Depression · Mental Health · Parenting · Pregnancy and Postpartum

Will I have postpartum depression again?

For anyone who has survived postpartum depression, you know how painful and unsettling life felt after your baby arrived. During that first year, you are overwhelmed with feelings of irritability, helplessness, anger, rage, sadness, and anxiety (just to name a few). The fear of ever facing this experience again causes many parents to hesitate about having another child. There is nothing that they want to avoid more than those intrusive thoughts, hours of sobbing, or crippling anxiety. I hope this post will offer you some support and guidance in considering your next steps.

You have the right to say no

Pressures for nuclear families are constantly pushed at parents. I hear many well-intentioned family members asking when moms will be pregnant again, and expressing concerns that their children will be lonely if they do not have siblings. Firstly, let’s all agree that these folks need to chill out. No one should tell you what your family should look like. There are many, many single-child families who have wonderful, happy lives. If you have decided that one is enough, please rest assured that you are making the right decision. After all, it is your body, your lifestyle, your family, your income, and all of your resources. While loved ones may comment, at the end of the day, you have to take care of this little person. You are absolutely entitled to decide that you don’t want this option.

Many factors will influence your mental health

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There are a lot of vulnerabilities that influence mental health. When it comes to postpartum depression, the list can include: poor sleep, stress, hormonal changes, physical wellness, relationship struggles, financial worries, history of mental health, multiple children, and complicated pregnancies/deliveries. This is not an all-encompassing list; however, it does address some important influencers during the perinatal period.

History of mental health struggles (including postpartum depression with your first child) is only one contributing factor. Postpartum depression symptoms typically decrease between one postpartum period to the next, showing that we have the capacity for healing. Research has found that there is high variability of whether parents’ symptoms of postpartum depression increase or decrease in future deliveries.

What does this all mean for you? Just because you had postpartum once does not guarantee you will have it again. If you had experienced significant distress in your first experience, err on the side of caution and seek support as soon you are pregnant. Postpartum depression is treatable. Your recovery experience improves when you do not prolong suffering.

You know more today than you did during your first pregnancy

Many first time parents feel nervous and uncertain about taking care of their babies. I mean, why wouldn’t we? If we are not surrounded by babies all the time, or if it’s not within our line of work, it makes sense that we are not experts on this topic. Since there are many unknowns during the first year with our child, we can feel inundated with worries about the baby’s well-being and our own capacity to parent.

Postpartum depression. perinatal mental health. Worries about having a second child.

As cliché as this may sound, practice makes perfect. Consider how vulnerable you felt when you first took your little one home versus how you felt six months or even 2 years in to parenting. You’ve gone from feeling incompetent to suddenly having a knack for diaper changes, effortless feedings, and confidence in bedtime routines. That level of skill and knowledge took you weeks of trials and errors before you could confidently move forward. This is the beauty of having a second child. That level of uncertainty and worry still exists; however, it is significantly more muted than the first time experience. You are much faster at handling all of those questions from your first time simply because you have the experience in your tool belt.

Understand your vulnerabilities

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As painful as it may seem, I encourage you to sit down and reflect on your first-time experiences of pregnancy and postpartum months. What was hardest for you? When did you struggle the most? Did you have support available, and was your support team actually helpful? Were you able to rely on your partner? What kept you down on your hardest days? When did circumstances improve? Did you use medication, or were you able to manage without? What resources did you bring in the last time?

Knowing what was hard the first time can give us a working plan of how to handle the situation differently this time around. Some moms are so clear that they do not want to have another child while COVID-19 is still a concern. Other moms are aware that sleep training is what they needed in order to feel more stable. Many moms know that attending counselling and couples counselling helped them work through anxieties as they surfaced. It sucks to have to learn from our hardships. Knowing what did and did not work can help you decide what to do differently this time around. When you have the awareness, you have a lot more control and influence over the situation.

