Preparing for Postpartum: A Workshop at Mother to Mother Midwifery

It's Maternal Mental Health Awareness Month and I'm excited to be speaking locally here in        San Diego about this important topic.

Please join me on Sunday, May 20th from 1 - 3pm at Mother to Mother Midwifery in University Heights for an interactive workshop on planning for the postpartum period. You'll learn more about the common range of emotions expecting and new mothers may experience, and how to get the support you need throughout this transition. You'll also leave with a personalized visual map for staying connected with others and building a community that supports you through this time.

We know that 1 in 5 women experience a perinatal mood or anxiety disorder (PMAD) while pregnant or postpartum and that this isn't just part of the normal adjustment to motherhood. If you're not quite you and you're brushing it under the rug, please join us next Sunday to learn more. If you need help immediately or can't make it next Sunday, the Postpartum Health Alliance in San Diego and Postpartum Support International are great resources for finding therapists and support groups near you.

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Here's a snippet from the description of the workshop from Mother to Mother Midwifery's website: 

Riding the Postpartum Waves: Understand the wide range of feelings that come with a new baby and how to let your community support you

Becoming a mother is the biggest transition a woman goes through in her adult life. We’re taught to think and plan for the birth: Will I have an epidural? Pitocin? Vitamin k? I’ll bring music, wear an eye mask… There’s such a huge range of considerations. But what about after the birth? We anticipate happiness, love, deep connection with our partner and an instant bond with our baby. How will we foster these emotions and experiences? Will they just happen? And what else might I expect? Read more on Mother to Mother Midwifery's website. 

Making Mother’s Day Meaningful For You

As a therapist, and a mother, daughter, friend, neighbor and sister-in-law, I’ve supported countless girls and women through the emotional rollercoaster that Mother’s Day often brings. While we were all brought into the world by a woman, she’s not always the one we call mom. Some children are lucky to have one or more caring women in their lives who are regarded as a mother, or a mother figure. But everyone is not so fortunate; some children grow into adulthood never having experienced this type of maternal bond.

Growing up, one of my closest friends lost her mother to cancer when we were in 7th grade. Since then, I’ve always looked at Mother’s Day through a different lens. Intuitively I knew at that time that this holiday would be hard for her each and every year for the rest of her life. In graduate school and through my training and experience over the past 15+ years I’ve learned about the importance of the mother-daughter bond and the many ways that this bond can be impacted through developmental and situational life traumas.

Now, I spend my days in my private practice working with women who are on both sides of the motherhood journey—those who are yearning to be mothers, struggling with infertility, and those who have become mothers and are making their way through the transition to motherhood, often coping with symptoms of depression, anxiety and post traumatic stress. I also see women who are caught somewhere in-between on their motherhood journey, those who have lost their babies. Unfortunately no one is exempt from the myriad of emotions that may be stirred up by this second Sunday in May.

MOTHER’S DAY CAN BE PAINFUL

There are many reasons why this day might be hard for you. Not having a mother, or losing a mother can trigger emotions of loss and sadness as the day approaches. Even new moms who are navigating their way through this first year of motherhood aren’t excluded from this conversation. If you’re struggling with a postpartum mood or anxiety disorder, shame and guilt may be overriding any feelings of joy you’d hoped to experience.

Becoming a mother also makes us acutely aware of the ways in which we were or weren’t mothered. These experiences and memories can stir up a well of feelings.  The anticipation of the holiday can spark feelings of overwhelm, grief and loss. Similar emotions may arise for those who are still struggling to create a baby, or bring one into their lives and hearts.

The anticipation of Mother’s Day can be more difficult than the actual day for some. I have found that making a plan is one of the best ways to prepare for the day and to help make the day meaningful to you notwithstanding the pain you also feel.
 

PREPARATAION

I encourage my clients to focus on activities that feel nourishing—curling up with a good book, walking on the beach, eating yummy food, making a recipe that touches the soul like only the smells and tastes of certain foods can do. Taking care of ourselves is the first step.

You may be wondering how to cope with family responsibilities, the obligatory Mother’s Day brunch at Aunt Suzy’s or the BBQ dinner at your step-mother’s. For some, the idea of forgoing a family obligation just isn’t an option. And that’s OK. But I encourage you to check-in with yourself and weigh the pros and cons carefully. You matter. If you decide you must go, consider if you’re able to arrive late and leave early. This is often a great solution if declining the invitation might cause too much family drama. Try to add something to your day that feels supportive, so you don’t go to bed feeling depleted emotionally and physically, which is so often the end result when emotions are thoroughly taxed.
 

