Beyond the Blues
Understanding and Treating Prenatal and Postpartum Depression & Anxiety
By Shoshana S. Bennett, PhD and Pec Indman, EdD, MFT
Copyright 2015 by Shoshana S. Bennett, PhD and Pec Indman, EdD, MFT
Cover Copyright 2015 by Untreed Reads Publishing
Cover Design by Ginny Glass
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Excerpt from Chapter 3 of Beyond the Blues
Women with Perinatal Disorders
This chapter is for you if you are suffering. In the chapters to follow, we will discuss the role of practitioners, partners, and other family members in helping mothers recover.
Among the women we treat are those in the healthcare and educational professions, such as MDs, nurses, daycare and preschool providers, teachers, and therapists, to name a few. We often hear from these women, “This can’t be happening to me! I take care of everyone else in crisis.” What we tell them is that our brain doesn’t care what we do for a living! No one is immune. No matter what the educational or socioeconomic level, culture, religion, or personality, wherever women are having babies, the statistics remain consistent.
Women who suffer perinatal emotional difficulty experience their emotional pain in many different ways. Here are some of the common feelings they express:
- No one has ever felt as bad as I do.
- I’m all alone. No one understands.
- I’m a failure as a woman, mother, and wife.
- I’ll never be myself again.
- I’ve made a terrible mistake.
- I’m on an emotional roller coaster.
- I’m losing it.
- I wasn’t cut out to be a mom.
Please know that each woman may experience these feelings at varying levels. Some may feel all of them, and others may feel only a few. You might also recognize some of your symptoms listed in Chapter 2.
Finding a Therapist or Medical Practitioner
We encourage you to contact Postpartum Support International (PSI) at 800-944-4PPD (944-4773) or postpartum.net to locate a therapist who has shown interest and commitment in the postpartum field. PSI, along with other organizations, provides specialized training in perinatal mood and anxiety disorders. We have not found any graduate training that fully covers this material. Do not assume (as many insurance companies would like you to believe) that someone who has expertise in working with depression or anxiety is knowledgeable about the unique aspects of perinatal mood and anxiety disorders.
Most insurance companies have coverage for mental health. It is usually less expensive if you see a provider on their “panel.” Sometimes an insurance company is willing to add a specialist to its provider list or pay for you to see one. If your insurance company will pay only if you see providers on their list, here are screening questions to help you determine their knowledge in this area. It’s important to ask these questions, even if the therapist considers himself or herself knowledgeable. If you don’t have the energy to deal with the insurance company or to screen professionals, ask a support person to do this for you. Medical practitioners should be asked if they are comfortable prescribing psychiatric medication (if needed) to a pregnant or breastfeeding mother.
- What specific training have you received in perinatal mood and anxiety disorders?
- Do you belong to any organization dedicated to education about perinatal mood and anxiety disorders? Someone committed to working in this field should belong to at least one of these organizations: Postpartum Support International, Marcé Society, North American Society for Psychosocial OB/GYN.
- What books do you recommend to women with prenatal or postpartum depression or anxiety? Someone with expertise should be able to name several books listed in the Resources section of this book.
- What is your theoretical orientation? Research has shown the most effective types of therapy for your condition are cognitive-behavioral and interpersonal. You are experiencing a life crisis; long-term intensive psychoanalysis is not appropriate.
If you are unable to find a therapist with expertise, interview until you find someone who is compassionate and willing to learn. If you do not think a practitioner is helping you, move on! Be a good consumer. Shop around until you feel satisfied that you are in capable hands.
The Truth of the Matter
As you face the challenge of a perinatal mood or anxiety disorder, remind yourself of these truths:
- I will recover!
We have never met a woman who, after proper treatment, did not recover.
- I am not alone!
One in five women will experience a perinatal illness.
- This is not my fault!
You did not create this; it is a real illness.
- I am a good mom!
Even if you are hospitalized, you are still making sure your baby is provided for. The fact that you are trying to improve the quality of your life and your family’s proves you are a good mom.
- It is essential for me to take care of myself!
It is your job to take care of yourself so you can get better and take care of your family.
- I am doing the best I can.
No matter what your current level of functioning, you are taking steps, regardless of how small they seem. Good for you! Depression may interfere with your ability to believe these statements, so it is important to say them frequently, as if you really mean them. As you recover, this exercise will become easier.
