Pregnancy and Postpartum

Shame and the postpartum experience

One of the biggest aversions to attending postpartum therapy is shame. You feel ashamed that your emotions are messy. This isn’t like you. Normally, you’re calm and cool. But, suddenly your hormones are all over the place, your hair is a mess and you can’t remember the last time you showered. There hasn’t been a single day where you haven’t burst into tears or rage.

shame and postpartum. perinatal mental health. shame and pregnancy.

You feel ashamed about your relationships. It feels like a huge risk to acknowledge how you truly act around your family. What would the other person say if you admit you don’t really like your baby? What if you told them you sometimes screamed at your children? Are they going to judge you if you tell them you’ve stopped breastfeeding? Would you get mocked for admitting you haven’t had sex in months? What if you revealed that you suddenly can’t stand your spouse? How will the other person react?

It’s incredibly vulnerable to open up to a stranger, especially if you worry how he or she will respond. So rather than talk, you stay silent. Shame feels awful, but it protects you. It keeps you safe from being judged. But it also means you are stuck with all these difficult thoughts and feelings bubbling inside.

The shame of mental health

Despite all of the social media posts, campaigns, and recognition about mental health today, there is still a stigma in admitting we are struggling with mental illness. You may worry about what it means to be attending therapy or starting medication. Does it make you incompetent? Are you still able to say you are a good parent if you also admit you are mentally unwell? How do you cope with your family members telling you to “suck it up” or “get it together?” All of these shameful questions and thoughts prevent you from admitting that you need help.

shame and postpartum. perinatal mental health. shame and pregnancy.

Perinatal mood and anxiety disorders are genuine illnesses. During pregnancy and postpartum months, an individual could live with anxiety, depression, OCD, bipolar disorder, or PTSD. The chance of experiencing any one of these illnesses is not uncommon (e.g. approximately 1 in 4 Canadian mothers reported experiencing symptoms of postpartum depression or anxiety).

As with any illness, you deserve appropriate treatment and care. It is not a matter of will power. We cannot wish it away. My favourite recommendation is to consider how you’d talk to a friend in a similar position. Chances are you would be more compassionate and open-hearted. For example, following a surgery, you would encourage said friend to attend medical appointments, take prescribed medications, and follow their health team’s recommendations. In the same way, would you be able to give yourself the permission to seek the treatment and attention that your mental health needs?

What if the therapist judges me?

Every therapist claims they are nice and nonjudgmental. That doesn’t mean you truly believe it. For those cautious and skeptical parts of you, I want you to know, that’s okay. It’s absolutely okay to have your guard up. Starting therapy feels awkward. As with every relationship, it takes time to build trust.

Take the time to share slowly, if that is what your system needs. Watch how your therapist responds to your words and concerns. You will notice that you either feel more settled and at peace, or if your shame increases. Trust this internal feedback. If you are comfortable, let your therapists know you feel this way, and see how they respond to your words.

Will I get in trouble?

shame and postpartum. perinatal mental health. shame and pregnancy.

One of the biggest fears that pushes clients away from voicing their experiences is the fear of how others will react. In prenatal and postpartum therapy, I see many clients hesitate to talk about how they truly are with their children and relationships. Not only are they managing their internal shame, but they are weary of judgement and negative consequences. Clients are often fearful because they fear the truth will lead to the therapist ending the relationship, calling the Children’s Aid Society or disliking the person. So let’s address these fears:

1) If I am truthful, my therapist will end the relationship:

In most cases, therapists will only end the relationship if they are outside of their clinical scope or the treatment goals have been met. If you have met your treatment goals, that’s wonderful! Celebrate all of your hard work. You don’t necessarily have to end your relationship with your therapist, but you can talk about tapering off sessions or increasing the time in between appointments. If it’s loneliness that drives you to stay, your therapist will support you in exploring how to improve outside relationships. It is not okay that the therapy room is the only space where you are heard, validated and supported.

If your counselling goals are beyond your therapist’s knowledge and skills, they will admit this to you. It isn’t personal. Consider your experiences with other specialists. You may really love your hairdresser, but this is not the person who can necessarily answer your medical concerns. You connect with the clinician who is best able to meet each of your needs. If you keep asking your hairdresser for advice on all things medical, neither of you will leave satisfied or confident that your goals can be achieved.

2) What if they call the Children’s Aid Society (CAS)?

shame and postpartum. perinatal mental health. shame and pregnancy.

This is a common myth that prevents parents from reaching out for postpartum therapy. Postpartum depression often shows up as rage, anger, outbursts and distress. I see many parents who are frustrated with themselves and with others, but are too scared to ask for help in fear of being reported. Postpartum depression deserves respect, compassion and appropriate support. The only reason to reach out to CAS is if there is a genuine concern about a child’s physical or emotional safety. If there is a worry about abuse or neglect, your therapist will ask you directly. However, yelling at your child does not mean an automatic phone call for outside authorities. Having negative or intrusive thoughts does not mean we are automatically contacting outside authorities.

3) What if my therapist dislikes me?

shame and postpartum. perinatal mental health. shame and pregnancy.

I can’t speak for other therapists, but I can speak for myself about this worry. The beauty of Internal Family Systems (IFS) therapy is that IFS therapists are always looking for positive intentions. This means, irrespective of the behaviour, words, or emotion (anger, infidelity, jealousy, disgust, etc), your IFS therapist is always trying to understand how there are parts of you trying to get you through a difficult moment. It’s not about assessing whether the outcome is successful or whether the efforts are worth it. It’s about understanding the actual intention.

IFS therapists go to their own therapy. It’s how we do the work we do. If I feel triggered in a session, that’s an indicator that there is some part inside of me needing support and attention. It has nothing to do with you; it has to do with my own history and experiences. That part, similar to yours, will need support and processing. I take it to my own session or my supervisor. IFS therapists’ intentions are always to keep our parts out of the session, because in therapy, it really is about the client. It’s not about my agenda or my needs; it’s about yours.

The shame of not meeting our own expectations:

You had lots of hopes and dreams of how your pregnancy or postpartum months would turn out. Chances are you did not wish for mental illness.

Many of us struggle when our expectations are not met. We feel a sense of shame and inadequacy in falling short. You may have hoped to be a Pinterest-parent, and realized you have zero interest in arts and crafts. Perhaps you thought you’d enjoy spending days with the baby, and found you were bored out of your mind by week 4. Maybe you thought you’d ace the whole sleep training thing, only to be struggling 15 months later with a toddler who refuses to go to bed. Somehow these results create a sense of failure that we equate into our self worth.

For any parent who struggles with this sense of “inadequacy”, please know that you are not alone. We all have moments where we worry about being good enough parents. Remember that you have so many years ahead of you to figure this out. We often label ourselves as success or failures, but we fail to pay attention to all the efforts and practice we need to improve our skills. We will screw up many times, and we will learn constantly. In this way, there is always space for us to grow.

goals, high expectations. shame and parenting

It isn’t fair to assume we’ll be great at parenting from day one. Think about how it was like when you first learned to drive. In the start, you were in the “conscious incompetent” stage where are very aware that you have no idea what you are doing. However, with time, you get to a place where you can automatically drive your car. Unfortunately, when we are at this place of “unconscious competence” (a.k.a. “I don’t have to think about it, I can do it in my sleep”), we forget how much we initially struggled. We forget the intensity and shame of not doing well.

Make it safe

We can all play a role in reducing the shame of mental illness and perinatal mental health. Talk about your experiences openly with safe others. Offer validation and compassion to those who are in this phase of life. Reach out to a therapist that you can trust. We can work to shift away from judgment, and instead, appreciate that we are all doing our very best.

Warmly,

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Uncategorized

Little Known Ways to Surviving The Newborn Stage

If you are in your first few days of parenting, congratulations! Welcome to the club! 🙂 The newborn stage is exciting and petrifying. If you are a first time parent, you may be tested in ways that you’ve never dealt with previously. I hope the following tips will help you during these early days.

The 5 S’s.

