Wondering When It Gets Easier, Mama? Why it's harder than you imagined to mother an older infant +7 tips to help you through

Your baby is 6 months old. Perhaps 8 or 10 months. You thought you'd "have it together" by now. Or at least feel like a version of your former self. You've managed to piece together some semblance of a routine and take care of the basics- you go food shopping, hit the park after the second nap occasionally. But you feel anything but together. 

You crossed the threshold into motherhood many moons ago, tho some days it feels like it's harder than the first week after you brought your baby home. You knew the media's portrayal of moms was too good to be true, but this?! You had no idea how hard it could be. 

As a mother of 2 and a psychotherapist specializing in maternal mental health, i spend a lot of time reminding my clients (and myself) just what an enormous transition motherhood is. 
 

Reasons why parenting hasn't gotten easier, yet

Becoming a mother is the biggest transition a woman goes through in her adult life. Many women I see in my support group and my private practice struggle immensely with the loss of self, figuratively and literally. There's no way to prepare for the jolt that assaults the mind and body as you pour every ounce of energy into another human, selflessly abandoning your own basic needs like sleeping, showering, using the bathroom and eating to ensure the health and wellness of your baby. Let me unpack that for you. 

Sleep

The average infant isn’t sleeping through the night at 6 months, despite the myth that society continues to perpetuate about sleeping like a baby. It's just that, a story. Babies. Don’t. Sleep. At least most or many don't sleep well at this age. It's not uncommon for older infants to routinely take 30-minute naps. And wake 2-4 times a night. Or more.

As you well know, if baby doesn't sleep, mom doesn't sleep. Lack of sleep is correlated with both depression and anxiety. Sleep deprivation makes life harder, which is why it's is used as a method of torture! 

Many new moms anticipate they'll have time to clean the house, prep dinner and maybe take a shower when their baby naps. Never had they considered the reality of holding, wearing, bouncing or driving their tired or crying child to try and induce sleep and eek out a 30-40 min nap here and there. That downtime you imagined to effortlessly have-- poof! Being a parent is a sacrifice for sure; you knew that cognitively of course. But when you haven't been able to put your child down to nap since they were two weeks old and it's 85 degrees outside and your walking up and down the street so they'll fall asleep-- it's real. 
 

Relationships

Many women I work with share how struggles with their partners seemingly erupt out of nowhere. Relationships that previously had no cracks feel like they're crumbling. As I prod and question I learn more about the communication gap and the resentment that builds when responsibilities fall on the shoulders of one person more than another. When needs go unmet, feelings of not being appreciated, thought of, cared for and loved begin to grow.
 

Identity Loss

It's not unusual that during the very early stage, if mom is breastfeeding or recovering from birth she spends many weeks at home, bonding with her newborn.  But often, I hear that as partners return to work and resume regular social activities, mom feels more isolated from friends, society and her former identity. She's no longer working and no longer engaging in the activities that previously identified her as the person she though of as herself. Instead she's counting poop diapers and bouncing a baby on a ball so she can maybe check her email or do something for herself if she can get the baby into a bed. 
 

Overwhelm

These aren't unusual issues to face as individuals and couples transition into parenthood but they shouldn't be ignored. So many moms I work with talk about the overwhelm kicking in at this stage. They think it should get easier by now. That having a routine should help. But the sicknesses and lack of sleep bookended by full-time jobs and no babysitter leave little time for breathing let alone a date with her partner.

When we have no time to play, to connect and to nurture ourselves, life feels hard. When you've been going and going, devoting all of your energy to learn about this new incredibly important member of your family, to meet their every need, it's intense. 
 

