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How To Handle Postpartum Depression

“None of my friends ever told me this could happen so I was ashamed to tell them what I was feeling. I thought they'd think I was terrible to be depressed when I had such a beautiful, healthy baby. One day I read somewhere that other girls went through the same thing and I realized it wasn't only me. It wasn't my fault. And then I started feeling better.”

“The main thing that helped me get out of feeling so low and depressed was when I heard on a radio program that some postpartum depression was normal. I had never heard of postpartum depression until then and I thought there was something wrong with me!”

In medical terminology, the word depression refers to a condition requiring medical treatment, which is generally not the case after childbirth. Depression, as we use the word and as it is frequently used in everyday language, refers to the common “down” or “blue” feelings many women (and men) experience after having a baby. The New York Times has quoted Yale University psychiatrist Dr. Myrna M. Weissman as saying that the postpartum blues occur with such proven regularity “that it is to be considered normal.” (Friday, December 10, 1976, B-12) Postpartum blues can occur after a first or subsequent baby. Fathers as well as mothers experience some degree of the “blues.” While it may be difficult to predict who will have a rough adjustment period, there are some indications that certain conditions may predispose a woman to the “blues.” These include: exhaustion, isolation, lack of emotional and physical support, unusual family pressures, separation of mother and baby (the longer the separation, the greater the blues.)

Postpartum blues can be experienced in varying degrees - from vague feelings of sadness to some teary-eyed moments to unexplained crying jags to feeling down for several hours, days, or weeks. It is believed that the blues are caused by a combination of psychological, sociological, and physiological conditions.

Some degree of tension, anxiety, and general “down” feelings are common to the adjustment period accompanying any new situation or experience. Think back: was your decision to share your life with your mate accompanied only by joy and expressions of love, or were there some misgivings, doubts, worries? What were your feelings during the early weeks of living together - total happiness, or was there some degree of friction? But your commitment was not made blindly. You knew something about the person you were going to live with and this knowledge was complemented by the feelings that were already established between you before your lives were joined. You also knew something about couples and how people live together from observing your parents, the parents of others, and perhaps some of your own friends.

The adjustment period after having a baby is similar in many ways to the adjustments after marriage or “moving in.” New roles are defined. New household tasks are apportioned. But there are many significant differences. Very few couples today start a family truly knowing what they are getting into. Their commitment in this case is often a blind one, based on love for each other the decision to have a child (for whatever reason), and the faith that they'll be able to “handle it” - “it” never really being fully defined. Of course, there is information to fall back on and patterns of parenting you are familiar with - how you were raised as a child, what your friends are doing with their children, what your pediatrician advises, and what the books say. At least when you had to adjust to considering each other, you knew something about each other. The adjustment to new parenthood is complicated by the fact that you now both have to consider the feelings and desires of a total stranger who can make his or her preferences known only by crying.

Giving birth also means a shift of the spotlight away from you, the expectant mother, to your baby and then the realization that you will be responsible for this baby's well being for years. In addition, the fact that you were pregnant grew on you – literally - month by month. The fact that you are no longer pregnant hits you quickly; there is no gradual adjustment period.

If you are staying home with the baby after having worked outside the home, new motherhood also means a drastic change of lifestyle. Today, women in our society are encouraged to attend college and find fulfilling careers. They are then expected to shift gears suddenly and find perfect contentment in the world of motherhood - forget the brain they were encouraged to develop, drop all of their skills and training, because now it's time to play mother. Ooops, they weren't prepared for this part of their lives, but they're expected to know how to handle it. Yes, our society sets up a rough adjustment period for many women.

There are also physiological factors affecting the mother. A good part of the emotional highs and lows you might experience are related to the hormones in your system which have not as yet leveled off. Discomfort and fatigue are strong contributory factors. Occasionally the blues are a symptom of a thyroid dysfunction or a reaction to a drug.

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Whether you are the mother or the father, when things do not go as planned or expected, there is surprise, disillusionment, and frustration. When they are compounded by the physiological changes the new mother is undergoing, the changes in lifestyle and the realization of what parenthood really entails, it is easy to see why the joy after childbirth is often accompanied by what we refer to as the blues.

How To Minimize “Down” Feelings

EXPRESSING AND ACCEPTING YOUR FEELINGS - whatever they are - is a major step toward dealing with them and avoiding the blues. Some women (and men) find it helpful to keep a journal for writing out their feelings. You can say anything you want without fear of interruption, contradiction, ridicule, or reprisal. Journals do not talk back. Committing yourself to keeping a journal ensures you time for introspection, the opportunity to identify by name the feelings you have, the chance to understand and deal with them most comfortably, and the luxury of getting to know and keeping in touch with yourself.