A fussy baby is one of the hardest part of the newborn stage. It’s not like they can communicate through words, and chances are you’re starting to feel frustrated when you can’t figure out how to settle your little one. If you have heard of Harvey Karp and the Happiest Baby on the Block, this tip will seem familiar for you. Dr. Karp encourages a method that helps calm a fussy baby very quickly, which he refers to as the Five S’s:

Step 1. Swaddle:

Yes, it may seem that your baby hates being swaddled. Your baby may kick up a storm or try and escape those tight confines. However, the swaddle resembles the safe and snug cocoon of the womb, which will feel comforting and familiar. Keeping your little one swaddled also prevents him from accidentally waking himself up due to the Moro reflex. Rather than give up right at this stage, get your baby swaddled and move forward to the next step. (TIP: Using swaddles with a velcro attachment will make life much easier because it reduces the likelihood of babies wriggling out).

Step 2. Side/Stomach position:

When babies are lying on their back, it often feels like they are falling. They are likely to display the Moro reflex when this occurs. While sleeping on their back is necessary, holding them on their side or stomach is a fast way to help soothe a fussy baby.

Another influencing factor is that your little one is watching you trying to comfort her. Although you are using a soft and soothing approach, you may end up stimulating her by maintaining eye contact. The next time you are trying to settle your little one, try holding her in this hold, and see how she responds.

Step 3. Shushing:

Your current strategy may involve ensuring the house is completely silent when it’s time for baby’s nap. After all, having a quiet and dark environment is the ideal way for you to go to sleep. Ironically, a silent environment is not as helpful for babies. When babies are in the womb, things are loud. They can hear all sorts of noises coming from inside of you (e.g. blood flow) and from your external environments (e.g. conversations). Rather than keeping a quiet space, it’s best to include white noise to mimic these familiar rumbling and indistinct sounds. Try setting up a white noise machine (or using a free app on your phone) to help introduce some sound to their sleep environment.

Step 4. Swing

The fourth step: Swing

While gentle rocking or swinging motion will be helpful, what is most effective in calming a fussy baby is using a bobblehead-type movement. The womb is not a smooth, gentle place. Instead, it’s quite jiggly. Take a look at the following video to demonstrate how to create the right swinging movement.

Step 5. Suck/Soother

The soother is either your best friend or your nemesis at this point in time. Many parents find that their baby takes the soother right away and it is a fast way to stop the tears. There is an equal number of parents who have bought 14 different soothers and feel frustrated that their baby continues to gag or spit them out. I find this video really helpful for introducing a pacifier.

Seeing it all in action

The following video shows Harvey Karp incorporating all of these tips together. Again, the newborn stage involves a lot of tears. Putting the 5 S’s together is a fast and effective option to help your little one settle.

The 5 S’s in action

Beware of the Google Trap

google trap. anxious parents. Surviving the newborn stage.

It’s easy to keep researching things. If you are anything like me during my first postpartum experience, you will have diagnosed your baby with 20 medical issues (none of which were actually the case). This is super common, and everyone is aware of the vulnerability of searching on WebMD when anxieties are high. Rather than getting into this spiral, reach out to your health care team (e.g. lactation consultant, family doctor, nurses, social workers). You may worry about “bothering” your health team, but I promise you, they are used to parents reaching out. It is common to have questions , especially if this is your first baby. Whether you are struggling with breastfeeding, worried about baby’s health, questioning your relationship, you don’t have to figure it all out by yourself.

Stay Connected

Whether it’s an online forum or with your fellow friends and neighbours, it’s important to have others to talk to. Getting through the newborn stage is tough. There are a lot of questions and anxieties as the baby does new things (or doesn’t do new things). Please know that with every worry you have had, another parent has dealt with the same fear. Anxiety is normal.

Online communities (e.g. What to Expect) are especially helpful for addressing fears that occur in the middle of the night. There is almost always someone available to support you irrespective of the time of day. Speak to your friends, family, and partner. Sometimes our anxieties can escalate. In these moments, it’s helpful to talk them through with a grounded and non-judgemental person.

Get some sleep

In the beginning, when you are on a two-hour feeding cycle, it may seem that sleep is impossible. The idea of sleeping when baby sleeps feels like a joke. This baby never rests unless being held. Whatever the circumstances are with your baby’s sleep patterns (or lack thereof), you still need some rest. I encourage all parents to find opportunities for shift sleeping. Decide among yourselves who is a night owl and who prefers early mornings. Have a bottle ready and let your partner be in charge for those hours. Ideally, you are trying to get a 4-hour chunk of sleep so that you have the opportunity to enter REM sleep. Remind yourself that this is not permanent. While, it’s hard and challenging, your little one will eventually sleep through the night.

Know when your baby is in Active Sleep

I remember that I used to rush in whenever my kids made the slightest noise during the night. I’d assume they were awake, needing another feed, and that I would have to help them settle in some way or form. Unfortunately, my attempts to intervene only frustrated them. This is because I was actually interrupting their active sleep.

Active sleep is noisy! It involves grunting, squirming and even crying. Of course, in my sleep deprived and anxious state as a first time parent, I would see these cues and rush over to “soothe” my eldest, not knowing he was still resting. This tip involves identifying active sleep, and learning to stay out of the way when baby is resting. This video is a great resource to help you identify active sleep:

Attachment can take time

Some parents feel enamoured with their baby from day one. However, many parents do not feel this way. Building an attachment with your baby can take time. It is perfectly normal to feel scared, overwhelmed, confused, nervous or a variety of other emotions when you first meet your child. The newborn stage is meant to be a time where you develop a relationship. You get to know your child, and like any other relationships, you build trust and communication.

Will this tiny person ever stop crying?

There is a hormonal surge that kicks into full gear as soon as we hear the baby cry. You may be among the few who dash from one end of the house, leaping through obstacles in order to stop the tears ASAP. Alternatively, you may feel a rush of anger coursing through your body when you hear your baby wailing. Both responses are common. Our lovely friend, oxytocin has turned things up a notch making parents incredibly sensitive to a newborn crying.

When you hear someone in distress, it triggers you to respond. You will reach for your baby and start to sing, rock, or nurse. You will use any old tricks to help her calm down. However, if you have found this experience tiring or unsuccessful, those tears can make you feel plagued by helplessness and anger.

What to do if you feel anxious or angry about your baby’s tears:

  • Pause for 15 seconds. Yes, your natural instinct is to rush and rescue, but give yourself a moment to regulate. Give your baby a chance to settle.
  • Remind yourself it’s not personal. Your baby is not mad at you. You are not a bad parent. Babies cry. All. The. Time. It’s their only way of communicating. Sure, it makes your blood pressure skyrocket, but it’s the only way they can let you know something is up. Trying to decipher those tears will take time and practice, but you and your baby are doing your very best in figuring it out.
  • Write a plan for yourself. When your baby is fussy, what will you do? Perhaps you will follow the 5 S’s listed above. You may choose to sit in a rocking chair. You might whip out a bottle to nurse him back to calmness. Whatever option you decide, it’s helpful for you to feel confident and aware of your next step.
  • Ask to switch out. If you’ve already been taking care of a fussy infant all day, you may feel at your wit’s end. Tap out. Have your partner, friend, family member take over for an hour. Try and get out of the house during this time if you’re fighting the urge to run in and fix, correct, or offer suggestions. Take this time for self-care.
  • Shower yourself with positive affirmations. Ideally you’re saying these positive thoughts to yourself. However, if that is too hard, have a loved one reassure you. Get your daily reminder that you are doing your best. These difficult moments do not make you a bad parent.

Reach out

Postpartum anxiety and depression are common and difficult struggles. They go beyond the stressors of the newborn stage. You may find that you are constantly irritable, overwhelmed, unable to sleep, feeling miserable, or disinterested. If you are struggling, please do not stay silent. Your moods can get better. Reach out to find out more.

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Pregnancy and Postpartum

The pressures of breastfeeding

That first year with a baby is all about feeding, feeding and more feeding. For every parent, there is a time when he or she decides whether to breastfeed, exclusively pump, stick to formula, or use a combination approach. There are a variety of factors that push a parent towards one choice over the other. There is no “right” choice outside of what works best for a caregiver and baby.

pressures of breastfeeding. support for parents who are struggling to breastfeed

Unfortunately, there is a push in our society to breastfeed. We see signs of it right from the day we deliver. There are subtle cues from healthcare staff as they share latching tips before inquiring whether formula is preferred. We are provided pamphlets of breastfeeding support in our care packages before bringing our newborns home. There are posters for breastfeeding help at our midwives’ office.

