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.

6 Ways to Improve Your Postpartum Self-Care

My nanny’s a college student and her schedule changed mid-January. She’s working fewer hours now and no matter how much I tried to prepare myself for less childcare, it’s been an adjustment. The biggest thing that seems to have taken a hit is my self-care. This transition has me reminiscing about the early days with my son. There’s no greater adjustment that a woman goes through in her life – that from woman to mother. During the postpartum stage, self-care often takes on a new meaning.
 

The New Normal

I remember vividly the time after my son was born 5 years ago. The days would seem like an eternity, and at the same time hours would fly by before I’d figured out how to eat a simple meal. Toast. Cereal. I’d be starving but holding my infant so he could sleep. He could sleep while my arm would go numb, my legs would ache, and my stomach would rumble. But it was worth it so I thought. I can remember the light in the house, the quiet. How my husband would leave for work and I’d be sitting on the couch, nursing the baby. He’d return 8, 9 hours later and I’d be in the same exact spot. Nursing the baby.

This was the new normal. Gone were days of trail runs before work, surfing with friends on weekends, movies, checking out the newest brewery— moving at my own pace. These changes were expected to some degree, of course. But nothing can prepare you for the exhaustion that mitigates your greatest fantasies about what new motherhood might look and feel like.

And so began my own transition to motherhood. I looked forward to the local Mother’s Circle that met weekly. It was facilitated by a lactation consultant and was everything I could have hoped for: a safe place to bond with other women who were navigating this life transition along with me. We could gripe about our desperate need of sleep, the breastfeeding challenges, or the pile of dishes accumulating in the sink. Eventually we met at other times too, becoming supports for one another, affectionately referring to each other as our Mama Tribe.

Why is Self-Care SO Important?

We live in an era of isolated nuclear families, where it’s not uncommon to live hundreds if not thousands of miles from our own nuclear families. New parents are often without support, which can place a huge strain on a growing family. Caring for a newborn, coupled with the fluctuation of postpartum hormones, lack of sleep, and round-the-clock feedings is an adjustment. Sometimes the physical sensations of new motherhood cloud the emotional transformation that’s occurring side by side.  If we don't make a conscious effort to focus on self-care during this time, we put our own mental health at-risk. 

In my work as a psychotherapist specializing in Maternal Mental Health, I help my clients prepare for and cope with their transformation as mothers. I help mother’s manage challenging emotions and improve their well-being so they can focus on themselves and their budding family. Much of the work I do with my clients incorporates some or all of these six elements of self-care:
 

Set Realistic Expectations

It’s easy to get caught up with what other new moms seem to be doing. Social Media is powerful, and it certainly doesn’t represent a realistic picture of what motherhood, or any stage of life, truly looks like. I help mom’s think through their long to-do list and pare it down to bite-size goals. This helps reduce stress and anxiety. Feeling like you need to do the dishes, the laundry, go for a walk, take a shower, hit Target AND care for you infant is just not realistic for the majority of new mothers.
 

Stay Connected With Others

Spending 24/7 with a baby is challenging. You may find your partner comes home tired at the end of a busy day and isn’t the social companion you were hoping for. Perhaps you’re the first of your friends to have a child. Connecting with other women who are going through similar experiences can help avoid isolation and build your network as you navigate this new stage of life. As my own momma always says: “Joy shared twice the gain, sorrow shared half the pain.” Finding your Mama Tribe, or even one new friend who’s in a similar stage of life can be a huge support and relief for a new mom.
 

Nourish Yourself

What you put in your body has a direct correlation with how you feel. It’s not uncommon for new mothers to become so consumed with their babies that they completely neglect themselves. If you’re breastfeeding, it’s important to maintain a healthy and regular diet to sustain your milk supply. I love the Meal Train idea for the early weeks and months, and often encourage families to plan ahead if possible by freezing meals, while they’re still expecting. Small packages of food are helpful to have on hand for snacking throughout the day— nuts, fruit, granola bars. And lots of water.
 

Practice Self-Compassion

Being kind to yourself can never be stressed too much, in my opinion. Motherhood, sadly, is riddled with feelings of guilt and shame. Feelings of uncertainty and not knowing, and wanting to do things “right” all lead to feelings of being not good enough. You are good enough! There is no one right way. It’s important to be loving, kind and gentle with yourself, just like you treat your new baby. You are enough!
 

