I enjoy working with young mothers in my practice. My husband and I raised our own 5 children "attachment parenting-style," and I was a La Leche League leader for 12 years. I have also been trained as a birth doula, and 4 of our children were born at home. I support the mothers that I see in their own philosophies about childrearing, and I believe it is important to promote the mother-child bond. Mothers of infants often choose to bring baby to my office for their sessions, which I encourage.
Post Partum Depression and More:
Pregnancy, childbirth and new motherhood are life passages when more support may be needed. As fulfilling and meaningful as these experiences are in the life of a woman, they also carry with them added stress.
One of my areas of special interest is “perinatal mood disorder and anxiety,” which refers to the changes in mental state that occur during pregnancy and after childbirth. I also work with women who have experienced extreme fear or terror during childbirth. This is referred to as “birth trauma,” and some women even develop Acute Stress Disorder or Post Traumatic Stress Disorder because of difficulties in their birth experience.
Simply put, some women experience flashbacks of the birth, as well as intrusive thoughts about it. They avoid reminders of the birth, and sometimes even avoid the baby because of the traumatic associations.
More common is depression in the two weeks after the birth. The so-called "baby blues" (insomnia, tears, irritability) should pass after two weeks. If not, the mother needs help, as she may be experiencing postpartum depression.
This is a time in your life that requires you to be at your best, and yet it can be a time when you feel depleted in energy and unable to cope. You do not need to suffer; you do not need to handle this alone.
More on Postpartum Depression and Other Perinatal Mood Disorders
Below is my article which appeared in the online magazine, The Attached Family, February 26, 2013.
The Emotions of Pregnancy and New Motherhood
The Joy of Motherhood
The joy of motherhood is the subject of much art and idealistic images. Our expectation that the arrival of a baby is a time of peace and pure bliss is enforced by the culture. Certainly, for many mothers, the months of carrying a precious new life and bringing a brand new person into the world are experiences unparalleled in satisfaction and happiness. Of course, even the most exhilarated mother has her moments of feeling overwhelmed, intimidated by the formidable job ahead, and just plain physically exhausted. Overall, however, new motherhood is expected to be a wonderful time, and it often is.
The Baby Blues
The Baby Blues is a very common, transitory experience of tearfulness, irritability, overwhelmed feelings and mood swings. More than half of all mothers pass through this phase during the first 2 weeks after childbirth. For the Baby Blues, no treatment is needed unless the depression appears to be extreme. If the new mother is breastfeeding on demand, using no bottles or pacifiers, with the baby having continuous access to the breast, her hormones are at that euphoric level that seems to offer some measure of protection (there is no sure guarantee, of course) against the low mood that is known to follow childbirth, namely the Baby Blues, and even against the clinical illness, Postpartum Depression. The Baby Blues will pass, untreated. Postpartum Depression is another matter entirely, and requires professional attention.
Postpartum Depression and Perinatal Depression
The term “postpartum depression,” which refers to depression after childbirth, is being replaced by the wider term “perinatal depression,” which includes depression both during pregnancy and after childbirth. Women who are depressed during pregnancy are at risk of being depressed after the birth as well, and ideally should seek help when the symptoms of depression are felt.
Perinatal Depression is recognized by its duration and severity. A mother who continues to be depressed after her baby is 2-3 weeks old should be assessed for postpartum depression, as by 3 weeks, her hormones should have "settled down." Symptoms of perinatal depression include:
· Depressed mood, tearfulness, hopelessness, and feeling empty inside, with or without severe anxiety
· Loss of pleasure in either all or almost all daily activities
· Appetite and weight change
· Sleep problems: trouble with sleeping, even when baby is sleeping
· Either restlessness or sluggishness
· Extreme fatigue or loss of energy
· Feelings of worthlessness or guilt, with no reasonable cause
· Difficulty concentrating and making decisions
· Thoughts about death or suicide, or fears/thoughts of hurting the baby
Some mothers begin to be overly concerned about cleanliness during pregnancy or after the birth. They may spend an inordinate amount of time cleaning and scrubbing to the point of having little time for anything else; others notice that the items being cleaned are already clean or that the mother’s hands are raw from constant scrubbing. (This is an example of Obsessive Compulsive Disorder, which is one form of anxiety.) Some mothers begin to worry much more than ever before, to the point of having this constant worry interfere with their daily functioning. Some mothers may be horrified by thoughts that they cannot stop; these thoughts may concern hurting the baby. These are some examples of anxiety; this can begin for the first time during pregnancy or after childbirth, or it can be a returning problem that the mother experienced earlier in her life. In any case, counseling can help her manage her symptoms of worry.
Perinatal Bipolar Disorder
A woman may develop bipolar disorder during this time of shifting hormones. This may begin as a severe depression, but then cycle into feelings of euphoria, and mania, accompanied by insomnia and extreme feelings of excitement, happiness and confidence. She may be reckless of safety or make rash decisions during these times. Bipolar disorder requires both counseling and medication and people who have this challenge can lead very satisfying lives. The most important thing is staying on the medication which would be prescribed by a psychiatrist.
Post Traumatic Stress Disorder following Childbirth
Birth should be a natural event. However, it can be overwhelming or terrifying to a woman, especially if something goes wrong, or if there is extensive medical intervention combined with a lack of emotional support. Post Traumatic Stress Disorder (PTSD) is a condition we usually associate with combat veterans or victims of domestic violence. It can also affect new mothers. PTSD is caused by feelings of horror or extreme fear and the perception that one (or a loved one) is in danger of dying or being severely injured. Not all people in such a situation develop PTSD; some are more vulnerable to this condition than others. A woman is more likely to develop PTSD if she has an emergency Cesarean, a very long labor, a lot of blood loss, or a high level of pain. Symptoms of PTSD include:
· Re-experiencing the event again and again; flashbacks, nightmares, intrusive thoughts, being upset by the memory of the event
· Avoiding reminders of the event (which could include avoiding the baby); feeling emotionally numb
· Irritability, difficulty concentrating, difficulty falling or staying asleep, an exaggerated startle response (jumping when surprised by a sound, for example)
Fortunately, this is the rarest of perinatal mood disorders, but it does occasionally occur. Psychosis is a loss of contact with reality, thus the person may have auditory hallucinations (hearing voices), or even visual hallucinations (seeing things that other people do not see). Hearing voices is the more common kind of hallucination. Psychosis may also cause delusions, which are bizarre false beliefs, such as the belief that one is possessed by demons, or the belief that one’s thoughts are being read by passersby on the street. The mother who is experiencing these distressing symptoms needs immediate emergency care at the local hospital. There are medications which can usually get these symptoms under control quickly.
Pregnancy and new motherhood are emotional experiences. The vast majority of women will pass through these special times with no incident. However, a significant number of women do have difficulties as outlined above. The important thing to remember is that there is treatment for all of these conditions. In many cases, counseling with a therapist who is well-versed in perinatal mood disorders will be enough to bring the mother to health again. In some cases, medication prescribed by a psychiatrist will be necessary. When medication is necessary, the utmost care should be taken to consider the risks and benefits to both mother and baby. It is important to remember that these disorders themselves may pose a danger to the mother and baby, and for that reason it is important to have an open mind when weighing decisions concerning medication.
Mothers struggling with mood disorders need and deserve help and support. If you or a mother you know is struggling with sad thoughts, extreme anxiousness, mood swings or other emotional difficulties, please remember that there is no need to go through this alone. It is vital to the mother herself and to her whole family that her symptoms be attended to and that she be restored to balance. Professional help is available, and can make all the difference in the world.
Crisis hotline for postpartum depression and psychosis:
1 800 PPD MOMS