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.

Knowing instead of assuming

Genevieve Paiemont-Jacobson's recent piece in Salon trashing both her birth and post-partum doula has gotten a lot of attention.  Most of the comments following the article seem to blame Paiemont-Jacobson for the negative experience she had.  I agree in part but I think the bigger issue are the assumptions she had about her doulas-

First, most birth and post-partum doulas (because there are two kinds) are independent contractors.  They work for themselves which means that they do all their own marketing, vet their own clients, are themselves on hand for the job that they were hired for.  Except, of course, when they're not.  Like other professionals, doulas have clients other than us.  And while I do think that many birth doulas tend to overbook themselves, it's important to remember that there is still a customer and a provider here.  If Paiemont-Jacobson wasn't comfortable with the possibility that her birth doula may be at another birth when you go into labor, she shouldn't have booked that doula.

Secondly, birth doulas aren't angels who, if on hand at your birth, ensure "smooth sailing and rainbows and unicorns".  They are real people without magical powers. Yes, having a birth doula can reduce your chance of a C-section.  But it's no guarantee against unexpected complications, such as the ones that arose at Paiemont-Jacobson's birth.  Same for post-partum doulas.  At our intake conversation, my post-partum doula clients are provided with a clear list of what they can expect of me during my time with them and what is not included.  Missing that, I can see why Paiemont-Jacobson feels she was "ripped off" but, to be fair, some of the blame does rest with her for not getting the information she needed by asking the right questions. 

Pro tip: Both kinds of doulas are providers, like any other. Interview carefully in advance to make sure you are hearing what you need to.

Thirdly, it sounds as if Paiemont-Jacobson assumed her birth doula was also a childbirth education expert. Whether she was misled by the birth doula or if she just connected these disparate dots doesn't matter.  What's disturbing is that Paiemont-Jacobson still remains misinformed about the role of a birth doula in childbirth.  My own birth doula recommended a wonderful CD to help with relaxation and visualization but my husband and I took childbirth classes with-you guessed it!- someone trained as a childbirth educator. Birth doulas are real people.  

Pro tip: If a resource is recommended to you by your birth doula, or anyone else, check it out. But taking any recommendation as insurance isn't smart.

Rachel Gurevich over at Womb Warrior made a good point in our Twitter exchange about this article: "more time to process would have helped,".  A natural place for processing your birth experience is with your post-partum doula.  I spend a great deal of time, really as much as they need, with new moms on processing their birth experience because it is so important. But Paiemont-Jacobson's experience with hers was so completely lacking that I imagine the processing piece was absent too. Which is a shame.  It is essential for women to process their birth experience (I wish I'd done this!) no matter what kind of birth they have.  And often that's difficult to do, whether it is because of preconceived ideas about childbirth or because we lack someone with whom to speak frankly and emotionally about our birth experience.  This is one of the reasons that I offer a service called NewMamaLuve with this idea in mind.

A lessons learned piece from Genevieve Piedmont-Jacobson would have not only served other pregnant women and informed the general public but gained her more sympathy for her experience and perhaps even greater respect for her writing.  Her anger isn't the problem; her assumptions are.

Book Review: Expecting Better by Emily Oster

I had high hopes for _Expecting Better_ when I read Emily Oster's article in Slate, here, about the myths of bedrest.   The article is a terrific read, so much so that I sent it onto my post-partum doula pal, Victoria Facelli, who specializes in dealing with mom's who have been put on bed rest.  And, forgive the pun, but this book, economist Oster's first, really delivers.

When Oster first discovered she was pregnant, she set out to learn the facts about what she should and should not do,  What she fast discovered (and what you might have learned already, as I did) is that many "rules" are arbitrary (like the idea of bedrest), and not backed up by real science and actual research.  _Expecting Better_tackles a lot of what's regarded as "the usual" advice to follow when you're pregnant (avoid caffeine, don't eat sushi, NO drinking and hair dying, etc.) and debunks most of it.  The full title of the book is _Expecting Better: Why the conventional pregnant wisdom is wrong-and what you really need to know_.  This is one book that actually gives you what is promises: exactly what you do need to know if you are pregnant.

Being pregnant is HARD.  And one of the least discussed reasons that it's hard is that hard and fast rules aren't really rules at all.  So, what do you do?  Who do you listen to?  What advice can you follow?  Oster makes this piece of pregnancy, at least, easy.  She tackles every issue that you could possibly come up against (and a few that I hadn't even heard of!), chapter by chapter starting with "conception" and ending with "labor and delivery".  Honestly, you don't even need to read every single word.  Just skip to her neat, 3-4 bulleted point summary at the end of each section which gives you "The Bottom Line." Easy, easy!

Emily Oster is an engaging writer who tackles complex subjects in a manageable, approachable way.  She's a trained economist who teaches at The University of Chicago but even that background doesn't get in her way of authoring an honest, easy to understand book that every pregnant woman can relate to and SHOULD read. 

Outside The Mom Box rating:  5 stars out of 5