Basic Mom Care
Women today are expected to be supermoms and do it all. There is a lot of pressure to have a perfect baby who never cries, a clean and well-organized home, and a happy, supportive partner. Even when there are helpful people around, many women are uncomfortable asking for help. We often hear the expression “it takes a village,” but many feel that asking for or needing help is a sign of weakness. You deserve to be well no matter how much help it takes.
Finding Support People
Very often when we are in crisis, we overlook the people around us who can be of help and support. People can support you in different ways, and all types of support are needed. Physical support can be cooking, cleaning, caring for the baby, shopping, or taking you for a walk or to an appointment. Emotional support may include sitting and listening, hugging, and giving encouraging words. Accept all the help that’s offered and ask for more.
This is a brainstorming exercise—write down everyone who comes to mind, regardless of the type of support he or she may be able to give you. If possible, do this exercise with a support person. Keep this list of supporters’ names and phone numbers handy by your phone in times of need.
Here are some places where our clients have found support. Think about how these sources might help you the best:
- Family and extended family
- Religious communities
- Professionals (including doulas, lactation consultants, nannies, housekeepers)
- Hotlines and warmlines
- Online postpartum depression message boards (see the Resources section)
- Prenatal/Postpartum depression support groups
- Do not assume that because someone is in a helping profession or is family, he or she will be helpful or understanding. Find and surround yourself with nonjudgmental, caring support.
Often women with perinatal depression and anxiety crave sweets and carbohydrates. If you can eat something nutritious, especially protein, each time you feed the baby, you can help keep your blood sugar level even. This will contribute to keeping your mood stable. We understand this may be difficult if you are experiencing a lack of appetite, so do the best you can. If you have trouble eating, try drinking your food—for example, protein shakes or drinks. Avoid caffeine.
Ask a support person to shop for things like yogurt, sliced deli meat and cheese, hardboiled eggs, precut vegetables, fruit, and nuts. Better yet, if they are not already offering, ask people to bring you food. Don’t forget to drink water—dehydration can increase anxiety. Appetite problems are quite common with perinatal depression and anxiety. Please tell your health practitioner about any major appetite or weight changes. It might be helpful to consult a nutritionist who is familiar with depression and anxiety when you have the energy.
A recent study of over one thousand women looked at the effect of diet on depression and anxiety. Women (across age, socioeconomic status, education, and health habits) who ate a diet high in vegetables, fruit, meat, fish, and whole grains had less depression and anxiety. Women who ate a diet of processed or fried foods, refined grains, sugary products, and beer had higher rates of depression and anxiety.
Mood is severely affected by lack of sleep. Moms are more depressed, irritable, and anxious when they have interrupted sleep. Nighttime sleep is the most valuable sleep in helping you recover. Sleep is necessary to restore brain health and ideally, the brain needs eight hours of uninterrupted sleep each night. Although with only six hours of uninterrupted sleep the ability to think clearly and respond is decreased, it’s often a more reasonable goal for many families with a new baby. You need to be “off duty” physically, emotionally, and psychologically for a few hours per night. The baby can be fed breast milk in a bottle or formula by your partner or other support person. You can either split each night with your partner or alternate taking a full night “on,” then a full night “off.”
If you don’t have a partner or your partner is not home, you will need to enlist a support person to be responsible for the baby during this time. When you are “off,” you should sleep away from the baby in another room, with earplugs. Many of our clients also use a fan, air purifier, or another appliance to block all baby noises.
Remember, it is your job to take care of yourself. Even if you cannot arrange for this nightly, a few nights a week will help. If you are able to nap in the day, do so, but naps do not replace nighttime sleep. Sleep problems occur frequently with mood and anxiety disorders. If you are unable to sleep at night when everyone else is sleeping, please talk to your health practitioner.
Even a few minutes of brisk physical activity can help your mood. When you are physically able to be active, find something you are willing to do (for example, walking, dancing, or bike riding). If the thought of walking around the block is overwhelming, start slowly and work up. It will get easier as you feel better. If you know you would feel better if you did the activity, but it is hard to mobilize yourself, designate a support person or buddy to encourage you and participate with you. Pregnant and postpartum women who got some exercise (including walking with a stroller) were found to cope better and have a reduction in depression.
If you have sleep problems or are very sleep deprived, do not do intense aerobics—this can actually make your sleep condition worse. Wait until you have had at least a couple of weeks of good sleep before you resume or begin a heavy exercise program.