Find a community

The stats are very clear. About one in seven mothers and one in ten fathers experience postpartum depression. Yet, we live in a world where we suffer silently. Joining a support group, or connecting with other safe parents is one of the best things that you can do for your system. Let go of the pinterest-moms in your world. Don’t try and find validation from your next door neighbour who always looks well-presented and has the most well-tempered baby. These people will (hopefully, unintentionally) make you feel lousy. FInd parents who help you feel less alone. Your worries are similar to the stressors that others have also experienced. Find those who have survived postpartum mental health, and hear about their experiences. Learn what worked for them to not only have this level of encouragement, but to also find strategies that you want to employ.

If you experienced postpartum depression with your first child, it’s highly likely that you felt overwhelmed or frustrated with parenting. The circumstances are much more complicated if you are a single parent, or if your partner works long hours. While this is no one’s fault, feeling isolated in your parenting is an important factor to keep in mind. Gather your support team and come up with a plan that will support your needs. This may involve asking your mother to stay with you for the first week, or asking a friend to check in daily. You might contact resources like a lactation consultant, a postpartum doula, or a sleep-training specialist earlier into your postpartum experience. Your support team can be informal like friends or family, or professionals. Irrespective, these folks are helping you to fill in the gaps. There is a reason for the saying “it takes a village to raise a child.” No one should be expected to do it all alone.

Move your body

When we struggle with depression, our body wants to shut down, isolate, hide, or retreat. This makes a lot of sense when the world feels too much. Of course, you want to escape and disengage. It’s far safer in your home than to socialize, take the baby out, or pretend that everything is normal. When we stay hidden away, we can get caught in this safety net for a long time. Sure the world may feel safer when you’ve stayed away, but it’s also felt bleak and painful everyday that you’ve been hidden. If you are ambivalent to have another child because of this shut down experience, there are strategies that can help. There are many coping strategies that can be employed to use address anxiety and depression. The key is to find the right set of skills that fit for you.

One effective distress tolerance skill is to increase our activity level. I get that exercise is not everyone’s cup of tea, but I want to emphasize how quickly it can help you in getting out of a funk. When it comes to a crisis situation, getting even 2-5 minutes of intense exercise will force your physiology to change. Your shut down system is forced to be more alert with this sudden intensity. After this burst of working out, we have about 15-20 minutes of reprieve. We feel more regulated and think more clearly. This gives you a chance to look at your current setup and schedule. You may find you have more capacity to get out of your room, go for a walk, or call a friend. Things that felt unmanageable, suddenly feel more accessible.

Seek treatment

Postpartum mental health is not based on will power. Crying everyday, or stressing about spending time alone with the baby is not a normal part of parenthood. If this is your experience, I want you to know that it does not have to be like this. Postpartum myths can prevent us from seeking out help, and I can appreciate that these are genuine barriers. Whether it’s due to internal shame, external pressures, cultural expectations of motherhood, or any other factors, it can be hard to shift away from this perspective. However, the best part of working in perinatal mental health is that I know it gets better. I see mothers improving within a year or two of delivery. This may involve regular therapy, a community of support, various coping strategies, use of medication, or a combination of interventions. With support, postpartum mental health can improve.

Postpartum depression does not have to define your experience

If you are feeling scared of having postpartum depression again, please reach out. Just because you struggled with your mental health the first time does not mean it will happen again, or that it has to get as bad. There are numerous preventative and reactive interventions that we can incorporate to help you feel more resilient. Reach out when you feel ready.

Take care,
Kasi

Pregnancy and Postpartum

Working through the Baby Blues

Many postpartum parents can attest that the first two weeks after delivery can feel like a nightmare. With the numerous changes that a parent experiences (e.g. hormones, sleep patterns, feeding schedule, diaper changes, etc), those initial days are about surviving the storm. Unfortunately, for many of us, adapting to these new changes can feel like an emotional roller coaster, and we begin to experience baby blues.