This blog post is not to push formula feeds. I have no right to claim whether formula is better than breastfeeding, or vice versa. Ultimately, I am true believer that fed is best. As long as your baby is getting the nutrients he or she needs to develop, I consider it a win. Instead, this post is for the parents who are struggling to breastfeed. Whether by choice or by capacity, they are stuck in that internal battle of guilt, frustration and helplessness as they face yet another feed.

The pressures of breastfeeding:

We live in a culture where breastfeeding is encouraged and subtly (or sometimes, not so subtly) pushed as the best option for our baby. New mothers face an onslaught of judgemental messages about breastfeeding, and these comments are made in permanent and absolute terms: “breastfed babies have higher IQs”, “breastfeeding will prevent illness, infections and chronic conditions,” “breast is best,” “you won’t have a good bond if you formula feed,” etc, etc.

struggling with breastfeeding. postpartum support. new mother.

I agree that there are a lot of values to breastfeeding. However, I also work with parents who are driven to the point of exhaustion and anxiety in trying to produce enough supply for their baby. These parents are so angry at their bodies for failing them and not doing enough to support their baby’s growth. If the option of working with a lactation consultant or consuming fenugreek daily is working, then please keep it up! In fact, I encourage you to start here if you truly want to breastfeed. However, if your baby is losing weight, you are feeling stressed out, or are experiencing any number of production difficulties, I want you to take a moment and consider why you are trying to keep up with this expectation.

The “Mommy Wars”

New parents would love to have the ideal postpartum experience. We see images of celebrities looking beach-wear ready a few days after delivery. We see influencers posting feeds of their babes sleeping through the night. There are endless tweets and posts about the “right ways to parent”.

pressures of parenting. super mom. mommy wars.

With all of these messages of ideal parenthood, it makes sense that we are self-conscious about our own parenting. The Times wrote a beautiful article in reference to the Goddess Myth: “Like millions of other American moms, [mothers have] been bombarded by a powerful message: that she is built to build a human, that she will feel all the more empowered for doing so as nature supposedly intended and that the baby’s future depends on it. ” With this constant push for doing things “naturally”, moms carry the stress of parenting a certain way. There is a need to delivery vaginally, breastfeed on command, only feed your body the “right” foods, and of course, look stunning throughout the process. Of course, mothers then bear the burden of immense guilt when they are unable to meet these pressures.

This push to parent in a specific way also comes from mom-shaming experiences. These experiences can include rude comments and glances from others as a new mother orders a second cup of coffee, buys a drink, and of course, pulls out some formula. It’s as if there is a moral obligation that has been violated by not following the rules others deem best for our children. It’s no wonder that new parents are surrounded by a sense of failure and dread as they step into parenting.

Know that you’re not alone

The American Pediatric Society encourages breastfeeding for the first six months of your baby’s life. While 80% of mothers start off with this intention, the Center for Disease Control and Prevention state that only about 58% make it to the six months.

Why is this? Breastfeeding is described as natural and easy; however, any parent who struggles with breastfeeding can vouch that this is not the case. From poor latches, supply issues, mastitis, and other complications, many women start to experience a sense of dread when it comes closer to feeding times. These parents may undergo a period of grief as they cope with the disappointment of needing to put aside their hopes for breastfeeding.

Other parents prefer to not breastfeed. This decision could be based on a variety of reasons: struggles with hormonal shifts while breastfeeding, managing the demands of other children, returning to work, wanting support with nighttime feeds, sexual abuse histories, or simply not wanting to feed in this way. These are not selfish or bad parents. They care deeply for their children while also respecting their own boundaries. At the end of the day, a happy parent is better able to support their baby. If formula feeds provide a calmer structure for the parent, then this is the right decision for this family.

Worries about attachment

Sometimes we push ourselves because we think it’s what’s best for the baby. Sure there are physical benefits to breastmilk, but there are significant benefits to having a grounded and calm parent. If you are overwhelmed everytime you start nursing, that bond is going to feel so much more difficult. You have years to build and nurture the relationship with your child. It does not have to be perfect from day one. Listening to your mental, emotional and physical limits will set you up for success.

For those who feel that nursing creates a better attachment, I encourage you to consider your attachment with your own parents. Are you truly better connected with your mother because she chose to breastfeed versus formula feed? Is your IQ significantly higher than a peer who was formula-fed? Who even asks these questions today of other adults?

You are doing your best for your child

cheerful young multiethnic parents admiring sleeping baby on bed
Photo by William Fortunato on Pexels.com

A hungry baby is a cantankerous baby. A guilty mother is an unhappy mother. Pressures that come from strangers, the internet, and sometimes our own friends and family are perhaps meant with good intentions. However, you are this child’s parent. And if you are feeling stressed and guilty about breastfeeding, you are allowed to stop. You will always be this child’s caregiver, and your bond can be secure irrespective of how you feed this little one. Your baby will grow up and eventually eat food, and this pressure to breastfeed will no longer be the central focus of conversations. So for now, go and enjoy your child. Focus on getting those baby snuggles. Spend time playing, singing, talking, and teaching him or her. And when your little one gets hungry, feed them in whatever way is feasible for you.

All the best,

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Pregnancy and Postpartum

What is happening with my mood?! D-MER and Breastfeeding

What is your experience with breastfeeding? Do you feel angry or tearful as soon as you start? Is there a sense of dread when you begin another pumping session? How intense is your anxiety during these moments? When it comes to nursing, there are many parents who enjoy the experience and feel it’s an opportunity to connect with their infants. However, there are also many parents who are frustrated and distraught by the same encounter. Before we assume that the reason we are struggling with nursing is due to postpartum mental health, we want to rule out a physiological illness called D-MER.

Signs of D-MER:

Dysphoric Milk Ejection Reflex (a.k.a. D-MER) is a breastfeeding struggle that occurs during letdown of milk. This includes nursing, pumping, or manual expression to release milk. Normally when lactating, parents experience the warm and loving feelings that come with an increase in oxytocin. However, with D-MER, a caregiver has a sudden drop in mood, and can experience any of the following difficulties:

Breastfeeding and D-MER. Anxiety, sadness or distress during pumping
  • dysphoria, or a state of unhappiness
  • panic
  • restlessness
  • hopelessness
  • anger
  • anxiety
  • sense of dread/doom
  • paranoia
  • thoughts/urges about suicide or self-harm

D-MER most commonly shows up as anxiety, agitation or sadness. The intensity of these experiences can vary from mild to moderate to severe. These symptoms can last anywhere from a few seconds to 2-3 minutes. It typically shows up about 30 seconds prior to milk release. D-MER struggles subside as you continue to nurse, but reoccurs as soon as another let down happens. Typically, parents start to feel better after 3 to 6 months once milk production regulates. Unfortunately, there are no specific tests or assessments to confirm you have D-MER. If you notice an abrupt shift in mood when you are pumping or nursing, it warrants considering whether D-MER is a factor for you.

D-MER versus Postpartum Mental Health

Breastfeeding and D-MER. Anxiety, sadness or distress during pumping

D-MER is a physiological issue. It happens because of hormonal and chemical changes in the brain during breastfeeding. This is not a psychological issue, although it certainly feels like one. Folks who have a history of mental health struggles are not more vulnerable to experiencing D-MER. It is completely by chance. Parents who have experienced D-MER with their first child have a higher likelihood of experiencing it again with future children.

D-MER is not the same as postpartum mental health. While an episode of postpartum anxiety can last for hours or days, D-MER lasts a few minutes and only occurs during the release of milk. Once breastfeeding is completed, parents moods regulate and they are able to re-engage in their daily activities. Unlike any prenatal or postpartum disorder which involves a combination of biological, psychological and social influences, D-MER is caused solely by hormonal shifts.