You begin your journal during pregnancy and continue it during the hospital stay. At home, choose a time of day or night when you can be completely alone with your thoughts. Evaluate your day in terms of emotions. Write your thoughts in a continuous flow, without stopping to correct spelling or grammar; include your sad and negative thoughts and feelings as well as your happy and positive ones. This is not to be a log of your activities, but a record of your reactions to your activities;. to being a parent, your new lifestyle, your relationships. Include not only the baby's latest achievements, but your reactions to seeing him or her grow and develop.

COMMUNICATE, COMMUNICATE, COMMUNICATE. Your mate can't know what you're feeling unless you tell him. Discuss what you are feeling. Both of you! Don't let your feelings stay bottled up.

HOUSEHOLD CHORES SHOULD BE AVOIDED or kept to the barest minimum for the first month at least. Before doing anything at all, ask yourself, “Does this really have to be done? Can't it wait?” Have someone help so you can recuperate. Exhaustion lowers your defenses.

SLEEP (not just rest) should be gotten whenever possible. Fatigue lowers your ability to cope.

DO NOT OVER-CONCERN YOURSELVES WITH PLEASING OTHERS by trying to do things their way or by entertaining them during the postpartum period. Your obligations are first to each other and the new baby.

POSTPONE MOVING YOUR FAMILY TO ANOTHER LOCATION if at all possible until at least six months after the baby is born. The extra pressures and work involved in addition to the usual difficulties encountered during the postpartum period can be devastating.

SPEND TIME ALONE TOGETHER AS OFTEN AS POSSIBLE - even if it is just to take a long walk and have the opportunity to talk while someone else watches the baby. Re-establish your bond and interest in each other. Let each other know you care and will work together during the rough periods.

MAKE IT A TOP PRIORITY TO FOLLOW YOUR USUAL DRESSING/BATHING/HAIR CARE REGIME. Knowing you look well helps to make you feel well.

EAT A WELL-BALANCED DIET. Be sure you get foods high in protein and iron.

ASK FOR HELP WHEN YOU NEED IT. Do not allow feelings of embarrassment or worry that you are imposing get in the way of your recuperation.

KEEP UP YOUR SOCIAL CONTACTS through the use of the telephone. This allows you to maintain personal interests, gives you the feeling of being in touch with the outside world instead of being isolated, keeps lines of communication open, and affords you outlets for expressing your feelings - all while you are resting at home. If you were working before the baby was born, keep up your business contacts. Keep in touch with co-workers.

CHANGE YOUR ENVIRONMENT by getting out of the house daily if possible, for brief, non-exhaustive periods, with or without the baby.

DO NOT TAKE ON THE CARE OF SICK OR ELDERLY RELATIVES DURING THIS TIME.

DO NOT BELIEVE THAT TO BE A “GOOD” PARENT you must spend your time constantly with your baby. Everyone needs some relief from responsibility.

PLAN SOMETHING IN ADVANCE TO LOOK FORWARD TO DOING EACH DAY AND DO IT! Shop for the perfect chocolate chip cookie, plan to visit a specific shop or park, write a letter to your loved one, do disco-dancing to a record in your living room.

FIND A FRIEND WITH A CHILD APPROXIMATELY YOUR BABY'S AGE. If none of your present friends fit this category, ask your obstetrician, pediatrician, or childbirth educator to put you in touch with other parents. Comparing notes with a “buddy” allows you to realize that you are not alone in your feelings.

JOIN OR ORGANIZE A RAP GROUP. Exchanging thoughts and feelings with others going through a similar adjustment can be invaluable.

MAKE A LIST OF THINGS TO DO IN ADVANCE FOR DAYS YOU CAN'T GET OUT so that on those days you don't have to wonder what to do with your time.

DEVELOP OTHER-THAN-BABY INTERESTS. Make it a point to do something for yourself daily (reading, working on a project, etc.).

How To Feel Up When You're Feeling Down

KNOW THAT “THIS TOO SHALL PASS.” New mothers who have gone through the adjustment period will tell you how difficult it can be to believe at the time that the sadness, the fatigue, the chaos, the feelings of helplessness and that things will never change - will not last forever. It does pass and things will, in all likelihood, get better. So hang in there!