Small steps towards change

When you reach the point of feeling overwhelmed, of questioning how things will get better and why they feel harder every day, it may be time to consider making some small changes. Here are 7 recommendations I often make to families I work with that are struggling during this stage of their transition to parenthood:

1. Open up. Communicate with your partner. Share your feelings, your expectations, desires. Let them know how they can help you feel more supported during this ongoing transitional time. As much as we might like to have married a mind-reader, relationships are built on communication that must be fostered.
2. Get more sleep. Discuss your sleep needs with your partner. Try and develop a plan to get more sleep if you think you aren't getting enough. If you're getting less than 5 hours in a night, that's not enough for most.
3. Eat well. Make sure you're eating well. Three meals plus snacks.  Balanced meals with adequate fats and proteins are important, especially if you're breastfeeding.  
4. Move. Walking is a great place to start.  Physical exercise has been shown to release endorphins, which naturally trigger positive feelings helping to reduce levels of depression and anxiety, and can actually help prevent depressive symptoms. 
5. Get outside! Being in nature is not only restorative but can improve your positive outlook on life and your ability to cope and recover from stress and illness.
6. Schedule breaks. Schedule time for you, even if you have no hobbies, don't play sports and have no interests that come to mind. Schedule a time for you to do whatever you choose. Regularly.
7. Connect with others. Join a support group of other new moms. Find a way to connect with people and activities that you enjoy and bring joy to your life. 

And lastly, ask for help! If you're not sure if what you're experiencing is part of the normal transition to motherhood or something more, like postpartum depression or anxiety, I encourage you to reach out for help from a therapist trained in maternal mental health. Many people are surprised to learn that they can develop a perinatal mood or anxiety disorder at 6, 8 or even 12 months postpartum. Here are some of the symptoms of perinatal mood or anxiety disorders (aka postpartum depression or anxiety). 

It's not realistic nor do I anticipate that someone would adopt all of these changes at once. I'm a strong believe that small acts change lives. See if you can find just one thing from the list above that you can do this week to help improve the way you are feeling. What will it be? Make a commitment! I'd love to hear your plans for change in the comments. 

If you're reading this article and thinking about a friend or loved one, you can help them get the support they need. If you'd like some tips on how to do that you might find this article useful. If you're in San Diego, please feel free to reach out. I maintain a private practice in the Banker's Hill neighborhood where I women struggling with infertility, loss, and pregnancy and postpartum mood and anxiety disorders.. I offer a free 30 minute in-person consultation to find out if I'm the right therapist for you. Postpartum Support International (PSI) is a national organization that maintains a warmline and a list of trained providers specializing in Maternal Mental Health.  If you’re in San Diego, CA, The Postpartum Health Alliance is our local chapter of PSI and a wonderful resource.

Reducing the Stigma of Maternal Mental Health Disorders

May is Maternal Mental Health Awareness Month. It’s a month to raise awareness for postpartum depression and anxiety and just how prevalent it is—One in seven! It’s a month to educate people about postpartum PTSD and that you CAN in fact be traumatized by your birth. It’s also an opportunity to let our community know that some women are at a higher risk for developing postpartum psychosis (a personal or family history of bipolar disorder increases her risk). Many are surprised to know that up to 80% of new moms experience the baby blues, it’s that common! Perinatal Mood and Anxiety Disorders (PMADs) are the number one complication of pregnancy. 

Advocates are hopeful that by normalizing the prevalence of maternal mental health disorders, more women will understand the differences between the baby blues and postpartum depression. Greater awareness will help people detect when “something’s not right”— with me, my wife, my sister, my daughter, and hopefully lead to more screenings for prenatal and postpartum depression and anxiety. It's estimated that less than 50% of women struggling with a PMAD seek treatment, despite the fact that they're extremely treatable with professional help. Some reports estimate as few as 15% of women who struggle seek treatment, though it's difficult to know for sure since shame and stigma prevent many from reaching out. 

There are many ways to support the mental health of women and their families during the childbearing years. Below are 5 ways that you can help reduce the stigma of maternal mental health disorders and advocate for greater awareness in our community.

5 Ways to Advocate for Maternal Mental Health 

1. Join your local chapter of Postpartum Support International. In San Diego, our chapter is called the Postpartum Health Alliance. I’m proud to volunteer my time as the Outreach Co-Chair and serve as a warmline volunteer. There are loads of ways to help build awareness and educate your community through your local organization.
    
