"I'm OK. I know what I'm doing. I'm prepared. It won't happen to me. I don't
even have a history of any mental or emotional problems, so I'm good."
"Excuse me! I think there was a mix-up. This isn't what I signed up for. You see, I signed up for the smiling family, go ga-ga over your baby, feeling passion for life, super-parent gig. You know what I mean, the happy family stuff they show in all of those diaper and infant formula commercials and talk about in the pregnancy and infant books."
Guess what? It doesn't always work that way.
Important Notes
It is important to realize that just because you don't have every symptom on the list that you aren't suffering from a postpartum disorder. Some women may have just a few symptoms. Some, unfortunately, have them all.
Step #1: Know that Free Support Groups Can Help You
Please make sure that you look at both websites for a postpartum support group. If your location isn't listed on one site, it may be listed on the other.
Postpartum Support International
PPD Support
Robyn's Nest
I personally am involved with Baby Blues Connection in Oregon. We have an amazing group of staff and volunteers who screen resources, provide emotional support via telephone, email, and in person, and are constantly learning new information about postpartum and antepartum disorders. I urge you to visit the http://www.babybluesconnection.org for more information if you think that you are a loved one is suffering from postpartum or antepartum depression, anxiety, or psychosis.
Postpartum Blues
The Bad News: Baby blues end within the first 2 or 3 weeks and includes symptoms like:
Mood swings
Crying (with or without a reason)
Sadness
Anxiety
Lack of concentration
Impatience
Irritability
Restlessness / hyperactiv ity
Feeling you need to be cared for
Feeling vulnerable
The Good News: Baby blues occur in about 80 percent of all mothers and is not considered a disorder. It will go away on its own. If you still have postpartum blues after 3 weeks, it may be depression.
How Your Family Can Help:
Give her a shoulder to cry on
Take over the chores
Give her a massage every night
Jump up at every chance to change a diaper or give a feeding (unless she insists that she wants to do it)
Make sure she gets at least one hour alone every day to do something for herself (if you have multiple kids, she may need to leave the house to be alone since kids tend to follow Mom into every room of the house, and you can't bother her either)
Tell her you love her frequently ( and be sure to elaborate on how much you love her)
Brush her hair for at least 5 minutes (it's very relaxing)
Listen to her joys and complaints
Talk to her about non-baby stuff that she's interested in (not just stuff that you're interested in)
Go ga-ga over the baby ( even if you don't feel a bond yet) and thank her for bringing this child into the world, never tell her she is doing a bad job or point out mistakes
Don't go out with the boys (or anyone else) unless she is also getting equal time out with friends
Don't drink alcohol (it impairs your ability to keep your mouth shut when you need to)
Don't smoke anywhere near the kids (especially the baby) or play loud music (both can harm your baby, and doing them is selfish and will surely be met with resentment and an argument)
Bring home a meal (always find out if she has already started making the meal because if she has and you bring som ething else home, she'll probably cry)
Buy her some ultra comfortable clothes and some attractive but comfortable pajamas that are nice enough to wear in front of unexpected company
Don't you dare ask for sex but do be romantic
Hug her frequently
Gently stroke her face and neck
Hold her hand
Rent comedies and watch her "woman shows" (like Oprah) with her (even if you hate them)
Read books about how to be a good parent and taking care of babies in front of her
Postpartum Depression / Anxiety
The Bad News: Postpartum depression can occur at any time within the first year. You may start off having anxiety, but the anxiety may lead into depression. Likewise, you may start off with depression, which may lead into anxiety. Some symptoms are present in both anxiety and depression. Thus, I tie these two disorders together, but it is quite possible to have just symptoms of depression or just symptoms of anxiety. Symptoms may start immediately after birth (but are often mistakenly assumed to be baby blues by many healthcare workers) or they may start gradually and build up over time:
Fatigue (easily getting exhausted or just feeling sluggish or feeling like you need to sleep more)