This does not mean that the two are mutually exclusive. Parents with perinatal mood and anxiety disorders can also struggle with D-MER. If this is the case, then a combination of treatment is useful in order to address both needs.

Why it happens:

D-MER has only recently been identified as a breastfeeding struggle, and research has started in the past 10 years. However, dopamine has been identified as the primary influencer to experiences of D-MER. Dopamine (a hormone connected to feelings of pleasure) must drop in order for prolactin (the hormone which helps produce milk) to increase. What research has found with D-MER is that the drop in dopamine is too significant during milk letdown, which triggers an abrupt drop in moods.

What you can do if you have D-MER:

The first and most important thing to remember about D-MER is that it is not your fault. You are not doing breastfeeding or parenting incorrectly. This is truly a chemical change that is happening outside of your will power. It is not a psychological issue, and there is absolutely nothing “wrong with you.” It’s an automatic reaction, and the emotions and thoughts that come with D-MER are not based on facts, reality, or any truth to your capacity as a parent.

Approximately half of nursing parents stop breastfeeding by 6 months. This can happen for a variety of reasons, and only you are the judge of what is right for your body. If D-MER is one of the reasons to stop breastfeeding, it may be helpful to know that most parents struggling with this issue feel an improvement of symptoms in 3 months once milk production regulates.

Connecting with your health care team:

Lactation struggles. Perinatal mental health. Speaking to physician

Knowing that this ailment is a chemical imbalance, it’s best to speak with your physician or lactation consultant about your experience. In moderate to severe cases of D-MER, treatment options will likely involve medication or herbal supplements to support adequate dopamine production.

Behavioural Strategies

With milder versions of D-MER, there are several behavioural strategies that can be used to support your nursing experience. Firstly, it is helpful to keep track of your symptoms. What varies on days when your D-MER symptoms are worse? Common factors that can improve or exacerbate D-MER include: stress, rest, caffeine intake, hydration, and exercise.

Changing the Pattern:

Using distractions to help during breastfeeding.

Secondly, we want to create a more positive experience when nursing or pumping. When we know we are walking into a stressful event, our system braces in anticipation. With enough occurrences of D-MER, parents are typically anxious about lactation. To break this pattern, we want to pair positive experiences with breastfeeding. While nursing or pumping, add in a pleasurable activity that you can use as a distraction. Options can include: listening to your favourite podcast, reading a novel, playing a game on your phone, watching your favourite TV show, eating a delicious piece of cake. Use this activity only when you are breastfeeding to help your system create positive anticipation.

Mindfulness

Thirdly, mindfulness practices can be used to help during this time. When our system anticipates threat, we are hypervigilant of all signs and symptoms related to the threat. Unfortunately, this can make things worse because we are fixated on every nuance that can go wrong. We can also get caught in a negative spiral after breastfeeding is done because we continue to think about the experience and fret about what did not go well.

Mindfulness involves choosing a neutral anchor to focus our attention. For example, you can focus on the sensation of holding your baby, or keep count of baby’s gulps during a feed. You can pay attention to your own body or breath. You may also focus on external anchors like listen to music or noticing what is outside in your backyard. Your mind may wander, and mindfulness involves re-directing your attention to the safe and neutral anchor whenever this occurs.

Breastfeeding is Tough

There are a lot of factors that can influence our postpartum year, including breastfeeding struggles and D-MER. At the end of the day, no one can or should make the decision to start or end breastfeeding other than you, the lactating parent. If you find your mental health is influenced by your breastfeeding experience, please reach out. You do not have to struggle in isolation.

Take care,

Kasi

Kasi Shan, MSW, RSW
Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Parenting · Pregnancy and Postpartum

Building a bond with your baby: Strategies to help when you struggle with postpartum mental health

When it comes to postpartum mental health, many parents struggle to building a connection with their little ones. There may be feelings of resentment that our lives have changed. You may feel too tired to want to play or sing nurseries. Your anxiety feels too high for you to be comfortable spending time alone with your infant. Whatever the reasons may be, you’ve been coping these months by maintaining an emotional distance from your child and feel desperate to build a bond with your baby.

I want you to know that attachment can be formed irrespective of postpartum mental health. Our relationships can always grow and develop, even when the onset was rocky. The first five years with your child are pivotal, and there are many things that can be done from hereon in to nurture this new relationship safely and without overwhelming your nerves or emotions.

The following strategies will help you feel more secure to meet your baby’s needs. No, they’re not all about singing songs or giving massages. I recognize that singing and massages are great options, but not everyone is at this starting point. So, let’s start slow so that we can get you to a place of feeling more confident to building a better relationship.

1. Introduce your infant to activities that you enjoy doing.

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When the bond with your baby is already feeling tested, it’s incredibly hard to push ourselves to do “baby-focused” activities. Your motivation and desire to encourage tummy time or play peek-a-boo is next to nil. When you feel this way, it’s not helpful to ask you to force it. This may work for a day or two, but a stressful event will likely bring you back to square one. Instead, I want to encourage taking small steps that will feel more manageable for your system.

When you focus on your hobbies and interests, you’re often able to relax. There’s less pressure to perform. You have less anxieties about ensuring you’re “doing it right” and, instead, can just enjoy the task at hand. Whether it’s going for a run, cooking a meal, painting, reading a book, playing dungeons and dragons, there are creative ways to bring your baby into your world. Bust out that jogger to take your little one on a run with you. Introduce your baby to different smells, and speak to her about the different spices that are going into your meal. Show her the different colors you’re using while painting. Read outloud from your book so that your baby learns new words. Have her roll large dice for your various rounds in a board game. There are ways to still be you and foster your own interests while including your baby.

2. Build confidence with a support person

When you’re feeling insecure about being a parent, the pressure of parenting independently can feel like too much. Let your partner, friends, or family members know how you feel. Your sense of overwhelm with the baby does not mean you cannot be a good parent. Attachment struggles are a common sign of postpartum anxiety. Rather than avoid your baby all together (many have been here!), or become flooded with frustration or resentment, try and share the load.

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Speak with your family members about spending more time together so that you can grow into this role. It’s easier to play with the baby or learn to handle colicky moments when you have a safe friend or family member supporting you. Your trusted person may give tips (tell them to cool it if it feels too much), or may provide you encouragement as you try. They may be wonderful at providing a distraction, so that you’re less focused on doing things perfectly. This support should also include your friend providing you a time out when you have met your limit and need to take a breather.

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A word of caution that it can feel tempting to step away and allow your family member to take over. But if you are hanging out with your little one and there’s a fellow adult around, the conversation feels easier, and there’s less strain to manage by yourself. When you’ve had enough practice with your infant, speak with your support person about coming over for shorter visits. By slowly reducing the amount of support available, you are practicing gradual exposure. This type of practice helps you work set realistic goals within your window of tolerance, and slowly build confidence as you spend more time independently parenting.

3. Make sure you are getting enough time to sleep.

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I know this point sounds strange as far as suggestions to improve the bond with your baby. However, one of the biggest turning points for postpartum mental health is having enough rest. You will never feel at your best if you are working off days or weeks of sleep deprivation. Trust that you will feel calmer, more energetic, more engaged and more like yourself when you’ve had sleep. Once you’ve had a solid week or two of rest, check in on your feelings towards your baby. Are you still feel that intense aversion or fear or has it shifted a bit?

For new parents, I strongly encourage working collaboratively to at least have longer segmented sleep. This might mean that one parent takes an early morning shift so that the other gets to sleep in. Or vice versa, whoever is the night owl takes on the later evening feed so that the other can rest. Understandably, parents will have to consider their comfort levels with pumping or formula feeding. While this is a personal choice, I want to emphasize that your system will feel significantly better after having at least four solid hours of rest.

4. Eye contact and Communication

Eye contact and verbal communication are effective ways to building a bond with your baby. These verbal and non-verbal cues help foster language skills and emotional intelligence in your little one. Your baby starts to recognize faces, understand facial cues, and builds a sense of safety with you. By communicating more, your baby will pick up on various words and gain a stronger understanding of language.