CREATE YOUR OWN TRADITION

Whether you’re adding on to an existing event or starting from scratch, consider making your own traditions.  If you’re not sure what that might look like, keep reading. I’ve included a few ideas to help get you thinking and planning for a day that’s special to you. Hopefully one of these ideas will inspire you.

GO FOR A HIKE. Spring is the perfect time of the year in most areas of the U.S. to get outside, soak up the sunshine and breathe in some fresh air. Not only is a walk outside great for the body but also for the mind. Physical exercise has been shown to release endorphins (feel-good hormones), which naturally trigger positive feelings helping to reduce levels of depression and anxiety. The great thing about hiking is that you can do it alone, with a partner and even bring the kids, regardless of their age. And please don’t be put off by the word “hike”. A stroll in nature can be just as good for the body and the mind.

GARDEN. Another great activity to do alone or with others. If your garden has been neglected, weeding can be more gratifying than one might think. Try to embrace the tedious task as a practice of mindfulness, staying present as you loosen each stubborn weed from the grip of mother earth. Allow yourself to sense the soil in your hands, the sun on your back, the sweat trickling down your face. If you’re ready for planting, head to the nursery and find the vegetables, or flowers that catch your eye. Decide if you will plant from seed or not. Imagine the bounty that will grow from your hard labor and attention over the coming weeks and months and how the colors, smells and sounds of the garden will fill you, and perhaps your belly.

GET A MASSAGE.  The benefits of massage are too great to enumerate here. The physical benefits associated with pain management go without saying.  In addition, massage promotes relaxation and stress relief, which directly impact mood. Research shows that touch triggers a cascade of chemical responses, including a decrease in stress hormones, and an increase in serotonin and dopamine levels. The shift in these bio-chemicals has been proven to improve mood and decrease symptoms of depression.

EAT WELL. Make a point to feed yourself well. We’ve heard the saying too often- you are what you eat. Often feelings of stress and sadness are greeted with foods that are laden with sugar, salt or fat. Bad fat. These foods do little to nourish the body, or our mental well-being. But there are choices you can make that will actually help to boost your mood. Start by choosing meals for the day that incorporate a wide variety of fruits and vegetables. Avoid processed foods as much as possible. Prioritize foods that boost your dopamine and naturally boost your mood like animal proteins, almonds, avocados, bananas, chocolate, green tea, watermelon, yogurt, leafy greens and legumes. Choose non caffeinated tea in lieu of coffee, which can increase symptoms of depression and anxiety.

SLEEP! I’d be remiss not to mention sleep. Indulging in an afternoon nap or heading to bed on the early side can be a great add on to any tradition in the making. We live in such a busy society, and sleep is often the first thing to go. But not enough sleep can cause irritability, anger, stress and low motivation. So allow yourself to take it slow today and catch up on any sleep you may have missed this week.

I’d love to know how your day went and whether this article was personally helpful. And let us know what worked—or didn’t for you. If you found this Mother’s Day particularly difficult, consider reaching out for support from a trained therapist. If you are in the San Diego area, send me a message or give me a call at 619.780.3277 to see if we’re a good fit for therapy. Psychology Today is another great resource for finding a therapist near you.

Birth Trauma: Is THAT What I've Been Experiencing?

I met Sara and her 4-year-old daughter, Claire, at our local playground earlier this week. Claire instantly gravitated to my 5-year-old son and within moments they were chasing balls together, holding hands and laughing. Having just moved to San Diego from Boston, she was excited to meet us.

Like many mom-conversations go, Sara asked about the age difference between my two kids and how I felt about it. She told me that although her daughter was begging for a sibling and her husband was also ready, she wasn’t prepared to get pregnant again just yet. She was conflicted about her timing tho, noting her age and the pressure she was feeling to have another baby.

I empathized with her situation and shared some of my own personal experience, as well as my professional experience as a psychotherapist supporting women on their journey through motherhood. I offered myself as a local resource given my knowledge of San Diego’s network of reproductive health providers.  