Get Outside

Research confirms that 80 percent of women experience the Baby Blues. Physical exercise has been shown to release endorphins (feel-good hormones), which naturally trigger positive feelings helping to reduce levels of depression and anxiety, and can actually help prevent depressive symptoms. Walking is the only cardiovascular exercise that actually reduces cortisol (stress hormone) levels, which can easily be activated during the postpartum phase. 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. The benefits of walking in nature are evident. You decide whether you’ll choose to get out by yourself, with a friend, or with the support from a trained professional.
 

Ask for Help

Some people are great about asking for help— they get creative with their baby registry, including things like a postpartum doula, housecleaning and meal delivery requests from friends and family. Some of us aren’t as comfortable asking, or sometimes no one’s available to coordinate a shower. I recently heard a great idea from a colleague of mine, Kiersten Markham, Birth + Postpartum Doula and BIRTHFIT Coach here in San Diego, that I thought I’d share. She encourages new moms to ask a few close friends or family members to check in by text message. Have them text things like: did you shower today? Or, remember to get some fresh air. I love this idea!  Getting text messages a few times a week with helpful reminders seems like a wonderful way to help you take care of YOU. Doesn’t that sound doable?

What I’ve learned is that small steps change lives. Take a breath, look over these suggestions and see which one seems most doable. And then, make a commitment to yourself: What’s one small step you would like to take this week?

Bonding With Your Littlest Valentines: Staying Connected Through Infertility

Secondary infertility doesn't get a lot of press these days despite the fact that as many as 3 million couples are experiencing it at any given moment. Coping with your own emotions, managing doctor appointments and healing from physical loss(es) is consuming, and we haven't even discussed the laundry, the dishes, the food shopping and the cooking! With so much on your plate already, maintaining your relationship with your toddler or preschooler can be an added challenge when infertility enters your world. You might feel your motivation, energy and/or ability to maintain a strong connection with your living child(ren) slipping under such distress. 

When you're feeling badly physically or emotionally, you may not know HOW to strengthen your relationship with your toddler or preschooler. 

Connecting with your little one

Here are 3 easy steps to bond with your littles while navigating secondary infertility:

1- Schedule it. Plan a time of the day that you have five minutes to spend 1:1 with your child. Pick a time when both you and she are at your best, typically (avoid the notoriously challenging times like before nap or bed). Make sure you can completely dedicate yourself to your child for the entire 5 minutes. 

2- Set yourselves up for success. Give your child a choice of 1 or 2 (depending on their age) open ended toys to pick. What's an open ended toy? One that has no rules to play by. No winner. Think coloring, blocks, Legos, animals, cars, dolls...

3- Play. Be intentional. Let them know you're present. How?

• Describe what he's doing in his play. Say something like, "you're putting the green Lego on top of the yellow one," or "you're building a tower."
• Copy her play. Say,"I'm stacking the green lego on top of the yellow one too, just like you, or just do what she's doing. Copying is the greatest form of flattery, no? 
• Praise him. Find something you like about the way he's playing (ignoring what you don't like as long as it's not dangerous). Say, "I like how gently you're playing with the Legos," or thank him for sharing the Legos with you. 

These three steps are a good place to start if you're having difficulty maintaining your connection with your little one during this difficult time. In five short minutes you can let them know that you are really paying attention.

If you are struggling emotionally with secondary infertility, I encourage you to reach out for support. You are not alone!  If you are in San Diego, I can help. I maintain a private practice in Bankers Hill where I specialize in helping families struggling with secondary infertility, parenting and other areas of maternal mental health. Please call me for a free phone consultation to explore how I can support you and your family.

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! 

How Walk + Talk Therapy Will Change Your Life, Mama

I know what it’s like to have a new baby around the house. The dirty dishes piled high, the never-ending laundry, did you eat today? Just forget about exercise, you don’t even have time for a shower, right? You’re wondering if and when life will ever resemble those incredible Instagram photos you posted from your babymoon.