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Maintaining eye contact can be incredibly difficulty, particularly if you struggle with attachment traumas or social anxiety. This strategy may not feel right for everyone, and I encourage you to be kind to yourself and where you are in your healing process. If it feels manageable, try and look directly at your baby while breastfeeding, changing diapers, and when doing any tasks related to your little one. Feel free to look away when the baby loses interest or is over-stimulated. I want to emphasize that doing even a little bit is better than nothing at all. If you are able to maintain eye contact while changing a diaper but feel overwhelmed during breastfeeding, work with that capacity.

Many parents with postpartum depression struggle to spend time with their babies, and it’s a big ask to encourage them to speak to their infants more often. If you are not “feeling it”, you don’t have to coo, speak in baby-talk, or sing nursery rhymes. Keep it simple. Describe what you’re doing in that moment with your baby, even it if it sounds like a tedious play by play. Talk about things that interest you in front of your infant so that they hear the variance in your speech patterns. Have conversations with other adults in front of your babies so they can witness different verbal and non-verbal expressions.

5. When there are no words, use hugs.

Perinatal mental health. Crying, fussy baby. Improving bond. improving attachment

Sometimes the baby cries, and it’s the most aggravating experience. You can’t figure it out. You have tried changing diapers, feeding, rocking, and nothing is working. Rather than stress yourself further, if you have the ability, focus on just holding your baby. There’s no need to walk around or figure out a soothing gait. Spend that effort on giving your baby a gentle hug. Touch is one of the most reassuring options for your infant and it provides them a sense of safety. Having that skin to skin contact, when you don’t know the right words or actions to take, can help both you and the baby feel calmer. Building a bond with your baby can involve a variety of different strategies, but sometimes the simplest action of being held can be enough.

6. When there are no words, walk away.

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I know this seems contradictory to the previous point, but this is to give you the option to decide your current capacity. I encourage you to start with hugs when you are capable of this action. When you feel you cannot take it, and you are at your max, it’s essential that you have permission to put the baby in the crib and walk away. Giving ourselves timeouts is a wonderful option to take a break, find ways to regulate, and try again after a few minutes. I encourage using a distress tolerance skill (e.g. dialectical behaviour therapy skills like ACCEPTS or changing temperature) during your timeouts as it is a fast way to calm your system.

7. Plan your day

Boredom can be a significant trigger for many people. When you are bored, your mind starts to wander and, oftentimes, you’re back to that pattern of anxious, racing thoughts. Boredom can lead you to that rabbithole of social media where you fall into the trap of comparing your life to others. Boredom can be a common push factor towards drinking. When we are aware that boredom plays a role in our emotional struggle, we can form a plan. When your mental health improves, your ability to build a bond with your baby also improves.

While parental leave can be wonderful, it can also involve long and tedious days. In many ways, going to work provides us a lot of stability: we have a consistent routine of getting up, tasks to accomplish, opportunities for social interaction and consistent break times. If we know what the day will include, it can ease our anxieties, and we can plan ahead for boredom.

So, what will you do this week? Can you try and wake up and go to bed at the same time each day? Do you have opportunities to socialize each day? Are there playdates that you can schedule, outings that you can plan, activities that you’ve wanted to try out? Are there new play gyms that are available in your city? Will you register for a new online parent and baby class? Are there some new and exciting activities or hobbies that you’ve been wanting to take up (with or without your little one around)?

8. Building a bond with your baby does not require perfect parenting

Parenting has become a dreaded term. It’s a job that involves a lot of effort and patience on your part, and very little on the part of your babies. And as with any job, you may be striving to do it right. While your intentions are commendable, the desire to parent well can sometimes lead to additional stress.

When it comes to providing for your baby, “good enough” is more than enough. We are not able to get it right all the time, and it’s unrealistic to expect this of anyone. There are always going to be factors that pull our attention and that prevent us from being able to attend to our child’s emotional cues. In reality, we only get it right about 30% of the time. Other times, we are completely missing the mark on our babies’ cues or working to repair that misattunement. This is perfectly normal and expected in all parents. Rather than getting our hopes up to parent perfectly, we can focus our attention on repair if we have made a mistake. Repair work may involve: apologizing if you’ve been cross, paying attention if your child is trying to engage you in play, or providing that gentle hug if your baby gets frightened by your exasperated sigh. Our expectations can ease when we know that we will only get it right 30% of the time AND that this 30% attunement is what we can expect even in the most loving and secure of relationships.

Reach out

Everyone’s situation is unique. I don’t want to assume that the points I’ve listed out are going to meet your specific needs. If you are struggling with postpartum mental health and you’re concerned about the bond with your baby, reach out for a free consult. Postpartum mental health is treatable. You can get better, and your relationship with your child can be positive.

Take care,

Kasi

Pregnancy and Postpartum · Trauma

Understanding Birth Trauma

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You’ve been patient, waited 9 months, and dealt with all of the aches, nausea and fatigue in order to get to your delivery date. You may have an ideal birth story in your mind; many of us do. Some parents imagine a specific atmosphere while delivering (e.g. support people around, delivering at home). Some parents plan pain management strategies (e.g. I want an epidural). Others are keen to have skin to skin contact immediately after delivery. No matter what your plans are for delivery, there is hope that things go smoothly. Unfortunately, birth trauma can pull us far away from our ideal birth story.

Trauma is an unexpected and stressful experience that alerts our system of danger. We become acutely aware of impending harm or threat to our being. A birth becomes traumatic when we are fearful that we, or our baby, will die. Birth traumas happen in about 1 in 4 deliveries. These parents experience feelings of being abandoned, helpless, disrespected, scared, overwhelmed or powerless during their birth experience. Approximately 9% of parents experience their moods worsening into a diagnosis of postpartum post-traumatic stress disorder.

Types of Birth Traumas

There are various complications that can happen during or after delivery. Common birth traumas include:

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  • Emergency treatment following birth (e.g. stay in NICU)
  • Stillbirth/neonatal death
  • Preterm deliveries
  • Assistance during delivery (e.g. use of forceps)
  • Unplanned c-section
  • Prolapsed cord
  • Feeling a sense of abandonment or powerlessness
  • Lack of support or clarification during and after delivery
  • Lack of privacy or dignity
  • Physical complications (e.g. postpartum hemorrhage, unexpected hysterectomy, perineal tears, prolapsed uterus)

Following these birth traumas, caregivers begin to notice a change in their own moods and capacities. Similar to post-traumatic stress disorder, survivors can experience:

understanding birth trauma. postpartum PTSD. Kasi Shan Therapy. Counselling in Kitchener, Ontario.
  • Extreme sensitivity and awareness to surroundings (a.k.a. hypervigilance)
  • Easily startled
  • Difficulty concentrating
  • Change in appetite
  • Memory blocks (unable to remember parts of the traumatic experience)
  • Difficult coping behaviours
  • Intense shame, irritability, or anger
  • Suicidal urges
  • Sleep difficulties and nightmares
  • Difficulty in social relationships
  • Unpleasant intrusive thoughts
  • Flashbacks
  • Pain, sweating, trembling, when thinking of the birth
  • Avoidance of birth reminders (e.g. being with own child, seeing other babies, hearing other birth stories, medical settings)
  • Anger towards medical professional or others involved during delivery
  • Poor attachment with baby

As with any mental health struggle, this is not a matter of will power. You are not choosing to respond in this way. You are not in control of these overwhelming emotions. When traumatic experiences occur, our system cannot always manage. We lean into whatever coping strategies are available to help us survive. Some of these coping strategies are done intentionally (e.g. avoiding the baby), and other times, we have limited control over them (e.g. bursts of anger).

What influences PTSD?

During the first month following a birth trauma, we want to monitor a parent’s well-being. This time is pivotal. Trauma survivors continue to assess the world and whether it is safe and predictable once again. They need to see that this birth trauma is a unique experience, and that it is highly unlikely to reoccur. Grief, anger, anxiety, wanting to understand, and seeking support are all natural forms of processing that tend to occur during this phase. The body’s ability to naturally process and return back to a sense of safety can be influenced by the following factors:

Prenatal Stressors

Prenatal stressors can include miscarriages, unplanned pregnancies, health scares, physical complications, unexpected bed rest, or fertility stressors. During these months of pregnancy, an individual can survive a variety of unexpected hardships, such as financial burdens, divorce, or bereavement. Furthermore, some pregnant couples have lived through a traumatic experience earlier in life (e.g. medical traumas).

