Our Bodies, Ourselves (98 page)

You can find support for yourself and your family in different ways. Many of us turn to family and friends or parenting, breastfeeding, or new-mother support groups both in our communities and online. Others draw on the help of paid caregivers.

Talking to your partner, your family, and close friends ahead of time about what you think you might need once the baby arrives helps set the stage for support. It is hard to know exactly what your needs will be, but having a support group of willing family members and friends is a good place to begin. Even if you didn't make plans in advance, turn to those people for help once the baby is born. It might also be helpful to talk with other women about what they thought was most helpful when they first became mothers.

As much as possible, ask for
concrete
help. Sometimes you are not even sure what you need when friends ask what they can do for you. Saying yes to small things—your partner offering to be with the baby and/or watch your other children while you sleep; friends who ask if they can bring you food, watch your kids, or clean your house—helps you to recuperate and to learn what kind of help is actually useful to you. Practicing can also help you know when to say no—for instance, to people who offer things you don't really want or need or whose company drains you.

Your local hospital may offer support groups for new mothers through its social services or childbirth education department. Often these groups are free. Libraries, children's bookstores, coffee houses, places of worship, and YWCAs and YMCAs sometimes host weekly meetings for new mothers and babies. You can find these groups by checking your local library or community center, looking online, or asking friends, neighbors, or other new mothers. If you take a childbirth class, the instructors may have a list of community resources.

There are many websites devoted exclusively to the experience of new mothers; some feature online support groups or schedule local, in-person meet-ups. And there's no limit to the number of blogs and online communities offering real women's stories about their day-to-day experience of motherhood. For more links and resources, visit ourbodiesourselves.org/childbirth.

Your local family services agency, public health department, community health center, mental health agency, or hospital providing maternity services may offer counseling in a group or individual setting, often for a sliding fee.

A postpartum doula, a caregiver whose role is to mother the mother, can help with everything from providing breastfeeding support to caring for your baby day or night to making sure you are fed and well rested. Some doulas charge an hourly or flat rate, while others offer a sliding scale, and occasionally doula support will be covered by health insurance. To find a certified doula in your area, visit DONA International (dona.org) or call 1-888-788-3662. You can also contact the Childbirth and Postpartum Professional Association (cappa.net) or 1-888-692-2772. (For more information about doulas, see page 393.)

Night nannies, home health aides, and part-time or full-time child care providers can provide relief, even if it's just a few hours a couple of times a week so you can rest or get out of the house for a while. Small breaks can make a big difference.

Emotional highs
and
lows are normal during the first few weeks after giving birth. Many women have times of feeling irritable, moody, weepy, and overwhelmed. These “baby blues” are very common. They usually occur in the first two weeks after birth and can last for days or a few weeks. Typically new mothers feel better after these down times and don't remain stuck in one continuous emotional rut.

Some new mothers, however, struggle with more painful feelings for a longer period of time, experiencing what are classified as postpartum mood disorders.

I know that I don't exude excitement and joy, but I don't know how to process what I am feeling. I just want to have one really good cry and let it all out, but I'm ashamed to. I'm afraid that if I start crying I won't be able to stop. There's so much love going on around me, and all I feel like doing is screaming until my head explodes. I don't know how to share any of this with anyone, so I cry alone when I get a chance; just a few minutes here and there
.

Many women who experience postpartum emotional difficulties are afraid to discuss their negative feelings for fear of being seen as a bad mother or crazy. But postpartum mood disorders are both common and treatable, and it is important, both for our own sake and for the sake of our families, to seek help.

Postpartum mood disorders can include severe depression (sometimes mixed with anxiety), as well as other seriously disabling problems labeled with terms such as anxiety/panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and, very rarely, psychosis. Postpartum depression is by far the most common of postpartum mood disorders, affecting about one in seven new mothers. It can start anytime in the first year after giving birth. Symptoms of postpartum depression can include hopelessness, suicidal thoughts, sleep
and eating problems, inability to feel good or be comforted, and withdrawing into oneself. A woman experiencing postpartum depression may have a hard time caring for her baby or meeting the other demands of daily life.