This is a typical scenario for a family going through the transition to parenthood, yes? Of course there are precious moments, but it’s intense. That first year of life is nothing short of a hurricane sweeping through your world. When you factor in the inevitable additional emotional stress parenthood brings, life is more challenging. You may know you want professional help in the form of counseling, but you just can’t figure out how to fit it all in.
 

ENTER WALK AND TALK THERAPY

A recent conversation with a friend reminded me that although I offer Walk and Talk Therapy sessions in my San Diego-based private practice, where I specialize in maternal mental health, many people are unaware of it’s existence.

In my work as a licensed psychotherapist, over the past 15 years I’ve found that Walk and Talk Therapy is helpful for clients who are going through life transitions, have anxiety, are experiencing some kind of loss or grief among other challenges. Mothers of young children in particular, seem to really gravitate towards this modality; it’s so easy to bring your baby and stroller and go. Walk and Talk Therapy combines traditional talk therapy with physical exercise. Want to know more? 

So here's the skinny on what Walk + Talk is and what it isn't

Walk and Talk Therapy is:

• a great option If you don't enjoy all the eye contact inherent in traditional office-based psychotherapy sessions.
• helpful if you're suffering from phobias, excessive anxiety, or are newly postpartum and not sure how to fit exercise of any kind back in your life.
• an opportunity to breathe fresh air and connect with nature (and another adult who happens to be trained to support your mental health)

Walk and talk is not: 

• a cardio workout.
• strenuous.
• the same thing as chatting with a friend while walking.

Sounds pretty good so far, yes? Walking side by side with a trained psychotherapist feels collaborative and encourages conversations. Clients often feel more at ease sharing personal information in this informal, outdoor environment than traditional office-based therapy. Some clients also find it less intimidating to talk to a therapist when you’re both doing something else. And be assured, your confidentiality will be maintained, just as if you were in an office.  

Here’s how Walk + Talk therapy will change your life, mama

1.    You will feel better
Participating in regular Walk and Talk Therapy sessions with a trained therapist has been shown to reduce anxiety and tension, improve mood and increase energy. Physical exercise releases endorphins (feel-good hormones), which naturally trigger positive feelings helping to reduce levels of depression and anxiety, and can actually help prevent depressive symptoms. Many people report improved self-esteem and feelings of well-being, improved sleep (clearly that research wasn’t conducted on parents of young children), and an enhanced mind-body connection

2.    You get to move your meat (aka exercise) AND take care of your mental health
It’s hard to fit in exercise as a new mom, or even an experienced one. Sure you could get a fancy jogging stroller but just the logistics of it all seem overwhelming. So here’s an opportunity to start small while also improving your mental health. Although Walk and Talk Therapy isn’t a workout, it is exercise and it can help you start to carve out time for what’s important.

3.    You don’t need childcare
Enough said.

4.    You will feel better
I already said this one but it’s worth repeating. As a new mother, it’s not uncommon to put everyone else first. After all, you have a new being that’s relying on you. But like they say on an airplane- you need to put your own oxygen mask on first before helping others. Self-care is important. If you don’t take care of you, not only will you suffer, but those you love will too.

If you’re struggling with your adjustment to motherhood, please reach out for support. Contact your doctor, Postpartum Support International, or a mental health professional. If you have more questions about Walk + Talk Therapy, or think it may be a good fit for you, check out these Frequently Asked Questions. And if you're in San Diego, give me a call! 

Setting New Year's Resolutions: Seeing Past Your Infertility

New Year's day has come and gone and if you haven't set a resolution for 2016 yet you're likely reminded through various forms of media multiple times a day. When you're struggling with infertility, "having a baby" feels like an obvious goal that's constantly on your mind. However, I encourage my clients to choose a resolution that they can be 100% responsible for. Infertility, as we know, is very often outside our control. So when you're consumed with thoughts about your next treatment, phone call with xyz adoption agency, finding your surrogate, or the miscarriage you're still mourning, it's important to find a way to harness your energy to navigate this stressful, anxiety producing time of life.

Setting a goal for an entire year can certainly be intimidating. As a therapist, I've spent a lot of time helping clients develop and modify goals, resolutions and aspirations. Using the SMART acronym helps me help my clients get set up for success; every goal needs to be specific, measurable, attainable, realistic, and time-bound. I also coach my clients towards choosing resolutions that promote their overall well-being, and specifically their mental health. 