Baby blues can show up in a variety of ways. Within the first few days postpartum, caregivers can experience one of the following symptoms:

  • Easily irritable and snappy
  • Feeling overwhelmed
  • Sadness or tearful (sometimes with limited reason or triggers)
  • Higher levels of anxiety and worry
  • Impatience
  • Restlessness
  • Fatigue
  • Difficulty sleeping (even when the baby is asleep)
  • Mood changes
  • Poor concentration

Unfortunately, baby blues is a normal part of the postpartum phase. It is experienced by approximately 80% of caregivers, and improves within two weeks without any intervention. While baby blues is no longer considered a mental health issue, many parents struggle during these early days. For anyone who has experienced this distress, you can relate to the desperation of needing to get off this emotional roller coaster. I hope the following tips will offer comfort to you and your family during these times.

1. Remember that it takes time to adjust

Beyond the hormonal fluctuation, a new parent is thrown into various physical and lifestyle changes. Your body has just gone through the painful experience of child birth, and is trying to recover. You are figuring out how to breastfeed, or coming to terms that you will use formula with your little one. You may have limited access to rest as you wake up every two hours to feed your baby. Perhaps you are struggling with regrets (e.g. you were hoping for a different delivery experience, or grieving that you have a baby boy instead of your preferred baby girl). Many mothers struggle to accept their post-delivery body, and resent that they still look pregnant. There is a huge learning curve with your partner in managing household chores and parenting. These are just a handful of changes that a parent can experience during these early days.

These changes are significant, and can take time to sort through. When it comes to adjustment, every one has a different capacity of how well they transition. For most people it can take anywhere from 4-6 months before accepting a new reality (e.g. adjusting to new job, new career, new city). This time frame will vary if there are additional stressors placed on our system (e.g. lack of sleep, financial constraints, loneliness, grief).

While we know that change can take time, we often have a hard time accepting that we need the time to adapt. Ideally, we’d love to shine and present as well-adjusted human beings irrespective of whatever stressors are thrown our way. While I hope you are one of the lucky few who are adaptive, chances are you are among the norm for needing some time to readjust. My favourite reminder during my own postpartum phase was that it took me 9 months to grow this baby, it’s okay for me to take the 9 months to learn and adjust. This time frame helped me ease my own expectations of getting things right or expecting fast results. What time frame have you set for yourself?

Watch out for shame

Baby blues is not your fault! I hope you repeat this line to yourself as many times as you need to in order for that message to sink in. The majority of your emotional distress is influenced by hormonal changes. During the course of pregnancy, there are thousands of hormones taking over a mother’s system. These hormones quickly leave your body within the first two weeks following your child’s birth. Unfortunately, this quick shift in hormonal fluctuation can create a huge emotional roller coaster inside. For example, a reduction in estrogen can affect our ability to concentrate, and a drop in progesterone increases our fatigue. Both estrogen and progesterone plummet once our body recognizes we are no longer pregnant.

Many new parents struggles with attaching to their newborn. While this is perfectly normal, it’s not often openly discussed. Instead, we are bombarded with images online of parents who are overjoyed and attached to their new baby as soon as delivery happens. There can be a lot of shame for parents to voice that they do not feel attached to their baby. I want you to know this is perfectly normal. In all other relationships you are given the time to build rapport and get to know another person. This doesn’t mean we stop taking care of the baby, or attending to its needs. However, like with any relationship, it’s okay to take the time to get to know one another. For many folks attachment can take a few months. We often see improvements when the baby becomes more interactive and starts to respond to smiles and other social cues.

As often as possible, I encourage you to practice self-compassion and forgiveness during these two weeks. You will, understandably, have less patience when you are sleep deprived and tired. It would make sense that you are having a hard time concentrating on what others are saying because you feel like a walking zombie. It’s normal to feel overwhelmed during a major life transition. As much as this is a beautiful moment in your life, it can also be a moment of suffering. This moment will pass, and you will keep surviving. As long as you are not jumping on that guilt/shame-train, you can get through this moment.

Find opportunities to rest

I found that the most frustrating tip that others gave to me during my postpartum period was to nap when the baby was napping. Unfortunately for me, I am not a napper. I realized I became more frustrated and upset whenever I tried to nap during the day.

So let go of the pressure to fall asleep. Instead of focusing on getting some shut eye, try to take some time for your body to relax. This may involve watching TV, reading a book, or taking some quiet time outside in your backyard. If you happen to take a snooze during one of these activities, great! But ease off on the pressure to make this rest happen.