It is understandable that these parents enter the delivery room feeling more cautious and nervous. If we have experienced any of these earlier adversities, our nervous system has already been fighting for some time to cope. It is already experiencing symptoms like hypervigilance, intrusive thoughts and nightmares. When we have already experienced trauma, our window of tolerance becomes narrower. Another stressful event can push us past our limit of tolerance.

Interactions with medical staff

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The interactions you have with your healthcare team can immensely influence your experience of child birth. How did your healthcare provider connect with you following a miscarriage? Was there space for you to grieve or did your provider seem too busy? Was the physician empathetic or was he or she scornful? If you are already wary of medical staff, how would you feel entering a delivery room?

Deliveries are busy times times, and your healthcare team is focused on moving things as efficiently as possible. However, at a time when you feel vulnerable, it can easily feel like your healthcare providers are curt, dismissive or inconsiderate of your emotional needs. When decisions like C-sections or taking the baby immediately to NICU are outside of your decision making, it can feel like your autonomy and sense of control has been taken away. The medical team’s decision to take these steps are likely valid; however, caregivers are left feeling powerless and confused.

Lack of support

It is natural to want to hide when we are grieving. It is natural for us to avoid others if we feel ashamed or responsible for a difficult birth. Isolation and loneliness tend to worsen our moods. There is so much healing that occurs when we feel someone truly understands and recognizes our pain.

When parents express grief and distress following a birth trauma, many family members do not know how to respond. Our friends and family have good intentions when they reassure with comments such as: “At least the baby is here,” or “Count your blessings,” or “Be grateful for what you have”. These types of comments are, unfortunately, invalidating. A parent continues to feel alone and misunderstood by their support team.

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To offer better support, please ask caregivers if it’s okay to be with them during this time. If these parents want to talk, please listen with an open-heart. When we are grieving, our support team cannot fix the past or make the pain go away. However, by offering a safe space for these intense emotions, our friends and family provide us opportunities for healing.

Healing from a birth trauma:

Not everyone requires extra intervention following a birth trauma. Support from loved ones and time can be enough to help someone work through this intense and difficult experience. However, for more complicated situations, like postpartum PTSD, it’s imperative we reach out for help.

Eye Movement Desensitization and Reprocessing (EMDR) is an incredibly effective way to process and heal from birth traumas. This therapeutic modality helps an individual speak about traumatic memories while using bilateral stimulation (e.g. eye movement, audio cues, tapping) for short sets of time. In using this combination, EMDR triggers the traumatic memory network in the mind. Participants notice a reduction in distress and vividness to a traumatic memory. They also notice how the mind works to form connection with other events that have impacted this trauma, or have been impacted because of this trauma. Depending on the complexity of the traumatic events, clients can start to see improvement within 6-12 sessions. If you would like to learn more about EMDR, I encourage you to read this earlier post.

If you are struggling following a birth trauma, please do not stay silent. Reach out to a safe person such as a family member, friend, or a professional. If you would like to work through your birth trauma using EMDR or other effective therapy styles, please reach out.

Warm regards,
Kasi

Mental Health · Pregnancy and Postpartum

Postpartum OCD: The Curse of Never-Ending Scary Thoughts

While postpartum depression and anxiety have become more widely-understood, there is still limited research about postpartum obsessive-compulsive disorder. This mental health struggles occurs in approximately 1-10% of parents. Since postpartum OCD presents as excessive worrying and helplessness, it is commonly misdiagnosed as anxiety, or worse, it is dismissed as “normal worrying”.

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When you think of OCD, your mind may jump to stereotypical examples like excessive hand washing due to a fear of germs. With postpartum-OCD, parents are often struggling with scary thoughts regarding the safety and well-being of their baby. As a forewarning, some of the examples shared below can be triggering. Please read with caution, and reach out if needing support.

The first element of OCD: Obsessions

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There are two key components that make up OCD. The first is obsessions. Obsessions involves intrusive and distressing thoughts, images, or beliefs that continue to repeat incessantly. Individuals struggling with obsessions do not feel in control of these thoughts, and are quickly overwhelmed. Common OCD obsessions include:

  • needing order or symmetry
  • fear of harming yourself or other people
  • unwanted sexual thoughts
  • religious obsessions (e.g. fear of offending God)
  • fear of limited or lack of control (e.g. acting on impulsive urges to shoplift)

Common obsessions with Postpartum OCD:

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  • Contamination fears (e.g. bottles not being cleaned thoroughly)
  • Fear that baby will get sick or die (e.g. sudden infant death syndrome, car accidents)
  • Sexually intrusive thoughts (e.g. what if I am turned on when changing my baby’s diaper?)
  • Concerns about hurting the baby. For example:
    • What if I drop the baby and her head cracks open?
    • Intrusive thoughts about stabbing/shaking the baby
    • Image of drowning baby in bathtub
    • Urge to scream at baby
  • Concerns that others may harm the baby
  • Stress about making the wrong decisions (e.g. feeding the wrong food)
  • Rigidity to schedules/routine (e.g. nap times, feed times)

The second element of OCD: Compulsions

An individual with OCD is aware that these obsessions are not valid or logical. However, because the images or thoughts are so distressing, it feels important to get rid of them quickly. This is how compulsive behaviours start. When an obsession becomes too much to handle, compulsive behaviours are used to manage them. If you’re scared of germs, you start to wash your hands. If you’re scared of your baby dying during sleep, you may need to check repeatedly during the night to ensure safety. These compulsions are not effective in actually eliminating or addressing the fear; however, they provide a quick fix in that moment. Because the intrusive thought comes back quickly, the compulsive behaviour is repeated in order to help the individual calm down.

Common Compulsions with Postpartum OCD

When it comes to postpartum OCD, these parents are overwhelmed by the idea of harming their baby or being unable to protect their baby. Compulsive behaviours involve any means in which to offer their baby protection. Examples include:

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  • Avoidance of the baby
  • Checking repeatedly to see if bottles/supplies are clean
  • Excessive-reassurance seeking from health care professionals to confirm that baby is safe and healthy
  • Removing all sharp objects from the home
  • Avoiding any news or media related to child abuse (due to fear of being turned on)
  • Refusing to give baby a bath
  • Refusing to change diapers (due to fear of sexually abusing baby)
  • Avoiding breast feeding or eating certain foods to prevent contamination
  • Excessive praying
  • Isolating baby from loved ones
  • Not driving in the car with baby

Some compulsive behaviours seem normal. After all, double checking that the bottles are clean, or peeping in to the nursery to ensure your infant is asleep are perfectly normal tasks that all parents practice. The concern with compulsions is when these behaviours are done repeatedly. When intrusive thoughts are too distressing and compulsions take up a large chunk of time, our quality of life starts to suffer.

The commonality of intrusive thoughts

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Most of us, irrespective of having a mental health diagnoses, will have disturbing thoughts from time to time. In fact, intrusive thoughts happen to approximately 80% of new parents. We’ll have a fleeting thought about falling off a balcony, driving into oncoming traffic, or yelling at our family members. When we are not fraught with distress and fatigue, we can usually shake our heads and call it for what it is: a strange thought. We may scoff and think it’s odd, but we don’t put too much thought into it, and can move on. For those with postpartum OCD, intrusive thoughts are so distressing that these parents assume there is some truth or meaning to these obsessions. Rather than shaking their head and saying “what a weird thing to think”, they become overwhelmed with guilt and shame at ever considering these thoughts.

Fears in reaching out

In a previous post, I had talked about some of the barriers that prevent parents from seeking help. One of the biggest blocks in reaching out for help is the fear that expressing these intrusive thoughts will lead to a call to the Children’s Aid Society. For those who struggle with this fear, I would like to reassure you that having a scary thought does not mean you are going to act on them! Parents with postpartum OCD have the best intentions for their children. They are overwhelmed by the fear of causing any harm that they are willing to practice whatever forms of compulsive behaviours to avoid this potential issue. Seeking help does not mean a call to the authorities.