2. Display a Blue Dot—the new national symbol for Maternal Mental Health. You can purchase your magnet or sticker here. Not only are you supporting this important cause with your financial contribution, but you’re letting those around you know that you’re an aware and concerned citizen; It’s a conversation starter that will let more people know about PMADS and the risks to moms and babies who go untreated. 
    
3. Write letters to congress in support of the Bringing Postpartum Depression Out of the Shadows Act of 2015! That will provide grants for screening and treatment for perinatal mood and anxiety disorders. 
    
4. Participate in your local Climb Out of the Darkness hike in June to raise awareness of maternal mental health disorders. These events are coordinated by local volunteers through Postpartum Progress. To join San Diego’s hike, contact Julie Thorpe
    
5. Don’t forget to ask the mothers you love and care for about their mental health: How are you sleeping? How are you eating? How are you feeling? If you're not sure how to address someone you think is struggling, this article provides some helpful strategies. 

If you suspect that you or someone you love has a perinatal mood or anxiety disorder, reach out for help today. Rachel Rabinor, LCSW is a psychotherapist in private practice; she helps women struggling with their transition to and through motherhood in her San Diego office. She also offers in-home counseling and Walk and Talk Therapy. For resources outside of San Diego, contact your local chapter of Postpartum Support International.

Spread the Word: Ask that New Mom About Her Mental Health #AskHer

May is Maternal Mental Health Awareness Month worldwide, and today kicks off the May Campaign (May 2 - 6, 2016).  The goal of the May Campaign is to increase knowledge about and awareness of the serious and devastating emotional complications that many women experience during pregnancy and after the birth of a child. 

When a woman is pregnant people are so eager to chat, engage and support her.  Doors are held open by strangers. Family and friends gather to shower the expectant mother and her baby to be. Couples take babymoons to celebrate their time together as a couple and the new beginning that lies ahead. However, once baby is born, it’s not uncommon for mothers to be left behind while their new baby becomes the focus of attention— theirs and everyone else’s. 

This year the May Campaign is focusing on the importance of shifting the conversation from baby back to mom and encouraging you/me/us to #AskHer about her mental health. Ask the mothers you love and care for about: How are you sleeping? How are you eating? How are you feeling?
 

Why should you #AskHer?

You might be wondering why it's so important to ask her. One in seven women experience postpartum depression. There are many risks to both mom and baby if postpartum depression or anxiety goes untreated, including: a lower quality of life for mom, a decreased ability to function at home and at work, recurrent depression and suicide. Yes, suicide!

An infant with a mother whose depression goes untreated is at risk for an insecure attachment with their mother and delays in cognitive development. These are significant risks to both mom and baby. 

But it doesn’t stop there. According to research, half of all men whose partners have postpartum depression are depressed themselves. Additional risks include a decrease in care of other children in the home and an increase in overall stress and discord within the family unit.
 

How to help a postpartum mom you’re worried about: 

If you’re not sure if what she’s experiencing is part of the normal postpartum adjustment to motherhood or something more serious, this article can help you learn about 3 Differences Between Postpartum Depression and the Baby Blues. If you’re worried about her, below are three things you can do to provide support.

1. Speak Up! Share your concern for her. Most struggling moms are relieved to hear there’s actually something wrong. Feeling so overwhelmed, it’s difficult to imagine how they’ll manage if what they’re experiencing is truly normal. This article here talks more about why it’s important for YOU to say something.
2. Call her local chapter of Postpartum Support International. You can get her connected with the warmline, which can provide her with referrals to trained therapists and local support groups. There are even online groups if needed. If you can call with her, that’s even better. 
3. Be there for her. Listen to her. Hold her baby so she can shower, or rest. Make her food. Clean her house. Walk her dog. Fold her laundry. Listen. 