Insomnia
Changes in appetite (feeling like you need to eat more or not being hungry when you should be)
Poor concentration (easily distracted or confused)
Difficulty making decisions (even simple ones)
Difficulty in solving problems (even simple ones)
Difficulty in completing everyday tasks
Forgetfulness or memory loss
Mood swings (often extreme)
Sadness
Hopelessness (feeling trapped or stuck in an unhappy situation)
Crying (with or without a reason, sometimes uncontrollably)
Thoughts of suicide or running away
Thinking that maybe you made a mistake in having the baby
Irritability (short temper)
Anger (can be difficult to control)
Resentment
Feeling like everything is your responsibility
Feeling overwhelmed or can't cope
Feeling guilty or ashamed about making mistakes, not being the wife or mother you expected to be, or even about things that aren't your fault or have nothing to do with you
Feeling like you aren't good enough, inadequate, or worthless
Lack of interest or motivation (even in things you used to enjoy doing)
Decreased or absent sex drive
Excessive concern about the baby (worried that something bad could happen to the baby)
Feeling like you can't bond with your baby or have lost a bond with your older children
Lack of interest in the baby or not wanting to take care of the baby
Avoiding the baby or other children (often because being close to the baby or other children makes you feel uncomfortable)
Fear of accidentally harming the baby, your other children, or yourself
Fear of going crazy and harming the baby, your other children, or yourself
Fear of sexually abusing your baby or other children when you have no history or intentions of doing so
Fear of other people (including your loved ones) hurting or sexually abusing the baby or your other children (usually you rationally know that the individual isn't hurting or abusing your child, but there's that little "what if" voice that keeps popping up in your head)
The Good News: Postpartum depression can be treated.
First, find a support group for postpartum depression (not just a new mommy group). Online groups are okay to start with, but you really need interaction with humans in the real world. Groups are usually free, and you don't have to talk if you don't want to. You can just listen to what others have to say. You'll probably be quite surprised and comforted to find out that there are other women with the exact same symptoms as you. It really does help you to feel more normal. (In my group sessions, I was amazed at how similar our stories were, and prior to group, I was convinced that I was the only one going through this, like I was "worse than the typical postpartum case." I was even worried that I wasn't sick enough and that I would be faced with a group of women who thought I was weak because I wasn't nearly as bad as the rest of them and couldn't cope, but neither scenario happened to any woman who joined the group. It was all wonderfully supportive.) Look in your phone book, do a search on the Internet, or ask local doctors, nurses, and psychologists for group information.
Then, go to your doctor. Get checked out to make sure you don't have some other problem contributing to your symptoms, like a thyroid disorder or anemia. Find a therapist. Your support group can usually help you find one who specializes in postpartum disorders. If you feel that your therapist doesn't understand your situation (and some of them don't), don't hesitate to switch therapists (and don't feel guilty about it either; it's not your fault that the therapist didn't bother to specialize in your disorder).
If you feel that you aren't making satisfactory progress with psychological therapy alone, consider going to your doctor or finding a psychiatrist who can prescribe medication and getting on an anti-depressant. If you are breastfeeding, do some research on the Internet and talk to
your doctor and your child's pediatrician about what medications are safest, and start with those (I ended up on Zoloft, and it did help turn down the volume on my symptoms enough to help me help myself through therapy, but it didn't cure me, and there are nasty withdrawal effects that can last for months).
Talk to people. Do not isolate yourself from the world. Let yourself be vulnerable. Tell your neighbor how you feel or what you're thinking. Tell your friends and family members. Talk to people in your churches, schools, and at work. Just keep talking to people. Eventually, you will find somebody who understands and can help.