The myth is that if we really love our children enough, we shouldn’t need breaks from them or have fun without them. This certainly isn’t the case! We’ve bought into the idea that taking time for ourselves is selfish and bad, and therefore we feel guilty when we even think we need a break. There’s no other job that’s 24/7. The truth is that all good mothers take breaks—that’s how they stay good mothers. We strongly recommend that you get regularly scheduled time off each week for a minimum of two hours at a time (this does not include chores and errands—pleasure only). For every job other than being a mother, breaks are mandated by law, and you’d expect much more time off.
If you don’t recharge your batteries, you’ll be running on empty. You are not the only one who can care for the baby. Partners and family members, for instance, should be given alone time to bond with the baby too. This experience is important for the baby, and it can be done more easily with you somewhere else. Everyone wins.
If you are not able to leave the house, go to another room and use earplugs or headphones. Or maybe your support person can leave the house with the baby and give you time alone.
When you are depressed or anxious, the four walls feel as if they’re closing in. The world feels darker and smaller. You tend to fold in emotionally and physically (as in crossing your arms, hunching over, and fixing your gaze downward).
We encourage you to go outside your home, look up at the sky, stand up straight, put your arms at your sides, and breathe. You don’t have to actually go anywhere. Just go outside once a day, even if this means standing outside your front door in your bathrobe.
Improving Your Mood—Take Control of Your Environment
Avoid reading or listening to the news. If you want to watch a movie, choose a comedy. Avoid tragic or violent films. Open the drapes and curtains and let the sunlight in. If you are anxious, listen to soothing music. If you are depressed, try music with a good beat that gets your body moving.
Taking Care of the Baby
Depending on the level of depression, you may need someone to do most, if not all, of the baby care. A support person, such as a family member, doula, nanny, or friend, can be with you when your partner is not. Very gradually you can increase your participation with the baby care as your support person keeps you company.
Even though you may feel like a robot at first, just going through the motions without joy, it is still good for you to experience yourself doing some “mommy” tasks and interacting with the baby. Your feelings of competence and confidence will increase, and eventually you will be able to enjoy your day. Smile, touch, and interact with your baby as much as you’re able. Once you’re up to it, you might find it helpful to sign up for an infant massage or baby swimming class. These types of classes promote mother-infant bonding.
You may not know what you need when a support person asks, “What can I do?” It’s all right to say, “I don’t know what I need right now. I just know I feel awful.” However, don’t assume anyone can read your mind. You are most likely to get what you need if you ask for it.
Try giving your partner, family, and friends a script to guide them in how to best support you. For example, when you are experiencing anxiety, it will not be helpful to hear, “Just calm down and relax.” Instead, try giving them suggestions of what to say and do:
- I am sorry you are suffering.
- We will get through this.
- I am here for you.
A script does not detract from the genuineness of caring and love. On the contrary, it will give your support people an effective way to give you what you need. People who love you want you to get better. They will be relieved to know what will help.
For Women with Anxiety, Fear, or Extreme Worry
Be sure to avoid caffeine and keep your blood sugar level even (see the section titled “Eating”). For many women with anxiety or obsessions, information provides fuel for worry. Turn off the TV news, and don’t read the news. Don’t read books, magazines, or Internet information if you find it makes you more anxious. Avoid all media—including social media—if it fuels your worry or fear. If you go to the movies, select comedies. Find activities that can soothe or distract you, rather than those that stir up anxiety.
Preventing Too Much Stimulation
When the usual sights, sounds, and daily activity feel like too much, it is important to adjust your surroundings. Remember, you are in recovery. Treating yourself with “kid gloves” can greatly boost your recovery. Don’t push yourself. If, for instance, going to a family event seems overwhelming (even if you have had fun at this event in the past), you probably should not go. Trust yourself. As you recover, you’ll be able to handle more.
Perinatal women often feel hypersensitive to stimulation of all kinds—visual (seeing), auditory (hearing), and kinesthetic (touch). If this is happening, it may be soothing to lower the light in your house. (If you are feeling more depressed than anxious, try brightening your house with more light—open your curtains and add lamps, for example.) As long as you can hear what you need to, try wearing earplugs or headphones during the day to muffle unnecessary noise. You may become more sensitive to touch—for instance, clothing may rub, scratch, or itch. Be compassionate with yourself and do what you need to in order to be comfortable.