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Postpartum OCD is not a “mom’s issue”; it can also be experienced by dads, adopted parents, and other caregivers. If you or a loved one is experiencing intrusive thoughts during the postpartum months, please do not stay silent. Postpartum mental health is treatable. If you are concerned about your own symptoms, but are not ready to talk, you can fill out the Yale-Brown Obsessive-Compulsive Scale to complete a self-assessment.

Take care,

Kasi

Anxiety · Pregnancy and Postpartum

Common anxious thoughts during the postpartum year

Cognitive-behaviour therapy has taught us that there are certain themes to our anxious thoughts. These themes are referred to as “cognitive distortions” or “thought traps” in CBT lingo. Anxious thoughts can happen to any of us, irrespective of whether or not we have a clinically diagnosed mental health issue. More often, they tend to pop into our minds when we feel vulnerable. Unfortunately, during the postpartum year, there are numerous vulnerabilities that new parents face. Examples of these vulnerabilities include lack of sleep, hormonal shifts, adjustment to a new life, changes to routine, and an increased sense of responsibility. The following are a list of common thought traps, and examples of how they may show up for postpartum parents.

Common anxious thought patterns that new parents experience:

Over-generalization

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When we over-generalization, we are making assumptions based on limited information. This means we come to a conclusion about someone or something from a single piece of evidence. In future circumstances, we overestimate the likelihood that the same set of events will happen again. The following are a few examples of how over-generalization can show up during the postpartum stage:

  • “My baby is not latching right away, I’ll never be able to breastfeed.”
  • “This baby has been fussing for nearly an hour. I am never going to be able to get to sleep.”
  • “My spouse was so tired and cranky when he came from work yesterday. I don’t trust him to take care of the baby on his own in the evening now.”

Catastrophising

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This anxious thought pattern basically means we are magnifying an issue into something awful and disastrous. We may do this by exaggerating the meaning or importance of certain events. Often times when we catastrophise, there is a sense of dread in facing uncertainty. We don’t feel we have the skills or confidence to manage in this situation. Examples of catastrophising during postpartum care include:

  • “My spouse and I argued this morning. We must be heading towards a divorce.”
  • “I got angry with the baby. We are never going to have a good relationship. I’m not cut out to be a parent.”
  • “Sleep training was so hard yesterday. I can’t imagine that it’s going to get better.”
  • “My daughter freaked out at the doctor’s office. The staff must have been pissed that I couldn’t calm her down. I can’t go back there.”

All-or-nothing

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All-or-nothing thinking keeps us stuck between two restrictive options. This anxious thought pattern refers to when we things as falling into extreme categories without any middle ground. We are either perfect or a complete failure. Things are either good or bad. Life is either easy or impossibly hard. When we focus on these polarized options, we forgot to notice exceptions to these extreme thoughts. We don’t take into account all of the various and complex factors that may have affected achieving full success. We don’t consider how our self-worth is separate from our achievements.

Personalizing

Personalizing is when we take on the responsibility of a situation or take ownership of other people’s behaviours. This happens quite often with parents who take on the responsibility of their child’s behaviours as if they are fully to blame. It does not allow space for the many external factors that could have also influenced what had taken place.

  • E.g. the baby is teething and unable to fall asleep: “I’m a lousy parent. I can’t help my baby get some rest.”
  • E.g. Your partner received negative feedback from his/her boss. “It’s my fault. I kept my spouse awake by asking for help during the feedings.”
  • “It is my fault that my baby is not walking, talking, or meeting a developmental mile stone at this time. I must be doing something wrong.”

Should Statements/Perfectionism

This anxious thought pattern is really tough during the postpartum period. We are all trying our best as new parents, but the pressure to manage these high standards can be incredibly straining. Perfectionist thoughts involve terms like should, shouldn’t, must, must not, ought to, have to, etc. We use these thoughts as if they are iron clad rules. Unfortunately, there is a lot of frustration and resentment when we cannot meet these high expectations.

  • “I should be able to do the dishes, make supper, tidy up and take care of the baby.”
  • “I have to get to the gym. I can’t be walking around with all of this baby weight still.”
  • “I should be calm and soothing all the time, even when my baby is cranky.”

Do these anxious thoughts sound familiar?

Anxious thoughts can happen to any one. However, there is a higher vulnerability for anxiety during the postpartum year. If you are concerned that you may be experiencing postpartum anxiety, the Edinburgh Postnatal Depression Scale is a quick self-assessment that reviews signs of depression and anxiety in parents. Postpartum anxiety is treatable. If you are struggling, please reach out.

Mental Health · Pregnancy and Postpartum

Unhappy relationship after a baby

Relationships are tested all the time when life throws curve balls. As much as we’d love for a new family member to bring us closer together, having a baby can actually worsen the sense of an unhappy relationship.

Working in perinatal mental health, I hear a lot of parents talking about their relationship dissatisfaction. I know they are struggling with poor communication, lack of sleep, and adjustments to new responsibilities. One parent is trying to maintain a sense of normalcy, continuing to work long hours to provide financial stability to the family. The other parent is spending hours with their infant intent on keeping their baby alive and thriving. While these goals are both compatible, it’s easy to get lost in our own perspective of what is most important or necessary. During postpartum stages, I hear parents constantly share how much they yearn to feel connected with their partners. They want the security of knowing they have their partner’s love, understanding, and support.

The Four Types of Relationship Conflicts

There are many factors that can create an unhappy relationship; however, I’ll focus on communication struggles for this post. The Gottman Institute recognizes that there are four common trends in relationship conflict, which they’ve coined “the four horsemen”. With decades of research, the Gottman Institute can confirm that the presence of these four conflict styles create and exacerbate unhappy relationships. These communication conflicts can happen to the best of us, but it’s important to recognize when it is an off-chance occurrence versus a continued pattern.

Criticism

Unhappy relationship after a baby: Things to notice, and ways to fix.
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This type of relationship conflict involves one partner expressing criticisms about the other’s personality or defects. Often, with criticism, the angry party will state “you always-” or “you never-” or others forms of extreme language in order to highlight a partner’s inadequacies. Instead of voicing the actual complaint, the focus is instead on attacking your partner’s character to the core. Rather than stating “I feel frustrated that the dishes haven’t been washed tonight,” the angry individual will state, “you are such a lazy slob” or “you always watch TV instead of doing what you promised.” It leaves the other person, whether he or she is in the right or wrong, to feel hurt and assaulted.

Defensiveness

Unhappy relationship after a baby: Things to notice, and ways to fix.

When met with criticism, it’s natural that you wish to defend yourself. In an ideal world where our defensiveness is less heightened, we can hear a complaint, take responsibility of our actions, and apologize if necessary. Instead, the hurt partner gets angry and attacks in turn. The argument cycle continues as the other partner then feels blamed and hurt.

There are various ways in which we can become defensive:

  • attack back with a critical comment of your own “Well, they’re mostly your dishes from breakfast. What made you so lazy this morning?”
  • claim innocence “I rarely watch TV. Why are you bugging me the one time I get to sit down?”
  • express righteous indignation “I was going to do it after this show.”
  • whine “I’ve had such a long day at work. Can’t you give me a break?”

Contempt

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Contempt is the extreme version of relationship conflict. It is the highest predictor for divorce. When we are being contemptuous, we are genuinely being mean and disrespectful. This includes: name calling, using sarcasm, ridiculing, giving condescending lectures, throwing insults, eye rolling, etc. When we use this form of conflict style, it makes it hard for partners to move past our sense of disgust and superiority towards them.

Stonewalling

This form of unhappy relationship conflict involves shutting down or “becoming a stone wall” when our partners express their feelings. This means we offer zero verbal or non-verbal language in response to their comments and questions. Stonewalling is a protective mechanism that attempts to block out rather than take in our partners’ criticisms, defensiveness or contempt. The stonewaller often feels overwhelmed and unable to think clearly or know what do about the situation. Rather than face the conflict, a stonewalling partner may instead tune out, become distracted by other activities, or simply walk away.