How Your Family Can Help: Do all of the things listed under "Postpartum Blues" plus:
Assure her that she's a good mother (and be sincere, point out examples of why she's a good mother, and don't wait until she's doing the "I'm a horrible mom" cry; say it even when she's smiling)
Remind her that it's her body chemistry that's the problem, not her
Remind her that what she's going through is common and that it's too bad that more women don't talk about it
Gently tell her about the stresses and worries you have now that you're a parent, but don't say it in a way that accuses her or makes you the victim (just let her know that she's not alone without saying something like "You're not the only one suffering here" because she'll begin to feel guilty about her feelings)
Be very forgiving of any angry outbursts (you don't have to sit there and take it, but you do need to remember that it's not her fault)
Don't tell her that she's going stupid because her brain doesn't work the way it used to (just pretend you didn't notice that she made a mistake)
Make sure she has some time to just sit with the baby (no television or distractions) and interact with the new family addition, especially if she is having bonding issues
Keep critics away (old er family members with the "get over it" attitude tend to be the worst, so answer the phone, read the mail, and answer the door before the new mommy does, so you can intercept critics, send them on their way, or quietly remind them not to discuss parenting issues or give advice because she's ultra sensitive at the moment, and immediately interrupt critics if they are in the process of criticizing then try to change the subject of the conversation or make a "we have to get going" excuse)
Keep stimulation to a minimum (background noise, television, a busy schedule, and so forth are all forms of stimulation) because she could end up with stimulation overload which leads to a meltdown
Make sure she gets frequent breaks during which she can be totally alone (at least 5 minutes at a time throughout the day)
Encourage her to join a support group and see a therapist
DO NOT let her become isolated or withdrawn; continue to reach out to her and find other people who can also reach out to her and talk to her frequently
Postpartum Obsessive Compulsive Disorder (OCD)
The Bad News: Postpartum OCD is horrifying for many women who have it while others just find it inconvenient depending on what obsessions they have. Postpartum OCD stems from anxiety and is usually a result of the mother's natural protective instincts going out of control. It may lead to depression or other anxiety disorders. Your brain starts to show you every horrible thing that could possibly happen to your child. The images are often horrendous and disgusting. There are actually three types of OCD: traditional OCD (having obsessive thoughts which lead you to do various activities called compulsions), pure obsessive disorder (having intrusive, persistent thoughts without compulsions), and responsibility OCD (in which the individual believes that by not carrying out a compulsion, something bad will happen to other people, leading to a sense of guilt). It is also often accompanied by postpartum depression and anxiety. Symptoms include:
Intrusive thoughts or mental images (thoughts that just seem to pop up out of nowhere) that are often about the baby, yourself, or your other loved ones, that are disturbing; you often feel guilty, horrified, or disgusted by these thoughts. They may be irrational or seem perfectly logical. (VERY IMPORTANT: YOU MUST SEEK HELP FROM A PROFESSIONAL PSYCHOTHERAPIST AND MEDICAL DOCTOR IF YOU ARE EXPERIENCING INTRUSIVE THOUGHTS. Intrusive thoughts require treatment.)
Obsessing about worries or fears (often worries that you may go crazy or that you may actually carry out some of the horrible intrusive thoughts you've had) so much that they seem to take over your life (much more than in standard depression/anxiety) and may eventually lead to compulsive behavior.
Compulsive behaviors (such as hiding knives because seeing knives reminds you of or creates intrusive thoughts about stabbing the baby, yourself, or another loved one; refusing to give your baby a bath without supervision because you fear you may drown your baby, cleaning excessively so your baby doesn't get sick, checking to make sure your baby is in the backseat of the car in the car seat because you fear you may forget him somewhere, checking seatbelts in car seats repeatedly (even pulling over repeatedly to do so) to make sure they are fast ened correctly, so your baby doesn't fly out during a quick stop or an accident, avoiding the baby so you won't hurt her, constantly trying to keep things in perfect order or organized because you somehow feel that if you can just get organized you can get relief, etc.)
The Good News: Postpartum OCD can be treated using the same methods as postpartum depression and anxiety.
Postpartum OCD does not lead to hurting or killing your child. It does not lead to postpartum psychosis. It can, however, be accompanied by psychosis, so it is very, VERY important that you talk to a professional psychotherapist to determine whether those thoughts are the intrusive thoughts of OCD and the intrusive thoughts of psychosis.
Also, have an open dialogue with your loved ones and partner about the thoughts you are having. Always tell them what you intend to do or if you have any of your thoughts disturb you, even if you think they may reject you for having those thoughts or compulsions. It may seem strange to tell your spouse, "I'm going to check the locks again," but if you get into the habit of doing it, it will actually help you feel more in control by having another person validate your feelings or keep them in check until you can do it yourself.
Take a deep breath. Relax. And, the next time you have an intrusive thought, remind yourself, "It's just the OCD. My brain is just trying to protect my child from everything, including myself, by showing things that potentially could happen, but these things won't happen. These horrible things aren't going to happen because I recognize that they are horrible. If I wasn't disturbed by them, then I would have something to worry about because I would be psychotic, but as long as I recognize that these thoughts are disturbing, they won't happen because I'm still sane, and I will continue to be sane. Postpartum psychosis shows up very quickly after the birth (within a few days), and I'm already past that, so I'm in the clear. I just need to accept that my brain is going to show me some of these thoughts for awhile, so it can quickly pass, and I can go on with my day, enjoying my child and my life."