At the end of the day, please don't forget to #AskHer. Ask the mothers you love and care for about their mental health: How are you sleeping? How are you eating? How are you feeling? If you suspect that you or someone you love is struggling with a perinatal mood or anxiety disorder, reach out for help. Rachel Rabinor, LCSW is a psychotherapist in private practice. She sees women struggling with their transition to and through motherhood in her private practice in San Diego. She also offers in-home counseling to help ease this transition See above for other San Diego and national resources. 

How to #StartAsking for Support: The Journey of Secondary Infertility

This week is National Infertility Awareness Week (April 24-30, 2016) and the theme this year is “#StartAsking.” One of the goals of the #StartAsking campaign is to raise awareness, reduce the stigma and encourage people struggling to get the support they need. 

While infertility itself is seldom discussed at dinner parties, secondary infertility is even more of a hush hush subject. Sharing your experience with secondary infertility can help invite those who love you to advocate for you and support your family during this challenging time. 
 

What is Secondary Infertility? 

You have a child, or maybe two or three. You want to grow your family but it's been 6 months or 12 and still nothing. Or you've gotten pregnant but have miscarried. Again, perhaps. 

You discover on your own through your late night dates with google what you've got—secondary infertility. No one's said it but that's what you've got. According to Resolve, The National Infertility Association, secondary infertility:

is the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children. The birth of the first child does not involve any assisted reproductive technologies or fertility medications. 

Why hasn’t anyone mentioned it, you want to know? You wonder why your doctor shrugged you off and told you to keep trying. Are they ignorant? Optimistic? Lazy? What are they waiting for!? 

There are so many complicated aspects to secondary infertility and coping with those who love you but who just don't get it. But the only way for them to know how hard it is and how lonely it is, is if we #StartAsking them to take a peek inside your world, to pay attention to your struggle, and understand what it’s like to experience secondary infertility. 

Consider sharing this list with them as a way to help them understand what you’re going through. Tell them the number of the struggle listed below that's hardest for you today. Add your own. Let them in. Let them help you! 

Common Struggles of Secondary Infertility 

1. You’re depressed and overwhelmed that you might not have another baby. 
2. You're mourning a loss. The loss of a baby. The loss of your dreams. Your life isn't going as planned and you have no control. You feel helpless.
3. Your relationship is strained— it can be difficult to get on the same page about treatments and to connect on a deeper level outside of your timed TTC (trying to conceive) "appointments". 
4. The judgement— You feel judged in online communities and sometimes in the real world too because you have a child already and others don't. You wish you could tell them— there's enough sorrow to go around, folks! 
5. The appointments! Who has time for all the appointments (the other kinds!)? Your RE, OB, the HSG, the routine ultrasounds. Let's not forget your acupuncturist! All the work you need to miss or childcare you need to arrange. It's a LOT. 
6. You struggle with envy as those around you, unintentionally or not, become pregnant.
7. Anniversaries hurt- your due date, when you had your (first/second/third) miscarriage, the holidays that coincide with those now infamous dates that are forever marred. 
8. The well meaning but unintended hurtful things your friends and family say in an effort to comfort you.
9. Your child(ren). Yes- so lucky to have that source of light. but dealing with the emotional weight of repeat losses, the TWW (two week wait), negative tests... it's intense. If you'd like some suggestions on maintaining your bond with your child through this dark stage, you might find this article helpful.
10. Your physical pain. The hormonal impact of infertility drugs- the anxiety, mood swings, weight gain. Or the nausea that comes with each hopeful pregnancy. 

If you feeling inspired to #StartASking for support, consider sharing this article with someone you love who can help you through your journey.

If you’re struggling with primary or secondary infertility and think you could benefit from the support of a trained psychotherapist, reach out! In San Diego, call Rachel Rabinor, LCSW for a free 30 minute in-person consultation. She maintains a private practice in the Banker’s Hill neighborhood where she specializes in Maternal Mental Health including infertility and loss. Resolve is a great resource for those outside of San Diego. 

You Think Someone You Love Has PPD? Why YOU Need to Speak Up!