If it’s feasible, make a sleep chunking plan with a partner or family member. Find a way to ensure you have four hours of uninterrupted sleep so that you have the opportunity to complete a full sleep cycle. For example, speak with your partner and assess which one of you prefers to stay up late versus wake up early. This might involve going to bed at 7 PM so that your partner can do the 11 PM feed. You may also have to problem solve with your partner about feeds. This may involve pumping or formula feeding in order to have this time for sleep.

Do you want help or do you need space?

Everyone’s need for space and help changes and fluctuates. Knowing what your system needs, and being able to request this openly with our loved ones can make a huge difference to our moods.

There may be times where you are really craving alone time with the baby, and this is perfectly healthy and allowed. Pushing yourself to see friends and family who are eager to meet the baby may actually be causing more stress than good. The majority of us are conflict-averse, and oftentimes, we say yes for the sake of avoiding potential drama. However, what does that short-term aversion create for your system? If you find you are irritable or tired for hours afterwards, you get to decide if this option is actually working for you. The hard part with boundaries is that they are OUR limits, not those of others. Others will keep voicing their own needs; however, our mental health struggles if we become a ‘yes person’ for too long.

What to do with baby blues. Kasi Shan Therapy offers perinatal mental health in Kitchener, ON & online.

There may be times when you need support. If so, try and be specific of what would be helpful. Do you want someone to watch the baby while you rest? Would you like your parents to bring over some home cooked meals? Do you need a friend to help you organise the nursery? Your loved ones may say no to these requests, which is allowed. However, they will not always know that this is the type of support you need unless it’s stated. We would all love for others to mind read and “know” just what we need and crave. However, until this ability becomes feasible, we just have to ask.

What can my family members do?

Whether you have your loved ones read this section, or you have to explain it to them, make sure they are well-versed in these points. Family members, please try the following suggestions:

  • Check your expectations. Delivery is similar to surgery; your body needs 6 weeks to fully recover. Pushing a mom to do chores, make meals, manage what she used to, have sex, or any other responsibilities may not be feasible right now. Asking for these requests will not work in your favour and will only cause this new parent to feel guilty, ashamed or enraged. For everyone’s sake, wait it out.
  • Show lots of compassion. This is not a parent’s fault. Baby blues is not based on will power. This is truly a biological upheaval that is happening before your eyes. Your loved one will get better, and you will see a semblance of that person in a few days.
  • Ask what would be helpful. A lot of us love to cuddle babies. But if your only offer of support is to hold the baby while mom rests, this may not actually be as helpful as you intend. The easiest way to avoid this issue is to simply ask or offer suggestions.
  • Find other support systems. This new mother may be your favourite person to talk to and confide in. While this relationship works beautifully most days, she may not have the capacity to attend to these needs right now. Ask her what’s preferred. Pay attention to cues of stress. If it’s too much, it’s okay to reach out to other friends and loved ones.
  • Learn about postpartum mental health. Your loved one may not see the signs of postpartum mental health struggles until it is too late. It can be challenging to acknowledge we are struggling, and most of us experience a time of denial or avoidance. By knowing the signs for postpartum mental health disorders, you can be aware when you see your loved one shows symptoms. Let them know that postpartum mental health is treatable, and they can absolutely get better with the right help.

When should you be concerned?

The Edinburgh Postnatal Depression Scale (EPDS) is a self-assessment that can be taken during pregnancy and postpartum to assess moods. Complete the EPDS during your first two weeks postpartum, and take it again when you are closer to 4-6 weeks postpartum. If this current struggle is truly baby blues, your score numbers will be down significantly (either 8 or lower) by 6 weeks postpartum. If your anxiety and sadness continue to be a struggle, you may be experiencing other perinatal mental health struggles like postpartum depression. The wonderful caveat about postpartum mental health is that it can improve! With support and the right interventions, you can start to feel like your old self.

If you have any questions about the above information, reach out.

Warmly,

Kasi