It may take a few times before you start to believe any of this little paragraph of self-talk (and you may need to write it down on an index card that you carry with you for quick reference, maybe put a note on the back of your hand in ink that says "card" to remind you to look at it when you start having an intrusive thought), but eventually it will become a mantra that you memorize and will automatically pop into your head with every intrusive thought, quickly letting the thought pass on without making you feel like a horrible person. Instead of thinking "how could I think that" you'll begin to think "that darn OCD is doing it again," helping you get past some of the guilt and worry that can just make things worse. Always make sure that you talk to somebody about your thoughts or at least write them down.
Don't stress out about your compulsions. Logically you may realize that what you are doing doesn't make sense ("I know that my hands were clean of germs after the first time I washed them, so I don't need to wash them three times."), but your just don't feel the results you are looking for. The compulsions are like a high. They make you feel better while you're doing them or immediately after you've done them, but eventually (sometimes very soon afterward), that security and relief you felt is replaced by anxiety, and you have to repeat the compulsion to get that feeling of relief again. Feel free to laugh at them rather than be embarrassed by them. ("Isn't it that silly. I just finished washing my hands and now I'm doing it again."). After all, it's not going to hurt you. It's just annoying, but take peace in knowing that eventually the anxiety will go away, and you will be able to feel relief again without your compulsions.
How Your Family Can Help:
Do all of the things listed under "Postpartum Blues" and "Postpartum Depression/Anxiety" plus:
Don't say "how could you ...," "why are you ...," or any other such questions related to the disorder (she doesn't know the answer and it will just make her feel guilty)
Remind her that it's just the disorder
Indulge in her compulsions (keep the kitchen spotless, check the door to make sure that it's locked ten times, babyproof the house, hide the knives, etc.)
Postpartum Panic Disorder
The Bad News: A panic attack makes you feel like you're dying or going crazy. You may start off by going to the hospital or calling your doctor, convinced that you are having a heart attack or that you have a brain tumor or something, only to hear that you are having a panic attack, which makes you feel like a loony. Panic attacks can be so awful that you may eventually start to avoid situations in which you fear you will have a panic attack (such as alone, with social groups, in your car, at school, at work, at home, with your kids, without your spouse, etc.). Panic attacks may even wake you up from a sound sleep. The worst part is not knowing what is causing the panic attack, so you can't remove the stimulus. Panic disorder may occur along with or lead into depression or other anxiety disorders. Symptoms include:
Shortness of breath / difficulty breathing / can't inhale deeply enough or get enough air
Feeling like your choking or your throat is closing up
Hyperventilating
Chest pain and/or pain in other areas of the body (including arms and headaches)
Dizziness
Feeling like you're going to pass out or are suddenly sleepy
Trembling
Numbness
Tingling
Rapid heart beat
Palpitations
Nausea
Feeling like your stomach is in knots
Urge to urinate or defecate
Sweats
Hot flashes
Chills
Feeling like things are unreal (like you're dreaming, out of your body, dying, or going crazy)
Feeling like something bad is going to happen (but you may not know what)
The Good News: You're not dying! You're not going crazy! You're not having a heart attack! It can be treated.
Of course, you should always see your doctor immediately after you have your first panic attack, so you can get checked out to make sure that it isn't something more serious. Plus, your doctor can prescribe medication that may reduce or eliminate future panic attacks.
Panic attacks require you to sit back and go for the ride, reassuring yourself all the while that it will soon be over with. Try to distract yourself. The best thing you can do is go for a walk. Exercise will help you metabolize some of the adrenaline that is causing your symptoms and increases your serotonin levels. Plus, exercise can help reassure you that you aren't dying or going crazy because your symptoms will often decrease in intensity while you exercise (if you're having a heart attack they'll get worse), so as you walk and your symptoms decrease you can take comfort in knowing that you aren't going to die from your panic attack as if it were a heart attack.
Some people take tranquilizers to help them calm down. Others use sedatives and just sleep through the panic attack.