Crap! I do some of these things! How do I fix my relationship?

Unhappy relationship after a baby: Things to notice, and ways to fix.

If you happen to fall into some of these conflict styles, don’t worry! We all have moments of falling into these conflict styles. The following suggestions are some ways to improve the situation.

Use gentle and assertive communication

I love the DEARMAN acronym from DBT to help with assertive communication. This acronym helps us make requests or say no in a confident and conflict-reduced fashion. By using a gentle and assertive approach right from the start of a conflict, there is less likelihood for your partner to feel defensive or need to attack or shut down. Speaking assertively can push some of us outside our comfort zone, especially if your tendency is to stone wall and not express your feelings or needs. However, by asking clearly and respectfully, your partner has the opportunity to hear what you would like, and have the chance to negotiate with you on terms that seem manageable for him/her/them.

D= Describe the situation. Use a brief statement that sticks with objective facts. “I noticed there are still dishes in the sink.”

E= Express how you feel. Use an I statement to explain what emotions are showing up for you because of this situation. “I feel upset that the dishes haven’t been done because we had talked about sharing the household chores more equally. I feel disappointed that this task wasn’t completed.”

A= Assert what you want. Be clear about what change you are looking for at this time. “I would like for the dishes to be done after supper.”

R= Reinforce what is in it for the other person to follow through. It’s absolutely fair that you want your partner to “just know” that it’s right thing to do. However, it’s more helpful and efficient to provide a reminder for why it’s important to maintain a specific behaviour or make a change. “I was looking forward to relaxing at the end of the night with you. I’d love to cuddle up to watch some TV rather than waste our short chunk of evening time scrubbing away at dishes.”

M= be Mindful. Don’t use this as an opportunity to throw in twelve other requests. Focus just on this one situation.

A= Appear confident. There is no need to apologize when you are making a request for change.

N= Negotiate. Sometimes your partner will be willing to make a change so long as there is some wiggle room. Be willing to negotiate so that you can both come to a satisfactory middle ground.

Express appreciation and respect regularly

Unhappy relationship after a baby: Things to notice, and ways to fix.

One of the best antidotes for anger in a relationship is to voice appreciation and respect regularly. Are you turning towards your partner and commenting when they do a task you genuinely appreciate? Did you thank them for tidying up the garage or watering the grass this morning? It may seem unnecessary, but check in on the ratio of negative to positive attention that you provide your partner. How often are you expressing factors that you dislike? How often are you taking the time to express things you do like?

Expressing appreciation can also be done through behaviours. Consider small steps that would be helpful for your partner that he/she/they have expressed. Appreciative behaviours should not be grand gestures since this is unsustainable and can only happen so often. Instead, Dr. Gottman recommends “small things often.”

It’s also important during this phase to take note of our partner’s attempts for connection. When they are talking about their day, asking questions, or seeking physical touch, how do you respond? These are opportunities to express fondness, which goes a long way in strengthening your relationship.

Agree on safe time outs

For those who stone wall, it’s hard to problem solve or engage in an effective conversation. Turning away actually seems like the safest thing to do in that moment; however, it drives the other partner mad because they are getting zero feedback about how to move forward. In these situations, it’s important to have a clear conversation with one another on safe ways to ask for space. Perhaps this means stating clearly “I’m feeling overwhelmed. I need a few minutes.” It may mean practising some deep breathing exercises to help calm your body to feel less tense.

Turning your unhappy relationship into a positive relationship

Your baby needs you. No matter what the conflict or how intense it may feel, your baby need its parents to feel safe and secure. Your little one picks up on your emotional cues and recognizes signs of conflict at home. These comments are not meant to scare you but to encourage some introspection on the reality of your relationship. If it truly feels like your conflicts are getting out of control, reach out. Individual therapy can help you understand why you feel so contemptuous towards your partner or why there is a need to stone wall. Couples counselling can soften communication patterns and help you recognize when your partners makes attempts for connection. While conflicts are common, you do not need to be stuck in an unhappy relationship forever.

Best wishes,
Kasi

Parenting · Pregnancy and Postpartum

5 reasons why parents don’t seek treatment for postpartum depression

We know the rate of postpartum depression is quite high, and that it affects approximately 1/7 moms and 1/10 dads. The symptoms can vary from uncontrollable tears, rage, lack of appetite, and endless worries. It is meant to be a beautiful time where you build a bond with your newborn, but this emotional roller coaster doesn’t allow you to nurture this relationship. So, what gets in the way of seeking treatment for postpartum depression (PPMD)?

When it comes to accessing help, there are five common misconceptions that create a barrier:

1) Postpartum depression is a “mom” issue.

False! Firstly, there is no way to live with a family member who has mental health struggles and not become affected in some way or form. Mental health has a ripple effect. Secondly, the impact of adjusting to life with a baby is equally stressful for dads, adopted parents, and caregivers. In fact, these other support persons can also experience postpartum depression. PPMD can affect anyone, irrespective of age, race, culture, education or financial status.

What prevents you from seeking treatment for postpartum depression? Here are 5 common Myths. Reach out to Kasi Shan Therapy if you are struggling with postpartum depression.
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2) If I ask for help, they will take my baby away.

This comment gets whispered often, and my heart breaks every time I hear it. I think the Children’s Aid Society has done an incredible job over the years in supporting children in staying safe. At the same time, I think our history has been marred by CAS experiences that have created caution and distrust.

As a social worker, I can clarify that my duty to report is solely in situations where there is genuine threat to a baby. Postpartum parents struggle with their own emotions and this, in turn, makes it hard for them to take care of their child. The intent is not to be physically harmful towards their child. In fact, the primary stressors I witness in postpartum parents are guilt and insecurity. They are struggling because they worry of not being a good enough parent. There is guilty about not spending enough time with their baby or their loved ones. These caregivers stress about how they cannot provide for their child as well as they would like. None of these worries are a concern about child safety. Instead, this is a parent who is expressing suffering, and they should be treated with compassion.

3) I can’t have postpartum depression; I’m not crying or sad all the time.

Depression is often described as a heavy cloud that hangs over us, making it hard to feel motivated, enjoy life, or be ourselves. It’s understandable to dismiss symptoms of PPMD because it doesn’t show up in the same ways as depression. With PPMD, there are a variety of different symptoms that can be seen, including:

  • sadness
  • overwhelmed/stressed
  • scary of unwanted thoughts
  • flashbacks/trauma about the pregnancy or delivery
  • anxiety
  • sleep troubles
  • emptiness
  • rage/irritability
  • appetite troubles
  • lack of energy
  • avoidance
  • disinterest
  • fear of being along
  • fear of being separated from baby
  • concentration difficulties
5 myths that prevent a parent from seeking treatment for postpartum depression. Reach out to Kasi Shan Therapy for support
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4) I won’t get better or This is how parenting is supposed to be.

Postpartum depression is treatable! With effective support, parents can recover. Moreover, treatment is more efficient when support is offered sooner rather than later. Unfortunately, many parents assume “feeling bad” is normal during postpartum. There is an adjustment period involved when a baby comes into the home. However, if the stress in adjusting is overwhelming, and if it does not get better with time, it warrants some extra support. Others may make flippant remarks like, “get used to it.” It doesn’t mean your emotional struggles are any less real, nor should they minimized.

5) I didn’t think I had it. I was fine for the first few months.

Postpartum depression does not show up right away, and so it can often be missed. Postpartum Support International recommends that we assess for perinatal depression throughout the pregnancy (every trimester), as well as at 1, 2, and 6 months postpartum. There has also been new research indicating the benefits in assessing at 9 and 12 months as parents begin to return to work, and they face another large adjustment period. Because some parents may not have noticed clear indicators of stressors before this time, it is easy to assume that what they are experiencing is not postpartum depression.

What prevents you from seeking treatment for postpartum depression? Here are 5 common Myths. Reach out to Kasi Shan Therapy if you are struggling with postpartum depression.
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Fellow caregivers, if you are struggling with PPMD, know that it is not your fault. There is no single cause for having PPMD, and there are a variety of genetic and environmental factors that increase your vulnerabilities. If you, or your loved ones are needing support, please reach out.