Last week I got together with a new friend, Shelly, for a walk. When she learned more about the work I do with new and expecting mothers, the worry poured out of her. Shelly’s sister-in-law (SIL) had a baby 8 months ago, and she’s concerned about her. She's tired, irritable, incredibly anxious and doubting herself all the time (Yes, these are also symptoms of PPD--scroll to the bottom of this page for other symptoms you may not know about). Specializing in Maternal Mental Health, it’s par for the course to hear about sisters, friends, daughters and co-workers who are struggling with Postpartum Depression.

One in seven women deal with Perinatal Mood and Anxiety Disorders (PMADs), so really, it’s no surprise to hear about it so often. The thing that routinely does surprise me, however, is the hesitation many people share about approaching those they love with their concerns. This was Shelly to a T.  She felt close to her SIL, but was apprehensive about recommending that she seek out some support.
 

Hesitant to offer support?

The more we talked the more I understood what was getting in Shelly’s way of reaching out.  Shelly's the mom of a toddler and seems to have it together-- or together enough. She has a stable partner, family close by, a new business she’s passionate about; she’s confident and happy in her life. Her SIL, on the other hand, lives far from family and is further isolated by her husband’s current deployment with the Navy. She has a history of depression and other risk factors associated with PMADs.

By the end of our walk, I had a pretty clear grasp on Shelly’s hesitation to reach out to her SIL. She didn’t want her to feel judged, or less-than, by addressing concerns about her ability to cope with the adjustment to motherhood: A transition that has come fairly easily for Shelly. Shelly was also concerned about providing the right kind of support. With a history of depression, it was routine for family to jump in to “help” her SIL, and make everyday tasks easier. Her depression would subside for a bit and then the pattern would repeat. While a supportive family can be ideal in helping someone through their recovery, professional treatment may still be needed to address issues that may be contributing to the depression on a deeper level. Shelly wanted to help but she wasn’t sure how to do so effectively.
 

Why it’s important for YOU to speak up

If you don’t speak up, the person you love might not get the help they need! Many women suffer in silence. Too many.  More than 20 percent of moms are diagnosed with PPD. However, a recent study by BabyCenter shows that 40 percent don't seek the medical help they need due to feelings of embarrassment, guilt and the expectation that they can get over it without professional help. There are many risks to mom and baby if postpartum depression or anxiety goes untreated.

RISKS OF NOT GETTING HELP WITH PPD

• Risks to mom

  • Lower quality of life
  • Decreased ability to function at home or at work
  • Risk of recurrent depression
  • Suicide

• Risks to baby

  • Insecure attachment to mother
  • Interference in cognitive development

• Family stress and discord

• Decreased care or neglect of other children

• Loss of job/income

Also quite common is that women don’t even realize that what they’re experiencing isn’t normal! Just today I saw a third-time mom who started to recognize in my office that she had probably struggled with postpartum depression with her first two children without knowing. Sounds unbelievable but it’s true. The messages that women hear about motherhood reinforce that it’s natural, easy. That yes, you may be tired, but that’s normal. There’s a lot of grey area and it’s not always crystal clear whether what you’re experiencing is a normal adjustment to motherhood or something more serious.  So if you notice something doesn’t seem right in someone you care about—Say something!
 

What to say to someone with Postpartum Depression

Shelly is a great example of someone who really wants to support someone they love, can identify their struggle, and for various reasons isn’t sure how to help. The reality is, it may not be the easiest conversation to have. But I find that women who are struggling are usually relieved to learn that there’s help available and that they don’t need to suffer in silence. Here’s a few suggestions of how to start the conversation:

1.    Be direct

It’s important to be empathic, but it’s most important to be direct. Let her know that you’re worried about her; she doesn’t seem like herself. Let her know it’s normal, lots of women (1 in 7!) deal with PPD. It’s not uncommon for many women to go undiagnosed. Don’t let her slip through the cracks!

2.    Be genuine

Speak from your heart. Let your love and care shine through. If she’s struggling to care for herself or her baby, this is serious. Remember, she’s not choosing to be neglectful, she’s struggling. You know she wants the best for her baby, for her family. Help her get the professional support she needs.
 