For some people, panic attacks are strictly chemical, but for most people panic attacks are caused by a combination of chemical imbalances and stress or anxiety. Sometimes the stress and anxiety are obvious (like having a new baby and trying to be a parent), but sometimes it can be something deep seated from your past.
Take the same steps as you would for treating postpartum depression and find a therapist who has experience treating panic attacks.
(It really is surprising to find out how many people have panic attacks. Don't be afraid to talk about it with people, and you'll be amazed at how many people say "me too.")
Post Traumatic Stress Disorder
The Bad News: Post traumatic stress disorder (PTSD) occurs when a traumatic event gets "burned" into your mind, and the memory gets played over and over again, often accompanied by feelings of anxiety, dread, or sadness. The traumatic event may be the delivery of the baby, complications of the pregnancy or delivery, or anything else that is "traumatic" like a natural disaster, violence, etc. Sometimes the birth itself will be the event, and sometimes the birth will simply trigger memories of a previous traumatic event that may be completely unrelated to the birth. PTSD may be accompanied by or lead into depression and other anxiety disorders, including panic disorder and OCD. Symptoms include:
Replaying scenes or images of the event repeatedly in your mind
Avoiding anything that triggers the replaying of the event
Nightmares about the event
Consciously avoiding sleep or subconsciously (insomnia) to keep from having nightmares about the event
Subconsciously blocking out aspects of the event from your memory
Actively trying to forget the event
Exaggerated startle response
Feeling guilty about the event happening at all
Feeling guilty about being traumatized by the event
The Good News: Post traumatic stress disorder after delivery can be treated using the same methods used to treat postpartum depression and anxiety. Working with a therapist trained in PTSD and joining a support group are extremely important for the recovery process.
It's especially important for you to recognize the traumatic event as it was, including all of the good and all of the bad. You need to allow yourself to fully experience the event, including all of the grief and feelings of helplessness that surround such events. Once you acknowledge and accept the event for what it was, it becomes easier to let go of the trauma.
Postpartum Psychosis
The Bad News: 5% of women with postpartum psychosis commit suicide. 4% kill their babies. This is as bad as it gets and requires immediate hospitalization. A woman with postpartum psychosis won't realize that she has it. She might even insist that she is perfectly fine, that her thoughts are perfectly normal, and that everybody else is crazy. It is important that you have your family and friends aware of this disorder before you give birth because if you end up developing it, they're probably going to be the ones to notice before you do; they may even need to call 911 to have you restrained and taken to the hospital if you aren't cooperative.
If you have a history of bipolar disorder, schizophrenia, or any other psychotic episodes, you may be more at risk than the average woman to develop postpartum psychosis, but this doesn't mean that you will develop the disorder. It's just something you should be aware of.
Symptoms usually begin within several days of birth but can appear within the first month and, in very rare cases, within the first three months. Symptoms include:
Hallucinations (seeing or hearing things that aren't there and thinking that they are real)
Delusions (holding strong beliefs despite evidence to the contrary, such as believing that you are the queen of England when you obviously aren't or that the baby is the devil or even that there are monsters in the closet)
Unstable, unpredictable emotions that may not seem like the appropriate response to a situation
Behaviors that may not seem like the appropriate response to a situation
Disorientation (not knowing where you are)
Confusion
Extreme insomnia
Extreme anxiety
Extreme agitation
Extreme restlessness
Loss of touch with reality (sometimes described as out of body experiences)
The Good News: It can be treated with medication and intensive counseling.
It occurs in only 0.1% of women who give birth, so the chances of you getting it are low.
I've seen articles about postpartum OCD symptoms being called postpartum psychosis. This is quite upsetting to me. In postpartum OCD you have disturbing, intrusive thoughts, but you realize that they aren't real and you recognize that these thoughts are disturbing. In postpartum psychosis, you believe that those thoughts are real or believe that you need to act on them, that they are situations that have actually happened, and/or you aren't disturbed by these thoughts (and in some cases may think that they're a good idea). I've also seen articles that postpartum psychosis and postpartum depression are the same thing (such as when Andrea Yates, who had postpartum psychosis, was labeled as having postpartum depression). Be assured that they are not the same thing, and we hope that the media will one day figure that out.