A few days later we met again by the swings. Sara jumped right into the conversation, saying, "you know, I think I could probably use some help from someone like you. I'm pretty sure I suffered from some postpartum stuff and that's what's holding me back from having another baby." She went on to tell me about her difficult pregnancy, challenging labor and unplanned cesarean birth that left both her and Claire in the hospital for several days. The experience was distressing and she was anxious about becoming pregnant again. She had wanted an unmedicated, natural birth and was understandably afraid of having a repeat similar experience with her next child.

I spent some time talking with Sara about how her traumatic birth might be impacting her. As I spoke her face softened and her head nodded. She appeared to feel validated by my explanation: that trauma after birth is REAL.

While many around her would like Sara to move on and be grateful for a happy and healthy child, Sara is still reacting to her birth experience with Claire. Although Claire had suffered no long-term effects, Sara did. And her daughter’s health does not negate Sara’s experience and the anxiety and fear left in the wake of her birth experience. As we talked more, I stressed that it’s not the specifics of the birth that is traumatic, but one’s perception of these events. This is such a key aspect of trauma.
 

What Are The Symptoms of Birth Trauma?

Post traumatic stress disorder (PTSD) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a car accident, a natural disaster, or sexual assault. However, a traumatic experience can be any experience that involves the threat of death or serious injury to you or someone close to you, like your baby (birth trauma or postpartum PTSD). Again, it's your perception of your childbirth that matters most.  It is less important whether the hospital staff were in communication about recommended procedures than your interpretation of what happened.

Common symptoms of women who’ve experienced birth trauma may include:

• Feeling socially isolated
• Difficulty bonding with their baby
• Lonely
• Angry
• Depressed
• Irritable
• Difficulty sleeping
• Anxiety or panic attacks
• Worry excessively about the health of their babies
• Worry that their child might die
• Flashbacks or memories that repeat over and over about medical procedures or the behavior of medical staff.
• Nightmares

Why Some People Experience PTSD Postpartum

It’s not always the dramatic events that trigger childbirth trauma but other factors such as a loss of control, the intimidating, aggressive or difficult attitudes of people around you, not feeling heard, or a lack of informed consent to medical procedures.

Risk factors for Postpartum PTSD include a complex mix of objective factors, such as the type of delivery, ability to feed as planned, etc, and subjective factors like those mentioned above. Additional risk factors include:

• Induction
• Length of labor
• Feelings of loss of control
• Unwanted medical intervention
• Traumatic or emergency deliveries/cesarean
• Lack of support from partner or medical staff
• Impersonal treatment
• Not feeling listened to
• Lack of information or explanation
• Lack of privacy and dignity
• Fear for baby's safety
• Stillbirth or loss soon after birth
• Birth of a disabled baby
• Baby’s stay in NICU
• Poor postnatal care
• Previous trauma (childhood, with a previous birth, domestic violence)
• History of anxiety or extreme fear of childbirth
• History of abortion or infertility
   

How common is Birth Trauma?

It’s estimated that approximately 9% of new mothers in Western societies experience full blown post traumatic stress disorder. However, research shows that 25-34% experience subsyndromal symptoms (symptoms that don't meet the diagnostic criteria for PTSD)! So while not meeting diagnostic criteria for PTSD, up to a third of mothers experience symptoms like intrusive thoughts and memories that may stimulate feelings of fear, anxiety or helplessness that interfere with daily life. That's a huge number! 

It's important to remember that while mothers most commonly receive treatment for postpartum post traumatic stress, their partners and even their medical providers may also suffer. 
 

Why You Should Seek Help

There are numerous potential consequences for women who experience a traumatic birth. They may avoid routine follow-up medical care because it reminds them of their childbirth experience. Like Sara, they may fear subsequent pregnancies and are statistically shown to be less likely to have subsequent births.

Those who do have another child are more likely to have an epidural or a scheduled cesarean; they are less likely to breastfeed and more likely to experience challenges bonding and attaching with their newborns. They’re also more likely to experience difficulties in their relationships and sexual dysfunction. Moms who suffer from Postpartum PTSD are more likely to suffer from depression, which also impacts bonding and attachment with their baby.

In part 2, we’ll look at ways to avoid the effects of birth trauma and ways to support healing. If you’re not sure you can wait to read part 2, please don’t hesitate to give me a call. I’m a licensed clinical social worker in the Banker’s Hill neighborhood of San Diego, California. I’m passionate about helping families cope with trauma and other challenges after bringing home their baby. You can reach me at 619.780.3277 for your free in-person 30 minute consultation. 

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.