3.    Be available

Make time for her. Once you connect her with people and resources she needs to improve her mental well-being, she will still need lots of support from people in her life who love her. She is vulnerable. Bring her food, go for a walk, watch her baby so she can take a shower. Keep her company.

If you or someone you know is struggling with a Perinatal Mood or Anxiety Disorder, please reach out for support. PMADs are very treatable. Postpartum Support International (PSI) is a national organization that maintains a warmline and also list of trained providers specializing in Maternal Mental Health.  If you’re in San Diego, CA, The Postpartum Health Alliance is our local chapter of PSI and a wonderful resource.

Pregnancy loss: How to help your daughter/sister/BFF cope

Someone you love has lost a pregnancy, her baby. You don’t know what to do. Or say. Or how to act. You’re wondering how to show your love for your daughter. Your sister, or your friend you adore so much she’s like your sister. You never had a miscarriage or lost a baby and have no idea what’s the “right” thing to do or say.  

As a psychotherapist and Licensed Clinical Social Worker specializing in Reproductive Mental Health, I see clients struggling with miscarriage, pregnancy loss, and infant loss in my private practice in San Diego, CA. My professional and personal experience has taught me that there is no one “right” way to console a grieving loved one. That being said, I do have some suggestions to share that seem to be universally appropriate. There are always exceptions of course.
 

How to help

1- Be Present

Even if you can’t be present physically, don’t shy away. Make your care and love known in some way. If you are local or want to jump on a plane to be with her—do it! When you get there, to her house, to her couch where she sits with tears in her eyes, her heart torn wide open. Just sit. Just be there right next to her. Hold her hand. Hug her. Let her cry. Or let her be mad and curse the world. You don’t have to say much. Being emotionally present will let her know just how much you care.
 

2- Show acts of love

Bring food, send flowers. It doesn’t really matter what it is. The act of giving shows her that you’re thinking about her. If you don’t have money to spend, come and cook the food in her fridge, clean her home, send a card. The point is to let her know you feel her pain and you are there for her.
 

3- Honor important dates

Mother’s Day, the baby’s birthday or due date, the day she found out the pregnancy wouldn’t last or the baby died. These are important dates for grieving mothers. Even months after, when the calls have ceased, and the flowers have wilted, these dates will come and bring a torrent of emotions with them. Acknowledge these significant moments; she is thinking about them more than you will likely know.
 

4- Verbally acknowledge the loss

Many many women have shared with me that the worst thing someone can do is say nothing. Ignore the loss. You might feel this is unthinkable, that someone could move on with life without a single word of love, empathy or care, but it happens. And it’s devastating. If you’re not sure what to say, check out my guide below. 
 

5- Listen

Listening seems so obvious, but I can't stress how important it is to truly truly hear her out. It's normal to think about your own losses when you sense her pain, but avoid sharing the details of your own experience during this sensitive time. Let her know you're there for her. Listen to her and nod your head, acknowledge her pain.
 

6- Remember: tone trumps content

A few words on tone before jumping into the what to/not to say guide below. HOW we speak often has more impact on the way our message is received. If you stumble and say something you "shouldn't" have, it will blow over if you've said it with empathy and love. If you're callous and try to be funny and say the wrong thing-- it might not go as well. This is a time for honesty, for being vulnerable and being real. 

I’m hoping you noticed that the answer to each of the above scenarios comes back to expressing your empathy and care for her. Why? Because that’s the bottom line. You’re sorry someone you love is dealing with this. You can combine any of the recommended "what to say instead" statements. Make it feel natural. Find your own way to express your empathy. But that's the key— empathy. It’s important to squash your own burning desire to know what her next steps are, or to inquire about what went “wrong”. Let her guide you. Pay attention to her, check in with her and she will let you know when she’s ready to share more.

These tips and guide are intended to support and strengthen relationships. What has been helpful for you? Please share your experience in the comments below. And please, let me know what I’ve missed!