other cultures seem to get this idea - our culture praises the mom who jumps out of bed and loses 20lbs in 2 weeks.

If you are a new mom struggling with postpartum life, you will be bombarded with advice from parents, in-laws, doctors and websites, all telling you to put your child down and "fix" yourself by getting a better night's sleep.

Only you can make the best choice for your family, but I strongly believe that COI is not a long-term solution for depression. My blog post on PPD touches on some of the things you can do to get help, and resources here in Ottawa.

I'll finish by quoting Annie here, who says:

"Rates of depression are skyrocketing. Violent and senseless crimes are on the rise. As human beings, we need to spend more time being there for each other, showing compassion, nurturing our children. Learning that you can’t count on your parents to be there when you need them is a tough lesson to learn that early in life and can be a root of many of the social problems we are facing today. I want to give my kids every chance possible of escaping depression and staying away from violence. And I’m convinced that nurturing them and responding to their needs at night, as I do during the day, is the first step in the right direction."

{Ottawa Doula}: In Postpartum, What's Normal?

I wish I'd never done this.

I want to turn back the clock - go back to a time when I wasn't pregnant.

I don't think I love my baby.

I secretly hope my baby dies so that I don't have to take care of them.

If I were to die, I would rather my baby died with me.

Do these thoughts sound "normal" to you? I think a lot of people reading this would say no.

A woman harbouring these secret thoughts can feel terrified - she realizes that some of them are irrational, but that others are somewhat true (eg. I don't think I love my baby). And so she buttons up, and instead of talking about thoughts that are actually normal she instead feels like an outsider in a community of happy new mommies.

We hear a lot about postpartum depression (PPD) these days. Postpartum psychosis (PPS), a rare manifestation of PPD, is sensationalized in news stories, making it seem as though this kind of situation can happen to anyone.

And so we binarize postpartum emotions into three camps: normal baby blues, PPD and PPS. Baby blues happen to most people, and are a result of massive hormonal changes in the days following birth. PPD is characterized by a continuation of the baby blues, long past the accepted "normal" (usually 2-3 weeks postpartum). And PPS is an extreme form of PPD, where a woman loses touch with reality and may actually plan (and carry out) ways of harming herself and her baby.

But when has a woman crossed the line? Or are they blurred anyway, given that nothing in our emotional lives can be put into boxes?

I'll tell you this - many women with normal baby blues are harbouring secret thoughts that have never been expressed to a single person; not even to a partner. It's taboo to talk about death and desperation in our society - even well trained counsellors can botch a session with a client who expresses the desire to kill herself, either by overreacting (oh my god, you should have told me this earlier - I may have to report you, you know) or by dismissing the client's thoughts (that's ridiculous, you can't kill yourself. You have a baby to look after. You need to snap out of this.)

We want new mothers to be happy - to be like the sweet Pamper's commercials on TV. Lots of smiles, one-on-one time and cuddles with baby, and lots of cooing and ahhhing.

The reality is, postpartum life can be messy (I stress can be, because some women have a wonderful postpartum time). Your bed is sweat stained from postpartum sweats; milk is leaking out everywhere and soaking your sheets; your eyes feel like sandpaper from lack of sleep; and your baby is not cute and cuddly, but instead screams 5 hours a day.

It's no wonder some species eat their young...

I know, I know, I'll probably get a lot of feedback from people, telling me that I shouldn't be trivializing these types of thoughts - that any feeling of harming oneself and one's baby needs to be taken seriously.

And I completely agree. I hope I don't come across as trivializing a complex problem. Certainly, it's worth a trip to a trusted doctor, or several sessions with a counsellor. Especially when thoughts and emotions carry on past the "normal" timeframe we're alloted to be sad {insert sarcasm}.

My goal is not to trivialize, but to normalize. To say to new moms, living in a society where we have almost zero support in the postpartum period, that it's ok. It's ok to feel crazy.

What's not OK is when your thoughts and emotions take over - becoming real, rational plans for action. A way out. It's not OK to still be crying daily one month postpartum. It's not OK to have zero interest in your baby after spending many weeks with your child. The good news is that there's a lot of help out there - websites and forums abound, and Ottawa has an amazing MOMS (which I believe stands for Moms Offering Moms Support) group where you can go to talk about these unspeakable things.

But what if we changed our definition of normal, so that women could say the unspeakable without judgement? So that they didn't have to join a secret society of other moms just to say what they really think?

If I could really fantasize here, a world in which women were treated like royalty after the birth of their baby would be ideal. Then maybe these "crazy" thoughts wouldn't even enter our heads...

If you're about to enter the world of parenthood, consider these helpful tips for dealing with intense emotions after birth:

1) Have only sympathetic and helpful people stay with you in the postpartum weeks; people that share your views on newborn care. An abrasive in-law, who can't understand why you're hoping to breastfeed (for example), may not be the best choice.

2) Hire a Postpartum Doula - these are doulas who are specially trained to care for women in the postpartum period. It is definitely worth every penny. For Ottawa folks, check this doula and this doula out.

3) We hear a lot about "babymoons" - staying snug at home with your baby and partner. This is great for women adjusting well to postpartum life, but when you're experiencing baby blues, sometimes a sense of normality is what you need. Go for short walks, rent your favourite DVDs, and invite friends to come over for short visits. Don't isolate yourself!

4) Ask for help - the hardest one of all. It takes a village to raise a child, and you alone are not a village. Let people know you're struggling, and ask how they might help - dropping by a homemade meal? Sending you a care package with chocolate and epsom salts? Texting you positive affirmations every day? It can be anything!