Besides postpartum depression, women sometimes experience other postpartum mood disorders. Feelings of intense anxiety, fear, or panic, along with rapid breathing, an accelerated heart rate, hot or cold flashes, chest pain, and shaking or dizziness are symptoms of an anxiety/panic disorder. Recurrent frightening thoughts, including obsessing over the baby's health or acting out repetitive behaviors such as compulsive hand washing, are symptoms of an obsessive-compulsive disorder. A combination of depression with anxiety/panic disorder or obsessive-compulsive disorder is also possible.

Women who experienced fear, powerlessness, or a sense of being mistreated during labor and delivery are at greater risk of developing post-traumatic stress responses. These women may develop unpleasant repetitive thoughts, nightmares, agitation, fear of interactions with others, or an ongoing sense of panic.

A very small percentage of women (about one or two per thousand new mothers) experience a serious illness called postpartum psychosis. Women with postpartum psychosis may experience hallucinations and delusions and other symptoms including insomnia, agitation, and bizarre feelings and behavior. Postpartum psychosis generally develops within one to four weeks after giving birth and is considered a medical emergency.

Any women can develop a postpartum mood disorder. The hormonal changes that occur during pregnancy and birth appear to play a strong role in the development of these problems.

However, certain factors are linked with a greater likelihood of experiencing a postpartum mood disorder. These include severe or ongoing postpartum pain; health problems in the mother or baby; a high-needs baby; relationship, financial, or other major stresses; isolation; and a lack of social support. Ongoing sleep deprivation is also a risk factor.

Women who have a past history of physical or emotional trauma, depression, sexual abuse, severe premenstrual syndrome, substance abuse, or other mental health issues are at increased risk of postpartum mood disorders. Adolescent mothers are also at increased risk of postpartum depression.

If you are experiencing postpartum emotional problems, ask for support and practical help taking care of your baby and yourself. If you have a partner—or other support people—available, ask him or her to share household chores and nighttime feeding duties. Do only as much as you can, and don't blame yourself for leaving nonessential things undone. (For other ideas on practical help and self-care, see “Tips for the
First Weeks”
).

Isolation can contribute to depression and anxiety, so try to find at least one family member or friend with whom you can honestly share your feelings and your experience of motherhood. Meeting with a new-mother group can be a great way to connect with other women facing the same challenges. Many support groups and online chat rooms focus specifically on helping women with postpartum depression. (See
“Ways to Get Support.”
)

Sometimes, however, the support and help of friends and family is not enough. If this is true for you, consult with your primary care physician or ob-gyn or seek out a social worker, psychologist, or psychiatrist who is knowledgeable about postpartum mood disorders.

Besides getting more support from the people around you, the two basic types of treatment offered by mental health professionals for postpartum depression and anxiety disorders are talk therapy and medication. Talk therapy involves regular sessions with a counselor or therapist, discussing your feelings and developing constructive ways to meet the challenges of being a new mother. Medications—including antidepressants, antianxiety drugs, sleep medications, or a combination of the three—can sometimes be helpful.

In the rare event that you experience postpartum psychosis, you will likely need to go to a hospital for a short time for appropriate therapy.

Therapy sessions can help you express and understand your feelings more fully. They can also help you explore possible solutions for postpartum challenges and learn better ways to communicate your needs and get them met. Therapists and counselors can direct you to other community resources for new mothers and families.

Although antidepressant medications are commonly prescribed for postpartum mood disorders, surprisingly there has been only one small study (involving eighty-seven women) that actually tested the effectiveness of drug therapy for postpartum depression. This study showed that fluoxetine (Prozac) and six sessions of counseling (cognitive behavioral therapy) were equally effective in relieving depression. Cochrane Reviews summarizes this limited evidence about drug therapy for postpartum depression as follows: