{new post} #newmoms group: understanding #postpartum #moods

The second Saturday of each month is the free Outside The Mom Box support group for new moms with babies under 1 year. Each session starts with introductions and then goes in our main topic. We leave about 30 minutes for Q&A, then close. For November, we had local therapist and mom, Aimee Vandemark talk with us about understanding our postpartum moods. Here are a few noteworthy snippets from that conversation:

Aimee started our conversation off by sharing a story of an experience she had with her own young children. She asked herself in that moment and to us on Saturday to consider, "what does it mean to have another being call us "mom"?". That question segued into a conversation on how personal identity shifts for us during the postpartum period. Our identity as a woman shifts so much as soon as we become a mother. New moods, feelings or other different emotions can become a new norm. But when should we pay attention to those new feelings and when can we accept and move on?

What does postpartum depression look like? There are lots of different emotions or feelings that go into the mix (overwhelm, guilty, confusion, irritation, anger, sadness, numbness, etc.), Aimee told us. One mom commented, "that felt like Tuesday!". I know the feeling! So how do we know if we should be concerned? Aimee said that the intensity and duration of those feelings is really crucial to pay attention to. Thinking about duration: were they happening on Tuesday or for the past two weeks? And when examining intensity, it's important to consider how those feelings are affecting your life: are you able to get through the day? And perhaps find that things are better the next day? Or do you find yourself so overwhelmed that even basic daily tasks feel impossible? 

One of our new moms who has struggled with depression in the past shared that our partners can serve as a good reality check for our emotional health. What a good point! Our partners are the people who know us best in the world. If they are noticing that we are different or that our behavior seems problematic or concerning, then that is absolutely something worth pay attention to. 

In addition to awareness from our partners, Aimee said that our own self-awareness is a really important skill to develop. And that may be fine-tuning, instead, if it's been a while since we've been in touch with how we're feeling about things. Issues like anxiety, depression, sadness don't go away in pregnancy or even after we have our child/children. It's important for our emotional health as well as the health of our entire family that we are self-aware.

With self-awareness, ideally, goes action. So if we are feeling overwhelmed by some of the mood swings that we have going on during the postpartum period, or otherwise, we need to reach out for help and support. Help and support can include: self-care, groups like this new moms group, time talking to a professional like Aimee, connecting with other new moms or even adjustments to schedule, parenting responsibilities. And self-compassion.

I often focus on self-care as an important piece for new moms to practice getting into the habit of but Aimee reminded us that self-compassion is just as important. Self-compassion is just what it sounds like: letting ourselves off the hook sometimes. Talk ourselves the way that we would talk to our child, to at minimum a stranger. Compassion for ourselves can look as "simple" as putting away the parenting books that are causing anxiety, talking yourself out of a negative "tape" that's playing in your mind, or reaching out to someone who has been a supporter of you, to give you a reality check.

Questions? Comments? Share them by visiting my contact page or leaving your thoughts below.

For more information on postpartum mood disorders, please visit my page on mothering and mental health. Thank you for reading! On the calendar for next month: travel with baby! Join us on Saturday December 13 from 2-4 pm.

{new #OutsideTheMomBox post} "Did I have a traumatic #childbirth?"

I read a terrific blog post recently that one mom wrote about her childbirth experience. Her labor was long but not concerning. Neither she or the baby were in any kind of danger. From all outside appearances, things looks fine. The exact opposite of how healthcare professionals define "traumatic childbirth". But to this mom, her childbirth experience was traumatic. This is an important distinction.

If we followed the legal definition of domestic violence in terms of providing services to those in need, very few women would ever get help. The legal definition of domestic violence is just that limiting. Similarly if we allow medical professionals to define (or not) our childbirth experience, many of us would not only not have the opportunity to process it but perhaps more of us would feel reluctant to name our childbirth as traumatic. Both are problematic when it comes to our mental health. 

{Funny how both are "women's issues", isn't it?}

We make birth plans, hire doulas, take a childbirth ed class...all things we do to claim our childbirth experience. Claiming your childbirth experience doesn't end when that precious baby arrives in the world! If you feel that your childbirth experience was traumatic for any reason, that is enough of a qualification. 

You have a healthy baby, right? So what exactly do you have to "complain" about? Talking about your childbirth experience (or any aspect of mothering for that matter) is not complaining; it's you taking responsibility for your healing, your self-esteem and your identity as a woman and a mother. As new moms, it's important to practice separating out needs as individuals from our role as a mother so both pieces of yourself are allowed to matter. We've never done this before. As an individual, you have needs, dreams and wants. They are important. But as a mom, you're often told that your needs don't count. But that doesn't mean that those wants and needs go away. They are still important; we just need to own them better and feel supported doing so. Talking about your childbirth is one way to do this.

No, my childbirth experience wasn't traumatic. I feel very lucky because I have known so many women who did feel that theirs was traumatic but didn't feel that they could talk about it or name it for what it truly was. (And certainly no one asks!) This void is why I've started offering trauma counseling. Trauma counseling is a time for women to talk about a trauma related to their pregnancy or childbirth experience. So if you need to claim that childbirth experience as traumatic, today or five years now, you absolutely should...and feel supported doing so.

As always, thank you for reading! I am grateful that you're here.

{new #OutsideTheMomBox post} Impact of maternal #childhood #sexualabuse on #babies

Childhood sexual assault (CSA) survivors have a different set of challenges than new moms who aren't survivors. [For perspective, about 1 in 7 girls will be sexually abused before her 18th birthday.] These challenges can manifest themselves in different, often unexpected ways, not just in mom, but also in baby. As the first in a new series here dedicated to raising awareness about the realities that survivors face as pregnant women and new moms, I'm going to highlight three ways that a history of CSA in mom can impact a newborn's health and well being:

1. From the strange new feeling of your milk letting down to the realization that your breasts really aren't your own anymore, breastfeeding can be a very triggering act for a survivor. Add in factors like an infant's roving hand, pain of any sort, feedings at all hours and you can start to see why some survivors don't breastfeed. For survivor moms, it's usually less of a "choice" and instead often related to not being able to tolerate breastfeeding or the fact that it just doesn't work for them. And yet, we all know that breastfeeding is ideal for baby. Studies that confirm this are numerous; check out the first paragraph here for details. 
2.  Failure to thrive (FTT) is a state of undernutrition due to inadequate caloric intake, inadequate caloric absorption, or excessive caloric expenditure. There are two types of FTT: non-organic (a non-medical reason the infant isn't thriving) and organic (a medical reason that the baby isn't thriving). With both types, the bottom line is that baby isn't getting fed enough. There are many reasons why FTT can occur: lack of success breastfeeding, emotional overwhelm in mom, misunderstanding or a lack of understanding about basic infant needs in mom/parents, lack of attachment to baby by mom, etc. Each of these above reasons can be by-products of mom's past history of abuse. Dr. Kathleen Kendall-Tackett, IBCLC talks a bit about this here.
3. Not all women bond immediately with their baby.  For survivors, however, that bonding may take even longer, even if the baby is "just" a normal, dependent infant. If the baby is special needs, is "difficult" or has other challenges (colic, etc.) then bonding may be even harder. "Mere" insistent neediness of a baby may stir up past feelings of vulnerability and powerless that mom associates with the perpetrator of her abuse. It's normal: the perpetrator took what he wanted from the survivor and when a new baby enters the survivor's world, dependent and unable to feed or care for herself, the survivor's body is once again at the whim of someone else. This lack of bonding can become problematic though if FTT (see #2) develops and/or if mom begins to have ideas of harming her baby.

What does all of this mean? Well, simply due to their past abuse, survivors carry with them challenges that can complicate their ability to provide the best care for their baby. Add in factors like poverty, a lack of education, an absent or abusive partner, and you have a survivor mom who may barely be hanging on. This is something that should concern all of us. But here's what we can do:

• Keep in mind the challenges of survivors that we discussed above when you hear the ever-present "breast is best" motto. Click here for a bit more on this issue. Not being able to breastfeed a child can be devastating for a new mom's fragile mental health but what is often more detrimental to mom and baby is the societal guilt that moms are made to feel by not doing the "best" they can for their child i.e. breastfeeding.
• Provide support. Support is continually named over and over one of the best resources that you can give a new mom. Good, informed support helps new moms feel less alone, more normal and more accepted. Not to mention provide them with trusted resources that they trust when they need more help or advice. All of this is why I offer free groups. What can you do? Attend a group, help make a group happen for those who need it, or volunteer in a way that feels right to you.
• Rise above the "mommy wars". It can be so hard to sit back and mind your own business. That's true for me too! But we really must. When we accept that we can't ever know someone's whole story and therefore have no place to judge them, then we are removing ourselves from the insidious "us vs. them" battle. It's a battle that neither side will win, even if we "lean in" so let's just opt out of it altogether.

Starting this fall, I'll offer my first virtual program: a childbirth education class specifically for survivors. Open to any survivor, living anywhere, we will meet weekly over a conference call line for seven weeks. First names only. If you'd like more details, head over here to give me a call or message me. Thanks for reading.

Are you at risk for a postpartum mood disorder?

It's a little bit of a trick question because postpartum depression can affect any new mom. But it's important to note that there are some populations that are at a higher risk for postpartum mood disorders in general.  Here are some of those groups:

Women who have had health-oriented /physical challenges in their past:

• Survivors of intimate partner violence;
• Survivors of sexual assault, rape or childhood sexual assault*;
• Women who have suffered / suffer from disordered eating behaviors;
• Women with a history of depression;
• Women with a history of bipolar disorder;

Women with the following specific social or economic challenges:

• Women with limited family support;
• Women who are poor or lower income;

Lastly, there are factors related to the baby that put some women at a higher risk:

• Special needs babies;
• Colicky babies;
• Chronically ill babies or babies with life-threatening illnesses.

[Author, IBCLC and speaker Dr. Kathleen Kendall-Tackett talks about all of the above challenges and more in greater detail in her book, Depression in New Mothers. I highly recommend it if you are interested in reading more about postpartum mood disorders.]

I would also add women who have suffered from chronic pain, after reading this article.  This is just my opinion but I can't imagine how suffering from constant pain wouldn't make you predisposed to a postpartum mood disorder. Finally there is a new study out that says that women who fear childbirth are also at greater risk for postpartum mood disorders.

With all of these risk factors, I can't help but wonder why more women aren't diagnosed with a postpartum mood disorder.  But of course, as we know, postpartum mood disorder screenings aren't thorough, perfect or even often enough.  The onus is, once again, on the new mom herself to come forward.  But when you're in a haze of confusion, pain, sleeplessness and perhaps anxiety, it can be hard to sort through whether your feelings are normal.  Also not helpful is the fact that you don't see your OB until six weeks after you have your baby/babies.  That may not be early enough (postpartum depression can happen anytime in the first year) or it may be too late. 

Here are three things you can do, if you happen to fall into any of this categories of higher risk:

1. Make finding a good local new moms group, like mine, a priority for yourself before the baby arrives.  Good social support is ESSENTIAL as a new mom.  You will need to know that you aren't alone, that you (and your worries) are normal and that many new moms share your fears, wants and concerns.  . 
2. Consider hiring a postpartum doula.  They have the distance and the expertise to recognize problems before they arise.  Postpartum doulas are trained in, among other things, recognizing signs that mom gives...whether spoken or unspoken.  Postpartum doulas aren't counselors but they can refer out to a qualified professional.
3. Speak up.  If something is upsetting to you, talk with your partner, friend or another trusted mom about it.  If you need something, ask for it.  Too many of us suffer in silence, or just as damaging resentment, when it would be better for our physical and emotional health just to talk about it.

A postpartum mood disorder isn't a life sentence or something to be ashamed of.  Let's keep the conversation going so we can all stay better informed and in doing so, be better advocates.