IF YOU CAN, TRY TO PINPOINT EXACTLY WHAT YOU ARE FEELING AND WHY (e.g., I am feeling trapped because I haven't been out of the house for several days. I am feeling angry because everyone pays attention to the baby and ignores me. I am feeling tense because the baby's been crying for two hours, dinner isn't started, I'm still in my nightgown, and my mate just called to say his boss will be here for dinner with a gift for the baby). It is easier to deal with a specific emotion occurring in reaction to a specific situation than it is to handle a nebulous feeling of “the blues” seemingly without cause.

VERBALIZE WHAT YOU ARE FEELING. Say it out loud. Tell the baby. Call someone with whom you can be open about your feelings without fear of being laughed off or “ridiculed.” Even if at times you can’t pinpoint exactly what you are feeling, openly saying. “I am feeling down,” even to yourself, can act as a tension reliever.

SEE WHAT YOU CAN DO TO ALLEVIATE THE SITUATION YOU ARE REACTING TO. If you are feeling trapped, for example, take a walk; forget the housework and get out of the house (with or without the baby as you prefer and your situation allows). In cases where you absolutely cannot get out - for example, in a blizzard - visit with friends by phone, read, write letters, do something new - try a new recipe, begin a project, rearrange the furniture (on paper in the early weeks), etc. If you are feeling left out, besides telling your mate what you are feeling, you can do something for yourself. Buy yourself flowers; take yourself out to lunch; change your hairstyle or whatever. If you are feeling isolated, take a walk around the neighborhood in search of other new mothers (shopping centers, parks, bowling alleys that have nurseries, main streets and libraries are all good prospects). If you can’t get out, look through a telephone directory and make a list of places where you can meet other mothers. Call you obstetrician, pediatrician, or childbirth educator for a list of names and organize a rap group. If you are feeling tense, try taking a temporary “vacation” from the tension-producing situation before dealing with it. Sit down, put your feet up, and do slow chest breathing (slow, equal in and out breaths - in through the nose, out through the mouth). Supplying your system with more oxygen works to lift your mood. While you‘re doing the breathing, consciously release every muscle in your body, beginning with your facial muscles, working your way down your body to your legs and toes. When you are fully released, continue the breathing and try to imagine yourself in a restful situation - on a beach, on a raft, having a picnic, whatever works for you. Try to imagine it so clearly that you are “actually there.” What color is the sky? What sounds do you hear? What does the grass, sea, etc., smell like? Continue this for fifteen to twenty minutes.

If you are keeping a journal, take the time now and make an entry or start a journal. You can even write while holding a crying infant if you have to. Getting the feelings out helps!

When your doctor gives the okay, try yoga and deep breathing exercises which supply your system with more oxygen. Try jogging or jumping rope. The increased activity can help your mood and give you energy and a sense of well being.

When To Seek Professional Help

The adjustment to having a baby in the house is not an easy one and some new parents find they need professional help to learn to deal with their feelings. If you consistently feel “out of control,” “out of touch,” that you can't cope - by all means seek help. In addition, seek help

  • if talking out your feelings with friends, relatives, or in a rap group doesn't help you to resolve them
  • if you feel that nothing in life is giving you any joy, that life seems to be one big zero - all work and no fun
  • if you have no interest in caring for yourself or the baby
  • if you choose to remain in bed and not get dressed every day
  • if you withdraw and do not want to communicate with anyone
  • if you spend a good deal of your time staring at walls and/or crying
  • if friends and relatives constantly point out that you are not “yourself”
  • if you find that minor incidents continuously cause anxiety
  • if you know that if your feelings persist you will harm either yourself or the baby
  • if you have difficulty sleeping, lack of appetite, and/or severe constipation, without ascertainable physical cause
  • if you have thoughts of suicide

Call your obstetrician, pediatrician, or family doctor and make an appointment to discuss what you are feeling. Ask for a referral to a psychiatrist or psychologist who is familiar with treating these symptoms. If you find that your obstetrician, pediatrician, or family doctor is not helpful, laughs it off, or tells you these feelings will pass but you find they don't - seek help yourself. Contact your clergyman and ask for a referral. Call your local mental health association. Call your local hospital and ask them to refer you to a staff member. Family services agencies (often listed under Social Services Organizations in the phone book) offer family counseling, rap groups led by professionals, and often the services of a homemaker on a temporary basis to aid a family under stress.

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