Some of the most popular resolutions I've heard that support the big picture of having a baby this year include: yoga, meditation, walking, running, reading, healthy eating, connecting... What do these have in common? They will improve your well-being regardless of when or if you bring a baby home in 2016. 

Choosing a resolution

Take a moment and think to yourself: What do I need more of in my life? Really, I encourage you to stop reading for a moment (after you read these next three sentences), close your eyes and take a deep breath. Maybe two. Then, ask yourself: What do I need more of in my life this year? If you're coming up blank, here are a few questions to spark ideas: Could I benefit from a stronger mind-body connection through yoga, or running? Should I scale back on exercise and focus on building a meditation practice, walking, or being in nature? Nothing yet? How about your connections with others? Ask yourself if you need to take time this year to reconnect with those you love, or deepen your connection with yourself? Maybe you've been holding in too much for too long and really need to seek the support of a trained therapist this year. Dealing with infertility is intense. It can creep up on you just how stressful it is to juggle this unexpected life turn along with your day to day life. 

Setting your resolution in motion

So now that you've chosen your resolution for 2016, it's time to dig in. Lets make sure it's a SMART goal. I'm going to share one of my resolutions for 2016 as an example. But before I share my goal, please take out a piece of paper and pen or open up some app on your phone and work along with me. Here we go- My resolution is to camp more. Being in nature, unplugging from all there is to unplug from and taking a break from the day to day grind while breathing in fresh air and sleeping closer to the stars always makes me a happier person. It gives me the chance to connect more fully with myself and my fellow campers... It's food for my soul. 

While I'm instantly at ease envisioning this goal coming to life, it's hardly a SMART goal as is, so lets see how using the SMART format helps me flesh it out--

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Specific
My goal of camping "more" is not very specific. What's "more" for me might be less for some avid campers, right? According to the SMART Goals Guide, make sure your goal includes the "who", "what", "where" and "when". So, I'm (who) going to camp (what) 5 times in 2016 (when) in California (where). Specific- check. 

Measurable
How will you know you've achieved your goal? Can you see, hear, feel or taste it? Camping 5 times in CA-  Measurable, yes! At the end of 2016 I'll be able to look back and see whether I've reached my goal.  
 

Attainable
This is a key step in setting a SMART resolution. It's important to reflect on your own capabilities and skills when creating a goal that's attainable. Only you know what's going on in your life, what's a comfortable stretch and what's not. If you hate bugs and must have a flushing toilet, your goal would look different than mine. As an experienced camper, I feel my goal is very doable. 

Realistic
While your resolution should urge you to stretch and grow, maybe even learn a new skill, it should also be something you are capable of doing. Is the goal you're working on SMAR so far? I feel my goal is in fact realistic. But I have a confession to make: I originally wrote my goal as camping 10 times this year. But as I thought about it, I realized that last year I only camped once!!. ONCE. So I'm glad I went through this process and reassessed what is realistic for ME this year. Five will likely be a stretch after a mere one time last year, but there were other years I camped more, so it's a comfortable stretch and goal for ME. I'm stressing the ME here because setting a New Year's resolution is personal and only applies to one person- YOU. So make sure it's realistic so you can set yourself up for success in 2016.

Time-bound
Having a deadline for completing your goal is crucial. Since we're discussing New Year's resolutions, our deadline is built in. As we close out 2016 we'll check our progress and celebrate our success!

How's this going for you? Do you have your SMART resolution now? If you're wondering what you can do next to get moving on your New Year's resolution,  I want to invite you to 1, share your resolution for 2016 in the comments below, and 2, share this blog post along with your SMART goal with one other person. Think of that someone who you feel comfortable sharing with -- a good friend, your partner, your therapist-- and put it out there. Being accountable to someone other than yourself can be extremely helpful in reaching your goals. You can do it! 

If you're struggling with infertility, pregnancy or infant loss, or a perinatal mood or anxiety disorder, and think you could benefit from additional support in setting or accomplishing your New Year's resolution, feel free to get in touch by phone or email.